Stampedes normally kill more victims than the panic and as authorities storm toward the new SARS-CoV-2 vaccines, their missteps and mispronouncements are further killing the public trust in vaccines and the scientific community. The only strategy in most Western countries is to procure as many COVID-19 vaccines as quickly as possible. But words speak louder than actions when public fear and hesitancy is at a high point and I don’t see any clear strategy to ensure trust and public uptake of these sought-after vaccines. If the last week in vaccine communications is anything to go by, I sometimes wish our authorities would just sit down and shut up.

And amidst the seemingly incessant litany of risk management failures surrounding COVID-19 sits the anti-vaxxer, calmly recording each confused pronouncement as they prepare to swell their ranks. If the authorities don’t learn proper vaccine risk communications, I fear we’ll see anti-vaccine sentiment pass the 50% level in most Western countries. Forget herd immunity – we’ll only attain herd impunity (and a lot of discarded vaccine stock).

Several months ago I produced a series of guidelines to promote an effective uptake of the COVID-19 vaccines.

In the first weeks since the wonderful COVID-19 vaccine announcements we have seen not only a near complete ignorance of such basic rules, but worse, a verifiable stampede into stupid including:

Over-promising

As the vaccines will slowly start to be administered, governments are pre-announcing their procurement numbers. With millions of vaccines apparently soon available, many expect the world will go back to normal like: Snap! Everyone will get on flights and go on holiday over the Christmas season, all jobs will be returned to as before, malls will fill and the economy will boom. That is what investors seem to think and with this present market led by sentiment, any financial risk manager is quietly checking where the emergency exits are. The media will stop reporting on the coronavirus and the death-count tables will disappear from our screens.

But the virus won’t go away because we are tired of it. The vaccines (in the West) will take at least until the end of 2021 to reach desired herd immunity levels (while in certain developing countries it will likely never be attained among the general – poor – population). At what point will people promised a panacea in a preventative prophylaxis express their disappointment? And whom will they target (cue the anti-vax vultures)?

Logistical Nightmare

I asked my doctor if he would be administering COVID-19 vaccines. He just laughed and said with the present vaccines, he lacks the -70°C cold-chain technology. Unsurprisingly, so does my local pharmacy. We have governments falling over each other in the mad dash to procure millions of doses of these vaccines without any idea how they will be able to store, transport and administer them (in two doses!), without adequate cold-chain technologies and staff. Will people be comfortable being vaccinated by soldiers? Will they trust that the temperature has been kept stable?

This is just one more reason why I recommended these coronavirus taskforce committees needed to have a membership of diverse expertise and not just statisticians and healthcare officials. But should such sad incompetence and lack of risk management skills be surprising anymore in world where Western policy merely involves applying the precautionary principle?

Banning the Unvaxxed

I shuddered when I heard the CEO of Qantas proudly announce the other day you would only be able to fly on his airline after you have had a vaccine. IATA quickly tried to dial it back with their Travel Pass concept but let’s assume most airlines make their own decisions (meaning: doing whatever they can to reassure a nervous public). Would you pay more to fly on a “vaxxed flight”? How much more? And if they develop something like a yellow (vaccine) passport for travel between all countries, what other vaccines should be added to the list (for chicken pox? Dengue?). But why stop there? No unvaccinated coronakid should be allowed in school. And to get into shops, restaurants and offices, we’ll have to show our up-to-date “COVID-cards”. Stigmatisation does not attract trust and enforced immunisation does not encourage dialogue.

I can just see Del Bigtree dripping with saliva at all of this. This perception of scientists “imposing their poison on innocent naturopaths” (who know how to take care of themselves, thank you very much!) is going to rip through the perplexed population faster than any virus could. Poor French President Macron, in yesterday’s “Christmas is Cancelled” speech to the French Republic, had to stress that no one will be forced to get a vaccine. As seen on the streets of Berlin, conspiracy theories already abound before the outrage has even been given the chance to dial up.

Inequities

The authorities anticipate a stampede at vaccination centres similar to Walmart entrances on Black Friday and are trying to create a priority system to ensure that the more valuable and more vulnerable get vaccinated first. I already have the SARS-CoV-2 antibodies so I can wait (unless I need to travel) but should teachers be prioritised? What about civil servants? Christmas dinner talks will focus on questions like whether my mother is more important than yours (and how can I bump her up the list). Homeless people are definitely more vulnerable than the privileged but who will be there to speak for them (or ensure they get their second jab)? What about minorities and migrants without healthcare? In some countries with market-oriented healthcare systems, cash will sadly be an influential factor.

This is a completely useless distraction that the media obsesses over for its clickbait opportunity. Imagine scenes of terrified, angry people being turned away at cold-chain dispensary sites, fighting in parking lots and breaking into nursing homes (Full story at 11). Rather than rushing a rollout, authorities should take some time to get this right. “No you can’t!” is not an appropriate response to “Yes I need!” unless outrage is your desired outcome. Discussions should be over “Who gets which type of vaccine” rather than “Who gets to live safely“.

Injustice

Developing countries with little cash and few friends will evidently have to wait. I have a second home in the Philippines where a vaccine rollout will only frankly apply to about 25% of the population (and still they are aiming for the end of 2021). Those in the urban slums and provincial towns never mattered and will not factor into the government plans (after the Dengvaxia debacle, most of the poor frankly aren’t interested and would only benefit if a vaccine lowers restrictions and allows them to go back into the streets to survive). Among the fortunate, talk around the Christmas parol will be on the quality of the vaccine (German and American quality v Chinese and Russian risks) … and transport mules.

At some point, some vaccines will be freely distributed, the media will lose interest and the affluent West will feel safe. I’m already seeing signs that we are moving on and COVID-19 will very shortly join the list of historical health challenges now resolved (like malaria, TB, HIV or dengue). That this virus will continue to ravage the poor and the unmattered in developing countries will hardly be noticed. Why should this time be any different?

Bigger Pharma

Investors who bought Moderna stock are going to have a very merry Christmas. Come January when initial vaccine sales and procurement results come in, the obscenity of the profits across the vaccine manufacturing chain (contrasted to the injustice of the rollout) will create a narrative where even the most pro-vaccine social justice warrior is going to start sharing RFK Jr’s tweets.

The business model allows risk-takers to profit from their innovations but will their communications model be able to temper the anticipated attacks? The recent maligning of Bill Gates will be nothing compared to the anti-corporate outrage that has been brewing and stewing. If we have to all comply with updating our “COVID cards” or “Travel Passes”, will we soon resent the process or still admire the achievements?

No doubt there will be adverse effects from the COVID-19 vaccines – nothing is completely safe. But even a number like 0.01% risk, spread across 200 million vaccinations, would result in 20,000 adverse events. That would be 20,000 people finding each other on social media, telling their stories to the main news outlets, demanding justice… I am sure the Predatort lawyers would think twice before they focus their attention on the pharmaceutical industry.

Where have I seen this before?

I was involved in vaccine communications and awareness raising for around a decade at the beginning of this century. Looking back, the worst recent experience in the West was the mismanagement of the H1N1 (swine flu) vaccine rollout in 2009. Populations were fighting over who should have priority; there were miscommunications, over-promising, concerns the vaccine had been rushed and supply shortages. I recall from insiders that the Belgian government had to destroy around 40% of its unused H1N1 vaccine stock and I expect other countries would have similar numbers due to the global rise in vaccine hesitancy. Only then did we start talking about the anti-vaxx community as a serious threat to public health (rather than merely a band of misguided fools).

The herd did not stampede toward immunity with H1N1 and I worry, now with the added poison of social media herd mentality, that we are setting up today for a bigger failure. Maybe we should slow the herd down to get this right.