The Seven Deadly Sins surrounding the COVID-19 Vaccine

 An analysis of current affairs and the crisis of confidence, as well as some recommendations to reverse it

The speed with which COVID-19 vaccines were researched and developed shone a bright spotlight on the companies and scientists that had created them. Society and governments are more interested than ever in the advancements and differences between the various vaccines in the pipeline, and innovation played a major role.

However, as with all things new, unknown, or poorly communicated, innovation brings skepticism. If you add suspicion from certain leaders about pharmaceutical companies into the mix, then you find a crisis of confidence that could delay large-scale vaccination and lead to social and political actions around the globe. Indeed, we are already seeing some of these in Europe, the United States, and other parts of the world, and unfortunately, they will have a negative effect on the international fight against COVID-19. This issue requires a detailed examination of the current situation, as well as a clear set of actions that can offset potential damages.

Experts claim that distrust arises when we feel defenseless or afraid, particularly when we do not know how to defend ourselves against a threat. There is no question that COVID-19 is a threat to people’s health and a challenge for healthcare systems and the economy. Governments naturally wish to ensure their populations are vaccinated as soon as possible in order to begin a gradual return to normality and start regaining the confidence of their citizens.

Misgivings from governments and society, disinformation, fake news, and the polarization of ideas have given rise to a crisis of confidence surrounding the COVID-19 vaccines and the laboratories producing them. To address this, both companies and governments must engage in an exercise of transparency surrounding research, commercialization, distribution, and scientific communication.

“Misgivings from governments and society, disinformation, fake news, and the polarization of ideas have given rise to a crisis of confidence surrounding the COVID-19 vaccines”

The Seven Deadly Sins

1. Speculation: Lack of transparency, prices, and delays

According to the World Health Organization (WHO), vaccination considerably lowers morbidity, disabilities, mortality, and many other concerns around the world, reducing poverty and closing inequality gaps.

Vaccines represent the hope of protection against a disease that has caused 2.5 million deaths worldwide. However, in the eyes of some, the pharmaceutical companies developing them also represent a threat. Vaccine deliveries were recently delayed and, according to a report in the New York Times, there is a lack of transparency in certain contracts signed in the European Union (EU); information is not available on the price per dose, the delivery schedule, or the amount of money paid up front.

These delays led to the EU imposing certain measures, such as checks on all vaccine exports from the region, to guarantee that it would have the vaccines it needs. This led to an avalanche of negative media coverage, including speculation on potential deliveries to countries outside the EU where companies could obtain larger profits.

Governments are acquiring vaccines through at least three channels: Purchasing them directly from pharmaceutical companies; acquiring them through regional bodies such as the EU, though this kind of continental negotiation with the pharmaceutical industry is new and complex; and buying them through the COVID-19 Vaccines Global Access Fund (COVAX), an alliance that seeks to reduce vaccine costs to ensure they can also reach poorer countries.

Despite these established purchase mechanisms, speculation on the acquisition, lack of transparency, and constant hoarding grew to such a degree that some companies had to speak out to refute rumors and clarify that the delays were due to problems at production plants. When paired with a lack of third-party validation on the reported effectiveness of certain vaccines, such as the Sputnik-V vaccine from Russia, this information becomes concerning to a large part of the population. It is worth noting, however, that the Russian vaccine’s effectiveness results were recently explained in The Lancet.

“Governments are acquiring vaccines through at least three channels: Purchasing them directly from pharmaceutical companies; acquiring them through regional bodies such as the EU, though this kind of continental negotiation with the pharmaceutical industry is new and complex; and buying them through the COVID-19 Vaccines Global Access Fund (COVAX)”

2. Uncertainty: New messenger RNA vaccine technology

Distrust surrounding the COVID-19 vaccine began with skepticism regarding the speed with which a vaccine could be created. The average time needed in the past was 10 years, and the previous record was four years. However, the first vaccines authorized to prevent COVID-19 were developed in less than one year using messenger RNA (mRNA). This technology had been studied since 1970, according to scientific reports, but only a certain part of the scientific community was aware of this history. Most of the population grew uncertain upon considering what could happen with a vaccine that, to some, sounded “experimental.”

• Differences between vaccines
  • The United States Centers for Disease Control (CDC) explained that mRNA vaccines teach our cells to produce a protein, including a portion of a protein, that leads to an immune response. These vaccines have been subject to the same rigorous safety standards as all other types of vaccine. Scientists have studied and worked on mRNA vaccines for decades, as they can be developed in a laboratory with easily obtainable materials. This allows the procedure to be standardized, meaning they can be developed more quickly than traditional vaccines.
  • Traditional vaccines inject an attenuated or inactive virus to produce an immune response. Companies, researchers, and healthcare systems have extensive experience in the manufacturing process of this type of vaccine, which requires chemicals, cell cultures, and longer production times. This is due to the risk of biological contamination, meaning companies must apply a rigorous protocol to process them and guarantee their safety and effectiveness.
  • Though mRNA technology has been studied for decades, citizens remain uncertain of them because companies, institutions, and researchers have never conducted convincing informational campaigns about the research process behind and safety of vaccines that use this technology.

3. Disbelief: Stability, effectiveness, and freezing

As soon as the first vaccine was authorized, the challenge of how to freeze and stabilize it emerged. WHO numbers suggest that more than half of vaccines were wasted due to temperature control problems. There was one group predicting little success for the vaccine due to the need to freeze it, as well as the complex logistics involved in its distribution. However, one of the companies announced the creation of special containers that could maintain the required temperature (-70 ºC) to keep the first authorized vaccine stable. The issue of freezing has now been resolved, and Pfizer recently presented new data to the FDA demonstrating that its COVID-19 vaccine can be stored at warmer temperatures; according to this new data, Pfizer’s vaccine remains stable for two weeks when stored between -25 and -15 ºC.   

The company that owns the second vaccine to be authorized managed to raise its storage temperature to -20 ºC, while the Russian vaccine must be stored at -18 ºC. There is no question that managing temperature to maintain vaccine stability and effectiveness remains a challenge, but the fact that manufacturers are researching options is good news. In the meantime, any doubts the medical community and governments might have on the issue need to be dispelled. 

4. Inequality: Logistics, distribution, and hoarding

Another challenge facing governments and companies in the fight against the pandemic involved developing the necessary logistics and distribution infrastructure. However, this process requires both well-implemented procedures and coordination between all stakeholders, including logistics operators, manufacturers, laboratories, and the healthcare system in general. This unquestionably represents an ongoing challenge, as vaccinating such a large portion of the population so quickly has never been done before. The logistics to be used remain to be seen, especially in countries with fewer resources and deficient infrastructures. Nonetheless, their need for vaccination is just as great as that of developed countries’, if our goal is to contain the epidemic on a global level.

Questions have recently been raised in international forums about vaccine hoarding among rich countries, leaving less-developed countries at a disadvantage. Selt-interest aside, the mobility of unvaccinated citizens could jeopardize global efforts.

“There is no question that managing temperature to maintain vaccine stability and effectiveness remains a challenge, but the fact that manufacturers are researching options is good news.”

5. Anxiety: The anti-vaccine movement, virus variants, and trust in manufacturers

Another issue that has generated distrust for some time is one fed by the anti-vaccine movement: Fear that vaccines might cause other diseases by introducing inactive viruses. Recent data shows that vaccination prevents between 2 and 3 million deaths each year, and that, since 1990, mortality in children under five has fallen by 52%. According to the Global Alliance for Vaccines and Immunization (GAVI), more than $150 trillion in economic benefits were generated between 2000 and 2017. Despite all the proven benefits of vaccines, the anti-vaccine movement continues to grow, primarily via the internet. There, thousands of people (including healthcare groups, politicians, and even scientists) claim that vaccines and vaccination represent a greater danger to humanity than the benefits they bring. 

Without any scientific basis whatsoever, these fears are exacerbated by the emergence of variants and mutations in the virus, such as the South African variant. This is already causing uncertainty, mainly because the issue has not been entirely clarified. Though we hear that existing vaccines can work against these variants, companies such as AstraZeneca, Oxford, CureVac, and GSK, among others, have announced partnerships on and research into new booster vaccines to combat these mutations.

6. Popularity and… Distrust

Before the pandemic, few people were interested in knowing which companies were researching and manufacturing their medicines. That responsibility remained firmly in the hands of their doctor, or sometimes relatives or friends who had previously suffered from the same disease. COVID-19 has radically changed this. Now, the names of vaccine manufacturing companies, and even some of the scientists involved, have been skyrocketing in popularity. This interest extends to differentiating between the vaccines based on effectiveness percentage, number of doses required, and even which might be the best option for each individual.

However, this popularity has created a situation in which a certain vaccine, manufactured by a certain company in certain countries, becomes more desirable than others. Data from a survey conducted by YouGov, which interviewed 19,000 people across 17 countries, showed that the majority of those asked distrusted the COVID-19 vaccine developed in China, feeling more comfortable with vaccines produced in Germany, Canada, or England. There is no question that the Chinese vaccines can make a huge contribution to the global effort to contain the pandemic and are attractive for certain countries, but the lack of initial transparency, questions over effectiveness, and a number of media scandals regarding potential deaths caused by the vaccine – such as the case in Peru, and none of which were address head-on by the companies – continue to be an outstanding problem if the goal is to gain the population’s trust.

This sudden interest from people creates a huge opportunity to put more effort into trust-building communications capable of, in turn, increasing interest in vaccination. This will ultimately help achieve the healthcare objective of stopping the pandemic.

7. Disillusionment: Why this vaccine, if the other one is better?

When the COVID-19 vaccines first became available, the question was which groups of people should be vaccinated first: Medical staff or the most vulnerable? However, with the authorization of more vaccines with varying effectiveness rates, dosage requirements, mechanism, and suitability by age group, an ethical concern and difficult decision arose in deciding who should receive which vaccine.

Companies Johnson & Johnson and Novavax recently published positive results from their Stage 3 clinical trials. This is undoubtedly good news, as it means our vaccine arsenal is growing. With luck, these vaccines will soon join those already approved from Pfizer/Biontech, Moderna, and AstraZeneca, as well as the Russian and Chinese vaccines. Each one multiplies our ability to produce and vaccinate a larger group of people around the world.

The challenge for health authorities regarding the available vaccines, including those from China and Russia and the two soon-to-be-approved ones, will be how to distribute them according to the type of vaccine in question (one or two doses; cooling requirements; effectiveness in certain age groups or against new variants, such as the South African variant, etc.) and the type of prioritization within populations. For example, the AstraZeneca vaccine has been approved by the EU for all adults. However, in scientific studies, the effectiveness of this vaccine only looked at those up to the age of 65, meaning that certain countries, including Belgium and Spain, have applied restrictions and will only give it to people between 18 and 55.

For those waiting in line, all this media noise without any clear guidance on which vaccine they will receive might cause disillusionment or rejection. This is true to such a degree that we are already seeing movements based on the freedom to choose whether to receive the vaccine, as well as which vaccine to receive. People know there is a difference between 72% and 95% effectiveness, between one or two injections, and whether one causes more side effects or deaths than another. Based on this, a question emerges: Why am I getting this vaccine if the other one is better?

Companies need to clearly report the advantages and disadvantages of their vaccines, and healthcare authorities need to have a roadmap and action plan in place regarding which type of vaccine the population will receive, based on their age, vulnerability, and logistical requirements. One thing is for sure: No vaccine is worse than an unused vaccine when facing a pandemic such as this, with its enormous humanitarian, social, economic, and political impact.

“Companies need to clearly report the advantages and disadvantages of their vaccines, and healthcare authorities need to have a roadmap and action plan in place regarding which type of vaccine the population will receive, based on their age, vulnerability, and logistical requirements”

Five Recommendations for rebuilding Trust

The COVID-19 pandemic revealed the fragility of healthcare systems, the need for faster research when developing medicines and vaccines, and the imperative demand that companies properly manage their relationships and affinity with customers, employees, and shareholders, among others. Pharmaceutical companies urgently need to overcome the crisis of confidence that has arisen around vaccines in order to ensure themselves a future. Although it might seem simple, this is more complicated now in such a volatile environment. But it is not an impossible task. Now is the time to boost relational capital. Here are a few basic recommendations:

1. Timely, clear, and transparent communication

Those organizations that understand that the only constant is change will be able to get ahead, harnessing opportunities created around crisis situations such as the one we are experiencing now. Boosting communications and responding in a timely fashion are essential, as this avoids dead air that could be filled with speculation.

The new social leadership paradigm facing companies requires a transition from dialogue processes toward genuine conversation. In this, collaborative conversation and commitment platforms have become essential when dealing with problems that affect the health of millions of people.

These conversation and collaboration platforms will be where stakeholders can actively participate in developing solutions, ask questions, and find answers to their concerns from reliable, scientific, and research-based sources. 

2. Have a roadmap

The COVID-19 pandemic became a threat of unprecedented scale for the whole world. The virus spread rapidly from country to country and brought healthcare systems to the brink of collapse. The world placed its hopes on research to develop medicines and vaccines to contain it. Since the vaccines arrived, a huge number of challenges have emerged, many of which researchers and pharmaceutical companies were previously oblivious to. Now that the vaccines are ready and large-scale vaccination programs have been launched, companies and governments must have a roadmap or strategic plan to clearly define their goals and how to achieve them.

We are witnessing how the conversation about vaccines, which began as one centered on hope, has transformed into one of distrust. Institutions like the Center for Disease Control (CDC) have detailed roadmaps to help guide countries on how to stop the spread and prevent deaths and healthcare system collapse, but they must also pay attention to disinformation. This could impact their reputations and, above all, the chances of success when working to immunize large portion of the population within a short period of time.

This roadmap is a tool that formulates, implements, and, above all, communicates a strategy.

3. Specialized consultancy

Consultancies are a great ally for companies, as they offer new, disruptive, and specialized ideas on reputation management, public affairs, corporate communications, and digital tools, all of which enable a greater positive impact for the company.

Consultants serving pharmaceutical companies should have experience in and knowledge about the health sector ecosystem. Pharmaceutical companies need consulting services to not only understand how the sector operates, but also to share the value of innovation and understand the paymasters’ role in healthcare systems, the weight represented by diseases, the challenges of vaccination, and, most importantly, the need for patients to receive the right medicine at the right time. 

Therapeutic areas; the health sector’s degree of specialization; digital tools; public affairs, such as regulation and challenges facing healthcare; and geographic specialization should all be subject to evaluation, because knowledge about how things operate and how business is done in the various regions, such as Europe, Latin America and Asia, is necessary.

This specialization will facilitate the communications process, making it more effective by working with a team that understands the challenges facing the medical community, research centers, healthcare systems, patient groups, and all other stakeholders fighting to obtain better health conditions and combat inequality.

4. Create shared value with stakeholders: Human, financial, and relational capital

In addition to financial capital, which many think is all companies look at, intangible capital is now gaining importance. It makes a significant contribution to trust-building exercises, which lead to greater profit and more prosperous businesses.

Human capital, which enables organizations to function properly, must be managed to focus on people’s development. It is company personnel who go on to become the leading ambassadors for all missions undertaken by businesses.

Knowledge capital is essential for companies wishing to maintain a good level of competitiveness and ensure sustainable value propositions.

Relational capital gains particular relevance when distrust is an issue, because it is key to maintaining good relations and changing perceptions and attitudes toward companies. It also helps businesses be perceived as strategic partners in containing health problems, such as a pandemic. Furthermore, it will very soon be important for building strategic partnerships capable of reducing the burden of diseases on healthcare systems as well. Reputation creates value, highlighting the importance of considering it an indispensable and key intangible asset.    

5. Know and interact with stakeholders

Identifying a company’s stakeholders is simple: All groups with an ability to interact with the company are stakeholders. However, each one’s informational needs, level of influence, and capacity to react must be assessed. It may seem that companies already know and interact with the environment in which they do business, so dialogue is part of their day-to-day. But this premise has been shattered in the post-COVID era because new stakeholders are taking part in a conversation that never existed before. Companies have realized that these new stakeholders play a decisive role in the balance of results.

The crisis in confidence, which stems from poor company management, has encouraged both legislators and companies themselves to regulate business activity within a regulatory and ethical framework that inspires confidence in their stakeholders. In this regard, certain pharmaceutical companies and industry organizations have ethical business guidelines that have helped to prevent crises and inspire confidence among certain stakeholders.

However, in this era of fast-moving information and disinformation, any stakeholder can impact business development. Dialogue with stakeholders should provide information about company risks and its decision-making process. The delay in delivering vaccines to the EU raised suspicion in governments due to the delay in information on the reasons behind it and the lack transparency around the decision. This led to an avalanche of media articles questioning pharmaceutical companies’ interest in stopping the pandemic. To prevent mistakes of this magnitude, it is important to develop communication mechanisms capable of involving all stakeholders via a strategically designed and implemented plan. This will help lead companies toward success from any perspective. 

The crisis in confidence facing vaccines is a debate we never imagined having just one year ago, when all our hope was placed on the researchers and developers working on medicines and vaccines against COVID-19. The debate will only continue to grow until researchers and developers, as well as decisionmakers and those who write public policy, seriously consider the importance of precise and transparent communications to convincing the public of the value of receiving a vaccine to stop the pandemic. Nobody will be safe until we are all safe.

The crisis in confidence facing vaccines is a debate we never imagined having just one year ago, when all our hope was placed on the researchers and developers working on medicines and vaccines against COVID-19. The debate will only continue to grow until researchers and developers, as well as decisionmakers and those who write public policy, seriously consider the importance of precise and transparent communications to convincing the public of the value of receiving a vaccine to stop the pandemic. Nobody will be safe until we are all safe.