Critical Findings on COVID-19 Select Publications from the National Academies of Sciences, Engineering, and Medicine (2021) / Chapter Skim
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity
Authors: Baruch Fischhoff* Vaness Northington Gamble*
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 1 UNDERSTANDING AND COMMUNICATING ABOUT COVID-19 VACCINE EFFICACY, EFFECTIVENESS, AND EQUITY April 2021 Authors: BARUCH FISCHHOFF*
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 2 EXECUTIVE SUMMARY Effective communication is needed to ensure shared understanding of how well COVID-19 vaccines work and whether they are being equitably distributed. Without clear, consistent, readily accessible communications, people may lose faith in the vaccines and in those providing them.
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 3 BOX 1 Defining Vaccine Efficacy and Effectiveness Efficacy refers to the percent reduction in the probability of a designated clinical endpoint, such as infection regardless of symptoms, symptomatic disease, moderate or severe symptoms, hospitalization, or death. A vaccine has, for example, 95 percent efficacy for reducing symptomatic COVID-19 if a person receiving it has a 95 percent lower probability of observable symptoms relative to an otherwise identical person not receiving it.
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 4 INTRODUCTION In the United States, three COVID-19 vaccines currently have emergency use authorization.1 Their uptake will depend on a variety of factors, including whether people perceive them to work well. Those perceptions will depend on both the vaccines and the institutions involved in their production and distribution.
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 5 authoritative evidence (Breakwell, 2018; Fischhoff, 2013, 2019; Schwartz and Woloshin, 2013; U.S. Food and Drug Administration [FDA]
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 6 (FDA) requires greater than 50 percent efficacy for a predetermined primary clinical endpoint, as demonstrated in a randomized controlled trial.5 That is, the endpoint must be at least 50 percent less likely for a person who receives the vaccine (in the trial group)
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 7 process, it is a topic of active investigation.7 Because of current uncertainty about how many vaccinated individuals have no disease or asymptomatic disease, public health precautions (e.g., mask wearing) continue be recommended (CDC, 2021)
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 8 preventing deaths.13 Thus, among vaccinated individuals, few experienced symptoms, with rare hospitalizations and no deaths (Piper, 2021)
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 9 responsibility (e.g., liability, accountability, incentives) (National Research Council [NRC]
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 10 authentic engagement and messages tailored to recipients' concerns and perspectives. Individuals respond to different motivating factors for getting vaccinated -- some may choose to get vaccinated to mitigate personal risks and others may desire contributing to the protection of their friends, family, or community (Motta, et al., 2021)
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 11 (Schwartz and Woloshin, 2013)
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 12 4. Present all relevant outcomes.
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 13 vaccines they receive once they understand their minor differences. One issue that can be misunderstood, however, unless proactively explained, is considerations that may make one vaccine more appropriate for distribution to particular areas or groups.
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 14 conclusions, but will still want to see the supporting evidence. And some will want to see the evidence and decide for themselves.
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 15 APPENDIX A As mentioned above, although not clinical endpoints for the trials, hospitalizations and deaths are the priority public health burdens that vaccines aim to prevent (Dean and Madewell, 2021)
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 16 days after second (beginning 14 days after (beginning 14 days after dose) second dose)
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 17 –15°C (–13°F to 5°F) Vials can be stored temperatures of 2°C to for up to 2 weeks.
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 18 REFERENCES Breakwell, G
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 19 Lahariya, C
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 20 https://doi.org/10.1177/1745691620958003. Taylor, S.L., and Lurie, N
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 21 ACKNOWLEDGMENTS We thank the sponsors of SEAN -- the National Science Foundation and the Alfred P Sloan Foundation -- and of the Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats -- the U.S.
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 22 SOCIETAL EXPERTS ACTION NETWORK (SEAN)
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Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity Understanding and Communicating about COVID-19 Vaccine Efficacy, Effectiveness, and Equity 23 STANDING COMMITTEE ON EMERGING INFECTIOUS DISEASES AND 21ST CENTURY HEALTH THREATS HARVEY FINEBERG (Chair) , Gordon and Betty Moore Foundation KRISTIAN ANDERSEN, The Scripps Research Institute RALPH STEVEN BARIC, The University of North Carolina at Chapel Hill MARY T
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