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COVID-19: Beyond Tomorrow
May 26, 2020

Adverse Consequences of Rushing a SARS-CoV-2 Vaccine: Implications for Public Trust

Author Affiliations
  • 1NYU Langone Health, New York, New York
JAMA. 2020;323(24):2460-2461. doi:10.1001/jama.2020.8917

As the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic persists across the US and the world, the spotlight on vaccine science has never been more intense. Researchers across the globe are working rapidly to produce a potential vaccine, and 7 candidates are already in clinical trials.1 Operation Warp Speed, the vaccine development project announced by President Trump, has advocated for a vaccine to be made available in the US by the beginning of 2021.1 But for scientists and physicians, the term “warp speed” should trigger concern. Good science requires rigor, discipline, and deliberate caution. Any medical therapy approved for public use in the absence of extensive safeguards has the potential to cause harm, not only for COVID-19 prevention efforts and vaccine recipients, but also for public trust in vaccination efforts worldwide.

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    2 Comments for this article
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    Polio is not the only dirty vaccine caused by a rush into the unknown
    Thomas Hilton, PhD | Retired, NIH
    We all know that one of the first antiviral vaccines was for anthrax. Until our adventures in Iraq, the vaccine was used mainly to protect people in the agriculture and livestock industries. Then in 1991 President Bush initiated Operation Desert Storm, and subsequently it was discovered that Iraq had weaponized anthrax. In 1996, the Joint Chiefs of Staff decided to vaccinate all troops deployed to the Middle East. What was not widely known until problems began arising was that the vaccine was dirty. The drug provided to DOD was contaminated with sloppy manufacturing impurities that led to significant infection and various nonfatal side effects. It also created a torrent of bad publicity and service members refusing to be vaccinated. One sad result was to increase the momentum of the antivaxxer movement.
    CONFLICT OF INTEREST: None Reported
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    Nurturing Public Trust is Crucial in Medicine
    Parthasarathy KS, Ph.D. | Science journalist and former Secretary of Atomic Energy Regulatory Board,India
    The article by Dr Brit Trogen and co-authors is very timely. It lists telling examples to highlight the implications for public trust in development of vaccines and their continued use. Specialists who develop vaccines and others at every level, particularly at the highest echelons of decision making, must ensure that there is no trust deficit between the members of the public and other stakeholders. The word of caution applies to vaccines, drugs used for treatment, and tools for medical procedures.

    An equally important factor which causes public anxiety and enhances trust deficit is when there is
    controversy between specialists or professional associations or scholarly societies on a course of action. Media love controversy. Some say that the controversies between specialists or scholarly professional groups must be confined to the halls where seminars/conferences are held! Researchers and scientists must resolve them by publishing them in mainstream, peer-reviewed journals. However, it is very difficult to keep such papers away from the popular press and medical journalists. It will be extremely beneficial if specialists/researchers themselves assume the role of medical journalists to convey the decisions taken by the medical community after due discussions. Unfortunately, it is unlikely to happen. Admittedly, many medical journalists carry out a thorough job though they are not physicians! It is very difficult to decide how members of the public can arrive at decisions. Ideally, the patient-physician relationship must encourage shared decision making.

    The COVID-19 pandemic which overwhelmed the medical community and patients and created untold uncertainty belongs to a special category. Lack of effective vaccines and efficacious drugs for treatment created an unprecedented situation. Recent controversies between learned agencies such as the WHO on the use of hydroxychloroquine in treating COVID-19 did not help. The Indian Council of Medical Research (ICMR) recommended the drug as a prophylactic agent to be taken by all asymptomatic healthcare workers, asymptomatic frontline workers and asymptomatic household contacts (all of them fulfilling prescribed eligibility criteria). Social media continue to discuss these matters. A section of the intelligentsia argued that researchers must discuss these topics in medical journals. Apparently, in the media and elsewhere, there was also misunderstanding about treatment and prophylaxis. In the prevailing atmosphere, one can justify the emergency use of certain drugs even when the evidence for benefit is anecdotal. Experts must travel an extra mile to explain why they took a particular decision.
    CONFLICT OF INTEREST: None Reported
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