Challenges Arise as Public Health and Scientific Communication Enters Uncharted Territory

Maurie Markman, MD

It is difficult to dispute that these are troubling times for government officials and public health agencies. Consider the residents of California, who have been facing unprecedented heat and drought. In many regions of the state, officials have asked the public to carefully conserve water and electricity and the potential for wildfires in the coming months is of great concern.¹ In addition to environmental factors, in September a rare gubernatorial election will take place in in the state in response to the sitting governor’s actions and decisions during the COVID-19 pandemic.

Further, the rapid spread of the COVID-19 delta variant, currently the most common variant in the United States, has become a concern both at home and abroad.2 How should governments and public health agencies respond? Many officials and individuals appear to believe the pandemic is coming to an end, but objective data challenge this view. For example, in the United Kingdom the delta variant is responsible for at least 90% of all infections and there is worrying evidence that the available COVID-19 vaccines, although effective against the variant, are far less beneficial after the first dose of the required 2-dose regimen. According to current estimates, the delta variant is twice as infectious as the alpha variant, the UK’s previously predominant variant.²

The situation in the developing world is far worse.3 A recent report of cases in Africa noted the incidence of 30,000 new cases reported each day, with less than 1% of the population vaccinated. Additionally, the World Health Organization reported that 18 African nations had already used at least 80% of their existing vaccine supplies, with 8 countries reporting that they had no available vaccines.³

Public Uncertainty Results in Conflicting Recommendations

Discussions and controversies associated with how the United States (and other countries) can optimally manage future developments associated with the pandemic are continually evolving. Points of contention include efforts addressing the issue of trust associated with COVID-19 vaccination.⁴ For example, reviewing a survey of more than 6000 individuals conducted in October 2020 and March 2021, at which time there was evidence of the approved acceptance of vaccination through regulatory approvals and mass vaccination programs, investigators concluded that “vaccine hesitancy remained high, especially among young adults and Black and low socioeconomic‒status participants.”⁴

Continued controversy is also associated with the use of masks and social distancing in general societal interactions, the workplace, and schools. The apparent disagreement between the CDC in the United States and declarations emanating from the World Health Organization has likely added a disturbing element of confusion for local and state public health officials who are attempting to make rational recommendations to government leaders.

The list of COVID-19–related scientific concerns does not end here, especially as we learn more about the nature and severity of persistent symptoms lasting longer than 60 days after diagnosis.⁵ In addition, much remains to be understood regarding the diagnosis and treatment of multisystem inflammatory syndrome in children who receive a COVID-19 diagnosis.^6,7 Just how common is this event and is the apparently rare occurrence a relevant justification for active efforts to vaccinate children?

Finally, although few objectively validated adverse events have been reported, some have been serious and even fatal.⁸ How should these evolving data influence recommendations for vaccination strategies given how uncommon these events are in the reported real-world experience? Further, how will officials balance multiple pragmatic considerations, including the availability of specific vaccines within a given health care authority?

Mitigating Trust Issues in Scientific Communication

The goal of this commentary is not to resolve these issues but to emphasize the magnitude of the potential concerns to be confronted. Unfortunately, in addition to the issues cited above, one must also consider several increasingly disconcerting events that have been widely reported in the media. These topics call into question the public’s ability to objec-tively trust information from various sources and transcend questions related to vaccine products.

Although space does not permit a thorough discussion of these events, some examples include: questions surrounding the complete unwillingness of China to participate in the critical review process of vaccines; concerns regarding potential conflicts of interest among members of the international scientific community involved in research in this arena⁹; an objective lack of valid information related to the clinical utility of Chinese COVID-19 vaccines against evolving variants¹⁰; and the quite public debate between the manufacturer of one of the mRNA vaccines and the FDA/CDC regarding the need for booster shots.¹¹ There are also the rapidly evolving events and serious implications related to the FDA’s review of potentially inappropriate interactions with a pharmaceutical company in their development of a highly controversial new Alzheimer drug.^12,13

This commentary highlights the possibility that such issues could also negatively affect trust in science and public health communi-cation associated with essential efforts in the cancer arena. In this regard, consider the recent report which found that 24% of individu-als who refused to receive, or whose parents refused to consent for, the HPV vaccination in 2019 stated that concerns with “safety and adverse events” were the reason for their decision, despite well-established data that unequivocally refute such fears.¹⁴

References

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10. Covid: What do we know about China’s coronavirus vaccines? BBC. July 13, 2021. Accessed July 15, 2021. bbc.in/2UyyrUJ
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13. @DrWoodcockFDA. Twitter post. Given the ongoing interest and questions, today I have requested that @OIGatHHS con-duct an independent review and assessment of interactions between representatives of Biogen and FDA during the process that led to the approval of Aduhelm. Posted July 9, 2021. Accessed July 15, 2021. bit.ly/3eyniu3
14. Chido-Amajuoyi IG, Talluri R, Shete SS, Shete S. Safety concerns or adverse effects as the main reason for human papillo-mavirus refusal: National Immunization Survey-Teen, 2008 to 2019. JAMA Pediatr. Published online ahead of print June 28, 2021. doi:10.1001/jamapediatrics.2021.1585