Public Health Weekly

The Benefits, Risks, and Future of Vaccines and the Pandemic

The latest Covid insights from former CDC Director Tom Frieden

Photo: Spencer Davis/Unsplash

This past week, we learned that our vaccine safety monitoring system works. Reports that a small number of people developed a rare form of blood clot after receiving the Johnson & Johnson vaccine led to quick investigation, quick action, and transparency about what is known, not known, and what next steps should be. Vaccines remain our way out of the pandemic.

Global collaboration has been critical throughout the pandemic. Public health and medical experts around the world are collaborating to determine whether events associated with the AstraZeneca vaccine are the same as those which may be associated with the J&J vaccine.

Vaccine technology transfer

The pandemic is the world’s most important problem, making technology transfer for vaccines increasingly crucial. Right now, mRNA vaccine technology is our best solution. We need to create high-quality manufacturing platforms around the world to improve vaccine access.

mRNA technology is an insurance policy against the pandemic. Why? mRNA vaccines are easier to tweak for vaccine-escape variants, less subject to production delays, and easier and quicker to bring to scale. They may be more effective against infection, and may also be safer. All licensed vaccines are safe and effective, but mRNA is the most promising technology.

We also need more efforts like Moderna’s to study vaccine thermostability at non-freezing temperatures and other efforts that may help get mRNA vaccines to places and communities that are harder to reach.

Vaccines: a public health success story

Vaccines are one of the most important public health interventions ever, having saved at least a billion lives. As with any medical intervention, there may be a small risk. The story of vaccines against rotavirus, which causes deadly diarrheal disease in young children, is instructive.

In 1999, the RotaShield vaccine was withdrawn from the U.S. market because of a rare, serious complication. Other countries followed suit. This decision led to literally millions of preventable child deaths around the world until a new vaccine was developed seven years later.

There’s still a low risk of serious complications associated with the newer rotavirus vaccines, but benefits of vaccination far outweigh the risks. Thus the U.S. and countries around the world continue vaccinating children against rotavirus, looking carefully for possible complications, and saving millions of lives.

Vaccine risks vs. benefits

Even as rare but serious events possibly associated with the J&J vaccine continue to be investigated, the pandemic is continuing — and accelerating in much of the world. About one in 200 people with Covid die from it. There have so far been six reports of blood clots developing in the brain among almost seven million people who received the J&J vaccine. There are no known reports of such events associated so far with the Pfizer or Moderna vaccines.

Analysis of risks and benefits guides recommendations for vaccines, including against Covid. This can be uncomfortable. We weigh “sins of commission” more heavily than “sins of omission.” But if every vaccine helps many thousands more people than it may harm, isn’t this the way to go?

Globally, until there is much more widespread availability of mRNA vaccines, benefits of use of the vectored vaccines will far outweigh risks in all communities in which Covid is spreading and for all populations at high risk of complications of Covid.

Vaccinating our way toward the new normal

The more people who are vaccinated with available vaccines, the lower the case rates, the more lives saved, and the sooner we will get to the new normal. I still think we’re likely to crush the curve of infections by summer and be in the new normal this fall in the U.S.

We must balance the immense risks posed by Covid with extremely low risks of getting vaccinated. Fundamentally, the case for scaling up mRNA vaccine platforms globally just got even stronger than when we advocated for it six weeks ago.

Scaling up production of mRNA vaccines won’t be simple. Life rarely is. Technological transfer of the most promising vaccine technology against Covid isn’t just the right thing to do altruistically, it’s essential to the health and safety of every person, everywhere in the world.

President and CEO, Resolve to Save Lives | Former CDC Director and NYC Health Commissioner | Focused on saving lives. twitter.com/drtomfrieden