tag:theconversation.com,2011:/ca/topics/vaccine-supply-chains-99237/articlesVaccine supply chains – The Conversation2022-05-15T20:15:16Ztag:theconversation.com,2011:article/1821472022-05-15T20:15:16Z2022-05-15T20:15:16ZAustralia risks relying on Pfizer and Moderna for its COVID vaccines. 3 ways to break free<figure><img src="https://images.theconversation.com/files/460499/original/file-20220429-26-ut9yfa.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C3180%2C1992&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/coronavirus-vaccine-affordability-people-want-buy-1908778336">Shutterstock</a></span></figcaption></figure><p>The rapid development and deployment of COVID vaccines has been one of the greatest achievements of the pandemic.</p>
<p>However, Australia <a href="https://www.mja.com.au/journal/2022/217/2/covid-19-vaccines-boosters-and-mandates-building-mission-economy-not-rentier">risks relying on</a> COVID vaccines from two main companies – Pfizer and Moderna – and that’s a problem.</p>
<p>While the need for COVID vaccines is not going away anytime soon, we need to shape the market to drive more competition for better access to improved vaccines.</p>
<p>Here’s what Australia needs to do to break free from an effective duopoly dominating the local market, especially when many of us are likely to <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-your-vaccination/booster-doses">need boosters</a>.</p>
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Read more:
<a href="https://theconversation.com/covid-vaccination-recommendations-evolve-over-time-who-is-due-for-which-dose-now-181779">COVID vaccination recommendations evolve over time. Who is due for which dose now?</a>
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<h2>How did we get here?</h2>
<p>When COVID finally broke out at scale in Australia late last year, the vaccines (and high levels of adult vaccination) worked extremely well to reduce deaths and severe illness.</p>
<p>Since January 1 this year, there have been <a href="https://ourworldindata.org/coronavirus/country/australia">more than</a> 5.9 million confirmed COVID infections nationwide, but about 5,300 deaths.</p>
<p>Yet current vaccines aren’t 100% effective at protecting against infection; new viral variants (<a href="https://theconversation.com/why-are-there-so-many-new-omicron-sub-variants-like-ba-4-and-ba-5-will-i-be-reinfected-is-the-virus-mutating-faster-182274">and sub-variants</a>) continue to emerge; protection via <a href="https://www1.racgp.org.au/newsgp/clinical/booster-protection-wanes-after-four-months-what-do">vaccination</a> and <a href="https://theconversation.com/how-long-does-protective-immunity-against-covid-19-last-after-infection-or-vaccination-two-immunologists-explain-177309">prior infection wanes</a> quite quickly, meaning reinfection is becoming more common and booster shots may remain part of the landscape for some time to come.</p>
<p>Meanwhile, <a href="https://www.sciencedirect.com/science/article/pii/S0140673622003282?via%3Dihub">vaccine inequity</a> remains an unresolved problem. This has led to a situation where rich countries, such as Australia, are giving booster shots where some <a href="https://www.sciencedirect.com/science/article/pii/S0140673622008170?via%3Dihub">poorer countries</a> don’t even have enough vaccine for first doses.</p>
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Read more:
<a href="https://theconversation.com/how-australias-fickleness-on-covid-vaccines-is-perpetuating-global-vaccine-inequity-165001">How Australia's fickleness on COVID vaccines is perpetuating global vaccine inequity</a>
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<h2>Pfizer and Moderna, but not much else</h2>
<p>In <a href="https://www.mja.com.au/journal/2022/217/2/covid-19-vaccines-boosters-and-mandates-building-mission-economy-not-rentier">a recent article</a> in the Medical Journal of Australia, we outline the need to break free from the handful of powerful players still dominating Australia’s COVID vaccine market.</p>
<p>While the number of <a href="https://covid19.trackvaccines.org/agency/who/">approved COVID vaccines</a> <a href="https://en.wikipedia.org/wiki/List_of_COVID-19_vaccine_authorizations">is growing</a> around the world, Australia largely still relies on only two, namely vaccines from Pfizer and Moderna.</p>
<p>The AstraZeneca and Novavax vaccines are only rarely <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/advice-for-providers/clinical-guidance/clinical-recommendations">used as boosters</a> if <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/approved-vaccines/novavax">no other vaccines</a> are suitable.</p>
<p>More than <a href="https://www.health.gov.au/sites/default/files/documents/2022/05/covid-19-vaccine-rollout-update-11-may-2022.pdf">95% of Australian adults</a> have received two doses of COVID vaccine already. So future requirements are primarily for boosters and child vaccines. Australia, therefore, continues to face an effective duopoly.</p>
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<a href="https://images.theconversation.com/files/462361/original/file-20220511-22-9sko2m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Middle-aged lady smiling with bandaid on upper arm" src="https://images.theconversation.com/files/462361/original/file-20220511-22-9sko2m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462361/original/file-20220511-22-9sko2m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462361/original/file-20220511-22-9sko2m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462361/original/file-20220511-22-9sko2m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462361/original/file-20220511-22-9sko2m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462361/original/file-20220511-22-9sko2m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462361/original/file-20220511-22-9sko2m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Future supplies of COVID vaccines will be used for booster shots and children.</span>
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<h2>The power of patents</h2>
<p>This effective duopoly further reinforces the already considerable power these manufacturers hold via the intellectual property rights to their vaccines.</p>
<p>These vaccine patents are protected by the World Trade Organization under the Agreement on Trade-Related Aspects of Intellectual Property Rights (or <a href="https://www.wto.org/english/tratop_e/trips_e/trips_e.htm">TRIPS</a>). This prevents international competitors from replicating patented technologies. </p>
<p>These patent rights allow companies to earn higher profits (or “economic rents”) than if their technologies were freely available to allow open competition.</p>
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<p>The intellectual property dimensions of COVID vaccines have been controversial. </p>
<p>Pfizer and Moderna have continued <a href="https://peoplesvaccine.org/resources/media-releases/pharma-companies-make-1000-dollars-per-second/">to make extraordinary profits</a> from COVID vaccines.</p>
<p>Yet Moderna found itself <a href="https://www.ipwatchdog.com/2022/03/31/nihs-fight-ownership-modernas-covid-19-patent-highlights-hazards-business-collaborations/id=148040/">in dispute</a> with the United States government, conceding <a href="https://www.nytimes.com/2021/12/17/us/moderna-patent-nih.html?msclkid=2baf60f6d0f511ec9526396a701fee1f">US government employees</a> had directly developed several technologies key to the Moderna vaccine (not to mention years of publicly-funded basic research). </p>
<p>Moderna has also <a href="https://www.npr.org/sections/goatsandsoda/2021/10/19/1047411856/the-great-vaccine-bake-off-has-begun">resisted sharing</a> the formulation of its vaccine to allow key middle-income countries to manufacture it.</p>
<p>Meanwhile, Pfizer has negotiated <a href="https://www.citizen.org/article/pfizers-power/?eType=EmailBlastContent&eId=9b708ddb-d34d-4dfa-95e4-d4d672a82a1b">advantageous</a> and <a href="https://www.theguardian.com/uk-news/2021/dec/05/wall-of-secrecy-in-pfizer-contracts-as-company-accused-of-profiteering">secretive</a> vaccine contracts with governments, shifting liability and risk onto governments and controlling nations’ ability to redistribute stock between themselves. </p>
<p>High-income countries have <a href="http://aftinet.org.au/cms/Civil-society-organisations-urge-Australia-to-oppose-ineffective-TRIPS-proposal">consistently resisted</a> or watered down <a href="https://docs.wto.org/dol2fe/Pages/SS/directdoc.aspx?filename=q:/IP/C/W688.pdf&Open=True">calls for a TRIPS waiver</a>, which would have allowed global sharing of manufacturing technologies. </p>
<p><a href="https://journals.plos.org/globalpublichealth/article?id=10.1371%2Fjournal.pgph.0000427">Critics argue</a> the opponents of a TRIPS waiver are largely concerned about avoiding setting any precedents that might allow the profits of Big Pharma to be limited in future.</p>
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<a href="https://theconversation.com/why-a-leaked-wto-solution-for-a-covid-patent-waiver-is-unworkable-and-wont-make-enough-difference-for-developing-countries-179642">Why a leaked WTO 'solution' for a COVID patent waiver is unworkable and won't make enough difference for developing countries</a>
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<h2>What should Australia do next?</h2>
<p>In Australia, the reality that current COVID vaccines only partially prevent transmission leaves us dependent on this effective duopoly for ongoing boosters. Boosters also remain mandated for people in <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/information-for-aged-care-providers-workers-and-residents-about-covid-19-vaccines/residential-aged-care-workers">many occupations</a>.</p>
<p>Australia can escape this captive vaccine market in three steps.</p>
<p><strong>1. Approve more vaccines</strong></p>
<p>Australia needs to expand the supply of new COVID vaccines by actively assisting a wider range of manufacturers to bring their products to the Therapeutic Goods Administration for approval. This would increase competition for boosters and stimulate the development and supply of more effective “sterilising” vaccines (ones that prevent viral transmission).</p>
<p>Meanwhile, Australia must extract maximum value from all existing vaccine contracts, and insist upon full freedom to transfer supplies to our regional neighbours.</p>
<p><strong>2. Push for patent reform</strong></p>
<p>Australia should use its influence to vigorously drive a TRIPS waiver at the World Trade Organization. It should also explore strategic options with a coalition of partners to consider how the current global intellectual property regime could be rapidly reformed or, if necessary, circumvented. </p>
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Read more:
<a href="https://theconversation.com/3-ways-to-vaccinate-the-world-and-make-sure-everyone-benefits-rich-and-poor-155943">3 ways to vaccinate the world and make sure everyone benefits, rich and poor</a>
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<p><strong>3. Set up domestic, not-for-profit capability</strong></p>
<p>Australia should institute an economic “mission” to establish publicly-owned, not-for-profit vaccine and essential pharmaceuticals research, development and manufacturing infrastructure and capability in Australia. This would serve domestic and wider regional needs for COVID and beyond. </p>
<p>Sadly, the Australian government’s recent agreement with Moderna for the company to establish <a href="https://theconversation.com/new-facility-to-be-built-in-victoria-to-produce-mrna-vaccines-173674">mRNA manufacturing here</a> is <em>not</em> such an example. It may risk entrenching existing power. The agreement is also <a href="https://www.abc.net.au/radionational/programs/sciencefriction/moderna-mrna-australia-covid-pharmaceutical-profits-business/13849344">still secret</a>. </p>
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<a href="https://theconversation.com/new-facility-to-be-built-in-victoria-to-produce-mrna-vaccines-173674">New facility to be built in Victoria to produce mRNA vaccines</a>
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<p>In an increasingly insecure world of growing disruptions – ecological and health crises, fracturing supply chains and heightened military tensions – Australia can provide a safe and resilient vaccine and pharmaceutical manufacturing capability to protect the health of Australians and our neighbours. </p>
<p>However, old models that privilege shareholders, via excess profits and intellectual property protection, will not deliver this new vision.</p>
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<p><em><a href="https://www.deakin.edu.au/about-deakin/people/sithara-wanni-arachchige-dona2">Sithara Dona</a>, an associate research fellow at Deakin University, co-authored the research mentioned in this article.</em></p><img src="https://counter.theconversation.com/content/182147/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Martin Hensher has received an honorarium from Novartis SA (Brazil) for a lecture delivered to the Novartis Access 2021 conference. He is a member of the South Australian Health Performance Council and a board member of Glenview Community Services, Tasmania (a not-for-profit aged care provider).</span></em></p>Boosters and vaccinating children mean we’re relying on two pharmaceutical companies to supply Australia’s COVID vaccines. That needs to change.Martin Hensher, Henry Baldwin Professorial Research Fellow in Health System Sustainability, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1746052022-01-10T03:44:56Z2022-01-10T03:44:56ZWhy has my child’s vaccination been cancelled? We’re reliant on overseas supply and a complex logistics network<figure><img src="https://images.theconversation.com/files/439941/original/file-20220110-13-gd4wmt.jpg?ixlib=rb-1.1.0&rect=0%2C22%2C5058%2C2589&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Reports of GPs <a href="https://www.abc.net.au/radionational/programs/breakfast/child-vaccine-appointments-delayed-or-cancelled/13700424">cancelling</a> or postponing COVID vaccine appointments for 5-11 year olds are piling up, with desperate parents expressing anger and fear about how their as-yet unvaccinated children will fare as Omicron case numbers explode.</p>
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<p>Federal COVID-19 Task Force Commander Lieutenant General John Frewen <a href="https://www.health.gov.au/news/lieutenant-general-john-frewens-interview-on-sunrise-on-10-january-2022">said</a> on Monday:</p>
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<p>Supply isn’t the issue; we’ve got enough vaccines. The real challenge now is just getting the distribution to where the demand is greatest. </p>
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<p>South Australia’s health deputy chief executive Don Frater, however, has reportedly <a href="https://indaily.com.au/news/2022/01/10/sa-health-reveals-shortfall-of-vaccines-for-children/">said</a> that state has “more demand than what we have supply”.</p>
<p>The child’s dose comes in different vials to the adult dose, with <a href="https://www.ncirs.org.au/safety-side-effects-allergies-and-doses-covid-19-pfizer-vaccine-5-11-year-olds-explained">different packaging</a>.</p>
<p>The rollout of the Pfizer vaccine for children has come at a difficult time, from a logistics perspective. Many GPs have said “delivery delays” are behind the need to reschedule appointments.</p>
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Read more:
<a href="https://theconversation.com/australia-may-miss-out-on-several-covid-vaccines-if-it-cant-make-mrna-ones-locally-148996">Australia may miss out on several COVID vaccines if it can't make mRNA ones locally</a>
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<h2>What might be behind the delays?</h2>
<p>This is a specialised product, which needs to be stored in special freezers <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-submit-covid-19-vaccine-stability-data">at -80°C</a>, and obviously needs to be transported in a certain way. </p>
<p>There are a lot of steps in the transport process – from the supplier overseas to the shipping service bringing them to Australia, from their landing spot in the country, to specialised storage, to individual GPs.</p>
<p>Each of those steps require staff on the ground to ensure the system works – and many workers in this system are likely being affected by Omicron.</p>
<p>The same staffing issues resulting in <a href="https://theconversation.com/supermarket-shortages-are-different-this-time-how-to-respond-and-avoid-panic-174529">empty supermarket shelves</a> could be affecting the vaccine distribution network too. </p>
<p>Thousands of drivers, administration staff, packers and logistics planners could be furloughed, off sick or in isolation because a household member is.</p>
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<p>The rollout of the 5-11 year old vaccination program, timed in an effort to get kids vaccinated before school starts, also comes hot on the heels of the Christmas and New Year break; even without Omicron, it’s possible staffing numbers across the supply chain and logistics network are still yet to return to pre-Christmas levels.</p>
<p>There have been <a href="https://twitter.com/Leighma03/status/1479403027517755392">anecdotal reports</a> of <a href="https://twitter.com/Leighma03/status/1479403027517755392">some</a> people having their booster appointments being cancelled too, so it seems it is not only 5-11 year olds who are affected.</p>
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Read more:
<a href="https://theconversation.com/safety-side-effects-allergies-and-doses-the-covid-19-pfizer-vaccine-for-5-11-year-olds-explained-173323">Safety, side effects, allergies and doses. The COVID-19 Pfizer vaccine for 5-11 year olds explained</a>
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<p>It’s hard to know how widespread the issue is. Frewen told Sunrise on Monday</p>
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<p>if you’re having trouble at the moment, maybe with your normal healthcare provider, your GP, then please do try pharmacies, maybe try one of the state and territory clinics as they come online. </p>
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<p>He <a href="https://twitter.com/RNBreakfast/status/1480285219496202240">told</a> RN Breakfast that: </p>
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<p>We will have more than enough vaccines for every kid to have their first dose before the end of the year.</p>
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<p>This must be very frustrating for people who have tried to get in early and are keen to have their children vaccinated as soon as possible.</p>
<p>Clearly, something has fallen over somewhere in the distribution. It would be good to have some clarity from government and industry on exactly where the systemic problems are and what’s being planned to address them.</p>
<h2>Domestic production of mRNA vaccines</h2>
<p>The Therapeutic Goods Administration (TGA) only just provisionally approved the use of Pfizer’s COMINARTY COVID vaccine for people aged 5-11 years on <a href="https://www.tga.gov.au/covid-19-vaccines-undergoing-evaluation">December 3</a>.</p>
<p>Moderna’s application for the use of SPIKEVAX COVID vaccine for children under age 12 is still <a href="https://www.tga.gov.au/covid-19-vaccines-undergoing-evaluation">under evaluation</a>, according to the TGA.</p>
<p>Hopefully, once that is approved, parents of children in the 5-11 year old age bracket will have more choice on where and how they can get their child vaccinated.</p>
<p>Both Pfizer and Moderna’s COVID vaccines are mRNA vaccines, and experts have long called for a boost in domestic mRNA manufacturing capacity so Australia is less reliant on overseas supplies.</p>
<p>Promisingly, Moderna and the Australian government late last year <a href="https://www.biopharma-reporter.com/Article/2021/12/14/Moderna-to-build-mRNA-vaccine-manufacturing-facility-in-Australia">announced</a> an in-principle agreement to build a mRNA manufacturing facility in Victoria. The site will hopefully be up and running by 2024, according to media <a href="https://www.abc.net.au/news/2021-12-14/moderna-to-be-first-mrna-vaccine-made-in-australia/100697324">reports</a>. </p>
<p>That’s something to be celebrated, and domestic manufacturing would hopefully mean a shorter and less complex supply chain with less opportunity for difficulties in future. But it does highlight it would have been good to have something worked out earlier. </p>
<p>It would also be prudent for the government to consider what it might take to lure Pfizer to develop mRNA manufacturing capability in Australia. You could argue, from a market point of view, it could be strategic for Moderna to have a manufacturing competitor here in Australia too. </p>
<p>If we are serious about building our biotechnology sector in Australia, then having monopoly of just one player in the country might not be ideal.</p>
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Read more:
<a href="https://theconversation.com/supermarket-shortages-are-different-this-time-how-to-respond-and-avoid-panic-174529">Supermarket shortages are different this time: how to respond and avoid panic</a>
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<img src="https://counter.theconversation.com/content/174605/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Archa Fox receives funding from the Australian Research Council. She is a member of the Australia New Zealand RNA Production Consortium that has lobbied for establishment of onshore mRNA vaccine manufacturing in Australia</span></em></p>We’re reliant on overseas supply - and the many moving parts of delivery. Each of those parts require staff on the ground – and many workers in this system are likely being affected by Omicron.Archa Fox, Associate Professor and ARC Future Fellow, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1634792021-06-30T19:59:56Z2021-06-30T19:59:56ZVaccine Rollout 2.0: Australia needs to do 3 things differently<figure><img src="https://images.theconversation.com/files/409049/original/file-20210630-23-1crdcj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/fVz1FH7sHx4">Unsplash/CDC</a></span></figcaption></figure><p>Australia’s vaccine rollout started just over four months ago. It has not gone well, to put it mildly. To date, only <a href="https://ourworldindata.org/covid-vaccinations">24% of the population</a> have had at least one dose of a vaccine, and nearly 5% – 1.2 million people – have been fully vaccinated.</p>
<p>This rate is far too slow. The United Kingdom and the United States are showing that effective mass vaccination programs can work, with <a href="https://www.bbc.com/news/health-55274833">more than 80% of Brits</a> and <a href="https://www.mayoclinic.org/coronavirus-covid-19/vaccine-tracker">54% of Americans</a> having received their first dose. Australia should be just as ambitious.</p>
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<p>The federal government should press the reset button and shift to Rollout 2.0.</p>
<p>Rollout 1.0 was plagued with supply problems – there just wasn’t enough of either vaccine available. But from July, there will be <a href="https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-covid-vaccination-allocations-horizons.pdf">more supply</a>, with about two million Pfizer doses, and half a million Moderna doses available per week from October – more than enough to cover the whole adult population.</p>
<p>With supply looking sorted, the federal government should set a new goal for when all adults will be able to receive full vaccination by.</p>
<p>The government – and its army of rollout consultants – has had months to learn from its mistakes. The actual army has also been called in.</p>
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Read more:
<a href="https://theconversation.com/calling-in-the-army-for-the-vaccine-rollout-and-every-other-emergency-shows-how-ill-prepared-we-are-162247">Calling in the army for the vaccine rollout and every other emergency shows how ill-prepared we are</a>
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<p>The government has no excuse not to have all arrangements in place for an efficient vaccination program when the vaccines begin rolling in.</p>
<p>Three key things need to be done differently to achieve this goal.</p>
<h2>1. Fix the logistics</h2>
<p>The supply side of Rollout 1.0 was a shemozzle. GPs and state governments had no idea how many doses were going to arrive and when. This was partly due to slow supply of doses from overseas, but mainly due to slow supply from the local producer, CSL.</p>
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<p>That should not be a worry under Rollout 2.0.</p>
<p>But Rollout 1.0 was also a distribution nightmare. It was seemingly impossible for anyone to organise to get doses from place A to place B.</p>
<p>There are now fewer anecdotes about distribution disasters than a few months ago, but the government needs to assure the public that the supply chain and distribution networks are working efficiently.</p>
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Read more:
<a href="https://theconversation.com/how-the-pfizer-covid-vaccine-gets-from-the-freezer-into-your-arm-155453">How the Pfizer COVID vaccine gets from the freezer into your arm</a>
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</em>
</p>
<hr>
<p>If I can be notified when my book or beer is due to arrive – and even the driver’s name – then GPs and state vaccine hubs should be able to be notified when their doses are due to arrive.</p>
<p>And it should be as easy for me to book my vaccination online as it is to book a restaurant table or parcel pick-up online, with advance bookings helping to guide where extra doses should be allocated.</p>
<h2>2. Widen the channels</h2>
<p>Of the Australians who are getting vaccinated, <a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-cumulative-doses-administered-by-channel">just over half</a> are doing so through GPs and primary care clinics.</p>
<p>If Rollout 2.0 is to make use of the millions of new doses arriving every week, it will need to deliver at least three times as many doses every week as it has been able to achieve so far.</p>
<p>Government planning seems to be putting GPs front and centre of Rollout 2.0 – the same strategy that failed in Rollout 1.0.</p>
<p>Sure, GPs should be invited to step up, but governments should continue to put a focus on mass state-run vaccination hubs that <a href="https://www.medrxiv.org/content/10.1101/2021.04.07.21255067v1">can vaccinate</a> up to 1,400 people every eight hours, compared to GP clinics that can vaccinate only 100 to 300 people in the same time.</p>
<p>Rollout 2.0 needs to increase both the hours existing outlets are available and expand the number of large vaccination hubs. It should also introduce new outlets such as pharmacies.</p>
<p>States should bring vaccines to people, by providing on-site pop-up vaccination centres at major sports events, workplace hubs, universities, major public transport stations, housing commissions, and regional town centres.</p>
<p>When the Pfizer vaccine is approved for people under 16, states should also arrange for vaccinations to be done in schools.</p>
<p>Because more doses will be available within one month, <a href="https://www.theage.com.au/politics/victoria/top-up-pfizer-would-be-used-to-fully-vaccinate-victorians-state-government-told-commonwealth-20210616-p581jl.html">states should no longer stockpile doses</a> to ensure second-dose availability but rely on fewer supplies for this purpose.</p>
<p>A faster rollout will need a bigger workforce. Planning needs to start now on how we should draw on medical, nursing, and pharmacy students to contribute to Rollout 2.0.</p>
<h2>3. Tackle vaccine hesitancy</h2>
<p>As the government fixes the supply side, it also needs to tackle the demand side – vaccine hesitancy. About <a href="https://www.smh.com.au/politics/federal/vaccine-concerns-ease-but-only-slightly-as-26-per-cent-say-unlikely-to-get-jab-20210615-p5812s.html">25% of Australian adults</a> say they may not get the jab. The aim should be to change the minds of those who are unsure, rather than focusing on those who are much less willing.</p>
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<a href="https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=806&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=806&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=806&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1013&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1013&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1013&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>There is <a href="https://www.sciencedirect.com/science/article/pii/S1364661321000334">a science</a> behind what works in addressing COVID vaccine hesitancy, drawing on <a href="https://www.tandfonline.com/doi/citedby/10.1080/21645515.2017.1394533">previous vaccine campaigns</a>. Government should use it, rather than developing ads that look like the cheapest possible <a href="https://www.smh.com.au/culture/tv-and-radio/australia-s-vaccination-ad-is-literally-wallpaper-how-can-it-be-fixed-20210521-p57u0g.html">bland offering</a>, which <a href="https://www.crikey.com.au/2021/06/25/where-bloody-hell-covid-19-ads/">compare poorly to international offerings</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1405278767627399168"}"></div></p>
<p>There is not one slick answer, and no one campaign. Different demographics will respond to different messaging. Different reasons for hesitancy will need to be addressed differently.</p>
<p>Ads should be placed at <a href="https://www.abc.net.au/news/2021-06-19/australia-covid-vaccine-ads-strategy-improvement/100227610">times when target audiences might be watching TV</a>.</p>
<p>A text message campaign could be used, sent to all Australian adults, regardless of their vaccination status, encouraging them to get vaccinated and telling them how, <a href="https://www.england.nhs.uk/2021/03/nhs-text-alerts-for-life-saving-covid-jab/">as is done in the UK</a>.</p>
<p>Some campaigns could start now, promoting the benefits of vaccines to individuals and their efficacy. Messaging should also emphasise the collective benefits of high vaccination rates, including protecting the vulnerable and bringing stranded Australians home, just as our collective effort saved lives to date.</p>
<p>Better real-time tracking of vaccine uptake by demographics can be used to develop different messages for different audiences.</p>
<p>The campaigns should <a href="https://www.nature.com/articles/s41591-020-1124-9#Tab2">go beyond simply pronouncing</a> that all the vaccines are safe and effective. The communication should be ongoing, clear and actionable, address concerns, and de-bunk misunderstandings, <a href="https://www.mja.com.au/journal/2021/communicating-patients-and-public-about-covid-19-vaccine-safety-recommendations">without over-reassuring</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-government-is-spending-almost-a-24m-to-convince-us-to-accept-a-covid-vaccine-but-will-its-new-campaign-actually-work-154062">The government is spending almost A$24m to convince us to accept a COVID vaccine. But will its new campaign actually work?</a>
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<p><a href="https://www.smh.com.au/politics/federal/older-australians-especially-older-women-most-concerned-about-covid-vaccines-20210519-p57tc4.html">Younger people, women</a>, and people who live beyond the inner-city are more likely to be hesitant. Communications should <a href="https://www.anu.edu.au/files/guidance/COVID%252019%2520in%2520Australia,%2520What%2520factors%2520drive%2520pro-vaccination%2520behaviour.pdf">build trust and confidence</a> in government, and not pit groups against each other, which would only increase hesitancy.</p>
<p>The government has over-promised and under-delivered on Rollout 1.0. It needs to push the reset button so that Rollout 2.0 takes Australians to a vaccine-protected future as soon as possible.</p><img src="https://counter.theconversation.com/content/163479/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities, as disclosed on its website. Stephen Duckett has been partially vaccinated with AstraZeneca.</span></em></p><p class="fine-print"><em><span>Anika Stobart does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With enough vaccine supplies coming online from October, the government has no excuse not to have all arrangements in place for an efficient vaccination program. Here’s what needs to change.Stephen Duckett, Director, Health Program, Grattan InstituteAnika Stobart, Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1592192021-04-26T05:10:32Z2021-04-26T05:10:32ZHere are 9 ways we can make it easier for Australians to get the COVID-19 vaccine<p>Between vaccine supply issues, confusion about the role of GPs, and changed advice for AstraZeneca, the Australian COVID-19 vaccine rollout is well <a href="https://www.theage.com.au/national/did-australia-get-its-vaccine-strategy-right-20210415-p57jey.html?utm_medium=Social&utm_source=Twitter#Echobox=1618621648">behind schedule</a>.</p>
<p>How can we make it easier for the <a href="https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(20)30559-4.pdf">majority</a> of Australians who want to be vaccinated? Especially given <a href="https://www.abc.net.au/news/2021-04-22/national-cabinet-over-50-vaccination-mass-hub-astrazeneca/100087334">all Australians over 50 years of age</a> are eligible to be vaccinated from May 3 next week. </p>
<p>There are tangible things we can do now to help people understand the benefits and possible risks of COVID-19 vaccination, and get the vaccine quickly as soon as they’re eligible.</p>
<h2>Improve understanding</h2>
<p>We know communication about COVID-19 hasn’t met the needs of people with low <a href="https://www.phrp.com.au/issues/december-2020-volume-30-issue-4/health-literacy-and-disparities-in-covid-19-related-knowledge-attitudes-beliefs-and-behaviours-in-australia/">health literacy</a> or those who speak different <a href="https://theconversation.com/multilingual-australia-is-missing-out-on-vital-covid-19-information-no-wonder-local-councils-and-businesses-are-stepping-in-141362">languages</a>. These groups are also more susceptible to <a href="https://www.jmir.org/2021/1/e23805/">misinformation</a> so it’s vital we communicate well to them. </p>
<p>Here are some practical things we can do:</p>
<ol>
<li><p><strong>use standard terms</strong>: governments need to develop a national glossary for COVID-19 vaccination terms. This would standardise and <a href="https://theconversation.com/how-can-governments-communicate-with-multicultural-australians-about-covid-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097">simplify information</a> for diverse communities. For example, the Department of Health provides a <a href="https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-wkstd13-toc%7Emental-pubs-n-wkstd13-glo">glossary for mental health</a> terms, which can ensure patient information and translations for words like “care plan” are consistent</p></li>
<li><p><strong>write for year 8 reading level</strong>: one study of COVID-19 information found government information in Australia, the US and UK was too <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.13066">complex</a> for many people to understand; and it was worst for Australia. Online “readability” calculators can be used to check health information is at the recommended year 8 reading level. Real-time editing <a href="https://hdl.handle.net/2123/24642">tools</a> help writers avoid acronyms and uncommon words, and use shorter, simpler sentences</p></li>
<li><p><strong>use supporting images</strong>: we can make sure text is supported by helpful images such as the vaccination timeline, rather than negative <a href="https://theconversation.com/pictures-of-covid-injections-can-scare-the-pants-off-people-with-needle-phobias-use-these-instead-157963">images</a> like pictures of needles that may scare people.</p></li>
</ol>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pictures-of-covid-injections-can-scare-the-pants-off-people-with-needle-phobias-use-these-instead-157963">Pictures of COVID injections can scare the pants off people with needle phobias. Use these instead</a>
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</p>
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<h2>Improve access</h2>
<p>We know vaccine supply is a <a href="https://www.theage.com.au/national/did-australia-get-its-vaccine-strategy-right-20210415-p57jey.html?utm_medium=Social&utm_source=Twitter#Echobox=1618621648">challenge</a> but we can still make sure every available vaccine dose is used as soon as possible.</p>
<p>Strategies to do this could include:</p>
<ol>
<li><p><strong>local vaccination</strong>: our COVID-19 testing model has been successful including pop up <a href="https://theconversation.com/morrison-government-funds-pop-up-testing-clinics-and-tele-consultations-in-2-4-billion-covid-19-health-package-133368">clinics</a> in places where there have been localised outbreaks. But our vaccine distribution logistics are falling <a href="https://theconversation.com/australia-urgently-needs-mass-covid-vaccination-hubs-but-we-need-more-vaccines-first-158416">behind</a>. The <a href="https://www.abc.net.au/news/health/2021-04-14/covid-19-anthony-fauci-what-australia-can-learn-from-us/100068256">US</a> has used community clinics, pharmacies and mobile field officers to vaccinate millions of people a day. While some testing clinics now offer vaccinations, we could be doing more to provide vaccines for free as locally as possible</p></li>
<li><p><strong>national registry</strong>: registries can keep track of vaccine doses and notify people as soon as they’re eligible. This is done in childhood vaccination, and notification systems are used effectively for cancer screening programs. We could use the existing <a href="https://www.servicesaustralia.gov.au/individuals/services/medicare/australian-immunisation-register">Australian Immunisation Register</a> to track and promote COVID-19 vaccination </p></li>
<li><p><strong>automated appointments</strong>: people could sign up for “opt out” appointments with their local GP or vaccination clinic. This means they would be automatically booked into an appointment as soon as they’re eligible and supply is available, or moved to an earlier appointment if there’s a cancellation. This <a href="https://theconversation.com/how-to-really-fix-covid-19-vaccine-appointment-scheduling-155438">pre-registration</a> approach will reduce wasted vaccine doses when several doses must be used from the same vial in the same day.</p></li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-really-fix-covid-19-vaccine-appointment-scheduling-155438">How to really fix COVID-19 vaccine appointment scheduling</a>
</strong>
</em>
</p>
<hr>
<h2>Improve motivation</h2>
<p><a href="https://www.medrxiv.org/content/10.1101/2021.02.04.21251165v1">Our research</a>, published as a pre-print in February, shows motivation is a particular challenge for Australia. Many people perceive their individual risk of contracting COVID-19 to be lower given case numbers are so low, and many people therefore haven’t been as strict with distancing behaviours.</p>
<p>Even before the new risk of <a href="https://theconversation.com/what-is-thrombocytopenia-the-rare-blood-condition-possibly-linked-to-the-astrazeneca-vaccine-158522">serious clots</a> was identified with the AstraZeneca vaccine, the <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30926-9/fulltext">top barriers</a> for getting the vaccine in 2020 were safety concerns and side effects, which may outweigh the individual risk of COVID-19 for some people.</p>
<p>But most Australians have high intentions to get vaccinated, and there are things we can do to maintain motivation:</p>
<ol>
<li><p><strong>explain benefits AND risks</strong>: rather than focusing on single cases of serious side effects, we need to balance information in the media. We can use simple <a href="https://www.health.gov.au/sites/default/files/documents/2021/04/covid-19-vaccination-weighing-up-the-potential-benefits-against-risk-of-harm-from-covid-19-vaccine-astrazeneca_0.pdf">graphics</a> to help people consider how the rare risk of serious side effects weighs up against the serious complications of COVID-19 for their age group during a local outbreak — which <a href="https://theconversation.com/whats-the-risk-if-australia-opens-its-international-borders-an-epidemiologist-explains-159208">could still happen any time</a></p></li>
<li><p><strong>emphasise community benefits</strong>: since COVID-19 is well controlled in Australia, we can focus on emphasising the benefits to the community of getting vaccinated. This might help people understand why they should get vaccinated even though their individual risk might be low. Our research in 2020 found the top motivators were “<a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30926-9/fulltext">to protect myself and others</a>” and “belief in vaccination and science”. Even if a 25-year-old views their individual risk of COVID-19 complications as low, protecting family, friends, and wider society may be important to them</p></li>
<li><p><strong>provide incentives</strong>: getting vaccinated as soon as someone’s eligible could be linked to financial incentives. This has been used for <a href="https://julieleask.wordpress.com/2015/11/23/no-jab-no-pay-a-questionable-main-course-with-some-excellent-side-dishes/">childhood vaccination</a> where access to childcare rebates is easier with up-to-date vaccination, and health professionals are incentivised to address vaccination gaps. However, this needs to be done carefully to avoid the concerns of coercive policies.</p></li>
</ol>
<p>More coercive options include: mandatory vaccination, such as for certain jobs; financial sanctions like fines; and movement restrictions, including requiring a “vaccine passport” for travel.</p>
<p>These may increase vaccination uptake, but there are <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30766-0/fulltext">ethical concerns</a> because such approaches could undermine trust and increase inequalities. </p>
<p>Australian vaccination communication experts have argued against a <a href="https://theconversation.com/5-ways-we-can-prepare-the-public-to-accept-a-covid-19-vaccine-saying-it-will-be-mandatory-isnt-one-144730">mandatory</a> approach, in response to a suggestion Prime Minister Scott Morrison <a href="https://www.sbs.com.au/news/scott-morrison-says-a-coronavirus-vaccine-would-be-as-mandatory-as-you-can-possibly-make-it">made in August last year</a> that a COVID-19 vaccine would be “as mandatory as you can possibly make it”, which he later retracted.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-ways-we-can-prepare-the-public-to-accept-a-covid-19-vaccine-saying-it-will-be-mandatory-isnt-one-144730">5 ways we can prepare the public to accept a COVID-19 vaccine (saying it will be 'mandatory' isn't one)</a>
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</em>
</p>
<hr>
<p>We could be doing much more to improve understanding, access and motivation among Australians right now. We need to ensure everyone has the information they need to get a COVID-19 vaccine as soon as they’re eligible.</p>
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<img alt="" src="https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1235&fit=crop&dpr=1 600w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1235&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1235&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Department of Health/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p class="fine-print"><em><span>Carissa Bonner receives funding from the NHMRC for a project investigating barriers to vaccination; and from the Marie Bashir Institute to investigate barriers to COVID-19 testing.</span></em></p><p class="fine-print"><em><span>Rachael Dodd receives funding from the Marie Bashir Institute to investigate barriers to COVID-19 testing. </span></em></p>There are tangible things we can do now to help people understand the benefits and possible risks of COVID-19 vaccination.Carissa Bonner, Research Fellow, University of SydneyRachael Dodd, Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1581962021-03-31T12:42:22Z2021-03-31T12:42:22ZModerna and Novavax – here’s what new vaccines mean for the UK rollout and the end of lockdown<p>Two new COVID-19 vaccines are due to arrive in the UK. As the country begins to emerge from lockdown, recent announcements about the <a href="https://www.ft.com/content/b07159be-9558-400b-a10f-5f7d9b4cb992">Moderna</a> and <a href="https://www.bbc.com/news/uk-england-tees-56570168">Novavax</a> vaccines will boost confidence in its vaccination rollout.</p>
<p>With more than <a href="https://coronavirus.data.gov.uk/details/vaccinations">30 million first doses</a> administered, the rollout is going well. It currently relies on two vaccines: Oxford/AstraZeneca and Pfizer/BioNTech.</p>
<p>The UK government aims to have the entire adult population vaccinated with at least one dose by <a href="https://www.gov.uk/government/news/30-million-people-in-uk-receive-first-dose-of-coronavirus-covid-19-vaccine">the end of July</a>. But recently, the country has been hit by delays in <a href="https://www.bbc.co.uk/news/uk-56435030">anticipated supplies</a>. During April, the focus will be on second doses instead of inoculating more people with their first doses. This has raised concerns about the vaccination programme remaining on track. </p>
<p>The two new vaccines will help with this. The Moderna vaccine gained <a href="https://www.gov.uk/government/publications/regulatory-approval-of-covid-19-vaccine-moderna">UK authorisation</a> in January and is already widely used elsewhere. The Novavax vaccine is expected to file for UK authorisation soon after <a href="https://ir.novavax.com/news-releases/news-release-details/novavax-covid-19-vaccine-demonstrates-893-efficacy-uk-phase-3">successful phase 3 trials</a>.</p>
<p>While some of the AstraZeneca vaccine is manufactured in the UK, the country is reliant on imports. A <a href="https://theconversation.com/did-the-uk-outsmart-the-eu-over-astrazeneca-vaccines-157926">large proportion of vaccines administered</a> in the UK are imported from India or the EU. While the <a href="https://www.theguardian.com/society/2021/mar/28/moderna-covid-vaccine-to-be-introduced-in-uk-from-april">government is adamant</a> that it will meet its targets, the health secretary, Matt Hancock, has called vaccine supplies “<a href="https://www.bbc.co.uk/news/av/uk-56437090">lumpy</a>”. </p>
<p>A letter from <a href="https://www.standard.co.uk/news/uk/coronavirus-vaccine-supply-uk-shortage-nhs-letter-b924775.html">NHS England</a> on March 17 advised vaccination sites of a significant reduction in supply from March 29. Vaccination centres were told to process as many adults over 50 as possible, to use up stock with a short shelf life, and to close down online bookings.</p>
<p>A key reason for this step is diminished supplies of the AstraZeneca vaccine <a href="https://www.bbc.com/news/world-asia-india-56513371">from India</a>. An order of 10 million doses of vaccines was only partially fulfilled, with 5 million doses remaining in India. India has <a href="https://www.ft.com/content/5349389c-8313-41e0-9a67-58274e24a019">imposed a de facto export ban</a> for vaccines while the country focuses on domestic vaccinations to ward off a new wave of infections. </p>
<p>But export stops are not the only reason for the insecurity in the vaccine supply chain. The Serum Institute of India, the world’s largest vaccine manufacturer, also reported material shortages <a href="https://www.bbc.co.uk/news/world-asia-india-55571793">affecting production</a>. This is not an isolated issue, and <a href="https://www.bmj.com/content/372/bmj.n781/rr">global agreement and coordination</a> is needed to alleviate bottlenecks.</p>
<p>In addition, 1.7 million doses of the AstraZeneca vaccine had to be <a href="https://www.lbc.co.uk/news/nhs-chief-warns-of-significantly-constrained-vaccine-supply/">retested</a> as part of the ongoing quality assurance for product stability. While strict quality standards are essential and difficulties in scaling up production at a global scale are not unexpected, there is an urgent need for alternatives.</p>
<h2>The cavalry is coming</h2>
<p>As countries struggle to secure sufficient supplies of vaccines and companies cannot scale up production fast enough. Enter the Moderna vaccine. Dr Anthony Fauci, chief medical advisor to the US president, said of the vaccine’s arrival there: “<a href="https://www.independent.co.uk/news/health/covid-vaccine-fauci-us-fauci-moderna-pfizer-b1722238.html">the cavalry is coming</a>”.</p>
<p>Yet in the UK, Moderna’s immediate impact, while welcome, will be limited. While 17 million doses have been ordered in total, only <a href="http://www.pharmafile.com/news/574110/500000-moderna-covid-19-vaccines-arrive-uk-next-month">500,000</a> are expected to arrive in April. This is enough to cover only <a href="https://coronavirus.data.gov.uk/details/vaccinations#card-number_of_vaccinations_given_by_report_date">one average day</a> of vaccinations. </p>
<p>Novavax will be another valuable addition to the UK’s arsenal of vaccines. Supplies for the UK market will be manufactured by <a href="https://fujifilmdiosynth.com/about-us/press-releases/fujifilm-diosynth-biotechnologies-welcomes-uk-prime-minister-boris-johnson-to-uk-covid-19-vaccine-manufacturing-site/">FUJIFILM Diosynth Biotechnologies</a> in Stockton-on Tees. </p>
<p>Originally, the serum would then have been sent to the EU to be filled into vials ready for use. But on March 29, drug company GlaxoSmithKline <a href="https://www.gsk.com/en-gb/media/press-releases/gsk-to-support-manufacture-of-novavax-covid-19-vaccine/">announced</a> that it had reached an agreement in principle with Novavax and the UK Government Vaccines Taskforce. They will support manufacturing of up to 60 million doses of the Novavax COVID-19 vaccine candidate by using a site in County Durham to “<a href="https://www.bbc.co.uk/news/uk-england-tees-56570168">fill and finish</a>” instead of the EU. Deliveries are expected from June. </p>
<p>This will ensure that the Novavax production for the UK market is entirely UK-based. </p>
<p>Boris Johnson is among the heads of state who have signed an <a href="https://www.who.int/news-room/commentaries/detail/op-ed---covid-19-shows-why-united-action-is-needed-for-more-robust-international-health-architecture">international call for more united action</a> around the world, acknowledging “that nobody is safe until everyone is safe”. Nevertheless, amid global shortages and vaccine nationalism, domestic vaccine production operation will reassure many. </p>
<h2>Ending lockdown</h2>
<p>On March 29, some UK <a href="https://www.bbc.co.uk/news/uk-56559173">lockdown rules</a> relaxed and residents in England are now permitted to meet in groups of six or as two households coming together. The <a href="https://www.bbc.co.uk/news/uk-56584380">end of shielding</a> for vulnerable patients has also begun. To the relief of many, outdoor activities and sports resumed. For those who had received their vaccinations, there was reason to celebrate their “deconfinement”. But some age groups now face a longer than expected wait for their doses. </p>
<p>The anticipated arrival of two new vaccines can boost the morale of those worried about the wait. The announcement of the domestic production of Novavax has reassured those unsettled by <a href="https://theconversation.com/did-the-uk-outsmart-the-eu-over-astrazeneca-vaccines-157926">discussions of export bans</a>. </p>
<p>But we have to ackowledge the complexity of vaccine supply chains. <a href="https://www.bbc.co.uk/news/world-asia-india-55571793">Essential ingredients</a> and tools for the manufacturing process including cell cultures, single-use tubing and specialised chemicals, bags and filters, are still likely to be imported. </p>
<p>There are other changes on the vaccine horizon which offer hope for people waiting to be vaccinated. AstraZeneca, Pfizer/BioNtec, and Moderna are all currently <a href="https://www.ema.europa.eu/en/news/increase-vaccine-manufacturing-capacity-supply-covid-19-vaccines-astrazeneca-biontechpfizer-moderna">upgrading their production facilities</a> in Europe. New manufacturing sites are being approved and processes scaled up. </p>
<p>Along with the collaboration with GlaxoSmithKline to advance the Novavax vaccine, this increase in production will bring some comfort to those adults under 50 still waiting for their vaccine.</p><img src="https://counter.theconversation.com/content/158196/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Liz Breen is the Director of the Digital Health Enterprise Zone one of the sites where the Novavax UK vaccine trial took place.</span></em></p><p class="fine-print"><em><span>Sarah Schiffling does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The anticipated arrival of two new vaccines can boost the morale of those worried about the wait for their dose.Liz Breen, Director of the Digital Health Enterprise Zone (DHEZ), University of Bradford, Reader in Health Service Operations, University of BradfordSarah Schiffling, Senior Lecturer in Supply Chain Management, Liverpool John Moores UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1574502021-03-19T12:24:15Z2021-03-19T12:24:15ZAstraZeneca vaccine: how to fix supply issues<figure><img src="https://images.theconversation.com/files/390428/original/file-20210318-19-d4u1pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sodertalje-sweden-april-13-2020-extrior-1702997644">Roland Magnusson/Shutterstock</a></span></figcaption></figure><p>If you thought that vaccine hesitancy was the biggest challenge of the pandemic, think again. A new challenge is approaching: supply chain hesitancy. The potential for interruption along vaccine supply lines may lead to pauses in vaccination rollouts that will affect millions of people. </p>
<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/astrazeneca-vaccine-how-to-fix-supply-issues-157450&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p>In the UK, the government’s Joint Committee on Vaccination and Immunisation has warned of a <a href="https://www.theguardian.com/world/2021/mar/17/nhs-covid-vaccine-rollout-under-50s-delayed-major-shortage">delay in under-50s getting immunised</a>, partly because of supply issues with the AstraZeneca vaccine. Meanwhile, the EU, where many countries temporarily suspended the AstraZeneca rollout due to reports of blood clots, has <a href="https://www.bbc.com/news/45877605">threatened to restrict</a> exports of the vaccine if supply in Europe does not improve. We await a clear European response. </p>
<p>So far, more than <a href="https://coronavirus.data.gov.uk/details/vaccinations">25 million people</a> in the UK have received their first dose of a COVID-19 vaccine. But the ongoing supply for the remainder of the month into April is now seriously at risk with the delivery of first and certainly second doses now subject to uncertainty. </p>
<p>While cross-border discussions and disputes unfold around the AstraZeneca vaccine in particular, it is likely that this problem is also being heavily affected by both political and public health concerns. </p>
<p>Successive lockdowns have made people more aware of how products and services move along a supply chain. Home deliveries of food, furniture, clothes, and any number of other things can be very easily tracked, monitored and confirmed from the supplier to our front doors. <a href="https://www.supplychaindive.com/news/covid-19-digital-transformation-supply-chains/579452/">Digital supply chains</a> are the norm, and information about demand, supply, orders and returns is now almost instantaneous. </p>
<figure class="align-center ">
<img alt="Graph showing number of vaccinations in the UK and Europe" src="https://images.theconversation.com/files/390460/original/file-20210318-17-g2ytzq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390460/original/file-20210318-17-g2ytzq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390460/original/file-20210318-17-g2ytzq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390460/original/file-20210318-17-g2ytzq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390460/original/file-20210318-17-g2ytzq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390460/original/file-20210318-17-g2ytzq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390460/original/file-20210318-17-g2ytzq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://ourworldindata.org/covid-vaccinations">OurWorldInData</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>So how is it that we might be facing a sudden halt to the vaccine rollout in the next few weeks in the UK?</p>
<p>Immunisation at scale is a highly complex challenge – and the global supply chains that will aid this are also intricate. No modern supply chain can totally avoid disruption. But in an age where there are many techniques to overcome a stop-start in supply chains (called “lumpy demand”), what might the effects of this be on the current challenges that the AstraZeneca supply chain is facing and what options do vaccine suppliers and governments have?</p>
<h2>Supply and demand</h2>
<p>In operations management, we normally teach our students about two types of supply chain problem. First is the “<a href="https://supplychain-academy.net/understanding-the-bullwhip-effect-in-supply-chains/">bullwhip effect</a>”, which concerns rapidly dwindling supply in response to demand shocks. Suppliers struggle to keep up with demand further down the chain and end up running out of product, commonly referred to as “stock-out”. </p>
<p>Then there is the “<a href="https://medium.com/strixus/the-osborne-effect-why-the-timing-of-your-new-product-announcement-is-essential-to-its-success-74717d0c1ca">Osborne effect</a>” – named after the early 1980s laptop manufacturer that went bust rapidly after raising consumer expectations of a newer product that rendered its current device obsolete overnight. This example is also not a good outcome, as the supply chain grinds to a halt with large amounts of unused stock <a href="https://www.theguardian.com/world/2021/feb/25/acceptance-problem-as-most-oxford-covid-jabs-delivered-to-eu-not-yet-used%20and%20http://news.bbc.co.uk/1/hi/health/8606032.stm">held in warehouses</a>. </p>
<p>What the UK government has outlined is ultimately a bullwhip effect of lumpy demand and supply – a brief pause between production and distribution of vaccine batches which will have a knock-on effect on expectations about supply.</p>
<p>Nonetheless, in both cases, the solution is one of understanding both supply and demand – adjusting the dynamics of supply and the actions of all the relevant people involved along the way, in order to match demand needs. In this way, it’s possible to level out the lumpy demand, balance the expectations of supply and generally coordinate a smooth flow of products.</p>
<p>If this transpires to be a minor blip, or if another hurdle is encountered in terms of distribution to the UK and EU, then we may be faced with a different but equally important challenge: take-up and rollout of vaccination being impinged by trans-border regulation, political arguments and the <a href="https://www.politico.eu/article/politics-threatens-cloud-eu-countries-pause-oxford-astrazeneca-vaccine-coronavirus/">decisions of medical regulators</a>. Yet even in this case, this would have nothing at all to do with supply chains.</p>
<h2>How to fix the problem</h2>
<p>The current issues the UK and EU are facing are related to India’s Serum Institute and the <a href="https://www.thenationalnews.com/uae/health/serum-institute-chief-sounds-alarm-over-vaccine-raw-materials-shortage-1.1185184">availability of manufacturing ingredients</a>. These issues of materials supply are immediately solvable, though impacted still by availability and multiple regulatory requirements. </p>
<p>The overall solution is either to increase supply or to stabilise demand through increased prioritisation and reducing the speed of vaccination – or a variation of both. Contractual commitments should not be affected, citizens should be assured, inter-governmental arguments should not rear their head.</p>
<p>This, of course, is not what’s happening. The global economic impacts of the pandemic, the physical and mental health effects of COVID-19, poverty and social inequalities all threaten to destabilise the vaccine rollout, especially now elements of the political economy are becoming increasingly involved (as in the case of Brexit).</p>
<p>But this should not deter us. </p>
<p>The UK is still at the forefront of a successful vaccination rollout at speed, and at scale – that should be highly commended. </p>
<p>The most important things now are to focus on sticking to the plan, ensuring vaccine delivery occurs rapidly when the frequency of supply can be assured again and – most importantly – shifting to a more agile supply chain mindset. That means governments and pharmaceutical companies need to work together in order to meet demand and supply as it changes, putting measures in place to assure a steady supply of vaccine in order to alleviate any concerns. </p>
<p>To ensure future supply chain problems do not occur, we strongly recommend both pharmaceutical companies and national governments think ahead to ensure COVID-19 vaccine supply chains are given priority support in terms of their ability to respond to shocks and “chokes” in supply and demand – devoid of political interference.</p>
<p>We cannot afford to take our foot off the gas now. Our citizens and our supply chains will not thank us for it. We will be answerable to future generations about what we could have done to turn the tide against the pandemic. That’s not a question we want to get wrong.</p><img src="https://counter.theconversation.com/content/157450/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amir Sharif has received funding from UKRI (MRC, Innovate UK) and the QNRF and is a serving board member of Bradford Council's Stronger Communities Partnership Board, West Yorkshire and Harrogate Healthcare Partnership's Climate Change Steering Committee and a member of the Ellen MacArthur Foundation Higher Education Network Universities group.
</span></em></p><p class="fine-print"><em><span>Liz Breen and Sankar Sivarajah do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Supply chain issues can be addressed – but the issues with the AstraZeneca vaccine are political, too.Amir M. Sharif, Associate Dean (International and Accreditations), Professor of Circular Economy, University of BradfordLiz Breen, Director of the Digital Health Enterprise Zone (DHEZ), University of Bradford, Reader in Health Service Operations, University of BradfordSankar Sivarajah, Head of School of Management and Professor of Technology Management and Circular Economy, University of BradfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1538472021-01-27T20:47:03Z2021-01-27T20:47:03ZWhy the next major hurdle to ending the pandemic will be about persuading people to get vaccinated<figure><img src="https://images.theconversation.com/files/380556/original/file-20210125-17-146zu9n.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5751%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Maria Saravia, a worker at the University of Southern California's Keck Hospital, adjusts her mother's mask before her COVID-19 vaccination.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/maria-saravia-left-an-environmental-services-worker-at-keck-news-photo/1230785871">Genaro Molina/Los Angeles Times via Getty Images </a></span></figcaption></figure><p>Today, more Americans hope to receive a COVID-19 vaccine than current vaccine supply will <a href="https://www.axios.com/demand-coronavirus-vaccines-outstripping-supply-7314861f-d8f0-4ee8-8480-85fea99846f8.html">allow</a>. Consequently, although President Joe Biden’s initial <a href="https://www.npr.org/2021/01/22/959700058/100-million-shots-in-100-days-is-bidens-covid-19-vaccination-goal-achievable">promise</a> to dole out 100 million vaccine doses in 100 days would require a <a href="https://www.webmd.com/vaccines/covid-19-vaccine/news/20210120/bidens-covid-challenge-100-million-vaccinations-in-the-first-100-days-it-wont-be-easy#1">ramp-up</a> in vaccine allocation, <a href="https://www.vox.com/future-perfect/22243713/biden-covid-19-coronavirus-vaccine-goal-100-million-100-days">some consider</a> the promise to be insufficient to meet current levels of demand and put the pandemic’s spread into decline. </p>
<p>The current mismatch between vaccine demand and supply, however, may be short-lived. Despite <a href="https://www.nbcnews.com/news/us-news/pharmacies-say-they-could-do-more-distribute-vaccines-states-are-n1254016">concerns</a> <a href="https://www.nytimes.com/2021/01/11/podcasts/the-daily/coronavirus-variant-vaccine-pandemic.html?showTranscript=1">about</a> <a href="https://public.tableau.com/profile/benjamin.renton#!/vizhome/COVID-19VaccineAllocationDashboard/DosesAdministeredDashboard">lagging</a> vaccine allocation for front-line health care workers and other vulnerable groups, <a href="https://www.cbsnews.com/news/covid-vaccine-when-can-you-get/">health experts</a> are optimistic that public demand for a COVID-19 vaccine will remain high in coming months as more vaccine doses become available.</p>
<p>While it is clear that many political leaders expect public demand for a coronavirus vaccine to be strong, whether or not expectations can live up to reality is an open question. In fact, there is some evidence to suggest instead that large segments of both the <a href="https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/">public</a> and <a href="https://www.npr.org/2021/01/01/952716705/some-health-care-workers-are-hesitant-about-getting-covid-19-vaccines">health care workers</a> do not intend to get vaccinated against COVID-19.</p>
<figure class="align-center ">
<img alt="President Joe Biden, wearing a mask." src="https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">President Biden’s 100-day plan to combat COVID-19 includes 100 million vaccinations. But a study says nearly one-third of Americans will not get vaccinated.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-elect-joe-biden-takes-off-his-mask-as-he-arrives-news-photo/1296577430">Alex Wong via Getty Images</a></span>
</figcaption>
</figure>
<p>Figuring out whether or not some people are less likely to get vaccinated – and their reasons for not getting vaccinated – can help political leaders and health professionals better anticipate vaccine demand. If some social, political and other demographic groups are more (or less) likely to intend to get vaccinated than others, demand for a vaccine may be higher (or lower) in vaccine distribution networks that primarily service <a href="https://www.nbcnews.com/news/us-news/racial-disparities-create-obstacles-covid-19-vaccine-rollout-n1249627">vaccine-hesitant groups</a>.</p>
<p>Additionally, understanding why some individuals are more likely to refuse vaccination than others can help inform health communication efforts to increase vaccine uptake. For example, if some Americans intend to refuse to get vaccinated due to concerns that the vaccine is not safe, health communicators can target these groups with easy-to-understand information about how scientists determined that the vaccine is safe. </p>
<p>In a <a href="https://doi.org/10.1016/j.socscimed.2020.113638">recent peer-reviewed study</a>, we provide important insight into what public demand for a coronavirus vaccine could actually look like, once most Americans have the opportunity to get vaccinated. Just as important, we detail reasons certain Americans do not intend to get vaccinated.</p>
<figure class="align-center ">
<img alt="People line up in their cars to receive a second dose of the vaccine." src="https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=356&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=356&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=356&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=447&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=447&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=447&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People line up in their cars to receive a second dose of the Moderna COVID-19 vaccine at a drive-thru vaccination site in Mount Dora, Fla.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-line-up-in-their-cars-to-receive-a-second-dose-of-news-photo/1230811372?adppopup=true">Paul Hennessy/NurPhoto via Getty Images</a></span>
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<h2>Some Americans more likely to get vaccinated</h2>
<p>We studied Americans’ COVID-19 vaccination intentions in a large, demographically representative online survey of 5,009 U.S. adults, conducted in June 2020. We measured vaccination intentions by asking respondents whether or not they would pursue getting vaccinated for the coronavirus if a COVID-19 vaccine became available. </p>
<p>Our study found that almost a third (31.1%) of respondents did not intend to pursue vaccination. This is concerning, given that recent epidemiological estimates suggest that <a href="https://doi.org/10.1016/j.socscimed.2020.113638">up to 70% of Americans</a> must become immune to COVID-19 in order to put the pandemic’s spread into decline. </p>
<p>We also found strong differences in vaccination intention between key demographic groups. Notably, we found that 35.7% of women (vs. 26.3% of men), 42.9% of Black people (vs. 28.6% of white people), and 37.8% of conservatives (vs. 33.4% of independents and 24.1% of liberals) intended to forgo vaccination.</p>
<h2>Why will some people refuse a COVID-19 vaccine?</h2>
<p>Our study provides new insights into the reasons that some Americans do not intend to get vaccinated against COVID-19. We found that concerns about the safety and effectiveness of the vaccine were the most consistent reasons for forgoing vaccination. We also found that portions of the American public did not intend to pursue vaccination because they lack health insurance, lack the financial resources they believe they need to be vaccinated or because they have already had COVID-19. </p>
<p>Our study also found considerable evidence that the reasons for not vaccinating were not the same for everyone. For example, women were more likely than men to say they would forgo vaccination due to concerns about safety and effectiveness. Additionally, we found that Black people were more likely to skip vaccination than white people due to perceived safety and effectiveness issues as well as concerns related to the cost of vaccinating and a lack of health insurance. </p>
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<h2>What this all means for vaccine uptake</h2>
<p>Together, our findings point to two key takeaways as the U.S. pushes to rapidly vaccinate its population against COVID-19. First, political leaders and public health experts need to recognize that what appears to be considerable public demand for the COVID-19 vaccine right now may be more modest in the coming months, as more Americans have the opportunity to get vaccinated. In its place, experts will be faced with the new challenge of convincing hesitant groups to get vaccinated in order to reach herd immunity and end the pandemic.</p>
<p>Second, our results demonstrate that in these efforts to vaccinate the hesitant, a one-size-fits-all approach to health communications will be insufficient. While health communications aimed at emphasizing the safety and effectiveness of the vaccine will be important, for some groups, it will be just as important to emphasize that Americans can be vaccinated against COVID-19 for free, regardless of insurance status. Developing these communications and identifying appropriate messengers to deliver this information will be vital to stopping the pandemic.</p><img src="https://counter.theconversation.com/content/153847/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Getting a vaccine is proving difficult for many older people now, but the mad rush for the vaccine won’t last long. Many people don’t want to get one at all, and that will impede herd immunity.Timothy Callaghan, Assistant Professor, Texas A&M University School of Public Health, Texas A&M UniversityMatt Motta, Assistant Professor of Political Science, Oklahoma State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1523772020-12-28T13:33:24Z2020-12-28T13:33:24ZGetting COVID-19 vaccines to rural Americans is harder than it looks – but there are ways to lift the barriers<figure><img src="https://images.theconversation.com/files/376601/original/file-20201223-17-kzbfy1.jpg?ixlib=rb-1.1.0&rect=0%2C661%2C4446%2C2746&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The first COVID-19 vaccines arrive packed in dry ice and need special freezers that can keep them extremely cold.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakPfizerVaccineRhodeIsland/27922a209cf141e8b78a72ad19cc7b7f/photo">AP Photo/David Goldman</a></span></figcaption></figure><p>The enormous job of vaccinating the nation is underway, but for rural Americans, getting a COVID-19 vaccine becomes harder the farther they are from urban centers. </p>
<p>The current vaccines’ <a href="https://theconversation.com/how-covid-19-vaccines-will-get-from-the-factory-to-your-local-pharmacy-151362">cold storage requirements</a> and shipping rules mean many rural hospitals <a href="https://www.houstonpublicmedia.org/articles/news/health-science/coronavirus/2020/12/14/387736/why-rural-hospitals-in-texas-were-excluded-from-first-shipments-of-covid-19-vaccine/">can’t serve as vaccination distribution hubs</a>. That can leave rural residents – <a href="https://www.census.gov/newsroom/press-releases/2016/cb16-210.html">about 20% of the U.S. population</a> – traveling long distances, if they’re able to travel at all.</p>
<p>Getting the word to rural residents about when they can be vaccinated isn’t easy either, and the <a href="https://www.nber.org/papers/w27417">extraordinary amount of misinformation</a> downplaying the risk of the coronavirus this past year has had an impact on rural residents’ <a href="https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/">willingness to get the vaccine</a>. </p>
<p>We <a href="https://scholar.google.com/citations?user=HGQz-EkAAAAJ&hl=en">work in rural</a> <a href="https://scholar.google.com/citations?user=KoOO0m0AAAAJ&hl=en">health care settings</a> and have been examining the barriers to health care for these patients to find ways to ensure health and safety.</p>
<h2>The problem with big batches and cold storage</h2>
<p>The first two authorized vaccines – one made by Pfizer and BioNTech and the other by Moderna – are mRNA vaccines. It’s a <a href="https://theconversation.com/how-mrna-vaccines-from-pfizer-and-moderna-work-why-theyre-a-breakthrough-and-why-they-need-to-be-kept-so-cold-150238">new type of vaccine</a> that uses the molecular instructions for building virus proteins rather than injecting parts of the weakened virus itself. Both must be kept in very cold temperatures.</p>
<p>To ensure stability, the vaccine doses are shipped in special containers with dry ice, and for now, vaccines are being delivered only in large batches. </p>
<p>The Pfizer vaccine is shipped in increments of <a href="https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/pfizer-bioNTech-faqs.html">975 doses</a>, which creates a challenge for small hospitals. Urban areas will be able to quickly distribute those doses, but finding enough patients to vaccinate quickly in rural areas may prove more difficult. </p>
<p>Moderna’s vaccine is <a href="https://www.wowt.com/2020/12/23/nebraskas-rural-hospitals-start-rolling-out-covid-vaccines/">somewhat more manageable</a>, with a minimum order of <a href="https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/moderna-faqs.html">100 doses</a>. </p>
<p>Both vaccines also require two doses per person, with the second dose of Pfizer’s vaccine given 21 days later and Moderna’s 28 days later. </p>
<p>As a result, the vaccine distribution efforts will favor hubs that cater to more populated areas to avoid wasting any vaccine or leaving patients unable to get their second dose. </p>
<figure class="align-center ">
<img alt="The vaccine packet." src="https://images.theconversation.com/files/376595/original/file-20201223-49872-1p8pxia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/376595/original/file-20201223-49872-1p8pxia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/376595/original/file-20201223-49872-1p8pxia.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/376595/original/file-20201223-49872-1p8pxia.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/376595/original/file-20201223-49872-1p8pxia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/376595/original/file-20201223-49872-1p8pxia.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/376595/original/file-20201223-49872-1p8pxia.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Pfizer vaccine ships in batches of 975 doses and must be used within five days.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-covid-19-vaccine-is-seen-in-cold-storage-at-the-news-photo/1230145931">David Ryder/Getty Images</a></span>
</figcaption>
</figure>
<p>Cold storage is another challenge, since small hospitals are less likely to have expensive freezers. The Pfizer vaccine must be stored at <a href="https://www.npr.org/sections/health-shots/2020/11/17/935563377/why-does-pfizers-covid-19-vaccine-need-to-be-kept-colder-than-antarctica">minus 94 degrees Fahrenheit</a> (minus 70 Celsius) and Moderna’s at <a href="https://investors.modernatx.com/news-releases/news-release-details/moderna-announces-longer-shelf-life-its-covid-19-vaccine">minus 4 Fahrenheit</a>. There are limits on how many times the vaccine shipping containers can be opened and how quickly the vaccines must be distributed. Once <a href="https://www.fda.gov/media/144413/download">thawed and prepared</a>, the Pfizer vaccine must be used within five days and Moderna’s <a href="https://www.theatlantic.com/health/archive/2020/09/covid-19-most-complicated-vaccine-campaign-ever/616521/">within 30 days</a>.</p>
<p>Each patient must receive both doses of the vaccine from the same manufacturer to ensure safety and effectiveness, adding to the challenge. Manufacturers have included <a href="https://www.npr.org/2020/12/03/942294593/vaccine-cards-and-second-dose-reminders-are-part-of-warp-speeds-immunization-pla">personal dosing cards</a> for patients to carry with them to help. </p>
<h2>Rural America’s take on COVID-19 and vaccines</h2>
<p>Rural America already has difficult barriers to health care access.</p>
<p>It has fewer health care providers serving a more geographically diverse population than in metropolitan communities. And in many of these areas, rural hospitals have been closing at an <a href="https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/">alarming rate, leaving people to travel farther for care</a>. The population is also older. Public transportation that could help poor or elderly residents reach hospitals is rare, and distance and geography, such as mountain roads, can mean driving to those sites takes time. </p>
<p>Getting accurate information about the vaccine and how to receive it into rural areas has also proved difficult. Many rural counties still have <a href="https://www.pewresearch.org/fact-tank/2019/05/31/digital-gap-between-rural-and-nonrural-america-persists/">limited access to broadband internet connections</a>, smartphone service and other technologies. That often means residents rely on television, newspapers and radio for news, which can limit the depth and scope of information.</p>
<p>While some rural counties have started <a href="https://www.9news.com/article/news/health/coronavirus/vaccine/rural-health-departments-fight-disinformation-as-they-encourage-people-to-get-vaccinated/73-3bce6bd2-4426-4c4c-bd7e-3b0e4ea30bcd">getting the word out</a>, many don’t not seem to have specific plans on how to inform their residents about <a href="https://www.al.com/coronavirus/2020/12/how-to-get-the-covid-vaccine-when-its-your-turn.html">how and when each person can get the vaccine</a>, let alone specific plans for actually giving it. They often rely just on <a href="http://www.madisonvillemeteor.com/stories/rural-areas-slow-to-get-covid-19-vaccine,32961">local press releases</a> that many residents never see.</p>
<p>Rural nonprofit health care organizations have tried to bridge that gap and improve rural communications about vaccines and the pandemic. <a href="https://carecompassnetwork.org/">Care Compass Network</a>, which coordinates organizations across southern New York, has offered educational webinars with the latest information about <a href="https://app.smartsheet.com/b/publish?EQBCT=928476bebc274b288b2660959b78de91">the virus and the vaccines</a>, for example. But there is still much work to do.</p>
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<p>Rural Americans’ views on vaccines are influenced by media and word of mouth, politics and religion, as well as previous experience with vaccinations and, perhaps most importantly, the difficulty of accessing health care.</p>
<p>In a survey conducted by the Kaiser Family Foundation in December, <a href="https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/">about 35% of rural Americans</a> said they probably or definitely would not get the vaccine, higher than the 27% nationwide. </p>
<h2>Small batches, new vaccines and pharmacies</h2>
<p>Getting enough of the U.S. vaccinated to eventually end the pandemic will require more work in all of these areas. That includes improving shipping and storage processes so orders can be broken up and distributed to smaller hospitals, distributing more vaccine doses, and <a href="https://abcnews.go.com/Health/video/people-hesitant-trust-covid-19-vaccine-74659883">improving communication</a>. </p>
<p>With Moderna’s vaccine arriving in smaller batches and not requiring such low temperatures for stability, it may prove to be more accessible for rural areas. <a href="https://kutv.com/news/coronavirus/moderna-vaccine-on-the-way-to-smaller-rural-hospitals-in-utah">Utah has already taken advantage</a> of those characteristics to get initial doses to smaller hospitals and has started vaccinating health care providers. Pfizer has said it may be able to offer <a href="https://www.washingtonpost.com/health/2020/11/23/covid-getting-vaccine/">smaller batches by April</a>.</p>
<p>Other vaccines on the horizon are also expected to have less stringent storage requirements and may potentially be delivered in one shot. The British government on Dec. 30 <a href="https://theconversation.com/oxford-astrazeneca-vaccine-is-cheaper-than-pfizers-and-modernas-and-doesnt-require-supercold-temperature-150697">authorized one of them</a>, a two-dose vaccine developed by the University of Oxford and AstraZeneca that can be stored in a <a href="https://www.astrazeneca.com/media-centre/press-releases/2020/astrazenecas-covid-19-vaccine-authorised-in-uk.html">normal refrigerator for six months</a>. U.S. officials are awaiting more testing on it, however, and don’t expect authorization for U.S. use <a href="https://thehill.com/policy/healthcare/532163-astrazeneca-vaccine-likely-wont-be-authorized-in-us-until-april">until April</a>.</p>
<p>The falling number of rural hospitals also remains a challenge for getting vaccines to patients. Allowing <a href="https://rupri.public-health.uiowa.edu/publications/policybriefs/2020/COVID%20Pharmacy%20brief.pdf">community pharmacies</a> to offer the vaccine – particularly if independent pharmacies are included – could eventually help expand the distribution network in rural areas.</p>
<p><em>This article was updated Dec. 30 with the U.K.’s Oxford-AstraZeneca vaccine authorization.</em></p><img src="https://counter.theconversation.com/content/152377/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The vaccines’ cold storage requirements and shipment rules put small, rural communities at a disadvantage, but that’s only part of a long-running challenge.Bennett Doughty, Clinical Assistant Professor, Pharmacy Practice, Binghamton University, State University of New YorkPamela Stewart Fahs, Professor of Rural Nursing, Binghamton University, State University of New YorkLicensed as Creative Commons – attribution, no derivatives.