The barrier to a COVID-19 vaccine won’t just be science: it will also be behaviour
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This article is part of a series in which OECD experts and thought leaders – from around the world and all parts of society – address the COVID-19 crisis, discussing and developing solutions now and for the future. It aims to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge. Opinions expressed do not necessarily represent the views of the OECD.
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With unprecedented efforts and resources put behind the development of a COVID-19 vaccine, there are good reasons to believe that one will be discovered. But even once such a vaccine is discovered, a very large part of the population will need to make use of it for the virus to die out.
Older adults are most at risk, but the level of take-up of adult vaccines is surprisingly low for existing illnesses such as pneumococcal pneumonia, flu or shingles. While the COVID-19 vaccine is being developed, we must ramp up efforts to develop a vast immunisation campaign, in particular for older adults who are not currently taking advantage of vaccines at their disposal.
Read the full OECD Policy Response COVID-19, Crises and Fragility
Such a campaign will have to draw on one of the most successful public health efforts of the last century: childhood immunisation started in the 1950s, a time when many of today’s adults were children recipients. The COVID-19 vaccination campaign must also become the foundation to jumpstart levels of adult immunisation for all vaccine-preventable diseases – an ever-increasing priority for 2 billion of us over 60 living in a world of more old than young.
COVID-19 is already having noticeable impact on how billions of us around the globe comply with public health guidelines — staying at home, avoiding close contact with friends and loved ones, wearing masks in public and other new behaviours in contrast with our “normal” way of living. If this level of public compliance becomes the new normal, it will enhance prevention and lead to healthier longevity, a critical contribution to the 2020 Decade of Healthy Ageing.
The COVID-19 crisis has the potential to lead to lasting and valuable shifts that will improve society’s health, provided it transforms in these four ways:
First, improve medication adherence. It is stunning to witness how much we struggle with medication adherence, or taking medicines as directed. In the United States alone, 125,000 people die every year due to a lack of medical adherence. The Annals of Internal Medicine reports that, across OECD countries, 20–30% of prescriptions are never filled, and roughly half of chronic disease medications are not taken as prescribed. Up to a whopping 25% of all hospital and nursing home admissions are caused by patients’ medication non-compliance. Across ageing societies in the OECD, as many as 40% of patients do not adhere to their treatment regimes, including for serious cardiovascular disease. In the United States, 42% of patients do not take hypertension medication as prescribed, and 25% of stroke survivors do not comply with their medication regime. Could public health education during COVID-19 radically improve people’s behaviour
Second, elevate adult vaccines. A COVID-19 vaccine is the single mechanism that promises to end this crisis. Yet, for years, rates of adult vaccination have been shockingly low, even though adults are most at-risk of severe health outcomes or even death due to vaccine-preventable diseases. Only 45% of American adults get their flu vaccine. In the European Union, just 60% of adults have received commonly recommended vaccinations, and, in Australia, 50% of 65+ have been vaccinated for flu and pneumococcal pneumonia. Even in fast-ageing Japan, where prevention and healthy ageing are major priorities and where rates of vaccine-preventable diseases are high, low levels of adult vaccination persist.
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Third, combat the anti-vax movement. Childhood immunisation is one of the historic public health successes of modern times, powering a revolution in longevity. But even here, the anti-vax movement has driven a stunning reversal in recent years. In 2000, the Centers for Disease Control and Prevention (CDC) announced the possibility of eliminating measles with a vaccine that is 99% effective and has virtually no side effects. Today, measles in the United States is back. As the CDC announced last week, this resurgence is due to anti-vaxxers spreading their message on Facebook, Twitter, websites and other media outlets, echoing a systematic effort throughout the United States and in other countries to convince parents not to vaccinate their children. Will COVID-19 and the vision for a vaccine panacea also “deep six” anti-science, anti-vax horrors?
Fourth, illustrate the link between health and prosperity. A COVID-19 vaccine will not just save lives, it will become the only true lever of trust to revive economic life across the OECD and beyond. So it is not at all too soon to begin an aligned Immunization Campaign; a global OECD-WHO Partnership to bring all of us into this essential public health exercise with profound economic and social consequences.
Even when a COVID-19 vaccine is found, even when we suspend – with caution – strict regulatory rules to ensure faster availability, and even when we establish the required global scalable manufacture and distribution capacities, we will all have to get vaccinated.
But even then, the struggle will not be over. We must apply our altered mindset and behaviour in the post-COVID-19 world to improve our compliance with medicine, and prevent and treat conditions such as stroke, hypertension, heart failure, fragility fractures and deteriorating visionfrom conditions like age-related macular degeneration, taking advantage of adult vaccines already available but underutilised to fulfill their valuable health potential.
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