Vaccine choice, hesitancy, and equitable roll-out
Vaccine choice, hesitancy, and equitable roll-out
March 9, 2021
Ruqaiijah Yearby
In the second edition of Penn LDI's new series, COVID Vaccine Equity Research Dialogues (CoVEReD)Ruqaiijah Yearby, JD, MPH joins  hosts Alison Buttenheim, PhD, MBA and Harald Schmidt, PhD, MA. They discuss equity implications of vaccine choice and vaccine hesitancy, and the role that governments and institutions can play in improving (or hindering) equitable vaccine roll-out.
Alison Buttenheim, Harald Schmidt
Dr. Yearby is professor of law and member of the Center for Health Law Studies at Saint Louis University Law School. She is co-founder and executive director of the Institute for Healing Justice and Equity at Saint Louis University. 
View the video discussion below, along with an episode overview, and further reading. We hope you find this new series informative, and encourage you to share it with your colleagues. Missed the first edition of CoVEReD? See it on our website.
CoVEReD Video
CoVEReD Episode Overview
The recent emergency use authorization granted by the FDA to the Johnson & Johnson COVID-19 vaccine has introduced a much anticipated third option to a depleted marketplace that has seen demand far outpace supply. It brings with it some serious logistical advantages, too: it can be stored in a refrigerator, rather than a specialized freezer, and it only requires a single dose. And yet, as a result of some lower absolute efficacy numbers as compared to the Pfizer and Moderna vaccine trials, a perception has emerged that it is a lesser option.
Though the lines are still long, we are seeing decreasing vaccine willingness overall, and the added wrinkle of vaccine preference will only compound the problem of efficient distribution going forward. Buttenheim recently provided testimony before congress regarding vaccine hesitancy, and argued that we need to relieve people of the cognitive burden of choosing between vaccines. Recognizing that these trial results cannot be directly compared to one another – they were conducted at different times, in different populations, and against different variants – we need to keep the focus on what matters most, which is that all of the available vaccines are incredibly effective, especially when it comes to the outcomes of critical illness and death. 
Yearby notes that it is critical to realize that vaccine allocation does not occur in a vacuum, but takes place against the background of concrete historical context. She highlights, in particular, the need for community engagement and ensuring access to vaccines in readily accessible and trusted settings. The just-authorized Johnson & Johnson vaccine presents a real opportunity for improving equity: its relative ease of storage allows for distribution to more vulnerable and marginalized communities and for versatile modes of distribution, for example through mobile clinics or FQHCs that may not have specialized freezers. The single dose regimen reduces the need for follow-up and time away from work. Yet vaccine hesitancy is also high in many of these communities, not just because of certain well known historical abuses, but because of the continuing lived experience of disparities in care.
Schmidt agrees that the single-dose vaccine has considerable potential, but cautions that prioritizing the practical advantages of the vaccine could be shortsighted. If the perception persists that Johnson & Johnson is “second-best,” and it is allocated disproportionately to more disadvantaged people while wealthier communities get the perceived “better” vaccine, an unintended consequence might be further entrenched distrust. As production of the newest vaccine ramps up, it will be crucial (but not simple) to allocate all vaccines across and within communities in a thoughtful and equitable manner.
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