9th December 2020

A vaccine is here, but the rollout won’t be easy

Vaccine momentum is building. European Medicines Agency (EMA) approval is due later this month for at least one Covid vaccine, and at the end of this week the government’s high-level Covid vaccine taskforce is due to report to health minister Stephen Donnelly setting out the detail of how the vaccines will be delivered.

We saw the first vaccinations in Britain and Northern Ireland yesterday, prompting the government here to rush the publication of its provisional vaccine priority allocation groupings, apparently not wanting to appear to be sitting on its hands. This has triggered the government’s toughest Covid communications challenge to date, and the stakes simply could not be higher.

A successful vaccination programme is the lynchpin on which all our hopes for a return to social and economic normality turn.  The government will face critical comparisons with every other country in the world for every choice it makes, as well as for the effectiveness with which its plans are delivered on the ground. It faces four key challenges.

Challenge one: who first?

The government has no option but to abandon its “all in this together” mantra.  The enormity of the task and the logistical realities mean that it will take many months to offer vaccination to the whole population, perhaps until well into the summer or even the winter of 2021/22.

Consequently, the government has had to choose who will be vaccinated first—and who will be last. It is not an enviable task, and while ministers can rely upon expert evidence and seek to be objective, their decisions are already being second guessed.

Those who get a safe and effective vaccine first will be at a very real advantage over those who go last. There will be contention, competing claims, strong arguments, even jealousy.

The government needs to find the right language—easily understandable and readily supported by a clear rationale—for its chosen vaccination sequence.

However, rushing to announce the priority “allocation groups” yesterday, ahead of the imminent implementation plan, was a misstep; the government should have first taken time to test the clarity of its proposed decisions, the intended explanations, and associated information materials with people from outside its own echo chamber. It should have considered holding over the announcement until the timescale for administering the vaccines can be projected and explained, thus completing the picture.

On 8 December, 90-year-old Margaret Keenan became the first person in the world to be vaccinated with the Pfizer-BioNTech vaccine outside a medical trial.

The government must abandon the current tired pattern of advance leaks followed by a headlong rush to the microphones as soon as the cabinet meeting is over; such a non-strategic approach to communications risks serious damage to the vaccine rollout.

Sufficient time should be taken after government decision-making meetings to fine tune the language, recalibrate the Q&A documents, test the message for weaknesses, and align all elements of the message so that they work for mass multi-channel communication.  It simply can’t afford to get this one wrong.

Those responsible for executing the plan, like the HSE, need to stick to it faithfully and be allowed to do just that, without interference.  The media and public scrutiny they will be under will find and expose any lapses or apparent unfairness. The plan must be seen to be honest in order to remain credible and enjoy public support.

Challenge two: herd immunity

To achieve herd immunity, the number of us who accept vaccination must go north of 75%. These are new vaccines, widely clinically trialled and developed quickly as a result of unparalleled scientific effort. They are also becoming available in the midst of rampant anti-vaccine conspiracy theories and a global effort at Covid denial, the flames of which have been partly fanned by irresponsibility at the top of the outgoing US administration.

Public confidence in these vaccines must be honestly obtained. It is essential not to confuse the legitimate worries of concerned and doubtful citizens—those in the middle—with the arguments of those who will never accept the science of Covid or these vaccines.

Messaging must address the worries of this middle rather than dismiss them into the arms of the anti-vaxxers. Informed consent is key. Seeking to be informed about the efficacy and safety of a new vaccine is not unreasonable and should be respected. Government needs to ensure that there is ready access to authoritative and balanced information, provided transparently. That includes comparative information about the range of vaccines that will be available.

The voices of medical professionals are key, and the brand equity of the chief medical officer and other key medical leaders should be centre stage.   It remains vital, however, to recognise that large sections of society now get their news and information, including lots of pseudo-science and misinformation, from non-traditional media sources, and this has to be combatted with good public health messages about the vaccines once they are approved.

We have the experience in Ireland of successfully reversing the damage done to the HPV vaccination programme by anti-vaxxers, and this knowledge should be utilised.  Anti-vax zealots should, for now, be left to fend for themselves and not become a pre-occupation.

A Pfizer-BioNTech vaccine storage facility in Belgium. This particular vaccine must be stored at -70°C, a logistical challenge in itself.

Challenge three: population access

There is considerable evidence from existing population health programmes in Ireland, such as childhood vaccination and cancer screening, that levels of uptake vary significantly according to the index of social deprivation.

Addressing this will require the establishment of multiple parallel strands of vaccination delivery.  There are likely to be mass vaccination centres as well as mobile teams visiting healthcare settings such as nursing homes. But for the traditionally hard-to-reach population groups, access to the vaccine as close as possible to their homes is going to be vital as the campaign progresses.

GPs and community pharmacists, with their existing relationships, community trust, and local intelligence, will have a huge role to play in motivating attendance for vaccination. They could be aided by carefully targeted local pop-up vaccination centres.  Grassroots communication and action will be crucial to get this job done.

Challenge four: public cooperation

The government needs to sustain public engagement and co-operation with the existing Covid measures even while the vaccination programme rolls out. We will still need to wear masks, wash our hands, and socially distance well into 2021.

Every sacrifice and every gain made could be reversed just as vaccines are being administered if government doesn’t find a way to balance the hope offered by vaccines with the need for sustained, ongoing vigilance.

The regular Nphet briefings need to continue. They must also be supported by re-invigorated public information campaigns and advertising, as well ongoing enforcement of Covid restrictions (as they apply from time to time), particularly mask wearing.

About the author

Tony is a veteran of Irish and international healthcare and one of the country’s most prominent organisational leaders. From 2012 to 2018, he served as director general of the HSE, Ireland’s national health service. Tony is also a lecturer in management and leadership at Trinity College Dublin; an associate and council member of the Irish Management Institute; a chartered director; a columnist for the Business Post; and an emergency first responder.

Cover photo: Joanna Sloan, the first person on the island of Ireland to be vaccinated.

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