Editorial: Our shot at normalcy

Politicization and accessibility of a COVID-19 vaccine

Editorial Board

The world is waiting for institutions like Case Western Reserve University and the Cleveland Clinic to do what they do best: research and develop biomedical technology. For until a vaccine is developed and released, the pandemic will continue to drive our everyday thoughts and actions. We are all waiting for the day when we will once again be able to embrace friends and return to our traditional ways of learning, working and loving—much like the endearing scene in “Contagion” when Matt Damon’s daughter is finally able to enjoy a night with her boyfriend. While our emergence to “normal” will likely not be as immediate, nor include a makeshift prom night, it is still of utmost importance that we consider what the transition to our new normal will entail.

This transition has surely already started. We will be wearing masks in public for months, maybe years, to come. We will sanitize, wash hands and clean more frequently (something we probably should have been doing all along). We will certainly be more aware of places we go and people we see—for our safety and theirs. The transition includes not only how our actions will change, but also the way we think, feel and love after living through a time of such great uncertainty. Most of all, this transition will culminate in the release of a vaccine. 

The U.S. has a spotty record with the politicization of vaccination campaigns, worsened by Americans who refuse to be inoculated, due to fears of autism or other unsubstantiated myths. 

In February 1976, Army Private, David Lewis, died of a novel flu on a military base in New Jersey. Then, President Gerald Ford, who had only taken office as a result of Richard Nixon’s resignation, was concerned with the possibility of an outbreak and even more worried by the impending presidential election in November. 

Do these circumstances sound familiar? Both involve a near (or actual) impeachment, perhaps an unqualified politician, an emerging public health crisis and a presidential election. So, perhaps we should try to learn from Ford’s choices and mistakes. The flu that killed Lewis was thought to be a descendant of the 1918 flu, but there was little conclusive data and the World Health Organization promoted a plan of patience, waiting to see whether the virus would start to spread. Ford disregarded the advice and instead moved forward with vaccine development and a national immunization program that would receive bipartisan support in Congress and be the largest mass vaccination program to date. As a result, nearly 25% of the population was vaccinated within 10 months for a virus which never ended up leaving the New Jersey military base or killing anyone besides Lewis. 

Moreover, the strong executive pressure for an immediate vaccine caused government researchers to use an weakened, live viral strain rather than a safer, inactivated form, increasing the likelihood of harmful side effects. Later, 450 people developed Guillain-Barré Syndrome (GBS), a neurological disorder sometimes resulting in paralysis and death. The National Academy of Medicine did confirm that there was an increased risk for GBS as a result of the 1976 vaccination. Herein lies the basis of some people’s concerns and fears with current vaccinations. 

Ford and the 1976 flu vaccination campaign provide a perfect example of what happens when medicine is politicized. Professor Arthur Silverstein at Johns Hopkins University suggested that “The poor planning and unprecedented, even uncalled for, sense of urgency was a failed attempt by Ford to shed his pusillanimous image and secure his reelection by taking swift, authoritative action.” 

Today, we are seeing the same concerns as the Trump administration urges Center for Disease Control and Prevention (CDC) and other institutions to hasten Phase III trials of the COVID-19 vaccine so it will be available prior to the presidential election. He demanded that plasma therapy be available prior to the Republic National Convention and overstated supporting research of this treatment. The CDC has since released that people should prepare for a vaccine on Nov. 1, two days prior to the presidential election. Thus, we must carefully consider the motivation behind this vaccine and its safety, especially given Trump’s ability to urge the CDC to rely on legal powers it was given in 2004 to use uncorroborated treatments and products during an emergency.

The entire situation is entirely opaque at a time when we need absolute transparency. The Trump administration is satisfied coercing a public agency to approve a vaccine with inadequate testing, yet felt no pressure to act during the first six months of the pandemic—despite clear warning signs from other countries that this virus was real, deadly and capable of devastating even the strongest health systems. 

Appealing to one of Trump’s favorite talking points, the economy, we could also consider how people are being monetarily affected by the development of the vaccine. Anmol Gupta, a 2019 graduate of CWRU, is currently attending medical school in Houston while advocating with the Free the Vaccine campaign organized in joint by Universities Allied for Essential Medicines and the Center for Artistic Activism. The campaign seeks to spread awareness of the role that taxpayer funds have in developing medicines and vaccines and why, for this very reason, medications should be affordable and accessible. 

Nearly all biomedical technology is developed by universities through taxpayer funds and then handed off to pharmaceutical companies for manufacturing and distributing. As such, universities have a lot of control over the accessibility of medical products, but rarely exercise it. As a result, life-saving medications like insulin are unaffordable for no reason other than corporate greed. All of these concerns are exacerbated during a pandemic with the added questions of who will get the vaccine when it is developed? How will it be distributed not only within the U.S., but globally? And this is assuming—perhaps incorrectly—that the U.S. will be the first to develop a successful vaccine. 

Free the Vaccine is asking universities to submit their patents to the Open COVID Pledge so that technology developed for the purpose of ending the pandemic will be free of charge to anyone who wishes to use it. There are also less demanding initiatives that universities can take, such as submitting their technologies to other global patent pools for eased accessibility, adopting language in licenses to ensure affordability or licensing the patent to multiple corporations instead of one to prevent a monopoly and high medication costs. 

Hundreds of institutions worldwide are receiving taxpayer funds to develop a COVID-19 vaccine; CWRU is currently receiving nearly $1 million. 

As a leading research university, we have a responsibility to ensure we are advocating for advanced technology and holistic education. However, we should also strive to “think beyond the possible” and promote a healthcare network that ensures affordability, accessibility and equity—three ideas inextricably linked to the delivery of medical care and public health initiatives.  

We don’t need a repeat of the disastrous 1976 vaccination campaign. We don’t need a presidential election—already rife with concerns of voter suppression, delayed U.S. Postal Service delivery and safety of in-person voting—to politicize our well-being by fast-tracking a vaccine that is not yet safe for a mass inoculation program. We, instead, need the institutions who are on the forefront of developing COVID-19 vaccines and treatment to take accountability for the role they have in making medical care accessible to all, especially vulnerable and marginalized communities around the world. 

Gupta said it best: “If not during a pandemic, then when? If you’re not going to try to do something that promotes access and equity now, then when will you?”