Sarah Eisenberg

The Lancet Commission on Vaccine Refusal, Acceptance and Demand in the U.S.A., which is co-chaired by Yale Institute for Global Health Director Saad Omer, issued a report outlining its findings on the current state of the country’s COVID-19 vaccinations and suggested strategies to promote vaccine uptake across the United States. 

Founded in response to a growing anti-vaccine movement and increasing measles vaccine refusal in 2019, the Lancet Commission aims to investigate the current and future trends in vaccine hesitancy, identify evidence-based interventions to combat misinformation and promote vaccination against different diseases, including COVID-19. Chaired by Omer and Peter Hotez ’80, Chair of Baylor National College of Tropical Medicine, the commission is composed of 20 medical and scientific professionals from across the nation. According to Omer, the diversity of the commission “enable[s] us to have robust discussions that [lead] to consensus.” 

The Nov. 15 report, published in The Lancet, addressed the causes of vaccine hesitancy and the consequences of insufficient COVID-19 vaccine coverage. The report evaluated the potential effectiveness of a variety of proposed interventions, ranging from mandates to centralized vaccination reminder systems, in increasing vaccine uptake. The authors concluded that interventions that “keep vaccination on individuals’ minds” are most effective. The report proposed solutions for addressing social media misinformation and sociodemographic inequities in vaccine access. 

The Lancet report also discussed the role of political rhetoric in creating the current COVID-19 vaccine hesitancy landscape, placing blame for anti-COVID-19 vaccine sentiment in the United States on the shoulders of far-right politicians and anti-vaccine NGOs. 

Omer said politicians should, at the very least, “make no more statements that undermine vaccine confidence.” 

Josh Sharfstein, member of the commission and professor at the Johns Hopkins Bloomberg School of Public Health, agreed with Omer and added that the political leaders of “Republican men in particular,” a group with one of the lowest vaccination rates, “could do a lot to help.” He believes that even at this point, pro-vaccine rhetoric from political leaders can make a difference and will “help followers of those leaders stay alive.”

In accordance with the report, Omer and Sharfstein conceded that public health authorities’ messaging on boosters could be improved.

“Everyone agrees that in high-risk groups like the elderly, boosters are extremely important and I think clearer messaging around this would be helpful,” Omer said.

According to Sharfstein, public health authorities can do a better job explaining the evidence they are considering before they make decisions, rather than afterward. He said that official messages regarding boosters were “a little jumbled” over the summer, where the “evidence was unclear” and “data was not shared.” Sharfstein added that people respond negatively when evidence is presented after an official decision has been made and not prior to it. 

Sharfstein also noted the effect novel variants could have on vaccination rates. He said that if Omicron “really turns out to be bad, dangerous,” it could push more people to get vaccinated.

“We saw during the Delta wave that as the number of infections in a particular area increased, more people lined up to be vaccinated,” Sharfstein said. “I think if it becomes a tangible threat to people and the vaccine does provide some value, some people will take action to protect themselves. In the abstract before it becomes a tangible threat, though, people will say all sorts of things if they’re trying to justify not getting the vaccine.” 

Sharfstein and Omer were largely in agreement that more data is necessary before deciding whether a booster mandate is justified and necessary. Sharfstein said that prior to the threat of Omicron, there was not yet justification to mandate booster shots, given the past effectiveness of the vaccines against previous variants. Both emphasized that for the moment, the greatest attention needs to be not on those who resist boosters, but rather on those who are completely unvaccinated, as they are most at risk.

While Omer believes the report will move the COVID-19 vaccine hesitancy conversation “toward evidence-based interventions,” the work of the Lancet Commission is far from done. The members of the commission plan to apply their COVID-19 insights to other diseases, breaking into subgroups to write issue briefs on emerging vaccine-related issues that have been highlighted by the pandemic. 

Currently, 90 percent of those hospitalized at Yale New Haven Hospital are unvaccinated.