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Issues in Interdisciplinarity 2020-21/Truth in Distributing COVID-19 Vaccines

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Introduction

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The upcoming vaccines would become a key solution to the COVID-19 outbreak, a global pandemic recognized by The World Health Organization (WHO).[1]

Nonetheless, the confrontation between the expected initial limited supply[2] and the "staggering global need"[3] leads to a controversial topic: How to distribute scarce vaccines effectively and equitably for the sake of the whole society?

This interdisciplinary problem has yielded arguments from different disciplines: Epidemiology, Economics, and Sociology. Due to contrasting disciplinary perspectives and priorities, different types of "truth" provided multiple insights, yet made the decision-making process tough by creating tensions between disciplines.

Truth in Epidemiology

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Covid Vaccine Clinical Trial, Padjajaran University

Epidemiology measures disease outcomes concerning populations at risk (groups of healthy or sick people, counted as cases if contracting the disease being studied).[4] In "truth", epidemiology uses positivism, being based on a posteriori knowledge, empirical evidence, inductive reasoning, and observational research.

Positivism in Vaccine Development

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The SARS-CoV-2 vaccine developed faster than other previous vaccines[5][6] through empiricism and observational research methods, associated with positivism.

The research methods included using preclinical and toxicology data already available (e.g. the 80% similarity between the genomic sequence of SARS-CoV-2 and SARS-CoV)[7][8] and new research tools (e.g. “structure-based antigen design, computational biology, protein engineering, and gene synthesis”).[9]

Despite the importance of a posteriori knowledge when defining epidemiology’s truth, data from the SARS-CoV-2 vaccine development are incomplete. Because the reactogenicity of the vaccine caused severe allergic reactions in some individuals[10], groups of people were neglected from the vaccine research: drug or alcohol addicts, the uncontrollably ill, pregnant women[11], children under 16, and individuals allergic to drugs (eg. Paracetamol).[12] That being said, most vaccine tests were efficient in adults.[13] Therefore, with minimal risk to human subjects, implementing an accelerated COVID-19 vaccine program is needed.[14]

Inductive Reasoning in Vaccine Distribution

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Epidemiological truth relies on inductive reasoning: generalizing research outcomes to effectively propose a vaccine distribution method. Based on previous vaccine distribution approaches, the standard age-based mathematical program proved to be the most optimal (fast in delivery, better uptake for the people at risk: health-care workers, the sick, and the elderly).[15][16]

However, since epidemiology prioritizes risk factors and vaccine doses are scarce, the first to receive the vaccine would be Health Care Personnel (HCP) and then essential workers, patients with high-risk underlying medical conditions, and elderly individuals.[17]

Vaccine effects remain uncertain.[18] Hence, countries like Switzerland delayed the accelerated COVID-19 vaccine program[19], which urges epidemiologists to conduct further research and alter their initial risk-based plan if needed.

Truth in Economics

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Economics concerns the production and distribution of goods and services.[20] When approaching truth, it uses positivism, interpretivism, and social constructionism to determine how distribution would affect different social groups and the economy.

Positive Externality of Vaccination

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From a positivist perspective, according to economist Tyler Cowen, one “uncomfortable truth” is that “Most of the best distribution methods are blatantly unfair.”[21] In this context, he claims fairness is overvalued.[22] He proposed a geographically concentrated approach to vaccine distribution that would save more lives and restore the economy through limiting vaccine doses within certain regions.[23]

In this approach, the underlying truth is making the most use of limited vaccine doses by intensifying the positive externalities of vaccination such as "herd immunity and reduced transmission of the disease".[24][25] This truth mirrors broadly the augmenting hidden health protection gained by third parties, that are not directly related to the production or consumption of vaccines. Thus, a dynamic social environment is constructed by economists.[26]

However, the validity of the truth is undermined. The real-life situation is oversimplified with external and unpredictable variables. Neither subtle extra benefits nor potential welfare gain could be precisely quantified before policy implementation.

Truth of Figures

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It was argued that based on the collection and analysis of macroeconomic data (e.g. high unemployment rate, unstable inflation rate), 75% to 85% of the population must be vaccinated to recover the economy.[27]

However, data “on the size of the effect of COVID-19 vaccines on transmission” is still unavailable.[28] The predictive "truth" is mainly based on the changing state of the pandemic and the economic outlook of the US.[29]

Moreover, there is an imperfect measure of a nation’s macroeconomic reality. For instance, unemployment figures do not take underemployment and hidden unemployment into account.[30] This implies the overestimation of actual macroeconomic conditions when observing and interpreting them from the perspective of the unemployment rate. Other unpredictable factors (e.g. domestic consumer confidence and business confidence) also influence the final observable impacts of vaccines on stimulating the economy. Therefore it is hard to verify the reliability of the ubiquity and precision of figures given as truth in this case.

Truth in Sociology

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Sociology studies the impact of society on observable phenomena.[31] When approaching truth, sociologists use both social constructionism and interpretivism, based on qualitative and quantitative data, and empirical and experimental evidence.

Health Inequalities

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From the sociologists' perspective, vaccines should not be distributed in a "colorblind" method in the U.S.[32], but instead by targeting racial minorities who have suffered more from the COVID-19 pandemic. They emphasized that health care services were already race-biased.[33] Surveys carried out in hospitals show that there are 4 times more Hispanic or Latino persons hospitalized for COVID-19 in the US than white persons.[34]

Widening socioeconomic inequalities also affect ethnic minorities (Black, Indigenous, Pacific Islanders, Asian, Hispanic or Latino persons, etc).[35] A report states that "the ethical justification for prioritizing economically worse-off racial minorities rests on epidemiological, economic, and social justice grounds".[36] Therefore, the World Health Organization (WHO) encourages governments to distribute vaccines by targeting the reduction of social inequalities.[37]

These "unfair" truths have been underlined by sociologists. However, sociologists' way of finding constructed meanings in society could be influenced by their subjective truth, which lines up with their values.[38]

Localization and Distribution

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With the Social Vulnerability Index (SVI) (an index that geographically studies social vulnerability), and the quantitative evidence of COVID-19 cases[39], sociologists can localize the regions where COVID-19’s aftermaths would be the most consequent with "people of color and other vulnerable populations" and where it would be "right" to distribute the vaccine as a priority.

They also emphasize that the ethnic minorities and the poor are disproportionately impacted by COVID-19 and are not reflected in the initial vaccine prioritisation order; despite this, those ethical questions need to be explored.[40] This shows that the research focus on the socially disadvantaged groups requires further exploration in the truth construction about certain neglected groups in sociology.

Conflicting Truth in Public Health

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Contrasting possible outcomes in vaccine distribution programs emerged in the field of Public Health.

While Epidemiology and Economics, use positivism to approach the truth, Epidemiology targets the high-risk population in vaccine distribution, while Economics seeks to maximize social utility. Both Economics and Sociology use social constructivism and interpretive truth within research in their field, however, Sociology stresses out the pre-existent social and health inequalities[41] in vaccine distribution.

Considering the significance and complexity of the "truths" formed by different disciplines, an interdisciplinary approach is essential in government policy-making of the COVID-19 vaccine distribution, to benefit society the most.

References

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  1. ↑ Ohannessian, R.;Tu, D.A.; Odone, A;. Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action [Internet]. Vol 6, No 2; 2020. Available from: https://publichealth.jmir.org/2020/2/e18810/
  2. ↑ L.S.J. Roope, J. Buckell, F Becker. et al. How Should a Safe and Effective COVID-19 Vaccine be Allocated? Health Economists Need to be Ready to Take the Baton [Internet]. PharmacoEconomics Open 4, 557–561; 2020. Available from: https://doi.org/10.1007/s41669-020-00228-5
  3. ↑ Kupferschmidt Kai.’Vaccine nationalism’ threatens the global plan to distribute COVID-19 shots fairly [Internet]. Science. Jul 28, 2020. Available from: https://www.sciencemag.org/news/2020/07/vaccine-nationalism-threatens-global-plan-distribute-covid-19-shots-fairly
  4. ↑ Coggon, D., Rose, G., Barker, D.J. P; Authors of Epidemiology for the uninitiated, 5th edition; BMJ Books;2 May 2003; ISBN-10: 0727916041
  5. ↑ Slaoui, M, Ph.D., Hepburn, M., M.D.; Developing Safe and Effective Covid Vaccines — Operation Warp Speed’s Strategy and Approach; The New England Journal of Medicine; October 29, 2020; 383:1701-1703, DOI: 10.1056/NEJMp2027405
  6. ↑ Le, T.T.; Andreadakis, Z; Kumar, A; Román R. G.; Tollefsen, S; Saville, M; Mayhew, S.; The COVID-19 vaccine development landscape; From The analyst’s Couch; Drug Discovery. Nature Reviews. may 2020 | volume 19, page 305
  7. ↑ Krammer, F.; SARS-CoV-2 vaccines in development. Nature 586, 516–527 (2020). https://doi.org/10.1038/s41586-020-2798-3
  8. ↑ Kirtikumar C.; Badgujar, Vivek C.; Badgujar, Shamkant B.; Vaccine development against coronavirus (2003 to present): An overview, recent advances, current scenario, opportunities and challenges, Diabetes & Metabolic Syndrome: Clinical Research & Reviews, Volume 14, Issue 5, 2020, Pages 1361-1376, ISSN 1871-4021, https://doi.org/10.1016/j.dsx.2020.07.022. (http://www.sciencedirect.com/science/article/pii/S1871402120302708)
  9. ↑ Graham, BS; Rapid COVID-19 vaccine development Science, 368 (2020), pp. 945-946
  10. ↑ Wadman, M; Public needs to prep for vaccine side effects, , Science 27 Nov 2020:, Vol. 370, Issue 6520, pp. 1022, DOI: 10.1126/science.370.6520.1022
  11. ↑ BMJ 2020;371:m4759; Vaccinating the UK: how the covid vaccine was approved, and other questions answered; BMJ 2020; 09 December 2020; 371 doi: https://doi.org/10.1136/bmj.m4759
  12. ↑ Investigating a Vaccine Against COVID-19 “A phase 2/3 study to assess the efficacy and safety of a recombinant adenovirus-based vaccine against Coronavirus Disease (COVID-19)”, IRAS Project ID: 281904 REC Ref: 20/SC/0179 COV002 PIS (Ages 18 – 55 years) version 8.0, 12th July 2020
  13. ↑ Bar-Zeev, N; Moss, W.J.; Encouraging results from phase 1/2 COVID-19 vaccine trials, The Lancet, Volume 396, Issue 10249, 2020, Pages 448-449, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(20)31611-1.
  14. ↑ Graham, BS; Rapid COVID-19 vaccine development Science, 368 (2020), pp. 945-946
  15. ↑ Department of Health & Social Care, JCVI: updated interim advice on priority groups for COVID-19 vaccination, 25 September 2020, Available from: https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-25-september-2020/jcvi-updated-interim-advice-on-priority-groups-for-covid-19-vaccination#fn:2
  16. ↑ Department of Health & Social Care, Independent report Priority groups for coronavirus (COVID-19) vaccination: advice from the JCVI, 2 December 2020 Updated 3 December 2020, Available from: https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-2-december-2020/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-2-december-2020
  17. ↑ National Center for Health Statistics; National Health Interview Survey; US Dept of Health and Human Services; 2016. Available from: https://www.cdc.gov/nchs/nhis
  18. ↑ Wallinga, J; Van Boven, M.;Lipsitch, M; Optimizing infectious disease interventions during an emerging epidemic. Proceedings of the National Academy of Sciences, 107 (2); 2010. pp. 923-928
  19. ↑ The Swiss Agency for Therapeutic Products; Benefits and risks of Covid-19 vaccines: rapid authorizations are possible, but premature vaccinations are not the answer for Switzerland; 12/13/2020; Available from: https://www.admin.ch/gov/en/start/documentation/media-releases.msg-id-81561.html
  20. ↑ Mankiw N. Gregory. Principles of Economics. 8th Edition. Cengage Learning, 20 Channel Center Street, Boston, MA 02210, USA; 2017.
  21. ↑ Cowen, Tyler. Vaccine Distribution Shouldn’t Be Fair [Internet]. BloombergQuint. 2020. Available from: https://www.bloombergquint.com/gadfly/vaccine-distribution-shouldn-t-be-fair
  22. ↑ Cowen, Tyler. Vaccine Distribution Shouldn’t Be Fair [Internet]. BloombergQuint. 2020. Available from: https://www.bloombergquint.com/gadfly/vaccine-distribution-shouldn-t-be-fair
  23. ↑ Cowen, Tyler. Vaccine Distribution Shouldn’t Be Fair [Internet]. BloombergQuint. 2020. Available from: https://www.bloombergquint.com/gadfly/vaccine-distribution-shouldn-t-be-fair
  24. ↑ Cowen, Tyler. Vaccine Distribution Shouldn’t Be Fair [Internet]. BloombergQuint. 2020. Available from: https://www.bloombergquint.com/gadfly/vaccine-distribution-shouldn-t-be-fair
  25. ↑ Younes, G.A.; Ayoubi, C.;Ballester, O; Cristelli, G; Gaétan de Rassenfosse;Foray, D; Gaulé,P ;Pellegrino, G; Van den Heuvel, M; Webster, E; Zhou, L; COVID-19: Insights from innovation economists. Science and Public Policy, paaa036; 2020. Available from: https://doi.org/10.1093/scipol/scaa028
  26. ↑ Younes, G.A.; Ayoubi, C.;Ballester, O; Cristelli, G; Gaétan de Rassenfosse;Foray, D; Gaulé,P ;Pellegrino, G; Van den Heuvel, M; Webster, E; Zhou, L; COVID-19: Insights from innovation economists. Science and Public Policy, paaa036; 2020. Available from: https://doi.org/10.1093/scipol/scaa028
  27. ↑ Cuomo warns Covid surge to last through January, expects first NY vaccine doses by Dec.15 [Internet]. CNBC. 2020. Available from: https://www.cnbc.com/2020/12/02/cuomo-warns-covid-surge-to-last-through-january-expects-first-ny-vaccine-doses-by-dec-15.html
  28. ↑ Priority groups for coronavirus (COVID-19) vaccination: advice from the JCVI, 2 December 2020 [Internet]. UK Government official website. 2020. Available from: https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-2-december-2020/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-2-december-2020#references
  29. ↑ Cuomo warns Covid surge to last through January, expects first NY vaccine doses by Dec.15 [Internet]. CNBC. 2020. Available from: https://www.cnbc.com/2020/12/02/cuomo-warns-covid-surge-to-last-through-january-expects-first-ny-vaccine-doses-by-dec-15.html
  30. ↑ Maley, S; Welker, J; Pearson Baccalaureate Economics. Pearson Education Limited, Edinburgh Gate, Harlow, Essex, CM20 2JE, England; 2011.ISBN: 9780435089986
  31. ↑ Durkheim, E.; Fauconnet, P.;Sociology and the Social Sciences. The Sociological Papers 1 [1904]pages 258–80. ISBN Durkheim E. (1982) Sociology and the Social Sciences (1903). In: Lukes S. (eds) The Rules of Sociological Method. Contemporary Social Theory. Palgrave, London. https://doi.org/10.1007/978-1-349-16939-9_9, page 258-259
  32. ↑ World Health Organization. Fair allocation mechanism for COVID-19 vaccines through the COVAX Facility. World Health Organization; 9 Sept 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/who-covid19-vaccine-allocation-final-working-version-9sept.pdf
  33. ↑ Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: confronting racial and ethnic disparities in health care.[Internet] Washington DC: National Academies Press. Aug 2002. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594273/pdf/jnma00325-0024.pdf
  34. ↑ Centers for Disease Control and Prevention. Hospitalization and Death by Race/Ethnicity. Centers for Disease control and Prevention. 30 Nov 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html
  35. ↑ Ali S., Asaria M., Stranges S. COVID-19 and inequality: are we all in this together?.[Internet] Can J Public Health 111, 415–416; 23 Jun 2020. Available from: https://doi.org/10.17269/s41997-020-00351-0
  36. ↑ Schmidt H, Gostin LO, Williams MA. Is It Lawful and Ethical to Prioritize Racial Minorities for COVID-19 Vaccines?[Internet] JAMA. 2020;324(20):2023–2024. doi:10.1001/jama.2020.20571 Available from https://jamanetwork.com/journals/jama/article-abstract/2771874
  37. ↑ World Health Organization. Fair allocation mechanism for COVID-19 vaccines through the COVAX Facility.[Internet] World Health Organization; 9 Sept 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/who-covid19-vaccine-allocation-final-working-version-9sept.pdf
  38. ↑ Gorski P.S. Beyond the Fact/Value Distinction: Ethical Naturalism and the Social Sciences [Internet]. Soc 50, 543–553; 2013. Available from: https://doi.org/10.1007/s12115-013-9709-2
  39. ↑ Karaye M. I., Horney A. J.. The Impact of Social Vulnerability on COVID-19 in the U.S.: An Analysis of Spatially Varying Relationships [Internet]. Elsevier Public Health Emergency Collection. 26 Jun 2020. Available from:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318979/
  40. ↑ Douglass T., Calnan Michael .W. All for Vaccination? Vaccination for All? [Internet]. Discover Society . pp. 1-3; 2020. Available from: https://kar.kent.ac.uk/84561/5/All%20for%20Vaccination%20Vaccination%20for%20all.pdf
  41. ↑ Williams, E.; Buck, D.; Babalola, G.; What are health inequalities?; The King’s Fund; 18 February 2020; Link: https://www.kingsfund.org.uk/publications/what-are-health-inequalities
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