Having sat in on the Vaccines and Related Biological Products (VRBP) Advisory Committee meetings on December 10th and December 17th, which (respectively) led to FDA granting Emergency Use Authorization (EUA) to both Pfizer/BioNTech and Moderna on December 11th and December 18th, I can tell you that there was a great deal of scientific rigor applied in each of the more than 8.5 hours-long meetings.

The question put upon the Advisory Committee was in both cases:

• Based on the totality of scientific evidence available, do the benefits of the Pfizer/BioNTech COVID-19 vaccine outweigh its risks for use in individuals 16 years of age and older?
• Based on the totality of scientific evidence available, do the benefits of the Moderna COVID-19 vaccine outweigh its risks for use in individuals 18 years of age and older?

In both cases, the recommendation from the VRBPAC was resoundingly “yes,” with a 17-4 vote in favor of Pfizer/BioNTech’s vaccine candidate, and 20-0 (1 abstain) in favor of Moderna’s vaccine candidate.

These Advisory Committee meetings represented a substantive new direction in human medical treatment as well, because there was previously no historical precedent for an mRNA vaccine being licensed for use from which to draw scientific and regulatory opinion.

So, throughout the Phase 3 clinical trials for these two vaccines, which both began around July 2020, as new data came in (in the form of safety signals, interim read-outs, etc.) they were truly that—new data. We learned a great deal through very accelerated vaccine trials, including that over the course of 30,000 patients in the Moderna Ph3 trial and 43,538 patients in the Pfizer/BioNTech Ph3 trial, that clinical efficacy for both vaccines was about 95% in preventing COVID-19 infections. We also learned that there were incredibly low numbers of adverse events from both vaccines.

What we haven’t yet learned is how to collect better data to develop better solutions to thwarting vaccine hesitancy.

Behavioral economics of vaccinations
I’ve been spending a great deal of time over the past 6 months working with State and Federal COVID-19 Task Forces to develop public health policy and bring science—not emotion—to the forefront of the discussions. In doing this work, I’ve developed a framework to connect the best of what we know from behavioral economics to bring to bear a better set of initiatives that take advantage of how people really think and behave—not just how they claim to do so on behavioral surveys.

Some of the sticking point in vaccine hesitancy has been a lack of education about the safety and efficacy of the available coronavirus vaccines (and other vaccine types, frankly). But this typically accounts for less than 10% of the effect of a resistance to vaccinate.

A devastating and disproportionate effect in vaccine hesitancy—and therefore directly linked to public health outcomes—is misinformation (and disinformation) stemming from social media. As the quote often attributed to Mark Twain (but not) goes: “A lie can circle the Earth three times before the truth even pulls its boots on.” There’s a very sticky quality about thoughts that countermand the accepted narrative—almost as if their very counterculture presence makes the reader (or listener) think that they’ve been let in on a little secret. However, it’s far from benign that these rumors and disinformative opinions circulate. In the case of vaccine resistance, they directly contribute to the suffering of serious illnesses and directly-countable, and very-associated, deaths.

Just providing the public with facts also does very little, because remember, that’s the accepted narrative. There’s nothing seductive or taboo about seeing facts. Emotionally-held opinions are far more powerful than facts. If they weren’t, then the survey data in the Paranormal Beliefs infograph below would not exist.


Thankfully, science doesn’t work on consensus opinions, otherwise we’d have to consider that some of these are true.

By the way, if you hadn’t heard, there were vociferous rumors early on in 2020 that 5G cell towers were causing coronavirus outbreaks. And 4G cell towers were blamed for the H1N1 Swine Flu pandemic in 2009. Oh, and 3G cell towers were indicted as responsible for the 2002-2003 SARS-CoV-1 outbreak. You get the picture. When your crazy idea doesn’t fit, try, try again.

So, it could be, as with the field of neurotheology, that Flat-Earthers, UFO and ghost believers, and anti-vaxxers are all very similarly linked within the realm of how features of the mind function. But there are also spectra of beliefs within each category—and so there are those who may be only vaccine-hesitant because they haven’t heard or seen enough truth to convince them that it’s the right thing to do. The people on that side of the vaccine distribution can very much be favorably targeted and influenced with facts and discussion.

There is also the idea of reducing the ‘friction’ of choice—we want to minimize what’s called the friction of making a smart decision. If getting appropriately vaccinated is harder for a number of reasons than putting off vaccination, then behavioral economics tells us that in most cases people will choose to put off vaccination. Often indefinitely. We need to directly minimize the friction of better decisions, so that it becomes easier to do the right thing than it is to do the wrong (or misinformed) thing. This is one of the reasons that a soda tax (a financial tax on sugary drinks) was put into place. A study in the Journal of the American Medical Association (JAMA, 2019) showed that taxing of sugary beverages really does incentivize people to consume fewer of them, and the study authors call the approach a ‘no-brainer’ for public health.

As of the time of writing this, there have been 5.1 million COVID-19 vaccines administered in the U.S. (1st dose of 2), and 15 million worldwide in 35 countries. By publication time, the trajectory of these numbers will likely about double. There’s a long way to go to inculcate herd immunity through a combination of those vaccinated and recovered from positive infection. This also means that behavioral measures (distancing, ventilation, masking, cleaning—in that order) will need to continue. The fear in the vaccinology world is that the presence of the 1st of 2 doses will enable people to ‘lower their guard’ and behave more irresponsibly. I would point out that these again are behaviors, and can be addressed with behavioral approaches. Because of this, I see the situation shifting from being one of virology to now being one of sociology.

For those intrepid ones out there, it should be entirely feasible to get back to some limited travel later this year, including in-person at the Contract Pharma Expo 2021. Stay safe, see you there.

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Ben Locwin
Contributing Editor
Dr. Ben Locwin, a health care executive, has worked on vaccinology and virology advisory boards, and has been on the front lines of the national coronavirus pandemic, participating in public health policy groups, and providing recommendations for government and private sector response amid its continued impact to public health and world economies. He has also worked closely with the FDA and the CDC.