The Covid-19 Vaccine and That Compliance Problem

By Michael Hodin

When the Covid-19 vaccine is discovered, it’ll be no good if we don’t get vaccinated. And if it is the elderly most at risk from Covid-19, it is in the area of adult vaccines where the usage of those already available — for illnesses like pneumococcal pneumonia, flu, or shingles — is surprisingly low where we have the most work to do. So, as scientists work to develop the Covid-19 vaccine, it’s not too soon for a parallel effort to develop the needed, broad-based immunization campaign, especially including older adults who are most vulnerable and precisely the demographic who currently aren’t benefitting from the adult vaccines at their disposal.

Such a campaign will have to draw on one of the most successful public health efforts of the last century: childhood immunization begun in the 1950s, when many of today’s adults were the children recipients. The Covid-19 vaccination campaign will then also become the basis to jumpstart the levels of adult immunization for all vaccine-preventable diseases, profoundly important for 2 billion of us globally over 60 in a world of more old than young.

Covid-19 is already having noticeable impact on how billions of us around the globe are complying with public health guidelines — staying at home, avoiding close contact with friends and loved ones, wearing masks in public, and other peculiar behaviors contrary to our normal way of living. If this level of public adherence becomes the new normal, it will enhance prevention and lead to a healthier longevity, precisely in 2020 as we launch the Decade of Healthy Ageing.

Covid-19 will lead to enduring and valuable shifts that improve society’s health moving forward, if it changes these four areas:

· Improve medication adherence. On medicines themselves, it is stunning how much we struggle with medication adherence — or taking medicines as directed. In the US alone, 125,000 people die every year due to this problem. The Annals of Internal Medicine reports that, across OECD countries, 20–30% of prescriptions are never filled, and roughly half of chronic disease medications are not taken as prescribed. Up to a whopping 25% of all hospital and nursing home admissions are caused by patients’ medication noncompliance. Across OECD aging societies, as many as 40% of patients do not adhere to their treatment regimens, including serious cardiovascular disease; in the U.S., 42% of people do not take hypertension medication as prescribed, and even one-quarter of stroke survivors are non-compliant with their medication regiment. Can public health education during Covid-19 lead to different behaviors following?

· Elevate adult vaccines. As we all now know, a Covid-19 vaccine is the single tool that promises to end this crisis. Yet, for years before the pandemic, rates of adult vaccination have been shockingly low, even though adults are most at-risk for severe health outcomes or even death due to vaccine-preventable diseases. Only 37% of American adults get their flu vaccine. In the European Union, just 60% of adults have received commonly recommendation vaccinations, and, in Australia, half of all of us over 65, have gotten vaccines for flu and pneumococcal pneumonia. Even in super-aging Japan, where prevention and healthy aging are priorities for the population overall and rates of vaccine-preventable diseases are high, there persist remarkably low adult vaccination compliance.

· Combat the anti-vax movement. Childhood immunization is one of the historic public health successes of modern times — powering the longevity revolution itself. But even here, the anti-vax movement has driven a stunning reversal in recent years. In 2000, the CDC announced the elimination of measles with a vaccine that is 99% effective and has virtually no side effects. Today, measles is back. As the CDC announced last week, this resurgence is due to anti-vaxxers spreading their message daily on Facebook, Twitter, websites, and other media outlets, reflecting a systematic effort throughout the U.S. and in other countries to convince parents not to vaccinate their children. Will Covid-19 and the vision for a vaccine panacea also “deep six” the anti-science anti-vax horrors?

· Illustrate the link between health and prosperity. An eventual Covid-19 vaccine will not just save lives — it will become the only true lever of trust to fully revive our economies. The Covid-19 vaccine will give all of us the confidence to revive economic life across America and globally. According to Klaus Schwab, Founder and Executive Chairman of the World Economic Forum, there is nothing more critical: “While governments and companies who have ‘bent the curve’ can cautiously start initiatives to get parts of social and economic life going again, always monitored by public health officials … [what is needed more than anything] … is to work together to ensure that the most effective vaccine can be determined as fast as possible, and the necessary production can start on a large scale as fast as possible. It is the only true way out of this crisis.” And the same principle applies beyond Covid-19, as the U.S. already spends $9 billion each year to treat vaccine-preventable diseases.

Even when we discover the Covid-19 vaccine; even when we suspend, with caution, the strict regulatory rules that could be the barrier to more rapid availability; and, even when we combine the best of market capitalism to allow for quick and scalable manufacture and distribution of the vaccine — yes, even when all of that is here, it will still not work if you and I don’t get vaccinated.

But even then, we’re not finished. Because we must apply our changed mindset and behavior in the post-Covid-19 world to rapidly and aggressively improve our compliance for all medicines — whether they be for stroke, hypertension, heart failure, fragility fractures, vision, or the adult vaccines already available but too underutilized to fulfill their valued health potential.

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