The Pandemic Data Initiative met with Dr. William Moss to discuss issues surrounding vaccination data, and how the United States can improve upon and leverage that data to more effectively contain the COVID-19 pandemic.
Comprehensive data on who is getting vaccinated in the United States is more critical now than ever, says Dr. William Moss, vaccinology lead for the Coronavirus Resource Center and executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health. As U.S. vaccination rates fall, government officials need accurate data to target their outreach to the populations and communities still hesitant to get vaccinated, adds Moss.
We have several highly safe and effective vaccines just over a year into this pandemic, and that is really remarkable progress. I think the U.S. government deserves a lot of credit for the large investment it made in vaccine development. And we have made tremendous progress getting people vaccinated.
Where I would give lower marks to the U.S. government was in the initial rollout. I don’t think we were as prepared as we should have been when the vaccines were authorized for use by the FDA and recommended by the CDC in December. We weren’t ready to hit the ground running with vaccine deployment. There were supply issues at that time. The U.S. government did not have the supply of vaccines that it anticipated in those early weeks after the emergency use authorization, but I think a lot more could have been done in preparation for a mass vaccination campaign.
Unfortunately, U.S. vaccination data has faced many of the same deficiencies as other data streams that have been so important in tracking this pandemic and our response to it.
There could and should have been stronger federal guidelines on the reporting of vaccination data.
I often talk about the Four D’s to a successful mass vaccination campaign: doses, delivery, demand, and data. That data part is critical for understanding who’s being vaccinated, who’s not being vaccinated, and for monitoring vaccine safety. We have done better on the latter because there were existing systems to look for safety signals in vaccines. But we were deficient with reporting who is being vaccinated, in large part because of the lack of standardization in data reporting across states.
Many key demographic characteristics are not consistently reported in the vaccination data, including age, race and ethnicity, gender, and occupation. There were vaccine prioritization plans established by the states, but it's impossible to determine if those priority populations are being reached without collection of the correct data. Take older adults of different race and ethnicity: if you’re not consistently collecting data on the ages of individuals being vaccinated or states are reporting different age categories, it’s impossible to track the vaccination status of these highly susceptible groups.
We know Black and brown communities in the United States were hit hard by the pandemic, and there may be more distrust for vaccinations in those communities. But states use different race and ethnicity categories and much data is missing, hindering our ability to track vaccinations in those demographics and to reach out with targeted vaccination efforts.
The federal government certainly has the authority to set guidelines. The states are reporting to the Centers for Disease Control and Prevention, and the CDC is attempting to aggregate data across states. What was striking to me was when the CDC stated that nearly half of the data on who was being vaccinated did not include key demographic data, including race and ethnicity. The CDC issued guidelines, but I think they needed to be stronger, and the states needed to recognize the public health importance of data standardization. It should be a national priority to be consistent in how we’re reporting data, so that we can look across states and aggregate data.
The first step is understanding who you’re not reaching. This is where having accurate and standardized data on who you are reaching allows you to better estimate who you’re not reaching. Step two is to investigate the underlying reasons why people are not being vaccinated. I tend to put those people into two broad buckets. First, there are people who want to get vaccinated and have not been able to do so because of difficulties accessing vaccines. They live in remote rural areas, can’t take time off from work, or lack computers and broadband to make online appointments. The other big bucket is of people who have access but choose not to be vaccinated for a variety of reasons, which is a complex phenomenon. They either do not trust the safety of vaccines or the medical establishment. Or they just want to wait and see. Data is critical to reach both groups of people.
On the vaccine hesitancy side, you need to understand who those people are, where they live, and what their underlying reasons are for not getting vaccinated. With the right data, you cannot only design the right messages, but also determine the right messengers.
It’s a complex question. There’s no doubt that some counts of cases and deaths are underreported. Some of that may be deliberate underreporting for political purposes, but some of that is forced underreporting because the systems aren’t in place to do accurate reporting or sufficient testing in a country overwhelmed by cases, like India. I’m sure they’re missing many cases, not because they don’t want to or are deliberately misdiagnosing cases, but they just don’t have the capacity. If you think about it, the United States should have the premier public health systems in the world, and we have struggled with data collection, so you can imagine how other countries are faring. This will continue to be a critical data challenge in the coming months as the global vaccine roll-out moves forward.