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Coronavirus vaccines are here, 
! Now what? A thread from a qualified doctor (the real kind of doctor) 1-
! Now what? A thread from a qualified doctor (the real kind of doctor) 1-
Eleven months into #COVID19 pandemic, many citizens of wealthy nations are looking to the new vaccines with hope and relief. But this hope emerges out of devastating and avoidable failures of public health programs 2-
In health systems research, there's long been debates over basic public health improvements vs. single-disease eradication through vaccination—with the latter being more powerful. The coronavirus pandemic response is on course for following in that same direction. 3-
COVID response is not either/or: public health infrastructure or vaccines? We need both to address #COVID19 4-
Great hopes pinned on new coronavirus vaccines because of disease, death, and loss. That hope also arises out of many months of civic disaffection, as we watched the many failures of leadership, both within nations and internationally, to enact robust public health responses. 5-
This civic disaffection is wrongly identified as “pandemic fatigue”, which suggests frailty of individual character rather than disillusionment with political failure to contain the virus and minimize harm. 6-
Political difficulties started early on, with the challenge of procuring reliable global health data to steer policy. Dozens of research institutes published models and predictions, and some of the most influential forecasts were dangerously wrong. 7- https://www.thenation.com/article/society/gates-covid-data-ihme/
Gov'ts promised to “follow the science” w little admittance that the science was emergent, uncertain, and saying different things. This provided a wide berth to politicians for enacting science-led policy; yet many of those same leaders then failed to follow the science at all 8-
More difficulties with disagreement between experts, as well as public resistance, re: every nonpharmaceutical public health measure enacted so far, especially masks and lockdowns. 9-
Stunning underinvestment by even the most affluent nations in the health measures that everyone agrees on—PPE for frontline workers, widespread and rapid testing, contact tracing. It is from here that #CoronavirusVaccine emerges as the great hope. But will it deliver? 10-
Public health experts already tempering expectations, advising that 
will not immediately allow 4 resumption of normal life. A 2nd shot will be required, community-wide vaccination will take time, & immediate and long-term effectiveness of the vaccines are still not known 11-
will not immediately allow 4 resumption of normal life. A 2nd shot will be required, community-wide vaccination will take time, & immediate and long-term effectiveness of the vaccines are still not known 11-
What’s more, logistics and financial cost of manufacturing, storing, and distributing the new slate of #CoronavirusVaccine across the globe is staggering, and the planning & investment so far mostly stands to impact the citizens of industrialized nations 12-
... while leaving the majority of the world’s population underserved 13- https://www.theguardian.com/society/2020/dec/09/nine-out-of-10-in-poor-nations-to-miss-out-on-inoculation-as-west-buys-up-covid-vaccines
Investment in vaccination for Global South, ex. WHO’s COVAX, remains insufficient. W/out strong leadership & global solidarity, the success of a global vaccination effort, of a scale greater than global wild polio program, seems unlikely. 14- https://www.who.int/initiatives/act-accelerator/covax
Stuart Blume wrote #CoronavirusVaccine "isn't just about saving lives. It’s also about power, profit & national prestige.” Effective & safe vaccine still possible, but these secondary interests put wider public health response in which vaccines should be nested, into question 15-
Public health measures are effective to the extent that they prioritize public interests and equity. Public interest includes health for everyone, as infectious disease does not respect regional or national borders. 16-
Health for all minimizes health disparities, reliable predictors of poorer health measures for everyone (even the rich). The technological fix offered through widely available & effective vaccine may stop the pathogen, but it will not establish health. 17- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5570780
Those (hopefully) secondary interests of power, profit, and prestige are already negatively impacting global access to vaccines, as “vaccine nationalism” and “vaccine disenfranchisement” follow from inequitable vaccine licensing and advance purchasing agreements. 18-
Depleting national health budgets on vaccine purchasing will also come at the expense of investment in other life-saving public health programs. 19- https://www.theatlantic.com/international/archive/2020/12/vaccine-nationalism-doomed-fail/617323/
Those secondary interests also give rise to vaccine hesitancy, as many citizens fortunate enough to have access to vaccines in the near future worry about the safety of this highly politicized and profitable vaccine technology. 20- https://upittpress.org/books/9780822946557/
For experts to dismiss all such concerns as “misinformation” is to ignore past harms when highly lauded blockbuster health interventions were mismanaged. Trust &mistrust travels. Dismissing concerns also shuts down conversation precisely when engagement is needed. 21-
When a large enough population comes to believe that profits were placed ahead of public health, even the most effective vaccine can fail upon delivery. A vaccine program is only good if people want to get vaccinated. 22-
The rollout of safe and effective #CoronavirusVaccine should be a welcome part of a broader pandemic response that includes major rethinking of & action on social arrangements and institutions that did not respond well to the COVID “stress test” on governance and society.23-
