According to the World Health Organization (WHO) Coronavirus (COVID-19) Dashboard, as of 18 May 2021, a total of 1,407,945,776 vaccine doses have been administered globally. 16 vaccines have been approved or authorised around the world and over 100 are in clinical trials in humans.
Vaccines are a critical component in the fight against COVID-19, however public awareness in how vaccines are developed and how they work is generally low. With a growing number of people refusing vaccines, termed anti-vaxxers, communicating the importance of developing an effective and safe vaccine to target COVID-19 is paramount in increasing public education in this area and supporting the rollout of approved vaccines globally.
Following lockdown in Canada in March 2020, Commonwealth Alumnus Dr Erica Moodie and her McGill University colleague, Dr Nicole Basta, worked together to develop an online COVID-19 vaccine tracker that aims to provide impartial and helpful information to a global audience on the development of COVID-19 vaccines, including how they are trialled and tested, and how vaccines work.
Here, in an interview with the CSC, Erica discusses the importance of developing a vaccine tacker for a non-medical global audience and the approach and considerations undertaken by the team at McGill university, and considers the impact of COVID-19 on future public engagement in healthcare.
“Being a statistician is so much fun. I know nobody would ever think that’s true, but it really is. There are so many potential applications, and there are so many interesting, either clinical or public health problems that, boiled down, have the same sort of structure. It gives you the opportunity to work in a number of different areas. And I do think a good statistician really does need to understand the context”, says Erica.
As a Professor in Biostatics in the Department of Epidemiology, Biostatistics, and Occupational Health at McGill University, Erica’s work focuses on the statistical study of optimal treatment strategies to understand how we can learn to adapt treatments to individuals. This area of her work, sometimes referred to as precision or stratified medicine, investigates macro or demographic characteristics that may impact the effectiveness or potential harmful impacts of different treatment strategies. Factors for consideration include body mass index (BMI), the type and severity of symptoms, tolerable and intolerable side-effects, and the length of time treatment has been administered.
The application of this work is typically within mental health, devising statical estimators to understand best treatment strategies for mental health illnesses, including depression and schizophrenia. Treatment adaptation is a major component in treating mental health and other illnesses, and Erica’s work seeks to identify the best treatment for an individual’s characteristics to develop guidelines on how treatments may be adapted based on responses.
Erica is also a statistical lead for a cohort researching behavioural risk factors facing HIV and hepatitis C coinfected individuals living in Canada, such as barriers to accessing treatment, stigma related factors, and issues around food security. The research cohort is comprised of approximately 2,000 individuals, representing a quarter of the co-infected population in Canada.
It is this work that led to Erica’s role in developing a COVID-19 vaccine tracker, bringing together her background in epidemiology, statistical analysis, and health communication.
“That HIV side of my work is what led to this collaboration on the vaccine, that thread of infectious disease work that I do.”
Public health awareness campaigns
Following the outbreak of COVID-19 globally, public health awareness campaigns were launched worldwide to slow-down and prevent the spread of the virus. In the face of a global pandemic, public interest in monitoring the spread and the development of health interventions, including a vaccine, were heightened. As a result, several COVID-19 online trackers became available to the public, including those developed by the WHO and national governments.
With so many trackers available to a captive public audience, Erica, and her colleague Dr Nicole Basta identified the need to provide clear, accessible, and comprehensive updates about COVID-19 vaccine development and approvals worldwide.
“There are a lot websites that do track different aspects of the pandemic, whether it’s the number of cases or the number of treatments, or even there are other vaccine trackers out there. But many of them take a different sort of approach. So, what we were aiming for with this was really to try to help non-scientists understand – how close are we?”
Since September, much has changed – more than a dozen vaccines gained approval in countries around the world, and the focus of the website has shifted from “how close” to “which vaccines, in which countries” although the site also continues to track vaccine trials.
Communicating progress and development of vaccines
Focusing on the general public, many of whom have no medical or public health background, or an understanding of vaccine development, and with the goal of helping people understand the scientific progress being made in developing safe and effective vaccines, the online tracker lists only those COVID-19 vaccines which have begun enrolling human subjects.
This was an important decision in communicating both the progress made in vaccine development and ensuring the website accurately reflected the number of vaccines at this critical stage of testing. In reporting only on vaccines at the clinical trials stage, Erica hopes the tracker addresses concerns on how vaccines can be developed at such an accelerated pace, without compromising public safety or the efficacy of the vaccine.
“[T]here’s a lot of concern of, well, is it being rushed? Everything’s happening so fast. Will it really be safe? So, trying to give some reassurance on the processes and what’s really happening, because there is some vaccine hesitancy even among people who are not anti-vaxxers at the best of times. And this is just a very different and accelerated timeline compared to other vaccines.”
However, Erica emphasised, the accelerated timeline did not skip any steps or see any corners being cut.
Before being approved, vaccine candidates are tested multiple times in progressively larger clinical trials involving humans. To help the public understand the progress made in developing safe vaccines, the online tracker provides information on the three clinical trial phases vaccines must complete before being approved. Each vaccine listed in the tracker is broken down by its clinical trial stage, the number of trials conducted, and number of countries trials have been performed in, and the type of vaccine developed. The tracker also allows for searches by country, and provides maps showing the number of approved vaccines in each country and the number of clinical trials in each country both to give a global overview and allow users to easily focus in on their own region.
Data source and analysis
Gathering accurate data to populate the tracker is an ongoing and extensive exercise. Data is gathered from a range of publicly available sources, including the WHO website and other websites publishing information on each of the ongoing trials. Each data source presents the information differently, and a team of students work to maintain a central spreadsheet of data which is used to update the tracker and create easy to access information.
The team is comprised of undergraduate, postgraduate, post-doctorate students, some hired and others volunteering their time to work on the tracker. They represent a range of skills and research and study backgrounds, including computer science, public health, epidemiology, and biostatics, which all contribute to the success of managing the tracker.
Communicating statistics and data visualisation is an important element in achieving the overall aims of the vaccine tracker, and the format identified came from outside the scientific and statistical research community.
“In fact, we were joking about it, but the cards that we have on the vaccine website were inspired by Pokémon cards, with this idea that you have your collector cards for each of the vaccines. That was sort of the idea behind them… trying to connect to that, I don’t know, almost that non-scientific, that ‘interest’ side where you’re hooked on it and you want to come back and find out more.”
Following a simple and prescribed format, each of the vaccine cards provide the same level of detail, making it easy for users to understand the information shared, compare the progress of vaccines, and access explanatory information. Erica credits her Commonwealth Scholarship and MPhil in Epidemiology at the University of Cambridge in exposing her to the interpretation of statistics within in a health context and shaping her thinking in an outcome-driven way.
Erica and the team have been surprised at the uptake of the vaccine tracker to date. Analytics from the tracker site confirm it has been accessed by people across the world. The website has been accessed by users from more than 230 countries, with more than 2.8 million-page views by nearly 750,000 new users. The last month alone (April 15-May 15, 2021) accounted for more than a third of the new users and page view.
On the uptake, Erica says “It’s just been really neat to see on the map where people are accessing our website from. So, we hope that we’re actually reaching that goal of making this accessible to a global lay audience.”
A lasting shift
The longer-term impact of COVID-19 on public health awareness has yet to be determined, however it is likely there will be a lasting shift in public and political dialogues around vaccines. Erica highlights the formation of COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, a global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatment, and vaccines. With national governments under pressure to deliver vaccines and health security to the public, political collaboration, and cooperation in vaccine roll-out is critical in achieving success on a national and global scale.
“I’m a big believer in a global community anyway, but I think that the pandemic has really made it much more obvious that we are all part of one community and that we are only safe if we look after everybody.”
Erica notes new threats to global health are on the horizon because of climate change, and that further global collaboration and cooperation will be required to combat the further spread of illnesses, such as dengue fever and Zika.
“…many of these illnesses are either affected by things like temperature, humidity, or indeed they’re vector-borne and the vector’s liveable areas are shifting with the climate changes.”
Creating new trackers for other viruses
Developing the COVID-19 tracker has highlighted the potential to create similar trackers for other illnesses to enable the public to monitor and understand developments in health treatments and interventions. Drawing on her own work, Erica believes a tracker for the HIV vaccine would be of important public interest, given global figures for people living with HIV, the level of investment in its development, and difficulties experienced producing a vaccine for a virus which mutates more rapidly than many others.
More broadly, continued, and accessible public information on vaccines would support global health efforts and provide lasting evidence on the importance of vaccine development and uptake on global health concerns, some of which we no longer consider.
“They have changed the way we live because there are so many illnesses that we simply don’t even worry about anymore.”
Erica Moodie is a 2000 Commonwealth Scholar from Canada. She studied for a MPhil in Epidemiology at the University of Cambridge.
Headshot credit: Sahar Saeed