Topic: Can technology increase COVID-19 vaccination rates?
Vaccine ready is the theme of the National Minority Health Month in April, 2021. This initiative aims to educate the public on health problems facing minority populations in the USA. The vaccine theme has been chosen because, paradoxically, although minority populations have been disproportionately impacted by COVID-19, they are also reported to be the least likely to be vaccinated. Barriers against vaccination among minority populations have been widely reported, including low confidence in the vaccine, poor access, and distrust of the health system. The WHO Digital Health Flagship initiative has stated that digital technology could play a critical role during the COVID-19 pandemic by improving communications between people and health services, empowering individuals and patients, and strengthening critical public health functions including disease surveillance. Can technology also help build trust and promote vaccination within communities that are most at risk?
Systemic biases in health care, typically caused by under representation in clinical studies, have caused mistrust among minority populations. Studies indicate that this mistrust is deep-seated, even among minority health-care workers who also show lower vaccine uptake in the UK and the USA. Representation of minority ethnic groups in vaccine efficacy trials has been disproportionately low. The lack of data in these populations is a barrier to uptake if communities perceive that these vaccines are not established to be safe and effective for them.
The most common reason for vaccine hesitancy amongst minority groups is concern about adverse effects. Rapid and transparent reporting on potential adverse effects could go some way to improve communication and potentially reduce hesitance among minority populations. One such technology, V-safe, employed by the Centers for Disease Control and Prevention, is a smartphone tool to track side-effects of COVID-19 vaccines directly from patients. A similar tool has been developed in the UK, the Yellow Card app, to enable close monitoring and real-time reporting of the COVID-19 vaccine roll-out. V-safe and the Yellow Card app have empowered individuals to provide real-time information of side-effects and help establish a trusted, public-led vaccine safety monitoring programme.
Success of these tools in tracking adverse events is essential as the UK regulating body, the Medicines and Healthcare products Regulatory Agency (MHRA), report that they are expecting between 50 000 and 100 000 adverse event reports for every 100 million doses delivered to patients over a 6–12 month period. However, simply increasing the volume of data will not solve the problem of tracking and communicating genuine adverse events to the public. Many reported side-effects are not causal and inaccurate reporting has been shown to cause significant damage, especially when influenced by the media, anti-vaccine activity, and political lobbying. An example of such harm has already been seen in the premature abandonment of the Oxford–AstraZeneca COVID-19 vaccine across countries in Europe despite an absence of robust evidence supporting the decision.
Here is where artificial intelligence (AI) could help. To manage the wealth of data from adverse events tracking, the MHRA have awarded £1·5 million to develop AI that can identify genuine COVID-19 vaccine adverse effects. While experts have applauded the MHRA’s forward thinking approach, development of AI based on limited self-reported public data and electronic health records that are subject to historic and systemic bias must be validated on data from minority and other at risk populations to maintain trust within these communities.
To combat bias in datasets and algorithms, transparent auditing of clinical AI tools is essential to accurately communicate results to the public for greater vaccine uptake. As the UK and the USA pass the milestones of 20 million and 100 million people (respectively) vaccinated against COVID-19, associated data must be made transparent and accessible. Datasets such as the England and Wales COVID-19 vaccination datasets, which are available upon request to researchers, are critical to communicate real-world effectiveness of the vaccine to the public.
Topic Discussed: Can technology increase COVID-19 vaccination rates?