As pharmaceutical companies edge closer to an effective coronavirus vaccine, healthcare executives say building trust with the public is the next hurdle in combating the pandemic.

While Merck & Co. Inc. is not leading the race — its vaccine candidate is still undergoing phase 1 trials, while the likes of AstraZeneca PLC, Johnson & Johnson and Moderna Inc. are already in phase 3 — executives told a virtual conference that the company's slower strategy will hopefully lead to an easily accessible and effective treatment.

Speaking at the HLTH VRTL 2020 conference Oct. 12, Merck's chief patient officer, Julie Gerberding, said previous experience with a vaccine for the Ebola epidemic taught the company that trust, combined with a measured approach, is a key part of the process.

"We tend to concentrate on vaccine[s] and vaccine approval or vaccine safety, but it's equally important, if not more important, to concentrate on vaccine delivery, vaccine trust and our ability to actually deploy it into the arms or the mouths of the people who will benefit from it. And that latter piece needs a lot of work right now," she said.

Gerberding called a lack of trust one of the more "worrisome" aspects of the COVID-19 pandemic and said that in the rush to develop vaccines as quickly as possible, the public health and medical communities have inadvertently portrayed the message that they may take shortcuts. This is why Merck joined other pharmaceutical companies, including AstraZeneca, GlaxoSmithKline PLC and J&J, in September to sign a pledge for coronavirus vaccine safety, she said.

"At Merck, there will be no safety shortcuts with the portfolio that we're prosecuting. And people need to hear that not just from manufacturers, but they need to hear it from their other trusted resources in the medical community," Gerberding said.

Alan Lotvin, executive vice president of CVS Health Corp., said in a separate HLTH VRTL panel that public trust in vaccines is not only needed to navigate the current pandemic, but also for the future.

"Losing faith in this vaccine or having a bad outcome from this vaccine will mean the next, even if not a pandemic, the next significant outbreak of any disease is going to be that much more difficult for us to treat," Lotvin said.

And while the U.S. government has been involved with COVID-19 therapy and vaccine development through the creation of funding programs like Operation Warp Speed, some healthcare experts said the heightened political dimension around how the general population should respond to the virus has further hindered public health officials in building trust. Helen Boucher, chief of geographic medicines and infectious diseases at Tufts Medical Center, said her experience is that the pandemic has become more politicized than the HIV/AIDS crisis of the 1980s and 1990s.

"In the very beginning when we didn't have enough masks ... the guidance was not as clear until we learned [about masks' effectiveness] in early April, but now the data are quite clear that masks help prevent the spread of this virus, and they keep people safe," Boucher said. "Despite that, which is a fact and a public health message, the politics have not abated. So I think that's just one example where the politics have made it really difficult."

Scaling up

In addition to transparency surrounding COVID-19 health data, Susan DeVore, CEO of healthcare services company Premier Inc., told the conference that drugmakers will need to be open about the challenges of manufacturing a vaccine.

"With so many manufacturers and distributors and pharmacies and providers, [we need] transparency to what the allocation process is, what the prioritization is, how much product do we have where? I do think that private-public collaboration with data and transparency is going to be critical," DeVore said.

Merck's chief marketing officer, Michael Nally, said one of the driving factors of the company's decisions on which platforms to use was the ability to scale up production once a vaccine or therapy is ready to go. Merck is working on two coronavirus vaccine candidates from the company's Ebola and measles platforms, as well as an oral therapeutic for COVID-19 in collaboration with Ridgeback Biotherapeutics LP.

"We've never thought about a vaccine for 7.5 billion people before. Scaling up to that magnitude is unheard of in our industry, and I think part of what we've given a lot of thought to is do we have platforms that we know can scale? That are proven to scale?" Nally said.

Another logistical challenge of distributing the vaccine, according to CVS' Lotvin, is that some products in development will, if successful, need to be refrigerated at temperatures lower than most cold-chain manufacturers can handle. Additionally, most vaccines will likely require a booster shot, and this will involve even greater quantities having to be produced.

"I applaud the government for investing ahead of time in manufacturing capacity so that we'll get to scale much faster, but the first 10 million, 20 million — pick whatever number you want — doses are going to be limited. How do we prioritize those among high-risk patients [and] doctors and nurses who are delivering care? That's going to be, I think, more of a bioethical conversation with the provider community," Lotvin said.

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