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Covid-19: Vaccine trials need more transparency to enable scrutiny and earn public trust, say experts

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4042 (Published 22 October 2020) Cite this as: BMJ 2020;371:m4042

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We must preserve the ends when communicating the means

Dear Editor,

Transparency in methodology should indeed apply to all the covid-19 vaccine candidate trials to allow for real-time assessment and scrutiny of trial design and practices by the scientific community. Demonstrating rigour in this regard, and communicating this to the public, inspires confidence and trust.

What, and how much, to make publicly available surrounding adverse events, when it is likely to be reported on by the international media, is not straight forward. The difficulty is that never before has the development of a new vaccine taken place under such a spotlight. Unfortunately, the minority who view covid-19 as a hoax, and those who grumble its effects are being exaggerated, have already generated resistance to public health measure such as mask-wearing, This, twinned with broader vaccine scepticism, looms large. There is potential for this group to rapidly capitalise on and amplify the reporting of adverse events to sound the alarm about vaccine safety.

Over the coming months, it is likely, as the number of patients enrolled in phase III trials increases, there will be more serious adverse events, and more trials halted, in line with standard practice. There is a risk that when this happens, confidence is eroded, and over time the mood of the public starts to shift. We are fortunate in the United Kingdom in that, according to an Ipsos poll, we are leading in Western Europe with 85% agreeing or somewhat agreeing with the statement, ‘If a vaccine for covid-19 were available, I would get it’. (1) However, the ability of a vaccine to bring the pandemic under control is a critical numbers game, dependent on its efficacy multiplied by the number of people vaccinated that, in turn, is influenced by uptake. Small shifts in those willing to have the vaccine may result in much larger shifts in its effectiveness.

As has been demonstrated throughout the pandemic, public relations and controlling the narrative has been a challenge no government or organisation have been able to master. Honesty and transparency are required, but this may have unforeseen consequences.

(1) https://www.ipsos.com/en-us/news-polls/WEF-covid-vaccine-global

Competing interests: No competing interests

29 October 2020
Henry D Marshall
Clinical Fellow in Critical Care
Barts Health NHS Trust
London