Alison Buttenheim Talks COVID-19 Vaccine

By Indrani Basu, Maya Cohen and Lina Huang

Recently, Pfizer and Moderna announced leading vaccine candidates found to be over 90% effective at preventing symptomatic COVID-19. Amid the burdens of the COVID-19 pandemic and the excitement these vaccines bring, Alison Buttenheim ’87’s critical work in vaccine distribution is “our hope for a route back to life as we know it,” she explained. 

Buttenheim is a social scientist who studies the behavioral aspects of infectious disease prevention. After graduating from Exeter in 1987, Buttenheim became an Associate Professor of Health Policy at the University of Pennsylvania, where she has researched HIV prevention and vaccine acceptance.

In August, Buttenheim was one of eighteen experts appointed to a National Academies of Science, Engineering and Medicine committee to draft recommendations for equitable distribution of a COVID-19 vaccine. 

Her recommendation came from careful review of written and oral testimony by different populations, whose importance co-introducer and senior Charlotte Lisa stressed. “You can’t just rely on the physician’s point of view or the economist’s point of view or the public policy point of view, you really need to have a lot of different voices in the room,” Lisa said. 

Senior Dennis Kostakoglu-Aydin agreed that multiple perspectives would be pivotal for COVID-19 work. “Just looking at this as someone who lives here who doesn’t want to keep having this COVID-19 impacting society for the next couple of years—and as someone who cares a lot about ethics—I think it’s important to consider different opinions, not just necessarily the scientific opinion,” he said.

“We wanted this to be a very fair and transparent process, in part because we felt like the public’s endorsement of it would be better if they could see our decision-making process,” Buttenheim said. “We also wanted it to be evidence based, not politically or otherwise driven. All of that was part of the ethical moral soup we were swimming in to come up with the allocation framework.”

The committee ultimately advised that healthcare workers and first responders, most likely to come into contact with others and the disease, as well as those at high risk, including older adults in congregate settings, should be the first to receive any vaccine. Next should be K-12 teachers, those with moderate risk, older adults and critical industry workers, the committee said.

“Once we had guiding principles and ethical and procedural principles, we also looked at different criteria. So you were prioritized in that list to the extent you were at high risk for getting the disease or for suffering illness or death if you got it,” Buttenheim said. “You were prioritized if there would be societal benefit if you could work. And finally, if you were at risk of transmitting to others, you were prioritized.”

“Everybody said, ‘My group should be first in line,’” Buttenheim recalled. “One thing we knew going in was that not everybody was going to love our recommendations.” 

To make the best decision, the committee made a plan aimed to both reduce death and viral transmission. “We aimed to give maximum benefit to the population, equal concern to everyone’s life and minimize health inequities.”

“With the vaccine, hopefully everyone will get it eventually–this is really just a question some number of months before it ramps up, but it’s still terrible to tell one group that they’re actually in phase two and not in phase one,” Buttenheim said.

Senior Osiris Russell-Delano, who co-introduced Buttenheim, valued the committee’s evidence-based approach. “It’s good to see that in those rooms of policy decisions they actually fully consider the topic, and it’s not all partisan; there’s scholarship happening as well,” he said.

Kostakoglu-Aydin stressed his appreciation for the committee, noting that moral questions should come first. “If we allow whoever makes the vaccine to make a profit off of it, I think that they’re gambling with human lives. No amount of money is going to replace a human life,” he said.

Kostakoglu-Aydin raised questions about Exeter’s place within the vaccine distribution guidelines. “We at Exeter live in a community with people who aren’t affiliated with the school and with students from all over the world. We travel frequently in airports, and we can potentially come from places with high COVID-19 cases,” he said. “Should we get a vaccine? Is it important for us to go to school, or should we take another term fully remote so that other people can have the vaccine, other people who might need it more?”

“I think the biggest thing to learn to take out of this is that, although this pandemic can affect individuals, it’s not just limited to individual impact; it affects the population. And so that’s how we should see it,” upper Russell Tam agreed. 

“We have a really narrow window to get the COVID-19 response right, and we’re at this unique moment where public trust and confidence in the CDC, in the FDA who’s going to approve the vaccine and other public health authorities are quite low,” Buttenheim said

Buttenheim’s career has extended beyond her pivotal work on COVID-19. “I’m just really interested in what people do and how people make decisions in ways that affect whether or not we can prevent infectious disease,” she said.

“Most of my work has been around prevention and mitigation strategies. We have to ask and answer questions in a really different way,” Buttenheim said. “I want to get to an answer quickly and help the most people the most quickly.”

Upper Emma Finn really admired Buttenheim’s behaviorial economics approach to tackling problems to leadership at Exeter. “I think behavior change is a really interesting science to look at, especially for people in StuCo trying to [make] decisions about how Exeter can be a better campus,” Finn said. “How can we encourage people to make better decisions?”

Buttenheim is also one of the founders of Dear Pandemic, an organization dedicated to publishing accurate information about COVID-19. “A colleague was answering a lot of questions for friends and family, and I was answering a lot of questions from friends and family, mostly along the lines of ‘Do I really have to cancel my trip?’ or ‘Should I go buy toilet paper?’ A third colleague suggested to us that a lot of people need these answers, and we should just have a social media page,” she said. 

Since its founding on March 10, Dear Pandemic has grown to have almost 50,000 Facebook followers. Information, whether science news or answers to common questions, is published usually twice a day, created by twelve female scientists and about a dozen volunteers.

“All of us are scientists or clinicians. This is just a side gig that’s grown to be this wonderful beast that’s extremely rewarding. We really have become a trusted source for people in this time, when there’s so much information flying at people and they don’t know what to trust or what to believe or how to act,” Buttenheim said. “It just really resonated with people; our voice saying, ‘It’s okay, here’s what you need to know.’ Our tagline is to ‘Stay safe, stay smart, stay sane.’”

In the future, Buttenheim hopes that the country can move forward with prioritization of the pandemic and to place more value on keeping schools open. “There was just a paper published estimating the years of life lost, not from the pandemic, but from kids missing out on schooling; that’s because there’s a very strong relationship between educational attainment and life expectancy. Because people have a slightly lower life expectancy when they miss out on schooling, they actually calculated more future years of life lost from closed schools than from COVID-19 this year,” she said. “We unfortunately aren’t in a society that was willing to prioritize keeping the schools open at the expense of other things.”

Buttenheim herself cited the critical role of formative education in her life. “I just remember really feeling at Exeter that… crackle… So many possibilities and challenges.” 

Mathematics Instructor Eric Bergofsky highlighted Exeter’s educational philosophy as seen in Buttenheim’s life. “We hope that one of the things we teach our students is that it’s okay not to get the answer the very first time because, in the real world, problems don’t get solved right away. Professor Buttenheim is clearly working on problems that don’t have any clear, obvious solutions–how do you convince people to wear a mask? Why are people resistant to taking a vaccine?” he said. “One of the great things that underlies everything at Exeter is persistence, which you see in Professor Buttenheim’s work.”

Buttenheim aptly recounted the academic rigor at Exeter as the most challenging in her life—and that “includes college and grad school and [her] PhD.’” 

Buttenheim hoped Exonians would take away a commitment to following their passions from her Assembly. “By the end of high school, especially when writing college applications, I know students feel like they need to determine what they’re going to do. But I didn’t study the work I’m doing now at Exeter. I didn’t start my PhD till I was 32,” she said. “When I was making the decision to pursue my PhD, I said to a friend, ‘I’m gonna be 40 by the time I finish this PhD.’ And I remember so well that she said, ‘You’re going to be 40 anyways, you might as well have a PhD.’”

“This is just a reminder to folks that they don’t have to have it all figured out,” Buttenheim said. “Your passions and the work will reveal themselves to you, and you’ll just prepare for that by being an engaged, interested, compassionate and kind human being ready for anything.”