Although COVID-19 has made the topic of vaccines front and center once again, vaccine hesitancy, the reluctance or refusal to take a vaccine, is not a new phenomenon.
In fact, it’s been declared by the World Health Organization (WHO) as a leading threat to global health.
The Health Writer Hub blog has covered the topic of vaccine hesitancy along with evidence-based strategies that health writers can use to address it.
In this blog, I re-examine vaccine hesitancy in light of the current pandemic. Experts share tips on how to convey accurate information about a new coronavirus vaccine. We also discuss how to address people’s distrust of the medical and scientific community without validating misinformation.
These are unique times – or are they?
For many people, a coronavirus vaccine has become their last hope to resume a pre-pandemic lifestyle. On the opposite spectrum, conspiracy theories are already spreading rapidly about a potential vaccine and misinformation about the vaccine has been shared across social media.
This conversation of a new vaccine is taking place against a backdrop of rising public distrust in the scientific and medical community – along with a growing awareness of the history of racial injustice and unethical studies targeting vulnerable communities.
A recent poll by CBS News indicated that only 21% of Americans would take a COVID vaccine if it became available at the end of this year. This is down from 32% in July.
There have also been some statements by leading American political figures expressing distrust in a potential vaccine. However, public distrust in a vaccine isn’t new and isn’t specific to a potential COVID-19 vaccine.
Half of the US population did not take the seasonal influenza vaccine in 2019, as Dr. Emily Harrison notes in a recent article for the European Journal of Epidemiology.
“There are long histories of vaccine hesitancy,” says Dr. Harrison, a Postdoctoral Fellow in Epidemiology and the History of Science at Harvard University.
“One of the strongest lessons from history, though, is that hesitancy is not a uniform phenomenon. The COVID-19 vaccine campaign will take place in a particular historical moment, just like all past vaccine campaigns have done.”
The politics of the vaccine
What makes this moment uniquely challenging in US history is the influence of politics in the discussion of vaccine safety.
“There are recent and specific concerns that the scientific integrity of at least some of the institutions charged with the public’s health in the United States has been compromised,” Dr. Harrison notes.
Dr. Emily Vraga, an Associate Professor of health communication at the University of Minnesota, says that in the US in particular, a coronavirus vaccine has become politicized. It has led to the public’s faith in the scientific community being undermined.
So how should these concerns be addressed?
Experts in the scientific and health communities need to clearly express what they are doing and distinguish that from “mere” politics. Dr. Vraga cites a recent pledge made by the top pharmaceutical companies that they would not push through a vaccine unless it has met the highest standards of safety and efficacy, as a step in the right direction.
“Statements like that are really important and scientists need to keep reinforcing that,” she adds.
Health writers can amplify these efforts by continuing to write about them and sharing them widely.
New vaccine – new fears?
Another factor to consider is the fact that the coronavirus vaccine is a new vaccine without a long medical history of success.
Unlike traditional vaccines such as the MMR vaccine, health writers won’t have a long list of medical literature demonstrating the vaccine’s efficacy and safety to draw from.
Dr. Vraga suggests health writers instead highlight the consistency that goes into making vaccines.
Even though this vaccine is new, scientists are using very similar mechanisms as they have before to make traditional vaccines.
Furthermore, health writers need to emphasize the rigorous protocols that are in place to ensure vaccine safety.
“Extremely strict guidelines for vaccine safety regulation have been developed over time exactly because public willingness to accept preventive medical intervention is fragile,” Dr. Harrison says.
Now, more than ever, there is increased scrutiny regarding a vaccine and this is a good thing.
Health writers should stress that vaccines “are adhering to the highest standards … there are vaccine watches so there are incentives to being incredibly transparent, “ says Dr. Vraga.
“Everyone is watching … that visibility can actually reassure people that nothing nefarious is happening.”
The backdrop of racial injustice
Along with a global pandemic, we are currently in the midst of an ongoing global reckoning against racial injustice.
From the early days of the pandemic, the issue of race has been publicly discussed.
In April 2020, a video of French scientists stating that any potential vaccine should be first tested on Africans went viral.
For many, this confirmed the belief that in the minds of the scientific community, people of color were subjects to be tested on.
The backlash was so immense that it prompted the WHO Director-General Tedros Adhanom Ghebreyesus to state: “Africa can’t and won’t be a testing ground for any vaccine.”
In the US, there is also a history of unethical scientific studies conducted on minority communities tracing back to medical experiments on slaves – and more recently in the infamous Tuskgee Syphilus study that targeted black men and refused them life-saving treatment.
“Growing public acknowledgement of the ways in which government has harmed some citizens on the basis of ideas about race has likely made many people, not only people of color or people in minority communities, more ready to doubt or demand more proof of safety from government authority,” Dr. Harrison explains.
Dr. Vraga advises health writers to be understanding and empathetic when addressing concerns.
We need to realize that vaccine hesitancy isn’t simply people refusing to accept science.
“Sometimes it’s rooted in incredibly real histories.”
Health writers need to recognize this history. “The messaging should be, ‘we know that your community has been hurt in the past. Here’s what we’re doing to safeguard it now’,” she continues.
This conversation is especially relevant with black and brown communities dying of COVID-19 at higher rates. It’s crucial that these communities are able to benefit fully from a vaccine.
Health writers need to speak with community leaders who are already trusted and include them in efforts to promote the vaccine.
“Trust building has to be happening now… to see what those needs are, what those concerns are and how they can be alleviated,” Dr. Vraga says.
WHO has coined the term for the rampant misinformation present on social media an ‘infodemic’.
“We’re not just battling the virus,” said WHO Director-General in a recent statement on WHO’s site.
“We’re also battling the trolls and conspiracy theorists that push misinformation and undermine the outbreak response.”
It’s important for health writers to continue to promote the correct information and make it widely and easily available.
Dr. Vraga explains, “Often people find misinformation when they’re looking for something they want to know.”
If for example, someone is interested in learning what vaccine trials look like and they don’t find a credible source with that information, then they’ll keep looking until they stumble upon something whether its credible or not.
Health writers need to also be careful with how they tailor their messages and this begins with the questions they ask.
According to Dr. Harrison, it’s important “that health writers be very aware and careful about the frame of investigation that they are choosing before they start tailoring.
What questions would you ask your sources if you wanted to have confidence that a future vaccine will be safe?
Are they different from the questions you would ask if you wanted to doubt that it would be safe? What questions would you ask if you wanted to believe that it would be possible to distribute a vaccine equitably?”
When debunking popular myths, health writers need to focus on the correct message and not the myth. Dr. Vraga advises not to say “Everyone is saying this – but it’s wrong.”
That’s because, in doing so, you’re making people aware of something they might not have been.
But you can certainly respond by writing “Here’s what’s accurate” without including the myth or referring to it subtly.
Finally, any message health writers craft should be rooted in empathy and sensitivity.
These are unprecedented times for many around the world.
Any effort to build trust and faith in the scientific community has to come from a place of understanding and acknowledgment of historical injustices that merited distrust.
Regurgitating statistics and scientific facts isn’t enough. Health writers need to listen to people’s concerns and respond to them in a thoughtful manner.
Dr. Vraga suggests sharing personal stories as they become available such as those of frontline workers who took the vaccine and thus were protected against COVID-19.
Vaccine hesitancy is a multi-faceted problem.
Health writers can be the bridge between the medical and scientific community and the public by communicating not only the facts but the legitimate fears held by the public.
We must be prepared to build the public’s trust in a vaccine by first reaching out on a community level and actively working to address their concerns.
The time to combat vaccine hesitancy is now.