Facts Over Fear

To end the COVID-19 pandemic, public health leaders need to ensure that enough people are willing to be vaccinated. Reaching the hesitant requires a multi-pronged approach that enlists trusted sources like community leaders and peers.

By: Shoshana Fishbein ’17  Friday, February 5, 2021 09:02 AM

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Illustration by Mike Austin

A subset of the population has been skeptical of or even opposed to vaccines since they were invented in the late 1700s. The modern anti-vaccination movement largely began in 1998, when a British gastroenterologist named Andrew Wakefield published a paper that claimed the small group of children he had cherry-picked to study had developed autism because of the measles, mumps and rubella vaccine. In 2010, the paper was retracted for using falsified data and Wakefield was prohibited from practicing medicine, but the misinformation had 12 years to spread around the world.

That period was also when people were starting to look to social media for more of their health information, where it spreads peer to peer. Research shows that the pro-vaccine community is bad at talking to people peer to peer—it tends to make blanket national statements instead. And because anti-vaccine rhetoric preys on people’s fears, countering those emotions with numbers and data isn’t always effective.

Amid the COVID-19 pandemic, the Food and Drug Administration (FDA) has authorized two highly efficacious vaccines (from Pfizer and Moderna) for emergency use. The question is: Will enough people take them? The most optimistic polls suggest more than 70 percent of American adults are willing to be vaccinated, but it’s unclear whether that will be sufficient to achieve herd immunity. The public health community needs to be strategic about how it reaches the people who have concerns about the safety of these vaccines.

Part of that involves framing. This isn’t about getting the vaccine versus not getting the vaccine. It’s about getting the vaccine versus experiencing more preventable deaths or more preventable long-term health issues. The choice to not get vaccinated can have major consequences. People who’ve witnessed family, friends or coworkers getting significantly sick or even dying from COVID understand this, and that may make them more motivated to get vaccinated. Those without personal experience with the disease, or those who’ve only seen someone get it and recover quickly, are going to be less likely to understand the severity of COVID and to feel they’re personally susceptible to serious illness or death. 

Public health entities need targeted messaging to reach these groups and others, including marginalized communities who’ve been disproportionately affected by COVID but also by decades of discrimination and other unethical treatment at the hands of medical providers and the U.S. government. Each of these groups will have its own unique fears regarding the vaccine. An outside entity like the Centers for Disease Control and Prevention (CDC) or even a local health department won’t necessarily be able to identify those fears and speak to them. Even if they could, these groups need to hear that vaccines are safe from a trusted source, and levels of trust in scientists and health agencies vary across political and racial lines.

The CDC has launched a Vaccinate With Confidence strategy, which essentially gives money to communities to have these conversations among their people. It’s the job of public health officials to arm community leaders with correct information. For example, it's important for people to understand that while the vaccines were produced quickly, that doesn't mean they were rushed. The “new” mRNA technology these vaccines use has been studied for decades—it just hadn’t been a match for other viruses. The trials moved quickly because of ample funding and volunteers, and because COVID was so widespread—it took only months for researchers to observe enough infections in study participants (with approximately 95 percent occurring in the placebo group of each study) to draw meaningful conclusions about the different outcomes between vaccinated and unvaccinated individuals.

The public may also be confused about how well the new vaccines will work. At the moment, we only have data on “efficacy”—that is, how well these vaccines prevented symptomatic illness in the controlled environment of clinical trials. “Effectiveness” refers to how well a vaccine works to prevent negative health outcomes, including asymptomatic transmission of illness, in the real world. 

Scientists are working to gather effectiveness data as the vaccines are deployed, but for comparison’s sake, flu shots have an effectiveness of 40 to 60 percent most years. They’re still an incredibly powerful public health intervention: They prevented approximately 7.5 million illnesses, 105,000 hospitalizations and 6,300 deaths in the United States during the 2019-2020 flu season. That’s why the FDA was prepared to consider authorizing COVID vaccines with efficacy levels as low as 50 percent—a vaccine needn’t be perfect to significantly reduce negative health outcomes. Because the Pfizer and Moderna vaccines had such high efficacy (about 95 percent each), we can expect both to have higher effectiveness than the flu vaccine. And, a key takeaway from the clinical trials is that both vaccines should help prevent serious illness that leads to hospitalization and death.

Once community leaders have the information they need, the experts must step back and let those leaders do the communicating. It’s not fair to a group that has a good reason to fear the medical community to be told what to do by an outsider, nor is it effective.

It’s also important for hesitant people to see other people getting vaccinated. On Twitter, medical professionals have been showing pictures of themselves after each dose. It helps to see that people are getting vaccinated and they’re able to go on with their daily lives. And, because these are people who are in contact with COVID, seeing how urgently they want the vaccine helps communicate the real choice here—the choice between getting the vaccine and the risk of serious illness or death.

The hesitant also need to see people who look like them—who have similar exposures, medical histories and family histories—get vaccinated and witness the safety of it. If you get the vaccine and share your experience on social media, that can make a positive difference in your own social network.

It will probably take until late 2021 for the vaccine to allow us to “get back to normal,” because before that, not enough people will be vaccinated. Expedited manufacturing and better deployment of the physical allotment will get us to a better place. But, we need as many people as possible to want to get the vaccine, to feel comfortable enough to choose to be vaccinated. It is the job of public health leaders to figure out how to reach those who don’t and to find ways to address their specific fears and provide the information they need through messengers they trust. In the meantime, we must rely on tried and true individual practices that collectively make a big difference, like wearing high-quality masks and only leaving home for essentials.

Shoshana Fishbein ’17, who was a public health and psychology double major at Muhlenberg, has a master's in public health from George Washington University and is a senior associate at a global communications agency the CDC has contracted to assist with vaccine communications.