Vaccine programs depend on public confidence, but trust is falling fast. One of the leading experts of vaccine confidence warned that without better science and a major shift in vaccine communications, vaccine programs could lose their most important supporters: doctors.
Dr. Heidi J. Larson heads the Vaccine Confidence Project (VCP) at the University of London’s London School of Hygiene and Tropical Medicine. The project aims to analyze concerns about immunization, and steer the public toward sustained confidence in vaccine programs.
At the last World Health Organization (WHO) Global Vaccine Safety Summit in Geneva in December 2019, Larson said that confidence in vaccines is waning.
“We have absolutely different publics than we did 10 years ago,” Larson told the summit attendees, which included leading figures in vaccine programs and research. “They’re demanding much more engagement. Much more answers.”
When the vaccine schedule included just six vaccines, Larson says the public was on board. But over the years, something changed. As the number of vaccines climbed, public support began to shift rapidly.
In order to get some sense of the rise in vaccine skepticism, Larson worked with scientists at George Washington University to analyze various vaccine groups on Facebook: from supporters, to the undecided, to those totally against vaccinations. They noted that those who raised concerns about vaccines recruited the undecided 500 percent faster than the positive vaccine community.
“That’s fast, and this is not hypothetical. These are real communities,” she said.
A part of the problem, she said, is the current public relations strategies being used to address the vaccine-questioning community. To date, the government, medical community, and media have largely dismissed anyone raising questions about vaccine safety as conspiracy theorists—anti-vaxxers—worthy of ridicule and dismissal.
Larson said the situation needs to change.
“One of our biggest challenges I think now is getting rid of the term ‘anti-vax,’ getting rid of the hostile language, and starting to have more conversations, to be open to questions to make people feel like they shouldn’t be judged when they’re asking questions, as crazy as those questions might seem.”
Concerns about vaccines have grown even as the number of vaccines on the schedule has ballooned to more than 40. Those concerns come from many sources, including distrust in the pharmaceutical industry, which has become the most poorly perceived industry in the United States, according to a 2019 Gallup poll. The reputations of pharmaceutical companies have plummeted due to the opioid crisis and ongoing drug scandals. The internet has also fed mistrust as vaccine critics share information on vaccine safety.
In response, internet companies, including Google, Amazon, Facebook, and Twitter, have tried to unlist or hide content that suggests vaccines as anything less than safe, effective, and essential for public health. That move has further infuriated vaccine activists, many of whom have painstakingly compiled detailed information about the regulatory and approval process for vaccines and their available safety data.
Larson says the biggest problem isn’t misinformation, but the seeds of doubt. People have legitimate questions about safety and the ingredients found in vaccines, and they don’t feel like their questions are being adequately addressed.
“Our problem, as we’ve heard in the last 48 hours, is that there is not anything that is 100 percent. What actually, legally, without creating a censorship thing, can we absolutely say this is misinformation? Because we have a lot of ambiguity in the safety field, and we have to come to terms with that. So we have to think about it differently than deleting misinformation, but building trust, so people are willing to put up with a certain amount of risk because they believe in it enough,” she said.
The challenge is how to directly address people’s concerns without shutting down dialogue, she said, as it’s hard to trust anyone when they look like they have something to hide.
To carry out that strategy, Larson advised a shift away from labels toward engagement. And to better answer questions about vaccines, there also needs to be better science around vaccine safety, she said.
“There’s a lot of safety science that’s needed. And without the good science, we can’t have good communication. So although I’m talking about all these other contextual issues, and communication issues, it absolutely needs the science as the backbone. You can’t repurpose the same old science to make it sound better if you don’t have the science that’s relevant to the new problem. So we need much more investment in safety science.”
One major issue is the comparable lack of safety testing that vaccines are subjected to compared to pharmaceuticals, despite that vaccines are administered to infants at critical stages of development with relatively weak immune systems.
Vaccines are classified as biologics rather than drugs. For that reason, they aren’t put through double-blind placebo testing as drugs are, and vaccinated populations aren’t compared to unvaccinated populations, which would provide assurance that vaccines don’t cause secondary illnesses or compromise immunity to other diseases.
One of the groups hardest hit by this lack of science and growing public distrust is doctors. Despite repeated assurances from the Centers for Disease Control that vaccines provide enormous benefit with minuscule risk, it falls to doctors to defend vaccines. Studies show that the people the public trusts most with this subject are their health care providers. And Larson says that if doctors can’t defend the safety of immunization, public support inevitably weakens.
That’s an urgent problem, noted Larson, because there is a trend now of health care providers losing confidence in vaccination.
“We have a very wobbly health professional front line that is starting to question vaccines and the safety of vaccines. That’s a huge problem,” she said.
Larson said health care professionals often lack the confidence to deal with patients raising specific concerns about vaccine safety. That may be in part due to the lack of training doctors and nurses receive about vaccines.
“In medical school, you’re lucky if you have a half-day on vaccines, never mind keeping up to date with all this,” she said.
The collapse of public confidence in vaccines comes even as vaccines become more critical to public health, she says. That’s because the natural immunity that people had developed to many diseases hasn’t kept up with the diseases themselves, and in some cases has even waned.
Larson says we now rely on vaccines more than ever, because our collective immunity isn’t what it used to be.
“We have shifted the human population to dependency on vaccine-induced immunity, and that’s on the great assumption that populations would cooperate,” Larson said. “We’re in a very fragile state now. We have developed a world that is dependent on vaccinations. We don’t have a choice but to make that effort.”
Larson didn’t respond to a request for more information as of press time.