Vaccine hesitancy and how the healthcare community should respond

One felt like salvation. Two felt like progress. And now, with last month’s announcement of Johnson and Johnson obtaining the latest emergency use authorization (EUA) from the Food and Drug Administration (FDA), three feels like relief.

We have come a long way since my last blog post where I talked about the feasibility of an “October surprise”. The authorization and distribution of a vaccine is not the only milestone we have achieved since then. Tragically, according to the World Health Organization, we have lost over 536,000 fellow Americans and over 2.7 million people worldwide. The strategy going forward remains the same – everyone needs to follow Centers for Disease Control and Prevention (CDC) guidelines and vaccination rates need to increase. This EUA may just be the ticket to ramp this process up. That is, if people are willing to be vaccinated.

“Lack of trust in biomedical research can occur just as easily when you do not feel represented, protected, or understood by the research community.”

-- Luke Watson

I have previously touched on how vaccines are developed and why this short timeline for development and clinical trials does not concern the research community. And yet, that message is hard to relay to the general public and probably for good reason. The hyper-intense public focus on vaccine development is something that the scientific process rarely sees.

Although scrutiny of science is a fundamental tenet of scientific consensus and the advancement of healthcare broadly scientific consensus takes time. Data needs time to accumulate and hypotheses must be rigorously tested. Thus, the community rarely gets it right on the first try, and that is “not the best” look during a pandemic. For those outside of the scientific process, hearing frequent changes and updates to recommendations – from no masks to masks all of the time, for example – can be confusing. It is completely understandable why they are skeptical of expert opinions.

Vaccine hesitancy and a culture of “choose your own expert” has been around for a while. The classical example of this is the anti-MMR vaccine campaign, which arose from the fraudulent reports in the Lancet journal from Dr. Andrew Wakefield on the relationship between MMR vaccinations and autism rates. To a lay person, this is a medical doctor describing a situation where children were unnecessarily being put at risk for developing this neurological disorder, in arguably the most prestigious, peer-reviewed journal in the world. Regardless of the fact that this experiment lacked proper study design elements and that these data have been refuted by decades of follow-up research, some people still either cling to the study itself or hold up its failure as an example of the lack of rigor and reproducibility in vaccine research.

Over a period of decades, the scientific process worked. Someone put out an idea (albeit a very controversial and unethical one), and over a series of subsequent publications this idea was debunked. Consensus to reject this information formed through this process. However, in the short term, the reason this was such a huge scandal was that Dr. Wakefield was by all accounts a credible source (until proven otherwise) given his medical degree and the caliber of journal he published in, the Lancet, which is almost unmatched in age and in reputation for cutting edge scientific publications.

There are other, equally valid reasons for hesitancy in vaccinations and more broadly in healthcare. Maurice Hilleman, Ph.D. is considered the father of the modern vaccination movement, developing more than 40 vaccines in the middle of the 20^th century, including vaccines against measles, mumps, Hepatitis A, Hepatitis B and chicken pox. While he followed the ethical standards of the time, clinical trials for his vaccines relied heavily upon children in orphanages. By today’s standards, we consider children a vulnerable population, as they are unable to legally provide informed consent. The advancements under Hilleman were very much on the backs of people who could not advocate for themselves.

Lack of trust in biomedical research can occur just as easily when you do not feel represented, protected, or understood by the research community. Such is the case with the Black community, who have suffered horrible abuse in the pursuit of biomedical research during the 20^th century. A prominent example, but most certainly not the only instance, was the Tuskegee Syphilis Trials conducted in part by the CDC, where the progression of untreated syphilis was observed in hundreds of Black men.

Beyond this egregious ethical blight on the nation’s premier biomedical research institution, another factor for Black American’s distrust in research is their lack of representation in the process.

“It's important for people to see people looking like them, like themselves, who can be involved,” said Kizzmekia Corbett, Ph.D., the leading scientist at the National Institutes of Health who worked on the Moderna vaccine, in a CBS article. “If it's about women, or if it's about Blacks because it shows that you've got people who understand what you've gone through.”

The bad actions of the scientific community’s past necessitate spokeswomen like Dr. Corbett to ease apprehensions of a large portion of our population. As a scientist and public servant, she has earned my utmost respect for being in this role.

As this will be my last piece for the CGS Speaks blog, I wanted to leave a last note on compassion in science communication. In preparing for this article, I found a Q&A from Gavi: The Vaccine Alliance, one of Bill Gates’ international vaccination non-profit groups, that I believe brought up a good point. In her response to these questions, Heidi Larson, Ph.D., director of The Vaccine Confidence Project, implored those of us who are science literate to avoid casting aside the opinions and fears of others who have mistrust in the vaccination process.

I firmly believe that given our education and privilege, it is our responsibility to listen to and internalize people’s fears and try our best to be transparent and informative about why we think that vaccinations are an essential public health tool. It is also our responsibility to articulate who we believe to be trustworthy experts and why we believe them. What are the specific data they reference when making claims and how has it been reviewed in the community? Who knows, your personal touch may convince someone to join the vaccine campaign and bring the pandemic to a swift and complete end.