As scientists around the world rush to find a vaccine to put an end to the death and economic destruction wrought by COVID-19, age-old fears and mistrust have been given a new lease of life. It didn’t take long after the first cases of coronavirus were reported for conspiracy theories and misinformation campaigns about the perceived danger of an eventual vaccine to begin circulating online. Perhaps unsurprisingly, these theories have bred reluctance to use a future vaccine against COVID-19 and this is a problem that may affect us all. This raises the question: How do you convert people who believe unproven theories over the informed advice of medical doctors and public health authorities?
Dr. Jonathan M. Berman, a researcher who studies the anti-vaccination movement answers this question in his new book, ‘Anti-vaxxers: How to Challenge a Misinformed Movement’, in which he explores the history of the anti-vaccination movement, from its nineteenth-century antecedents to today's anti-vax activism, offering strategies for refuting its claims.
Dr. Berman is an assistant professor of basic sciences at New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, and one of the founders of the March for Science movement who describes himself as a “scientist, science educator, and a science advocate”.
He was kind enough to take some time out of his day for this interview.
Q - Your book explores the historical precedents of anti-vax arguments. How did vaccine rumours emerge and spread before the era of social media?
In the past, people sent pamphlets, conducted influence campaigns, wrote letters to the editor, lobbied governments, wrote books, held rallies and drew political cartoons. Most of those are quite similar to what anti-vaccine activists do today, except their reach is perhaps broader than it was before. An unintended consequence of social media is that it allows us to isolate ourselves from sources of information that challenge our senses of identity. We can access memes, news stories, and anecdotes that continually reinforce what we want to believe and how we want to see ourselves. Anti-vaccine feelings emerge time and again for a lot of reasons, but it has much to do with fear, and control. Many people are wary of governments overreaching, or forcing medical procedures on them.
Q - What are the main reasons why the public may not trust a coronavirus vaccine?
The social distancing and lockdown measures we’ve had to implement due to SARS-CoV-2 have disrupted many people’s lives and businesses. Vaccine manufacturers and governments have done a poor job of communicating about the possibility of a vaccine, so people spreading conspiracy theories have been able to fill that space. In Russia, the Sputnik V vaccine was approved after promising tests, but only in 76 people. In the US there is a concern that Trump might pressure public health officials to issue an emergency use authorization for a vaccine.
Q - The public have been given mixed messages about the severity of the pandemic itself. Has the confusion the public faces when medical experts are forced to compete with political actors contributed to the anti-vaccine movement?
Most of the time political actors are on the side of medical experts because they recognize the importance of good governance. There are rare occasions where politicians have taken public anti-vaccine positions, like with the Five Star Movement in Italy. When politicians do come out against vaccination, or spread misinformation it undermines trust.
Q - Even before a vaccine has been approved, public health experts are watching as confidence in a hypothetical vaccine plummets — and they’re already trying to figure out how to win back the public’s trust. You argue in your book that 'people change their own minds; we can't do it for them.’ From your vantage point, how should health experts and governments engage with vaccine opponents?
It starts with having a solid communications plan. When they don’t say anything, other entities such as drug company CEOs, conspiracy theorists, and anti-vaccine activists fill that void. Fortunately many more people get vaccinated than surveys about doubts usually indicate, but right now we need transparency about study designs, a promise not to seek EUAs before completion of phase three trials, and other assurances that if a vaccine is approved it has gone through the appropriate process.
Q - You argue that effective pro-vaccination efforts should emphasize cultural aspects rather than battling social media posts. Could you kindly elaborate?
Parents look to what their neighbors, peers, religious leaders and family are doing when they make decisions about parenting. The assurances of a scientist who works at a large corporation, or for the government of a foreign country just aren’t necessarily very reassuring. People who understand the importance of vaccination can reach out to their trust networks, and show them how they feel and the importance of vaccination. One statement from your cousin might have more impact than a thousand statements from scientists.
Q - Complicating matters is the partisan nature of the public health crisis, as the use of masks was seen by a vocal minority of Americans as a political statement against Trump and as the administration has been accused of pressuring health agencies to expedite the vaccine-approval process. How warranted are those fears that politics is driving the Covid-19 vaccine?
So far I haven’t seen any evidence that the vaccine has been rushed, and it’s not immediately clear that there will be an effort to rush one. People are worried that it might happen because of the EUA for hydroxychloroquine, which more and more is being shown not to be effective, and for convalescent plasma, the data for which isn’t really in yet. It isn’t out of character for Trump to do anything he can to attempt to win (even if it endangers lives), but my hope is that the people in those agencies won’t be pressured.
Q - It seems that the anti-vaccine movement is a symptom of the larger issue, which is a real problem with a loss of trust in experts and expertise. What are the reasons behind ‘expert rejection’ and what is the best approach to deal with a crisis of confidence?
I think skepticism of expertise is necessary but not sufficient for vaccine denial. I see that as less that people are actively going out of their way to ignore experts (although that often happens), but more often people are evaluating the wrong people as experts. If you can select between two different people to listen to, and you don’t have any other reason to pick someone, you’ll pick the one who confirms the beliefs you already hold.
Q - Is vaccine hesitancy as widespread in low-income countries as it seems to be in high-income countries?
Worldwide the biggest rate limiting factor to vaccine uptake is availability. If vaccines are available, usually people will be vaccinated. In developed countries anti-vaxxers tend to be wealthier and live in suburbs. When we look at rates of vaccine hesitancy worldwide they tend to be higher than the rate of vaccine refusal.
Q - Has the anti-vaccine movement damaged the trust in the safety of a vaccine to such an extent that it could disrupt the eradication of the virus?
In either case it is unlikely that SARS-CoV-2 will be totally eradicated. We’ve only eradicated two diseases entirely: Smallpox, and rinderpest, which doesn’t affect humans. Smallpox took almost 200 years of vaccination to eliminate. We’re getting close with polio. The more likely scenario is that it becomes more rare over time, and we gradually succeed in eliminating endogenous transmission on a country-by-country basis. There are multiple vaccines being developed in different countries, so the story of treating the pandemic is going to be a long one before people should feel safe in crowds again. Even though some survey indicate skepticism of a future vaccine, I suspect that most people will want to achieve whatever level of immune protection they can get.