COVID-19 Is a Perfect Storm for Vaccine Skepticism
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In March, when a woman in Seattle volunteered for a COVID-19 vaccine trial, rumors immediately began circulating that she was a crisis actor who had received a fake vaccine. She is, in fact, real, and so is the prospective vaccine she got, as the Associated Press asserted in a follow-up story. In Oxford, England, another volunteer for a separate COVID-19 vaccine trial became the subject of a fake news story that purported she had died after a shot. She too was forced to clarify the situation: She is very much alive.
There is no COVID-19 vaccine, but there are already COVID-19 vaccine conspiracies. Even as vaccines for the disease caused by SARS-CoV-2 are being held up as the last hope for a return to normalcy, misinformation about them is spreading. A more fraught scenario for science communication is hard to imagine: a novel vaccine, probably fast-tracked, in the middle of a highly politicized and badly mishandled pandemic.
“I was initially optimistic that, when people felt the need for a COVID-19 vaccine, the anti-vaccination movement would undergo a period of retreat,” says Peter Hotez, a vaccine scientist at Baylor College of Medicine, who has himself become a frequent target of vaccine skeptics. “It’s actually had the effect of reinvigorating the anti-vaccine movement.”
Hotez points to a number of recent missteps that have given vaccine skeptics ammunition: unrealistically rosy timelines for a vaccine; the appointment of a former pharma executive with $12.4 million worth of vaccine-company stock options to lead the White House’s new vaccine initiative (he is now divesting); even the name of the Trump administration’s vaccine initiative itself, Operation Warp Speed. “A ridiculous metaphor,” Hotez says, “that plays right into the hands of the anti-vaccine lobby” by emphasizing swiftness rather than safety.
But the U.S. government has mismanaged the broader COVID-19 response too—including the Centers for Disease Control and Prevention’s botched testing plan and the flip-flopping on face masks and the president’s continued boosting of an unproven drug. “How people think about vaccines is very much going to depend on their trust relationship,” says Heidi Larson, an anthropologist and the director of the Vaccine Confidence Project. “Governments can either totally mess up, and they’ll lose their confidence in government and therefore when a vaccine comes along they’re not going to trust it. Or [governments] can do a pretty good job and that will help boost confidence.” The ultimate legacy of this pandemic, then, could be a broad erosion of trust in authorities, endangering public-health efforts into the future.
It’s happened before. The 1976 campaign to vaccinate “every man, woman, and child” during a swine-flu outbreak is discussed ruefully in the official chronicles of the CDC and the World Health Organization. In February of that year, a young soldier in New Jersey died after being infected with a new form of flu, which scientists at the time believed was related to the 1918 flu. Fearing another pandemic, the government drew up plans for a mass vaccination campaign. President Gerald Ford was photographed getting his shot at the White House.
To get vaccine manufacturers on board, the government agreed that the companies themselves would not be liable for bad reactions to the vaccines. “Its unintended, unmistakable subliminal message blared, ‘There’s something wrong with this vaccine,’” the government officials in charge of the program wrote decades later. “This public misperception, warranted or not, ensured that every coincidental health event that occurred in the wake of the swine flu shot would be scrutinized and attributed to the vaccine.” When vaccinations of the public did begin, doctors noticed an uptick in cases of a rare neurological disorder called Guillain-Barré syndrome that is usually associated with an infection. At least 25 people died. By the time the vaccination campaign was suspended, 45 million Americans had gotten the shot. Meanwhile, the feared pandemic never came, and the episode went down as a debacle that damaged government credibility. Today, decades later, vaccine skeptics still bring up the specter of Guillain-Barré syndrome.
The 1976 flu vaccine, like every seasonal flu vaccine, was at least based on a previous version, tweaked to protect against the current year’s strains. A COVID-19 vaccine, in contrast, would be completely new. “With vaccines, unlike many other products—like iPhones—novelty is not necessarily a desirable characteristic,” says Bruce Gellin, the president of global immunization at the Sabin Vaccine Institute. Although vaccine researchers have been able to leverage research on related coronaviruses that cause MERS and SARS to get a COVID-19 vaccine into clinical trials quickly, no human coronavirus vaccine has ever been approved. The novelty of such a vaccine could make even people without reservations about other vaccines hesitate.
A COVID-19 vaccine would also enter a world where the pandemic itself has been deeply politicized, where simply wearing or not wearing a mask, for example, can be seen as a political act. In 2017, Asheley Landrum and Dan Kahan wrote a paper considering the introduction of Gardasil, the vaccine for the human papillomavirus (HPV), in what they called a “polluted” science-communication environment. Gardasil was fast-tracked for approval in 2006, which at first limited its use to girls and young women, for whom the risk of cervical cancer from HPV warranted an expedited process. But this choice also landed the vaccine in the middle of a culture war over the sexuality of young girls. (Six years and much controversy later, Gardasil was also approved for males in 2009.) “It’s a great example of something that didn’t have to be politically polarizing, but because of the way it was introduced into the public sphere, you have political polarization,” Landrum says. “It’s clearly the same thing that happened here with COVID-19.”
Vaccine skepticism is not especially partisan, and it draws from elements of both the left and the right. But the politicization of COVID-19 could affect skepticism of a COVID-19 vaccine asymmetrically. A recent Reuters/Ipsos poll found that 24 percent of Americans have little or no interest in getting a coronavirus vaccine. When asked about a scenario in which President Trump affirmed that the vaccine was safe, 14 percent said they would be more interested, but 36 percent said they would be less interested.
How exactly a COVID-19 vaccine will be received is likely to depend on its perceived risks and benefits, which will depend on its effectiveness and the point in the pandemic cycle at which it arrives. The 1976 vaccine debacle was, after all, exacerbated by the fact that the feared flu pandemic didn’t happen; the risks of the vaccine clearly outweighed the benefits.
“Expectations are astronomically high as vaccines are now positioned as the only way we can get back to normal,” Gellin says. “If they aren’t 100 percent effective, or are significantly less, there is bound to be disappointment, and that might also extend to perceptions about vaccines more generally.” While most childhood vaccinations such as those for measles and polio are more than 90 percent effective, the seasonal flu vaccine is usually only 40 to 60 percent effective. You can still get the flu—if probably in a milder form—after you get a flu shot. This is one of the reasons why convincing people to get flu vaccines is so hard in the first place. Because of how the coronavirus infects the respiratory tract, and how immunity against coronaviruses specifically works, a COVID-19 vaccine might mitigate but not prevent the disease.
The less protective the vaccine is, the more difficult it may be to encourage uptake. This could be especially true for children, who are unlikely to get seriously ill from COVID-19. Neil Johnson, a professor at George Washington University, who has studied vaccine discussions on Facebook, says the recent online conversation has often turned to concern for kids. For example, he says, “If my child is only going to get a red toe or possibly a sore throat, then why should I run that risk?”
The vaccine’s timing could affect its reception too. Larson, whose Vaccine Confidence Project has been regularly surveying people in Europe throughout the pandemic, says the numbers have changed slightly over time: In mid-March, 7 percent said they would refuse to get a COVID-19 vaccine, which dropped to 5 percent two weeks later, when COVID-19 deaths spiked, and rose to 9 percent when talk turned to loosening lockdowns. “The public is in general pretty sensible in how they make their decision, and they are weighing their different perceived risks or benefits,” she says. If the pandemic seems as if it’s waning, fewer will be willing to take a chance on a new vaccine.
In recent years, experts have attributed the rise in vaccine hesitation, ironically, to the fact that vaccines have been too successful. We rarely see what happens when we don’t vaccinate. The COVID-19 pandemic has given us a visceral reminder of what it’s like to live with a disease with no cure and no vaccine—and perhaps this, some suggest, could scare parents into vaccination.
Or it might not. “How quickly do we forget?” wonders Matt Motta, a political scientist at Oklahoma State University. “How long does it take for us to say, ‘Okay, that wasn’t so bad’?” By the time a vaccine is on the market, the worst of the coronavirus crisis may very well be over. The strictest shelter-at-home restrictions will likely be lifted too. All the misinformation aside, a vaccine, instead of being like a savior, may feel like too little, too late.