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Now & Next: COVID-19: why vaccine mistrust is growing

Posted on 19 November 2020

A vaccine is the world's best hope for recovering from COVID-19, but an increasing number of people say they wouldn't take one when it becomes available. As trust in experts and our political leaders decreases, this film explores the reasons behind the crisis and looks at what can be done to rebuild trust in vaccines. 

See Trust Matters for further information.

COVID-19: Why vaccine mistrust is growing

A vaccine is the world’s best hope of overcoming the Covid-19 pandemic.

More than twenty vaccines are in development, globally.

But as scientists move closer to success…

Possible breakthrough in the development of a coronavirus vaccine.

…there’s a problem. 

Freedom. Freedom.

A growing number of people say they won’t take a vaccine.

I don’t want to inject anything like this into my body.

This is linked to declining trust in scientific experts and political leaders. Problems brought into even sharper focus by the pandemic.

I call it Covid bollocks.

And fuelled by a spiralling infodemic.

Take off your mask.

Anybody who has trusted the President has been lied to and many people like my dad have paid with their life.

This crisis of trust could have catastrophic consequences. So, what can be done to rebuild trust in vaccines and to protect the world from future disasters?

All vaccine advocates need to be more tech savvy. We have science and evidence and right and fact on our side. 

This is the front line in the race to find a Covid-19 vaccine. Professor Jonathan Heeney is one of those leading the charge.

Professor Jonathan Heeney, University of Cambridge

It has very much been a race against time and sometimes I wish time could stand still.

The professor has been developing vaccines for over 25 years.

Professor Jonathan Heeney, University of Cambridge

Now we have representatives of those viruses that are closely related to SARS-1 or SARS-2.

But finding one to fight a virus which has brought the world to its knees, feels different.

Professor Jonathan Heeney, University of Cambridge

I do know people who’ve had Covid and it’s a terrible, terrible death. It is an agonising disease.

This project in Cambridge is about to begin clinical human trials and the stakes could not be higher.

Professor Jonathan Heeney, University of Cambridge

If we don’t have a vaccine, we will be stuck in this lifestyle of isolation, social distancing, masks for a long, long time.

For a vaccine to immunise populations effectively against Covid-19 around 70% of people need to be willing to take it. 

Professor Jonathan Heeney, University of Cambridge

Trust is absolutely critical. If only part of the population is on board we’re never going to bring this virus to its knees and control this epidemic. 

Choose your side. Choose your side. Choose your side. Choose your side.

But in the rich world especially polls suggest that persuading people to take vaccines may be as difficult as producing them in the first place. 

Are you going to take it?

No.

Are you gonna let your kids have it?

No.

What are they?

Liars.

Many of these protestors belong to a growing minority who believe a Covid-19 vaccine would actually be harmful to their health.

Do I worry about vaccination, this one in particular? Yes, definitely. It’s been rushed and imposed on us and I, you know, I want to have my choice and I don’t want to inject anything like this into my body and into my children’s body.

Some here see a vaccine as part of a wider Government conspiracy to exaggerate the dangers of Covid-19.

We do not consent. We do not consent. 

Many of these people have lost trust in their Government. 

Take off your masks. Take off your masks. 

I call it Covid bollocks. What do you call it?

Covid bollocks.

We want the truth and we will not give up until we get the truth.

We are not going to stand for being lied to by our Governments, by people that we should trust. They want us to trust us be we can’t trust them.

The views being expressed here are extreme and belong to a minority. The proportion of the global population opposed to vaccines generally is estimated to be well under 10% but anti-vaxxers, as they are often called, are a vocal minority and their views are increasingly influencing broader society. Distrust can be infections. A poll carried out in America in September found that only 36% of adults said they would take the vaccine when one becomes available with 64% saying they wouldn’t take one or weren’t sure. In another survey, under four-fifths of people in sixteen countries responded positively to the idea of taking a Covid-19 vaccine if proven safe and effective. 

Professor Heidi Larson, The School of Hygiene and Tropical Medicine

In the context of Covid, I think empathy is absolutely crucial.

Professor Heidi Larson is an anthropologist and a leading expert on why significant sections of the global population feel hesitant about vaccines. She says a failure to confront the root causes of vaccine hesitancy, as she calls it, is driving more of these people towards anti-vaccination views.

Professor Heidi Larson, The School of Hygiene and Tropical Medicine

The majority of the public that is questioning, they’re hesitant, they’re anxious. These are people who have genuine questions who are open to vaccination but are feeling they’re not getting their answers and then migrate more to the more anti end that seem more acknowledging their concerns, endorsing their concerns. 

Professor Larson argues that one of the historic problems has been a failure by the medical establishment to listen to the concerns of parents who have doubts about inoculating their children. 

Professor Heidi Larson, The School of Hygiene and Tropical Medicine

A lot of parents feel like they are being judged, called names for even asking questions and that’s not at all been helpful in trying to support people in their decision-making and positive sentiments towards a vaccine. It’s really fundamentally about trust, relational trust.

Breaking news. Testing has been paused for one of the leading candidates developed by Oxford University.

In September, a volunteer from a leading Covid-19 vaccine trial was admitted to hospital and the project was temporarily halted. Professor Larson says an opportunity was missed to build trust with the public.

Professor Heidi Larson, The School of Hygiene and Tropical Medicine

I wish, in the news, instead of just, “This is normal process, safety events happen, we’re taking care of it”, that the voice of a participant said, “I appreciate the care and the attention that the clinical team gave to me during this uncertain time.” The message is sent that there is a caring team, that they’re not just putting vaccines in people to count numbers and get to the perfect vaccine, that there is human empathy in this.

The medical and pharmaceutical professions have been far from immune to missteps during the history of vaccines and this has helped fuel today’s climate of vaccine hesitancy and opposition, not least the legacy of a British Doctor named Andrew Wakefield. In 1998 he published research in a highly respected medical journal claiming there was a link between a measles vaccine and autism. 

Wakefield and colleagues altered facts about patients in their studies.

But his research turned out to be highly compromised.

Studies have shown no connection between the MMR vaccination and autism. 

The journal eventually retracted the research and Wakefield was struck off the medical register in the UK in 2010 but many members of the public continued to see Wakefield as a credible expert.

This guy has been set up, it’s nothing but lies.

And millions across the world still have reservations about taking the measles vaccine. It’s symptomatic of a wider decline in trust in traditional experts and Governments in rich world countries.

Dr Jonathan Kennedy is an expert in global public health and has investigated the link between trust in Government and authorities and hesitancy about vaccines. 

Dr Jonathan Kennedy, Snr Lecturer in Global Public Health, Queen Mary University

In this class we are going to talk about the question of how to think critically about global health. 

Dr Kenney analysed voting data and surveys on public confidence in vaccines across fourteen countries. He found a broad pattern. Where levels of electoral support for populist parties were higher, levels of mistrust in vaccines also tended to be higher. 

Dr Jonathan Kennedy, Snr Lecturer in Global Public Health, Queen Mary University

Populist sentiment, this distrust of elites and experts isn’t just, isn’t just isolated in politics, the forces driving scientific populism are all very similar to those that drive political populism. 

Dr Kennedy argues there’s a strong relationship between vaccine hesitancy and political, social and economic crisis. At a time when trust between people and politicians has been breaking down, a number of countries have seen a resurgence of measles. 

You trying to punch me sir?

I did not.

How dare you.

Yes. You racist.

Dr Jonathan Kennedy, Snr Lecturer in Global Public Health, Queen Mary University

It certainly wasn’t a coincidence that the UK last summer lost its measles-free status.

How about that.

Dr Jonathan Kennedy, Snr Lecturer in Global Public Health, Queen Mary University

At a time where there was massive conflict over Brexit.

During the Covid-19 pandemic the response of Governments has further decreased trust in public health experts and politician, not least in some countries with populous leaders.

If test and trace isn’t improved significantly there could be a second wave.

In Britain, under Prime Minster Boris Johnson’s leadership public health guidance has changed constantly and confusingly.

We’re constantly working to improve that delivery system, buying PPE from around the world. 

Creating a sense that the Government is failing and incompetent.

In a huge policy reversal affecting hundreds of thousands of pupils.

What’s more, senior political figures have failed to follow their own health guidelines. Trust in the British Government as a reliable source of information about coronavirus fell from 67% in April to 44% in August. 

Don’t let it dominate you. Don’t be afraid of it. 

In America, false information about the virus has flowed from a President whose contempt for truth has done more than anything else to sow distrust in politicians and experts.

One month ago today, President Trump said that the coronavirus was “dying out.”

I’ve read a lot about Hydroxy. I happen to think that it has an impact and then I see the disinfectant, it knocks it out in a minute.

Researchers at Cornell University analysed 38 million English language articles about the pandemic. They found President Trump was the single largest driver of misinformation around the Covid-19. 

This is me and my mum and my dad in New York the day I graduated from college.

For some, this has had lethal consequences. In June, Kristin Urquiza lost her father, Mark, to Covid-19. 65 year old Mark was a lifelong Republican voter and Trump support from Arizona. He died after Arizona’s Governor reopened the State, encouraged by the President. 

Kristin Urquiza

When the Governor and the President went around pushing a reopening strategy and by saying to the public it was safe if you didn’t have an underlying health condition it was safe to go out, resume normal activities. My dad listened and thought it was safe. 

Mark contracted Covid-19 after visiting a karaoke bar. His daughter says placing trust in his political leaders proved a fatal mistake.

Kristin Urquiza

Both the President and the Governor of Arizona are on record through that time downplaying the virus. Anybody who has trusted the President has been lied to, has been misled and many people like my dad have paid with their life as a result. 

While the actions of populist politicians have undermined trust in public health advice and institutions there is another factor which has driven this trend, the unprecedented speed at which misinformation can spread. 

In February, the World Health Organisation warned of twin dangers: a global pandemic but also an infodemic, a crisis in accurate public health information.

These insufferable globalist elitists like Bill Gates. He tells us we need a nationwide shutdown for months?

This Foundation is leading the charge to lower the world’s population.

Much of this infodemic is concentrated online. Social media users who may not hold strong views about particular issues can rapidly be exposed to misleading and extremist content. 

Folks, I think they’re trying to force a vaccine on all of us.

Neil Johnson is a Professor of Physics at George Washington University. His research shows how fake news can gain the upper hand in the online battle for hearts and minds.

Neil Johnson, George Washington University

What we expected to find was that there’d be a core of communities, maybe public health agencies, that were promoting vaccines and establishment health thinking and that around this central strong core there’d be other opinions, sort of extremes, but that’s not what we found, we found that that was actually sort of inside out. 

Professor Johnson’s team mapped conversations on Facebook about vaccines between 100 million people all over the world. They discovered that misinformation was exerting more influence than accurate information. 

Neil Johnson, George Washington University

In some sense it’s almost like a network of trust and if they flipped either way of course they could become red, they could become blue and that completely changes the battlefield.

On this battlefield map, red represents Facebook pages and members with anti-vaccination views and their spread over time. Blue represents pages and members with pro-vaccination views while green signifies the all-important groups of people who are undecided. The undecided greens are more engaged with the red anti-vaccination clusters than the pro-vaccination blues. 

Neil Johnson, George Washington University

The reds, they are completely entangled with the greens, the not sures, the communities of pet lovers, parents groups, organic blueberry lovers, the ones that can tip the balance one way or the other. The worry is, as we see the greens and the reds entangle, what we’re really seeing is a beginning of an entanglement of trust away from establishment science. Trust is the glue because in the end when we trust the community, if they happen to start talking about vaccines which is something that I don’t ordinarily think about, I will follow them in their thinking. 

This entanglement matters. Researchers found that online exposure to recent misinformation about a Covid-19 vaccine may significantly affect intent to take one and Professor Johnson believes this kind of content will continue to spread online with the result that anti-vaccination sentiment could become the majority view.

Neil Johnson, George Washington University

Within a few years red, with the concerned greens, will rise to essentially dominate that space and it will be very hard to reverse that so something different needs to be done now. 

Social media platforms have increased their efforts to stop the spread of untruths about vaccines and Covid-19. In April, Facebook put warning labels on about 50 million pieces of content related to the virus. The platform partnered with reliable sources like the WHO and the NHS and in October, Facebook banned anti-vaccine ads yet campaigners argue the platform isn’t going far enough and is failing to take down the majority of harmful content about vaccinations. More broadly, Facebook’s own algorithm undermines efforts to stem the tide of the infodemic says Fadi Quran from the online political campaign group, Avaaz. 

Fadi Quran, Campaigns Director, Avaaz

Facebook’s algorithm is sabotaging the efforts of the platform to fix the misinformation problem. It cares about keeping individuals engaged, interested and online, sensationalist, outrageous content, not the CDC guidelines but QAnon, for example, gets more engagement and hence the algorithm pushes it up in your news feed.

One solution might be to detoxify the algorithm.

Fadi Quran, Campaigns Director, Avaaz

What Facebook isn’t doing is redesigning its algorithm, redesigning its business model to ensure that it’s not continuing to amplify this content and this does not mean that the algorithm should be designed to censor content, it just means that the algorithm would downgrade instead of putting this malicious content at the top of one’s news feed, the platform would make sure that it is at the bottom of the news feed. Social media platforms could save lives. They have the power. This is a problem that Mark Zuckerberg and Jack Dorsey could literally say “We’re going to solve this right now.”

Yet redesigning algorithms and tightening regulations on tech companies is unlikely to get to the root causes of mistrust in vaccines. To do that, health bodies and experts will need to be pro-active about building relationships with the public, in person and especially online. 

According to doctors at this paediatric practice in Pittsburgh, the key to tackling distrust and misinformation is to fight fire with fire.

Hello, it’s a yucky doctor coming in. How are you guys doing today?

Good, how are you?

I’m doing okay.

While it might look like any other children’s surgery, the Kids Plus practice has its own in-house video production suite getting messages out to patients constantly and quickly. 

Chad Hermann, Communications Director, Kids Plus Paediatrics

The vaccine advocates are online using our voices, not the same way we are in the office, we’re saving lives. We’re protecting them against mistruths and disinformation that can literally kill people. I think all vaccine advocates need to be more tech savvy.

Kids Plus routinely post evidence based videos and information about vaccines on all major social media platforms. 

I’ll start things off until we see our questions start rolling in again. Hello to TikTok, hello to Facebook Live. 

And this presence allows them to respond to questions from parents and families who feel uninformed and concerned. 

Chad Hermann, Communications Director, Kids Plus Paediatrics

Our parents, our families, are living their entire lives right here, on their phones, on their tablets, on their laptops, their desktops. If people hear good evidence based information before they hear the mis and disinformation, that mis and disinformation is much less likely to affect them. What you are essentially doing is inoculating them against that bullshit before it can take root in them. 

These doctors also argue that it’s vital to take on the stream of highly organised and targeted viral attacks from anti-vaccine forces. 

Chad Hermann, Communications Director, Kids Plus Paediatrics

The reality of online vaccine advocacy right now is if you post it, they will come. The anti-vaxxers will find you and they will attack you. They want to terrorise providers into silence.

It’s a challenge the practice knows all about.

Together, we can prevent cancer in your children.

In 2017, Kids Plus released a video promoting an HPV vaccine that prevents cancer and faced a barrage of hostility.

Chad Hermann, Communications Director, Kids Plus Paediatrics

They attacked our post, they attacked our Facebook page, they attacked the private pages of our families and our patients who defended us on our post, they came right after our reputation.

Kids Plus has since created a toolkit for health professionals and built a digital cavalry of global vaccine advocates who can quickly come to the aid of those under fire from anti-vaccine forces. Now, as a vaccine for Covid-19 grows closer, Kids Plus and its self-styled keyboard crusaders, are steeling themselves for a bitter but all important new fight.

Chad Hermann, Communications Director, Kids Plus Paediatrics

There is no vaccine yet, there is no herd immunity for Covid and look, this is what life is like without herd immunity, this is what life is like without vaccines.

Past evidence suggests some people could end up taking vaccines after saying they might not but herd immunity to Covid-19 may require around 70% take-up of a vaccine and just a six percentage point decline in acceptance could endanger this goal and for many, alarm bells are ringing.

Chad Hermann, Communications Director, Kids Plus Paediatrics

We’re losing in large part because the anti-vaccine forces are much more passionate and organised than we are. There are far fewer of them than there are of us. We have science and evidence and right and fact on our side. That’s how we win. 

Hello, I’m Slavea Chankova, The Economist Healthcare Correspondent. If you’d like to learn more about the race to develop an effective Covid-19 vaccine, click on the link opposite. Thank you for watching and please don’t forget to subscribe. 

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