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Averting a COVID-19 vaccination crisis will take careful communication


President Donald Trump’s relentless talk about interference with the COVID-19 vaccine approval process is setting the stage for a vaccination crisis. 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.

In May, 72 percent of people said that they would get vaccinated, according to a Pew Research Center survey. By September, only half of people said that they would. That drop is partly driven by the swirling drama around the still-unproven vaccines. Data and study protocols that normally wouldn’t draw much attention are subject to intense scrutiny.

Now, many people who are normally comfortable with vaccines say that they’re worried. They think the process is being driven by politics, not science. They’re concerned that the Trump administration is pressuring federal agencies to authorize a vaccine before there’s enough testing to show that it’s safe or that it works.

It’s still early days, and vaccine development is still in progress. It seems to be unfolding appropriately — at least so far — and it’s still too soon to say what might happen after initial data from the trials is released by pharmaceutical companies. But the drop-off in confidence before a vaccine is available still concerns public health experts. A vaccine won’t be able to help protect people if they don’t take it. If too many people refuse, the population won’t be able to build herd immunity.

Fortunately, there will likely be a long lag between vaccine authorization and the time when most people will actually have the option to get a vaccine. That gives experts room to analyze the data and, if it’s warranted, alleviate some of those fears, says Melanie Kornides, an assistant professor at the University of Pennsylvania School of Nursing who studies vaccine hesitancy. They’ll probably handle it similar to how they handle parents who are scared of the measles vaccine. “We need to address people’s concerns, and talk about the benefits of vaccination,” she told The Verge.

This interview has been lightly edited for clarity.

How warranted are those fears around a politically motivated push to bring a vaccine out too quickly?

I think that we need to remember that a vaccine hasn’t come out yet, and that’s because they haven’t finished safety and efficacy testing. If people are concerned that it’s maybe being pushed through too fast, that hasn’t played out yet because we don’t have a vaccine. I think that we can be confident in communicating that scientists and pharmaceutical companies are taking the right approach of balancing safety and efficacy testing with wanting to end a very dangerous and deadly pandemic as quickly as possible.

Is there a difference between hesitancy around a COVID-19 vaccine and the hesitancy around childhood vaccinations, like the measles vaccine?

I think that there are actually a lot of similarities between the hesitancy that we’re seeing around the COVID-19 vaccine and the normal vaccine hesitancy that we see around childhood vaccinations. As I’m looking at things that people are saying on social media about the COVID-19 vaccine, we see a lot of the same things that people tend to express about childhood vaccination. Those include worries that it’s not effective or worries about unknown, long-term side effects. There are worries that it’s pushed through for commercial profit or to make the government look better. And to some extent, we see with childhood vaccinations this belief that natural immunity might be safer and better, and we’re seeing a little bit of that too with the COVID vaccine.

But the big difference is that this is much more widespread. Many people are saying that they normally get vaccinated and they normally accept vaccines, but they have particular concerns about this vaccine.

Have we seen similar things before, when people who are usually comfortable with vaccines balk at one?

My research before this was really focused on hesitancy around the HPV vaccine. It’s really similar because, like the COVID vaccine, a lot of parents that choose not to vaccinate their children for HPV are not anti-vaxxers. They just say they have these worries that maybe the HPV vaccine wasn’t thoroughly tested, or they’ve seen something on Instagram or Twitter saying that there have been negative side effects that are being taken seriously. You get these parents who are hesitant but, in general, are not anti-vaxxers.

Will the same strategies we use to overcome those worries with HPV vaccines work for a hypothetical COVID-19 vaccine? Are they different from the way you’d talk to someone who is stridently anti-vaccine?

In general, it’s just much harder to convince somebody who has really strong beliefs that vaccinations are dangerous to move over to the pro-vaccine camp. What we do with parents and children is we try to appeal the idea that everybody cares about their child and wants what’s best for their child. It’s about explaining or making them understand that, even though we don’t see these childhood illnesses anymore, they’re very dangerous, and they’re very deadly.

There’s lots of studies showing that the important thing is the trust in the person who’s giving the information to you. I think with COVID-19, what’s going to be important is making sure that health care providers have been really well-trained in communicating the safety and efficacy and importance of the vaccine. That is what goes a long way.

If most of the people who say they won’t get a COVID-19 vaccine are normally okay with vaccines, does that make it easier to help them understand why they should actually take it?

Absolutely. A lot of it is going to depend on how well the safety and efficacy of the vaccine is communicated through the media, through the pharmaceutical companies, and then also through health care providers. But assuming that we do a good job of that, I think that it will move the needle, and a lot of people that are saying they won’t get vaccinated will move over.

If the worst-case scenario does happen — a vaccine actually does get authorized without scientists feeling confident in the data, and there are negative side effects — what might happen?

I think that would definitely be damaging. We have had instances where vaccines have been pulled from the market because they weren’t as safe as the initial safety data suggested. When that happens, it’s usually that the number of negative outcomes is small, but on a population-level, you want to prevent that.

Ideally, hopefully, they’ll have several vaccines around the same time — so if one has to be pulled, the others will continue to be safe and effective.



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