The Secret to Addressing Vaccine Hesitancy

I originally published this essay three years ago in GreenMedInfo and The Defender, but I think it’s worth revisiting. Because the secret to addressing vaccine hesitancy is also the secret to addressing many of our problems.

There’s a lot of talk about the threat “anti-vaxxers” pose to public health and what should be done about them. Last year, the World Health Organization (WHO) named vaccine hesitancy one of the top 10 global health threats alongside Ebola, HIV and antimicrobial resistance.

The mainstream media kicked into high gear as it bemoaned the stubborn and growing population of people who were unwilling to roll up their sleeves. As a result, some health officials and legislators have started recommending punitive measures, like preventing vaccine refusers from receiving public education, getting on airplanes or entering restaurants. Others want to consider criminalizing the sharing of what they consider “vaccine misinformation.”

On community Facebook pages, posts deemed to be dangerous conspiracy theories are taken down and people mock and vilify their own neighbors if they dare to question the “safe and effective” vaccine narrative.

Organizations like the New Jersey Public Health Association have even enlisted the help of Joe Smyser and the Public Good Project (PGP) to use algorithms to help make sense of these resistors. PGP’s Project, Vaccine Communication Tracking & Response, uses artificial intelligence monitoring to collect and analyze publicly available media data in the hopes of amplifying pro-vaccination messages. PGP encourages the use of influencers and social media to better access specific populations.

It’s Stronger campaign takes a more aggressive approach. The organization claims to be “the first vaccine advocacy campaign to focus on the root cause of vaccine hesitancy — misinformation.”

According to PGP’s  website, “exposure to vaccine opposition content grew 60% during COVID-19” (and that data appears to be from May). They consider this “misformation” to be directly responsible for a considerable drop in vaccine compliance. Their solution is to recruit people to fight back by blocking and reporting people from social media feeds, making comments, such as “not true” to invite others to be skeptical, and following “experts” like Tom Freiden, former director of the Centers for Disease Control and Prevention, and WHO director, Tedros Adhanom Ghebreyesus.

Another organization, Shots Heard Round The World, describes itself as a “digital cavalry dedicated to protecting the social media pages of health care providers and practices.” Founded by pediatrician, Todd Wolynn, the organization’s motto is “When Anti-Vaxxers Attack, We Fight Back.” These practitioners describe the vaccine-hesitant as “anti-science, anti-vaxx terrorists” and offer a downloadable toolkit for fighting back.

But treating those who challenge the vaccine paradigm like the enemy is unlikely to enlist the cooperation of parents or promote vaccine confidence. And Stronger.org may have missed the mark with its misinformation claims.

Other public health authorities are finally beginning to acknowledge that resolving vaccine hesitancy is more than a matter of messaging. And some even lend legitimacy to the concerns of reluctant parents.

At the 2019 Global Vaccine Safety Summit, Dr. Heidi Larson, director of the Vaccine Confidence Project, acknowledged:

“There’s a lot of safety science that’s needed and without the good science we can’t have good communication … you can’t just repurpose the same old science to make it sound better if you don’t have the science that’s relevant to the new problems. So we need much more investment in safety science.”

WHO’s chief scientist, Dr. Soumya Swaminathan, seems to agree. At the same event, she said, “I don’t think we can overemphasize the fact that we really don’t have very good safety monitoring in many countries, and this adds to the miscommunication the misapprehensions because we’re not able to give clear-cut answers when people ask questions about the deaths that have occurred due to a particular vaccine. And this always gets blown up in the media.”

Given this, perhaps it’s time for a different approach. So far, virtually every attempt to address vaccine hesitancy has relied on denial, dismissal, censorship, shaming and even coercion, and most have resulted in louder voices and a growing number of people asking questions.

If our legislators and public health authorities are truly concerned about improving vaccine compliance without resorting to coercion, they will have to stop and examine the concerns of the vaccine-hesitant.

Here are some ways that public health agencies and media can begin a process to restore trust in the vaccination program:

1. Ditch the name-calling and gaslighting 

For starters, the term “anti-vaxxer” is misinformation, as most of these people start out believing that vaccines are the public health panacea they claim to be. “Pro-Informed Consent” is a much more accurate designation, which is why this community is so active in sharing what they know about adjuvants, clinical trials, legislation and science related to vaccines.

The majority of these people simply believe that people have the right to do their own risk/benefit analysis before injecting something into their bodies. Many, if not most, of these people have received vaccines and have given at least some to their children. Some continue to give vaccines, but want to do so on their own terms, while still others simply oppose vaccine mandates. At some point, most of them have witnessed vaccine injury with their own eyes or heard accounts of adverse events from people they trust. For some, there’s an undeniable and direct connection while others carry suspicions that are gradually confirmed as they read studies and learn more about vaccine ingredients. Many are mothers who have suffered profoundly and are still healing from the guilt of ignoring their own instincts and subjecting a child to harm. While insults and ridicule may successfully silence people temporarily, those same people tend to learn very quickly that there’s no science behind those insults and they’re often motivated to learn more.

2. Stop using fear

At a 2017 panel entitled “Communicating Vaccine Science and Advancing Vaccine Impact,” pro-vaccine advocate and co-inventor of the rotavirus vaccine, Paul Offit asserted that “fear sells” and suggested that an outbreak was the most successful way of bringing about vaccine compliance. But fear works both ways. And as more people learn about the real risks associated with vaccines and cultivate a deeper understanding of the immune system and its ability to navigate common childhood infections, fears become focused on the potential harm of neurotoxic adjuvants and a rapidly growing CDC-recommended vaccination schedule. Furthermore, the fastest way to lose the trust of a patient or parent is to use fear to elicit consent for a vaccine that ultimately produces harm. And once experienced, the fear of another vaccine injury never goes away.

 3. Hear out their concerns

People have legitimate questions about vaccine safety. Over the course of the SARS-CoV-2 pandemic, many people are learning about the adverse events associated with vaccines and they have questions. Some are just learning that vaccines are liability-free products that may contain fetal cells and ingredients from various animals.

Many are discovering that “safe and effective” claims are based on flawed clinical trials that use comparator vaccines instead of inert placebos and only track adverse events for a very short period of time. Still others have been told that their experiences are “coincidences” only to discover that their ailments are listed among reported adverse events in vaccine manufacturer inserts.

Shutting down conversations about these concerns and censoring information serves only to fuel a growing mistrust of “experts” and regulatory agencies. If “hell hath no fury like a woman scorned,” imagine trying to silence a mother who has watched her child suffer a debilitating and life-altering injury. When it comes to the health of their children, parents will not be silenced, particularly once they’re properly informed.

4. Acknowledge shortcomings and address the concerns

It’s becoming increasingly apparent that there are problems with our vaccination program. At this point, the holes in the science are large enough to fit tens of thousands of children (and adults) who now suffer from chronic disease and “mystery” ailments.

And while we may not agree on the cause of this chronic illness epidemic, we can likely agree that “We don’t know what caused it, but it’s NOT the vaccine,” is neither science nor progress. Despite all of the mantras about science, there is very little scientific discourse when it comes to defending vaccines. Science has taken a back seat to messaging in the vaccine debate. As a result, we have prestigious institutions like Yale University opting to focus its research efforts on a clinical trial designed to see which persuasive messages were most likely to produce COVID-19 vaccine compliance.

But without a truly safe and effective product, these efforts are in vain. As Dr. Heidi Larson suggested, “we need much more investment in safety science.”  We also need to have thoughtful conversations about other ways to address health. It would serve us all to remember that health, not compliance, is our ultimate goal.  It’s time to have hard conversations about how a vaccination program truly fits in with regard to reaching that goal and whether our heavy reliance on it has served us.

5. Don’t try to beat them. Join them.

Skeptics are a valuable resource. People who demand progress are the ones who drive it and these folks are challenging the scientific community to improve on a paradigm that has been coasting on our faith in it for decades. Surely we can all acknowledge there is room for improvement.

While we may not come to the same conclusions on our risk/benefit analyses of vaccines, we can probably agree that one-size-fits-all is an imperfect way of applying medical interventions.

Find ways to join them in supporting good ideas and better science, perhaps by working together to protect and strengthen the doctor-patient relationship or by making manufacturer inserts more readily available to vaccine recipients. Work with them to eliminate conflicts of interests so that we don’t always have to wonder whether our news outlet or legislator is simply regurgitating the agendized message of a pharmaceutical sponsor.

Join them in calling for the use of inert placebos in vaccine clinical trials and pausing to study alarming correlations between vaccines and a multitude of health conditions (instead of saying “correlation is not causation.”) Initiate discussions about the expansion and protection of medical exemptions so that no one who is vulnerable to vaccine injury is required to get a vaccine. Surely not all of these concerns are limited to “conspiracy theorists?”

The people who raise concerns about vaccines are not enemies of science. They are its conscience. Listen to them.

“Chaos” by Shen Rosen