How do we address the heterogeneity in vaccine hesitancy?

There is light at the end of the COVID-19 pandemic tunnel, but public trust in national and global public health institutions is at an all-time low. What happens if folks don’t want to travel to the light?

As the pandemic drags on, the banality of persistent distancing measures and continued calls for social distancing are falling on deaf ears. Cases and fatalities continue to set records. In an attempt to regain public awareness about the severity of the pandemic, social media and news outlets have shared some of the “deadliest days in American History,” of which COVID-19 deaths are starting to represent the lion’s share. With multiple vaccines active against SARS-CoV-2 approved and leaving their manufacturing facilities, perspectives swirl around how such a vaccine’s distribution and reception would look. Because of the ostensibly chaotic ever-changing nature of responding to a novel respiratory virus, public trust is at an all-time low, despite health institutions-executed measures having saved countless lives in the past.

The “anti-vax” movement has always been considered a “left” or “right” issue, but in reality, individuals who do not want to vaccinate themselves or their loved ones have lost trust in science, medicine, the government, or a combination thereof. Moreover, there are those that are just not comfortable with the perceived rapidity with which the vaccine was tested and rendered safe. The vaccine-hesitant and the ‘anti-vax’ are not a homogenous population. They run the gamut of scientists, clinicians, and parents who are concerned about the long-term effects of an mRNA vaccine or vaccine adjuvants, to conspiracy theorists who have decided the vaccine is an attempt by the government to control the general population. No matter their reason, the propagation of the anti-vax movement has led to a rise in the incidence and prevalence of vaccine-preventable infectious diseases. Public education systems have failed to provide a basic level of science literacy and diminished access to health care has only further fostered distrust in the public through the abandonment of underserved communities and bankruptcy of those struggling with chronic health conditions. And now, as we attempt to end the current COVID-19 pandemic, vaccine hesitancy reigns supreme, and herd immunity is a pipe dream.

Perhaps then, it is best to consider the anti-vax movement not so much an issue of political views—but a symptom of failed systems in science education, public, and health policy. For those who do not believe in COVID-19, or that a vaccine can save their life, or prevent their parent or neighbor from dying, we need to do better. We need to build systems that educate the masses. From STEM education to efforts that improve how our country responds to crises. Though intuitive, it is vitally important for physicians, scientists, and the press to reevaluate their opinions on the anti-vax movement as to not further alienate individuals who have already suffered sufficient violation of trust to warrant a radical shift in their behavior to a level edging on self and public endangerment.

It is important to recognize the issues at play in the complex web of misfortunes that led us to this point, but we cannot rely on pointing fingers. In an era defined by immense amounts of data and information, we have yet to adapt our media habits and information dissemination. Like scientists looking at massive data sets to detect a trend or abnormality, the public cannot simply digest enormous quantities of information thrown at them each and every day without assistance. However, if the assistance provided only fosters distrust, we will never be able to overcome the ongoing challenges our nation faces, including this pandemic.

There are legitimate ways to combat the onslaught of disinformation from circulating further and wreaking havoc on our society. A focus on scientific literacy in nation-wide classrooms; de-sensationalizing the news in order to provide more informative and less polarizing dissemination of information; improving social media algorithms to be more human-centric and less money-centric; but above all, what is needed most in science and medicine is civil discourse. The discourse between experts and the public, discourse between friends and family, and discourse among those with whom you disagree. Discourse transcends the idea of individual liberties and provides solutions in a manner reflective of communal responsibility.

Cullen M. Lilley is a medical student. Kamran M. Mirza is a pathologist.

Image credit: Shutterstock.com

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