If a vaccine for coronavirus is developed tomorrow, will you take it? Many people won’t. According to recent polls, three-quarters of Americans intend to get the vaccine if one becomes available – woefully short of what we’ll need to protect our communities.
As a paediatrician, I meet all kinds of parents who have concerns about vaccines generally; many have told me they won’t trust a coronavirus vaccine, and that they and their children won’t take it, at least in the short term. They question the safety of a vaccine developed on an accelerated timeline, and in the shadows of political pressure – a concern that has also been raised by staunchly pro-science, pro-vaccine experts. A few families even buy into the conspiracy theory that microchips will be implanted into the vaccine.
As repeated measles outbreaks demonstrate, we haven’t done a great job addressing people’s concerns about vaccines. And if we don’t learn from our failed response to them, a coronavirus vaccine programme will be doomed.
The anti-vaccine movement was once linked primarily to wealthy white parents. Nowadays these views are expressed both by liberal parents, who align with “natural” health and parenting identities, and conservative parents, who emphasise their distrust of government and the importance of individual liberty.
Race matters, too: For some families of colour, the sordid history of unethical experimentation on vulnerable communities makes them reluctant to vaccinate.
So far, the public health response has mainly focused on persuading people to accept vaccines through education and effective communication. But such an approach has proved to be largely unsuccessful. We need new strategies.
First, we must build a coalition of community leaders, public figures and other influential individuals to help combat disinformation and focus on the ethical importance of immunisation. Many people rely on their doctors for medical advice, but others turn to religious leaders, media personalities and alternative health providers like chiropractors and naturopaths.
Though most religious institutions do not discourage or prohibit immunisation, some religious belief often fuels vaccine opposition. Pastors, rabbis and imams could play an important role in clarifying a religion’s position on immunisation, not only against the coronavirus, but also against influenza and other diseases that vaccines prevent.
We also need to engage community leaders and public figures who can help mediate national and community discussions about the values, moral principles and identity concerns about vaccination and ensure that the most vulnerable groups get priority and protection when it comes to distribution of the coronavirus vaccine.
Second, marketing matters. Parents from across the political and cultural spectrum tell me that they simply do not trust the information made available about vaccine manufacturing and ingredients. We should explore ideas such as offering “green vaccines” – manufactured using transparent processes and ingredients – that vaccine-hesitant Americans may be more likely to accept.
Let me be clear: Our current vaccines are safe. But they can’t be effective if people are not willing to take them. We should consider what kind of vaccine Americans would be willing to accept, and what type of information would bolster trust.
We must turn our attention to the factors that have made government distrust such a potent factor in vaccine scepticism, and keep it there. In times of social unrest, people often turn to group identity and affiliation, and vaccines have become a powerful vehicle through which such affiliations are expressed.
A “green vaccine” should be designed that uses adjuvants (which increase a person’s immune response) and preservatives that don’t bring up scary search results about anti-freeze and mercury poisoning. It should be made in a factory in a city or town that can be easily identified. And it should come with accessible information about development, testing and monitoring, rather than an inscrutable insert with a list of side effects unrelated to the vaccine. These measures are not a scientific necessity, but they may be a social one.
Finally, we must turn our attention to the factors that have made government distrust such a potent factor in vaccine scepticism, and keep it there. In times of social unrest, people often turn to group identity and affiliation, and vaccines have become a powerful vehicle through which such affiliations are expressed. But the prevailing approach to vaccine hesitancy and opposition fails to reflect that.
One of the things I value most about being a paediatrician is being allowed a glimpse into the lives of so many different types of families. Regardless of parents’ economic, political or racial background, one thing is usually the same: their dedication to their children’s health and well-being.
That’s a useful starting point when I counsel families about vaccines. I can ask about their experiences and their values, draw diagrams about the immune system and talk through clinical trials and scientific studies.
I can work on building strong relationships and try to illuminate the ways in which vaccination aligns with their goals of keeping their children safe and healthy.
But what about the concerns of a single African-American mother of three who lives below the poverty line and experiences chronic disenfranchisement; of a young couple who have found meaning and support through an online “natural parenting” community; or of a father of five guided strongly by religious faith, whose pastor considers vaccines as interfering with God’s perfect design?
These concerns are difficult to address solely within the walls of an exam room, yet it is social conditions like income inequality, educational disparities, racism and gender discrimination that have created a cultural climate in which vaccines represent so much more than simply immunisation against infectious disease.
We can’t simply assume that if a coronavirus vaccine is developed, Americans will accept it.
Sufficiently widespread vaccination will be possible only if the values and goals of a vaccine programme are discussed explicitly, transparently and early, and if that discussion includes the full range of voices that have been telling us for years that trust in the American institutions and systems responsible for vaccines is broken.
• Phoebe Danziger is a paediatrician at the University of Michigan.
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