Farhad Manjoo: We’ve got a vaccine. How do we get people to take it?
(Courtesy of University of Maryland School of Medicine via AP, File)
This May 4 photo, provided by the University of Maryland School of Medicine, shows the first patient enrolled in Pfizer's COVID-19 coronavirus vaccine clinical trial at the University of Maryland School of Medicine in Baltimore. Pfizer and BioNTech say they've won permission Wednesday, Dec. 2, 2020, for emergency use of their COVID-19 vaccine in Britain, the world’s first coronavirus shot that’s backed by rigorous science -- and a major step toward eventually ending the pandemic.
In early September, officials in South Korea announced an ambitious plan to vaccinate 30 million people against the flu — 10 million more than last year, an increase aimed at keeping down rates of the flu while the country battled the coronavirus.
But as The New York Times reported last week, the internet soon got in the way. As the vaccine was distributed, a few logistical problems popped up, and South Koreans began circulating grave stories online — pictures of vaccine boxes that looked like they had been stored unsafely, reports of vaccine contaminated with mysterious white particles.
Then things got more serious. A 17-year-old died after getting the vaccine. Stories of more deaths began to pour in. “By Oct. 22, the reported death count had reached 28 and it was rising by the day,” The Times reported. “Singapore briefly suspended the use of a South Korean vaccine after the deaths were reported.”
Health officials were confident that the vaccine was safe, and they eventually determined that the deaths were coincidental; people die every day from a wide variety of causes, so it’s not surprising that among millions of people receiving vaccinations, some would die soon afterward for unrelated reasons. But online, the fear would not bend to rational explanation.
As the government took the time to thoroughly investigate the cases, “anxiety grew, trust fell and the vaccination program suffered,” Dr. Ki Mo-ran, an epidemiologist, told The Times.
This, I worry, is a taste of things to come in the United States.
In the last few weeks we’ve been blessed by spectacular news. “Operation Warp Speed,” the Trump administration’s program to expedite coronavirus vaccines, has been an amazing feat of science and public policy. Clinical trials suggest that vaccines made by Pfizer and Moderna are each safe and effective at preventing infections of the coronavirus; a third company, AstraZeneca, has also reported positive results with its vaccine, though scientists are less confident about its findings. The three vaccines were all created in less than a year, a blistering pace for vaccines.
Yet we might still snatch defeat from the jaws of victory. A vaccine is most effective if a large portion of Americans take it — and on that question, recent history leaves me with a sour feeling.
Americans in 2020 exist in splintered realities. A large number of us believe one truth about Ukraine, face masks, hydroxychloroquine, climate change and the results of the presidential election; perhaps almost as large a number of us believe the opposite.
How can we prevent the coronavirus vaccines from falling into that perilous reality gap? The next few months could be pivotal, vaccine experts told me. With a new president in the White House, a loose-cannon ex-president who retains a hold on public attention and an internet-driven media ecosystem adept at minting rumor and outrage, there will be ample room for missteps.
What worries me most is that Americans’ decisions about whether to get vaccinated against the coronavirus might become less about science than about identity.
Getting people to trust vaccines is a long-studied question in public health. Jonas Salk’s vaccine for polio, one of the most devastating communicable diseases of the 20th century, was popular after it was tested and declared safe in 1955; rates of polio quickly fell.
But even the polio vaccine was plagued by distribution and manufacturing problems, and rates of vaccination in some urban and other low-income communities remained low for more than a decade. Polio was eliminated in the United States by the late 1970s.
Other vaccines gained traction more slowly. Though vaccinations against measles, whooping cough, diphtheria and rubella were first offered much earlier, it took until the 1990s for vaccination rates to eclipse 90%.
More recently, the internet has accelerated a global movement against vaccines — the so-called anti-vaxxers. Their numbers are relatively small, and the United States still has high rates of immunization. But because vaccine skeptics tend to be savvy about marshaling social media, they’ve wielded outsize influence in debates over vaccines, leading to a resurgence of measles and other preventable diseases in some communities. Now they could cause trouble in the rollout of coronavirus vaccines, too.
“The anti-vaxxers were very involved in the reopen movement, and in the anti-mask movement, and in the reject-all-scientific-evidence” movement, said Renée DiResta, the technical research manager at the Stanford Internet Observatory and a longtime scholar of how these groups use the internet. While DiResta expects that Americans are sick of isolation and will be eager to get vaccinated, she fears that in some geographic or social circles, anti-vaccine activists will wreak havoc.
“In certain communities, the low rates could mean that the vaccine is not as effective as it could be, and so diseases continue to take hold,” she said.
There are other worries. Noel Brewer, a professor at the Gillings School of Global Public Health at the University of North Carolina who studies why people choose to get vaccinated, told me that he hates the name of the program that accelerated work on the vaccines. “Warp speed” was a good way to emphasize its speedy development — but emphasizing speed could also sow doubt about the vaccine’s quality. In September, a poll by the Kaiser Family Foundation found that two-thirds of Americans worried that President Donald Trump was rushing the vaccines for political reasons.
Brewer also fears a slide into partisan warfare. “We don’t have much history with vaccination being a right or left issue — vaccination is pretty well embraced across the political spectrum,” he said. But on the right, there is a strong resistance to government mandates, which might play into increased skepticism about getting vaccinated.
South Korea’s public health officials have been praised for the transparent way they investigated and shut down misinformation about the flu vaccine, but rates of vaccination remain low — only 19 million people have gotten the flu shot, far short of the goal of 30 million. Still, Bruce Gellin, the president of global immunization at the Sabin Vaccine Institute, told me that Americans should allow scientists, rather than politicians, to take the lead in communicating about vaccines, as the Koreans did.
“If you do the math, you can anticipate that strokes and heart attacks will occur within days and weeks of being vaccinated, and since these are common occurrences, every media market will have a story about this — the person was fine, and then following vaccination they had a stroke,” Gellin told me. “That speaks to the need to keep our eyes open for things like this — to anticipate them and to look into them.”
Preparing for these incidents requires setting up monitoring systems early and quickly and transparently investigating problems in a way that solidifies public trust — in other words, exactly the sort of competence that has been missing from the Trump administration’s coronavirus plans.
I expect the Biden administration to be more rigorous and transparent. And Brewer told me that making the vaccines free and easy for Americans to get will be a much more effective way of promoting their use than devising some clever public relations campaign.
Still, I’m gloomy. We’ve had a hard time getting Americans on the same page about anything related to this virus. Now, we might have a magic bullet — or we may not, depending on whomever you choose to believe.
Farhad Manjoo is an Op-Ed columnist for The New York Times.