Public Health Messaging Must Improve To Counter Vaccine Misinformation

Throughout the Covid-19 pandemic, not only has there been an abundance of misinformation posted on social media about vaccines, public health officials and others have committed plenty of missteps in messaging.

A veritable flood of misinformation–often in the guise of unfounded conspiracy theories–coupled with poor communication from public health authorities contributed to the U.S. having worse Covid-19 outcomes than its peers. This is partly due to the fact that among people most at risk to severe disease–the over 65 age group, immunocompromised and those with other co-morbid conditions–the U.S. trails other wealthy nations in Covid-19 vaccination rates.

In their book The Big Myth: How American Business Taught Us to Loathe Government and Love the Free Market, Naomi Oreskes and Erik Conway suggest that many millions of Americans seemed to either “disbelieve what government officials were telling them about Covid-19 or to regard public health measures such as vaccines and mask mandates as encroachments on their liberty.”

Oreskes and Conway claim that 40% of Covid-19 deaths could have been prevented if Americans trusted science and government more.

Similarly, in The Deadly Rise of Anti-Science, Peter Hotez, researcher and professor of pediatrics, molecular virology and microbiology at the Baylor College of Medicine, writes that 200,000 Americans needlessly lost their lives to Covid-19 during the Delta and Omicron variant waves in 2021 and early 2022, respectively. According to Hotez, many refused to get vaccinated because they were victims of an organized antivaccine disinformation campaign.

And, a recently published study in JAMA Network Open suggested that if “public health recommendations” had been followed, approximately 33% of U.S. Covid-19 deaths could have been avoided.

So, what gives?

In parts of America, an inherently libertarian streak averse to government mandates of virtually any kind appears to have played a role in opposing non-pharmaceutical interventions, such as masks and social distancing, as well as Covid-19 vaccine requirements.

What’s disturbing is that the Covid-19 pandemic seems to have also brought out the vaccine skeptics in full force, not only toward coronavirus vaccines but also traditional childhood immunizations, like those targeting polio, tetanus and measles.

From smallpox inoculations–which began in the late 18th century and ended when the disease was eradicated in the 1970s–to mumps, rubella, tetanus, diphtheria, polio and measles immunizations, vaccination has saved millions of lives and prevented crippling and life-threatening illnesses from occurring.

Mass vaccination programs with single or combination shots began in the 1960s and quickly suppressed the spread of measles in most developed countries. The measles vaccine is “sterilizing,” which means it not only prevents illness, but also transmission.

Yet vaccine hesitancy is on the rise. Faltering vaccine coverage has contributed to a rise in cases of measles in New York and London, for example. According to a report issued by the UK Health Security Agency, London is in peril of a major measles outbreak that could result in tens of thousands of cases and dozens of deaths and significant morbidity. This is because levels of measles, mumps and rubella vaccinations in the UK are at their lowest level in 10 years.

This isn’t the first time we’ve observed an uptick in childhood vaccine hesitancy. In the UK, vaccinations took a considerable dip in the early 2000s after false claims of a link between the MMR shot and autism were posted in the media.

Andrew Wakefield’s campaign at the turn of the millennium to connect the MMR jab to autism provides an infamous illustration of how the anti-vax community operates. While such assertions were unsupported by evidence, Wakefield’s trusted position as a physician-scientist helped his assertions dominate headlines, leaving a legacy of harm that persists even today, long after his work was exposed as fraudulent.

Whether MMR, polio, Covid-19 or other high-profile vaccines, the evidence pertaining to vaccination’s extraordinarily important benefits either isn’t getting through to people, or they’re being misled by misinformation.

Americans, in particular, appear to be less trusting in science and government than they were even as recently as a few decades ago. Some experts suggest that a conspiracy mentality pervades, together with what can be construed of as an anti-science attitude.

Furthermore, a widening politically partisan gap exists regarding trust in either the clinical science or the scientific and public health community, with Republicans often taking a more skeptical view than Democrats or Independents.

To illustrate, Republican state lawmakers have blocked increases in cigarette taxes, seatbelt laws and childhood vaccination mandates. And other public health initiatives are being actively impeded.

This public health crisis is contributing to life expectancy heading in the wrong direction in America. During the past decade, there’s been an alarming decline in life expectancy in the U.S. There are multiple causes, the most recent of which is Covid-19. But even prior to the pandemic, the U.S. exhibited stagnant or even a downward trend in life expectancy, in stark contrast to its peers.

Besides Covid-19, diseases of despair, which include drug overdose, alcoholic liver disease and suicide, are major factors. Also, gun deaths, motor vehicular fatalities and maternal and infant mortality have an outsized impact on life expectancy. What do these causes of premature deaths have in common? A large public health dimension. Here, public health is seen as the science of reducing and preventing injury, disease and death, while promoting the health and well-being of the population through the use of evidence-based policies and practices. In light of this, a comprehensive and multifaceted public health approach centered around improved messaging is needed to reverse the negative trend in life expectancy.

A critical review of how the Centers for Disease Control and Prevention handled Covid-19 found that its pandemic policies failed, particularly with respect to communication, which at times was muddled and inconsistent, and even “confusing and overwhelming.”

Consider masks, for instance. In the spate of 16 months–from March 2020 to July 2021–Americans were given conflicting and sometimes diametrically opposed information. First we were told to only wear masks if you are sick or caring for someone who is ill. Then in April 2020 the policy changed to everyone should wear masks. Subsequently, once the vaccine rollout began in the winter and spring of 2021 the CDC shifted its stance: No masks for fully vaccinated people, but masks must be worn by the unvaccinated. And soon after, once it became apparent in the summer of 2021 that reinfections were common, CDC backpedaled and advised the public to mask up indoors, vaccinated or not.

Former Director of the CDC, Rochelle Walensky bluntly stated that “for 75 years, CDC and public health have been preparing for Covid-19, and in our big moment, our performance did not reliably meet expectations.”

It is no wonder therefore that in 2021, at a critical time during the pandemic, only about half of Americans trusted the CDC.

While federal government agencies can do a better job at communicating, private sector stakeholders can, too.

In the winter and spring of 2021, for example, the CEO of Pfizer, Albert Bourla, posted messages on social media saying that the Covid-19 vaccine would stop transmission. In April 2021, for instance, Bourla tweeted “Excited to share that updated analysis from our Phase 3 study with BioNTech also showed that our Covid-19 vaccine was 100% effective in preventing Covid-19 cases in South Africa. 100%!”

Yet, four months earlier, in December 2020, based on data submitted by Pfizer which did not evaluate the shot’s effect on transmission, the Food and Drug Administration declared: “At this time, data are not available to make a determination about how long the vaccine will provide protection, nor is there evidence that the vaccine prevents transmission of SARS-CoV-2 from person to person.” The FDA has not altered its stance since.

In August 2022 CDC issued a report saying that the Covid-19 vaccine offered limited “transient protection” but that this quickly wanes over time.

In hindsight, perhaps a more cautious approach to informing the public about the benefits of Covid-19 vaccination would have been more fruitful: That is, emphasizing the vaccine’s effectiveness against severe disease and not transmission.

On the Covid-19 treatment Paxlovid, Bourla again committed an unforced error. After reports of rebound effect from some patients who took Paxlovid, the CEO told Bloomberg News that patients can take another course, “like you do with antibiotics.”

The FDA quickly rebuked Bourla’s proposed solution as it was not indicated.

Drawing lessons for future pandemics, regardless of whether messaging emanates from public health authorities or drug companies it’s critically important to be consistent, cautious and credible when communicating the clinical science.

Moreover, going forward the U.S. must carry out the difficult work of adopting strategies that support sound public health measures while countering science denialism. In this context, officials will have to strike a delicate balance.

Additionally, it’s invariably more constructive when public health messages target those people who stand the most to gain from preventive measures.

To illustrate, today a Covid-19 booster campaign focused on the most at risk from Covid-19 is a preferable strategy. A CDC report found that in 2023 adults over 65 made up almost two-thirds of people hospitalized with Covid-19 and 90% of deaths, but less than 25% were up to date on the recommended vaccines. Instead of aiming at this vulnerable population, we see, however, that the 33 year old star tight-end Travis Kelce is the face of the latest Covid-19 booster. Perhaps it would make better sense to aggressively promote the product to those for whom there is proportionately far more benefit.