As theorists from Samuel Coleridge to Kenneth Burke have noted, language often does our thinking for us. In health care, all too often, that leads to problems.
In a particularly worrisome example of this, recent headlines about the new monoclonal antibody injection nirsevimab (trade named Beyfortus) designed to protect infants against the third culprit in last year’s tripledemic — respiratory syncytial virus (RSV) — contain language that may cloud parents’ decision-making about the new intervention.
Delivered by injection, nirsevimab consists of monoclonal antibodies, which the Food and Drug Administration characterizes as “laboratory-made proteins that mimic the immune system’s ability to fight off harmful pathogens such as viruses.” By contrast, vaccines prompt the immune system to produce an immune response.
But coverage tended to obscure this difference. “New Shot for Infants Approved by CDC” read a headline atop an article that went on to cast the shot as a “new immunization” that will protect infants against the scourge of RSV. Only in the fourth paragraph do we learn that this shot is not a vaccine. Another article’s subtitle linked two forthcoming RSV vaccines with nirsevimab, referring to all three as “shots.” A “Good Morning America” rundown told viewers that although it is not a vaccine, nirsevimab acts like one.
Although we recognize that getting people’s attention in headlines and conveying nuance may be confllicting goals, this conflation is worrisome because anti-vaccine sentiment, which increased across the pandemic, remains in play, and trust in public health institutions is down. Linking this new technology to politicized vaccines, whether inadvertently or intentionally, risks invoking the same partisan sentiment. Anything that needlessly reduces uptake of a potentially-lifesaving technology that faces an uphill battle due to its cost and complicated reimbursement mechanisms is problematic.
Because nirsevimab is delivered by injection into muscle, it will even look like a vaccine to the parents who watch their young children receive it. Even though some vaccines can be delivered by mouth or through a nasal spray, the notion that vaccination comes in the form of a shot is the one perpetuated by most images of vaccination in media. We worry that adding vaccine-associated language to the equation may activate unwarranted fears among those already disposed to mistakenly accept the false assertion that autism is caused by receipt of multiple vaccines in the early years of life.
That unjustified concern translates into hesitance to vaccinate. Annenberg Public Policy Center evidence published in a spring 2023 issue of Vaccine suggests that among the fears driving the hesitance of vaccinated adults to vaccinate children against Covid-19 is the mistaken belief that the number of vaccines given to children may explain the rise in rates of autism.
To help minimize the likelihood of public confusion about nirsevimab and to inform parental choices about the new monoclonal antibody injection, we recommend:
Instead of telling us that a new RSV shot, injection, antibody, or drug has been approved for infants, tell us what it is designed to do. So instead of this headline from ABC News “New RSV shot for infants approved by CDC,” we prefer this one from NPR: “FDA approves a new antibody drug to prevent RSV in babies.” To increase audience retention, focus standardized language on the nature of the injection and the ways in which it works. Or add “antibody” to Yahoo News’ headline “FDA approves RSV injection for infants.”
At the same time, media outlets should emphasize that monoclonal antibodies and vaccines function differently. Whereas a vaccine activates the immune system, as the CDC press release announcing the approval explains, “Antibodies are part of our immune system and help us fight infections. Monoclonal antibodies are man-made proteins that mimic the antibodies that our bodies naturally produce.” Medscape signaled that difference with its headline “New RSV Shot is a Monoclonal Antibody, Not a Vaccine.” That approach works for a source like Medscape but might need to be tweaked for a general audience, many of whom won’t know what a “monoclonal antibody” is without further explanation. In those cases, the article can use a headline like “FDA approves RSV antibody injection,” but the body of the article must include explanations about what monoclonal antibodies are.
In the explanation process, journalists should avoid using the words “immunization” and “immunity,” which inadvertently convey that the protection is full and lasting. One of the lessons of the public health community’s pandemic experience is that inaccurate, non-caveated language can elicit confusion, lend credibility to attacks, and provide fodder for conspiracy theories about health science. We apply that lesson here by urging health officials and reporters to limit the use of the terms “immunization” and “immunity” to interventions that produce significant, lasting protection. This usage is consistent with the CDC website, which tells us that immunity means “protection from an infectious disease,” which the agency further explains means: “If you are immune to a disease, you can be exposed to it without becoming infected.”
But journalists aren’t the only ones to stumble here. If this definition of immunity is top of mind, terming the monoclonal antibody injection “an immunization,” as the CDC did in announcing its advent (i.e., “New immunization is the first approved and recommended in the U.S. to prevent severe RSV disease in all infants”), invites the mistaken inference that the intervention is 100% protective and that the “immunity” is permanent. As the pandemic-related assaults on the credibility of public health representatives taught us, such false inferences increase public susceptibility to assertions that officials deliberately mislead the public to secure uncritical acceptance of pharmaceutical products. Instead of long-lasting unqualified protection, the new injection reduces the risk of RSV hospitalizations and healthcare provider visits in infants by about 80 percent and can protect infants and young children for five months, the length of a typical RSV season. Over time, frontloading clear information about vaccine efficacy should minimize mistaken public belief that 100% efficacy is a hallmark of vaccines.
When some vaccinated individuals experienced breakthrough Covid-19 infections, the overly optimistic projections about the Covid vaccine’s efficacy came back to haunt public health officials. To avoid something similar happening, statements that the new RSV injection for infants reduces the risk of RSV hospitalizations by 80 percent could be followed by a brief explanation of what this means: For most infants, getting the shot will dramatically reduce the likelihood of being sick enough to be hospitalized with RSV.
The same argument for precise specification dictates avoiding the phrases “active immunity” (produced by vaccination) and “passive immunity” (obtained through injection with antibodies). Like “immunization,” the phrases “active immunity” and “passive immunity” are freighted with the assumption that the elicited effect translates into 100% permanent protection.
Communicating science to the public in a fast-paced, competitive news environment is always challenging. So too is compressing the nuances of science into headlines, Informing the public requires equipping all of us with protective knowledge and language that can help us accurately weigh the risks and benefits of various technologies and treatments. Because infection with RSV is common among the very young and two to three of every hundred infants who contract RSV may require hospitalization, clear communication about this new treatment has the potential to increase informed parental decision making, save anguish, and help safeguard the lives of babies at risk.
David Scales is an assistant professor of medicine at Weill Cornell Medical College and chief medical officer of Critica, a nonprofit organization seeking to center the role of science in making rational health decisions. Sara Gorman is CEO and co-founder of Critica and the executive director of Those Nerdy Girls, an all-woman team of Ph.D. scientists and clinicians whose mission is to empower individuals to better navigate science and health information. Kathleen Hall Jamieson is the director of the University of Pennsylvania’s Annenberg Public Policy Center and co-founder of FactCheck.org. The views expressed in this piece are those of the authors and do not necessarily reflect the official position of the institutions with which they are affiliated.