Aug 04 2020 8 mins 9
Six months into America's COVID-19 pandemic, cases are surging, small businesses are faltering, playgrounds are empty, and unemployment is at 11 percent. Our best hope for ending this nightmare is a vaccine, and there are more than 165 in development. But when a vaccine becomes available, how many Americans will refuse it? Vaccines are the greatest health care advance of our time, preventing an estimated 4.5 billion infections since their advent. So what explains the reluctance of so many Americans to vaccinate? It's a combination of bad science, the government's long history of misleading the public, and the collapse of confidence in public health authorities because of their catastrophic failures in response to the COVID-19 pandemic. But if the government responds by attempting to force Americans to take a COVID-19 vaccine, it will only help the conspiracy theorists. Public health officials can begin to undo the damage of the past six months by rejecting authoritarian and paternalistic approaches in favor of careful persuasion and brutal honesty about the limits of their own knowledge. Though most Americans surveyed say they'll probably take the vaccine, there's a real possibility that a sizable bloc of refusers could allow this novel coronavirus to continue spreading, based on what's happened with measles, cases of which surged to record levels in America in 2019 largely due to pockets of vaccine refusal, which tends to happen in clusters, according to researcher Tara C. Smith. "When you have some of these groups of individuals where vaccination rates are low, it just takes one person with measles to get in there and spread it through a community," Smith says. Vaccine skeptics often focus on the claim that childhood vaccines cause autism, an idea endorsed by Donald Trump during a 2015 presidential debate. This claim famously was amplified by a British researcher named Andrew Wakefield, whose 1998 paper linking vaccines and autism was later retracted. The U.K. General Medical Council found Wakefield guilty of multiple ethics violations for lying about his test subjects and failing to disclose a financial link to an anti-vaccine lawsuit. But concern about vaccines is rising among parents, along with objections to the use of mercury preservatives, which haven't been proven to do harm and haven't been present in childhood vaccines for nearly 20 years. An ecosystem of anti-vaccine information has emerged and, according to the American Journal of Public Health, bots and paid Russian trolls participate in online vaccine debates far more than the average social media user. The trolls don't always join the anti-vaccine side of the debate but aim to elevate the visibility to "create false equivalency, eroding public consensus on vaccination," according to the researchers. "You have some people that really don't know what to think," Smith says. "And they're really just trying to figure out, you know, what is going on? What do I believe? What do I trust? Maybe haven't cemented their ideas about vaccination yet…Those people in the middle are the ones that I try to reach." But U.S. public health authorities have sometimes misled the public about vaccines and other public health interventions, which has made the job of convincing skeptics more difficult. The Tuskegee experiment sowed deep distrust of the government and public health, particularly in black American communities. In 1932, government doctors recruited mostly poor black sharecroppers at the Tuskegee Institute for a study of the impact of syphilis. The participants, the majority of whom had the disease, were told that they were getting an experimental medicine when in fact they were all given a placebo. Scientists running the study were actually interested in the progression of the illness when left untreated. The experiment continued until well after penicillin became available in 1947, and many participants died. Another incident that damaged trust in public health oc [...]
