#WorldImmunizationWeek 2021: Addressing #AntiVaxxers, #VaccineHesitancy and #VaccineEquity

April 29th 2021
Sangy Panicker, Allyson J. Bennett, Amanda Dettmer & Jeremy D. Bailoo

As we have described in our previous two posts (1, 2), the public misinformation campaigns by Andrew Wakefield exacerbated the modern day anti-vaxxer crisis as we know it. Like most issues, however, there are not only extreme cases—i.e., individuals who never or always will be vaccinated—but those who fall somewhere in the middle. These individuals fall into the category of #VaccineHesitancy. Given the global health crisis of COVID-19, if global vaccination campaigns are to be successful in ending the pandemic, it is important to understand the reasons for such hesitancy. Addressing #VaccineHesitancy is, thus, a top priority.

As we’ve pointed out numerous times, starting assumptions matter and for as long as there have been vaccines there has been #VaccineHesitancy. The core arguments by critics of vaccinations have been the same for over 200 years: 1) the risks are greater than the benefits and 2) the government is interfering with individual autonomy.

Fact: The benefits of receiving a COVID-19 vaccine far outweigh the risks of not getting vaccinated.

The question of government interference with individual autonomy is to a large degree, a matter of political ideology rather than a scientific issue. One of the primary differences between present day and 200 years ago is access to information. Search engines and social media work in such a way that they reinforce our belief systems—showing us posts that we are likely to read and/or promoting highly clicked searches without regard for facts or fact checking. Scientists on the other hand are trained to search, review, and assimilate information. In addition, they are trained to evaluate disconfirmatory evidence that would prove their theories incorrect. Scientists also used specialized search engines, which collate peer-reviewed articles such as Google Scholar, Web of Science and PubMed. Unfortunately, many of the scientific articles are behind paywalls and are often inaccessible by the public. Despite differences in access to information between a scientist and a non-scientist, there are a number of strategies to reduce biased searching. We will cover these strategies in our next piece, as well as how to #FactCheck Information before sharing.

An example of differences in search strategies when evaluating the effectiveness of the COVID-19 vaccine, between a non-scientist and a scientist.

Fact: When searching for information, we should avoid the use of biased terms (such as effective or ineffective) and read exhaustively, before drawing a firm conclusion.

Present day #VaccineHesitancy is, however, very much a political issue. As we pointed out in January, the 40% of Americans unwilling to get vaccinated largely exhibit a crisis of confidence perpetuated by politically driven policy decisions. In that post, we demonstrated how under the Trump administration, science was repeatedly undermined and sidelined for four years. While Trump was president, both Democrats and Republicans alike, displayed #VaccineHesitancy prior to the November elections. Thereafter, #VaccineHesitancy shifted, with Democrats more likely to be vaccinated, and Republicans less likely. Much like the crisis perpetuated by Wakefield, Trump and his administration are directly responsible for deepening divides and mistrust between the public and the scientific enterprise in general and with respect to COVID-19 vaccines in particular.

An example of public misinformation.

This in turn directly translates to #VaccineHesitancy. A recent poll shows that despite no longer being president, the after-effects of Trump’s rhetoric are still being felt—Republicans and white evangelical Christians were the most likely to say they will not get vaccinated, with almost 30% of each group saying they will “definitely not” get a shot. As NPR news points out:

“We can’t get to herd immunity with only one party or just with the coasts. It has to be a nationwide effort. And so that’s why it’s so important right now for us to be reaching out to any group that has vaccine concern. And right now, that tends to be Republican voters.” [emphases added]

While there is increased awareness of the bi-partisan divide with respect to #VaccineHesitancy, there is less focus on #VaccineEquity, even though these two issues are intimately related. Within the US, #VaccineEquity can be viewed through specific lenses. For example, the lower efficacy rate of the Johnson & Johnson vaccines has called into light racial disparities with respect to the distribution of the three candidates vaccines approved for use in the US. Moreover, the recent pause in Johnson & Johnson vaccines as a consequence of thrombosis (blood clots) and thrombocytopenia (low platelet count) have called into account the safety of the vaccine. Further, while the US is still evaluating clinical data with respect to the AstraZeneca vaccine and Emergency Use Authorization, the reports of notable adverse effects, such as blood clots and low platelet counts, in the mainstream media, have called into question the US’ decision to share up to 60 million doses of that vaccine—despite the fact that the US currently has zero doses of the AstraZeneca vaccine in its possession.

As can be seen above, part of the issue with #VaccineEquity in the US deals with #VaccineHesitancy. In particular, Johnson & Johnson vaccines have been rejected (at worse) or prioritized lowly (at best) with respect to wealthier states with better access to healthcare. As we pointed out previously, even though the CDC has resumed Johnson & Johnson vaccines and even though the chance of blood clots and low platelet counts are rare, public opinion with respect to safety of that vaccine is affecting the willingness of individuals to take that vaccine. Similarly, perceptions of the safety of the AstraZeneca vaccine directly affects #VaccineHesitancy, willingness to accept the vaccine and opinions about why the US would choose to donate these vaccines.

While approximately 35% of the US is displaying #VaccineHesitancy or an #Anti-Vaxxer mentality, the global disparity in access highlights the #privilege of individuals in the US. With cases in Europe, India, Canada, South and Central America all increasing, without equitable access to a vaccine, the inequalities that lie at the root of so many global health challenges could not be more stark.

When thinking about #VaccineEquity, it is important to give precedence to facts and to update those facts in light of new information. For example, one of the reasons that Johnson & Johnson may be distributed to poorer cities within the US, and more remote locations with less amenities, such as electricity, stems from the facts that: 1) it is a single dose ensuring that those individuals with limited access to health services can be immunized after a single dose and 2) it can be stored in a standard refrigerator, as opposed to the specialized low storage temperature conditions needed for Moderna and Pfizer. So it would be overly simplistic to argue that Johnson & Johnson vaccines are being distributed to areas with poor access to healthcare based on efficacy alone—the overall goal must be considered—which is to get the population immunized. Moreover, as we pointed out in our previous piece, comparison of efficacy among the three vaccines approved in the US is inappropriate given the differences in the data collected from the clinical trials.

If you would like to read more about #VaccineEquity, we encourage you to read the document located here, from the National Academies of Sciences.

In our next piece, we highlight how you can combat some of the global misinformation campaigns and what you can do to reverse the damage.