Janet Rossant is president of the Gairdner Foundation, which rewards excellence in research affecting human health. Heidi Larson is founding director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine. She is speaking at Gairdner’s Vaccination: Moving Forward with Confidence event on March 30.
The production of multiple effective vaccines against the COVID-19 virus in less than a year has been a remarkable success story of scientific and industry collaboration. The next vital step to address the health and economic devastation caused by the pandemic will be ensuring the broad distribution and uptake of these COVID vaccines. Mistrust in vaccines, particularly with the fast-paced development of current candidates, has been amplified by misinformation on social media and threatens to hold back successful vaccine rollouts worldwide. To move forward, the extraordinary science of the vaccines must be supported by an understanding of vaccine hesitancy and the rebuilding of trust across societies to ensure a safe and healthy post-pandemic world.
Since 2010, the Vaccine Confidence Project has mapped out trends in public opinion on vaccination. The Project has revealed large national differences in overall confidence in vaccine importance, efficacy and safety, and mapped the unique changes related to local events and government actions. For example, overall confidence levels in vaccination fell dramatically in the Philippines between 2015 and 2018 after pharmaceutical company Sanofi reported that the new vaccine being used against dengue fever in the country could increase complication risks in those experiencing their first exposure to the virus, including children. One vaccine misstep can become a threat to the vaccination system as a whole.
Fundamentally, vaccine success is not just a matter of positive trial outcomes. The best science can be derailed by issues of mistrust in the institutions that influence vaccine development and delivery, including governments, the biopharmaceutical industry, health care systems, research science and the media.
Mistrust of the pharmaceutical industry is another factor in the vaccine trust landscape. People question whether the profit motive and the speed of production may have compromised the safety of new vaccines. In most cases, industry has aimed to counter this by openly reporting their processes, trials and results in ways that should serve them well in future clinical trial reporting. They should also be recognized for examples of cross-company collaborations to speed up vaccine development, such as GlaxoSmithKline providing its best adjuvant to help any vaccine developer and the recent agreement by Merck to produce the Johnson & Johnson vaccine to speed up delivery in the U.S.
Health care systems sometimes forget that they, too, are not always the trusted deliverer of health interventions. Access to health care is not fully equitable across socio-economic strata, including in the Canadian universal health care system. Systemic racism is endemic and only now being appropriately recognized and responded to. Government-led mass vaccination efforts can be a source of concern to racialized and Indigenous communities with generational memories of past unethical government-sanctioned experiments, as well as current concerns in countries with poor human rights records. Rebuilding trust requires providing non-medicalized delivery systems and targeted informational content through engagement with community leaders.
Science has generally done well in public perception during the COVID crisis. The innovative vaccines developed over the past year demonstrate how creative minds can converge from different directions to tackle a major health challenge. Scientifically gathered and interpreted evidence has been behind most of the public-health recommendations that we adhere to today. But premature reports of possible treatments for COVID without supporting evidence have damaged the reputation of the field. Scientists need to promote the principles of open science by sharing data, techniques and results to provide the most robust evidence base for COVID vaccines and interventions. The remarkable global collaborations underlying our current knowledge base on the COVID virus should be an exemplar for future initiatives to tackle the next big global challenges, and a point of pride in the scientific community.
Social media is a constant source of both information and misinformation on COVID and vaccines. Groups engage through different threads and platforms, making broad counter-efforts challenging. However, that should not discourage efforts to distribute trustworthy, scientifically credible and culturally appropriate content to encourage vaccine uptake. Efforts such as Science Up First, COVID-19 Resources Canada, and 19 To Zero need to be amplified, modified and expanded toward diverse audiences to increase vaccine confidence across society.
Despite these challenges, we see the successful rollout of vaccines in an equitable manner as a real opportunity to regain broad-based trust in the individuals and institutions that affect the health and well-being of people worldwide. We can move from a medicalized perspective on public health to an integrated wellness and equity lens that will promote public confidence in the future and demonstrate our shared ability to respond effectively to the next grand challenges.
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