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A vaccine—or vaccines—for COVID-19 could arrive soon, with Pfizer and Moderna among the first drugmakers to seek emergency use authorization for their candidates. But with so many people already skeptical of vaccines, how will we ensure that enough people take them when they’re available? To answer that question, I talked to Heidi Larson, an anthropologist and the founding director of the Vaccine Confidence Project, which monitors public concerns about vaccines. She’s been suggested by public health experts as an addition to President-elect Joe Biden’s COVID-19 advisory board. Larson says the way the scientific community handles the next few weeks will be critical. On Thursday’s episode of What Next, we discussed where the conversation around vaccines has fallen short, and what politicians and public health experts need to do to build trust for a COVID-19 vaccine.
Mary Harris: I’ve noticed you’re really precise in how you speak about vaccines and the way people feel about them. You never talk about “the public” as a monolith. Instead, you refer to “publics,” as in more than one—a collection of communities who have to make decisions about their health together. You dislike phrases like herd immunity and anti-vaxxers. Can you explain why?
Heidi Larson: I think it polarizes. On the one hand I appreciate that people want more of a sound bite world, but that also really risks polarizing, stigmatizing, grouping people in ways that are just not what real life is about.
Have you seen that in your work, where people say, “Ugh, people just brush me off as part of this bigger group”?
Absolutely. Parents sent me piles of information where they feel so, as one called it, demonized: “I don’t feel like I can even ask a question anymore. I’m called some flat-earther. I’m a concerned mother. Am I not allowed to even ask questions anymore?” And on the other side of it, I’ve seen … the language in the media, by politicians and by public figures and even some U.S. scientists, calling them … idiots, crazies, don’t care about their kids. Of course they care about their kids. They love their children. They just have a very different notion of what is right. They wouldn’t do that if they didn’t love their kids—which is another thing that some in the medical community just can’t get.
Do you think some physicians have brushed off people who have concerns about vaccines as “that’s just emotional”?
I think they might say “that’s not fact.” I think that they’re also uptight because they can feel questions coming their way that they may not be able to answer. They’re not experts in everything, and publics are really getting into ingredients and processes and all kinds of things. We’re kind of stuck in this conversation of different languages.
“This whole notion of a race hasn’t been helpful.” — Heidi Larson, Vaccine Confidence Project
I wonder if you see some of these mistakes around language repeating themselves now, with the coronavirus. You’ve talked about how speed is something that can really set people off, people who have had questions about vaccines. In the United States, our vaccine effort was called Operation Warp Speed. I wonder if you hear that and you just think, Oh, no.
That certainly wasn’t helpful. But it wasn’t just Operation Warp Speed—it was a number of politicians wanting to get there first or companies wanting to get there first.
The frame of the race.
Yeah, exactly. This whole notion of a race hasn’t been helpful because people feel like, “Wait a minute. We’re not stupid. We know that vaccines can take eight, 10, 15 years to be developed. What’s with this eight months now?”
You’ve tracked the rollout of so many vaccines internationally. What has your experience taught you?
My experience has taught me we should have started preparing, engaging with publics probably in July.
So you think we’re late?
Yeah. I think not too late, because they’re barely out the door and they’ll come in trickles, the vaccines. But we shouldn’t wait until people are in line for vaccines. That’s not the point to start listening to questions. Now is the time.
We don’t have answers for everything, but the important thing is to engage with people, to [let them] know that you care about their concerns, that you want to hear what their questions are, because that in itself is important. And if we don’t start engaging now, they’re going to go somewhere else for their information. And they are. We’re in hyper-risky times right now—I’m sure you know the phrase “a little information is a dangerous thing.” Uncertainty is super fertile ground for rumors, pieces of information waiting to be verified. And people are filling the space. They have enough information to start questioning. And we can see, with every piece of news, the social media spikes with a lot of conversation, a lot of looking for information, and a lot of them are not finding what they’re looking for.
“We shouldn’t wait until people are in line for vaccines. That’s not the point to start listening to questions. Now is the time.” — Heidi Larson
Because it doesn’t exist, or because we’re not making it available enough?
Some of it actually doesn’t exist, but that’s not stopping a lot of those who are trying to seed seeds of doubt and questioning. They’re pretty bold in offering answers which are not necessarily scientific or factful. We’re kind of waiting for the correct answer, but in the meanwhile, we need to be there with people. We tell them about the process we’re in, say “We don’t have that piece of information yet, but this is what we’re doing in the meanwhile.”
So we need to meet those “publics” where they’re at. And right now that’s online.
[There is] an initiative called Team Halo, and it is a lot of young scientists who are involved in the COVID trials around the world there on TikTok, doing short [videos]: Hey, I am whoever, and this is my job and this is what I do. And I’m happy to answer your questions. They’re really human. And I think we need a lot more efforts like that, which humanizes, which makes the lab less sterile, less remote.
I think for some health authorities and scientists, they’re kind of shy of going into the whole social media space because it feels pretty messy and emotional, which it is. But that’s where the public lives. So we need to establish as many opportunities as we can for people to ask questions and have somebody that answers them responsibly. Chatbots, numbers to call. Set up hotlines, set up people in communities that can answer basic questions, that are there to listen. That’s the best way to go. We need a listening administration that sends a message: “We care about what you think.”
Do you think the vaccine should be mandatory?
I don’t think vaccines should be mandatory in general. For other vaccines where there are mandates, it’s virtually always about the setting and not so much about the specific vaccine in itself: If you’re working in a hospital, which is a high-risk setting for spreading to other people or being at risk. If you’re a child going to school, where if you have one of the childhood diseases, you’re putting other people at risk. If you’re going on a pilgrimage to Mecca, which is millions of people gathering. …
I don’t think in the case of COVID we’re in a position to be mandating because, one, we don’t have enough of them yet and you can’t mandate something that you’re not ready to deliver equitably. And I also think mandating something right now, where I think publics are really at their wits’ end with the amount of externally imposed controls—even when you know it’s meant to be a good thing, there’s a limit. And I think right now, one more thing that’s mandated by government will not be well tolerated.
There’s been some criticism that the new coronavirus task force needs to include people who might reach communities that the Democratic Party and Joe Biden may have trouble reaching. I wonder whether you think that’s something that politicians need to be thinking about moving forward, building trust by talking to these people whom they might not otherwise talk to.
It does need the kind of approach of listening in communities that wouldn’t normally be listened to. Vaccines could be a kind of soft diplomacy, at a local level, to put down our guns, verbal or otherwise, and just start to have conversations again.
You know, I saw an interesting article in Le Monde, the French newspaper, and they were saying there are a few things you can’t talk about at the dinner table: One of them is politics. The other thing is vaccines. I understand what those tables can be like, but if we can get people changing the tune around vaccines, it might be an entry point. And we have a huge opportunity with COVID. It could totally change the landscape.
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