Vaccine Confidence’s Slow Erosion

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It’s been happening for many years, but until now, it did not receive much attention. Vaccines were once praised and hailed as medical miracles, but now, some individuals believe they contain tracking devices, spread diseases, and are unsafe. Vaccines are currently at the forefront of politics, medical mistrust, and conspiracy theories. But, how did we get here from there?

In 1954, a polio vaccine became available, and people lined up to get it. In the many years before the polio vaccine was available, between 13,000 and 20,000 paralytic cases were reported annually. Parents feared polio, and they would have done anything to protect their children from getting it, including not sending them to parties and playgrounds. In fact, swimming pools and movie theatres closed down during polio season to help slow the potential spread. Then, polio vaccines helped everyone get back to normal, but that’s because the vast majority of Americans chose the vaccine’s protection over taking a chance with the poliovirus.

And now, in 2021, more than a year after the emergence of the COVID-19 pandemic has led to overrun hospitals, forced lockdowns, and crippled economies across the world, public health officials are begging people to get vaccinated against COVID-19. In the United States alone, more than 600,000 deaths have occurred, yet there is still the need for an ongoing effort to increase COVID-19 vaccine uptake.

In order to choose vaccination, individuals must have vaccine confidence. That confidence includes trust in:

Recommended vaccines (are they safe, effective, and consistent with their beliefs)
Providers who administer the vaccines
How the vaccine was developed, licensed, manufactured, and recommended

Trust like this is built over time, not via one or two conversations. This includes a foundation of trust that must exist in all vaccine confidence areas. However, that trust has been eroding for years for various reasons. Now as we face an ongoing pandemic, we are trying to quickly build that trust back up, but it’s impossible to do overnight.

In America, some populations such as African Americans, have a long history of being mistreated by the government, public health, and the medical community. For other populations, immigration policies have garnered mistrust in the government for undocumented residents and their families.

The overabundance of information, misinformation, and false information via the internet and social media have contributed to the erosion of trust in vaccines and the development process. We encourage people to be active participants in their healthcare decision-making, and that is one of the reasons why there are many medical websites. However, not everyone has the amount of health literacy needed to fully process all of the information on the internet about vaccines, especially with all of the misinformation that circulates regularly. Social media provides a platform to talk about positive vaccine experiences, but many consumers of social media tend to be drawn to the scarier personal stories, which they share over and over. The trouble is, most of these are not true, but they are very memorable.

People may then turn to their trusted sources of health information, their healthcare professionals, but most doctors and nurses haven’t been trained in communications, and they often do not know exactly how to provide a strong, effective vaccine recommendation. In addition, busy medical practices often don’t have the time required to answer several vaccine questions. Patients may lose confidence in their provider (the person who administers vaccines) because they feel like their concerns are being dismissed, or they end up more confused.

Finally, consider how politically charged vaccinations have become. Data show that Republican men are among the most vaccine-resistant groups. Conservative Republicans were also the least likely group to wear masks when they were more widely mandated. Many of these Republicans believe that the media has exaggerated the pandemic and that there is no real need to get vaccinated. Others feel that choosing not to get vaccinated is a way that they can exert their personal freedoms.

The list of reasons for the decline in vaccine confidence continues to grow, but we must actively and collectively work to rebuild it. The work has begun, but it must continue more widely. CDC has several recommended strategies:

Opinion leaders should actively promote vaccines.
These leaders should include those in various settings for maximum reach, including faith-based, political, business partners, healthcare, schools, etc. Opinion leaders can be considered trusted messengers within a population; messages are trusted most when they come from within the community. Opinion leaders should all share clear, consistent messages to minimize confusion.
Individuals should approach personal conversations about COVID-19 vaccines with friends and families without judgment.
People are more likely to get vaccinated if those in their social circles are getting vaccinated, but if we don’t discuss it, they’ll never know.
More groups need to circulate credible information to replace the misinformation that vaccine critics regularly distribute.
People from all across the country should share positive, personal stories that are memorable about vaccine experiences.
Social media sites need to continue to monitor for and block vaccine misinformation.
Public health professionals need to create transparent messages about what they don’t and do know.
They need to acknowledge that they don’t always have all of the answers right away, but their recommendations are always based on the science that is available, and if that changes, they’ll adjust their recommendations.
Healthcare professionals should strongly recommend vaccines to their patients and make sure someone in their office can answer questions or address concerns about vaccines.
Having practice-level vaccine champions makes a difference in vaccination rates.

When everyone – from individuals to medical and public health professionals to social media companies – does a part to build vaccine confidence, we can build it back together and stronger.