Before the coronavirus disease-2019 (COVID-19), the issue of people opposed to vaccinations (known as anti-vaxxers) primarily involved parents who believed childhood vaccinations could harm their children. There were small pockets of outbreaks of diseases such as measles in areas where a number of parents sought philosophical exemptions after buying into the anti-vaxxer movement.
Now, as the country faces the worst pandemic in 102 years, if a significant number of people refuse to take the vaccine for COVID-19, it could lead to the epidemic lasting longer and causing more deaths and serious illnesses. So, it is particularly important that the best techniques are used to reach people who are afraid of vaccinations.
“Vaccination occupies a unique space as one of the most effective technologies ever developed to fight disease, as well as the only technology to ever eliminate a disease entirely,” Jonathan Berman, Ph.D., an assistant professor of basic sciences at New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, writes in a book published this month by MIT Press, “Anti-Vaxxers: How to Challenge a Misinformed Movement”.
Berman said three broad strategies have been used to sway people from anti-vaccine beliefs: reactive, information deficit, and community-based strategies. A reactive strategy of engaging directly with anti-vaccine advocates on the internet and mocking them or arguing with them is the least effective.
“Not only are vocal online anti-vaccine advocates not representative of the average person with vaccine doubts, but this strategy can backfire, resulting in more entrenched views and damaged family relationships,” Berman said. “Trying to provide scientific information, the information deficit strategy, isn’t effective when anti-vaccine activists cite scientific articles or use the language of evidence, typically aiming to justify beliefs that are held for non-evidence-based reasons. Addressing an argument without addressing the underlying emotional reasons for a belief is unlikely to be effective.”
Berman said when opposition to vaccination becomes attached to a person’s identity and values, contradictory information can feel like an attack on that identity and those values. Presenting science-based information resources to entrenched anti-vaccine activists is not likely to be effective. What he argues is more effective is community-based strategies showing those with doubts that others in their community are vaccinating.
“Community-based strategies have been used in the wake of measles outbreaks exacerbated by anti-vaccine activism and resulted in significant increases in vaccine uptake,” Berman said. “These strategies take into consideration the self-identity and values of those who are being targeted by anti-vaccine rhetoric.”
A recent survey indicated that only 70-80 percent of Americans planned to take the COVID-19 vaccine when it becomes available, which might not be enough for “herd immunity,” which is enough people being protected by the vaccine or by having developed antibodies from being exposed to the virus that it stops replicating in large enough numbers to sustain the epidemic.
Berman said when the vaccine becomes available, it is quite possible that more people will get vaccinated than indicated by recent surveys.
“Usually enough people end up getting vaccinated,” Berman said. “We want as many people who can safely do it to get vaccinated. The herd immunity threshold depends on the efficacy of the vaccines and the portion of the population that gets it. It is likely at this point there will be multiple vaccines coming out next year with different efficacy profiles. Also, there are going to be certain areas of the country where there is significant immunity because COVID has been spreading widely. Because of that, I think we’ll be able to get to much lower transmission.”
The effective reproduction number (R) is the number of people infected per case of COVID-19. If, instead of one person infecting ten others, less than one person gets infected from one case, the virus should disappear.
“It is not like we need it to get to zero,” Berman said. “It doesn’t require every single person to be vaccinated, but we want as many as possible. We have to wait and see what the safety profiles are of the vaccines that come out and see recommendations for who should receive them. There are so many different vaccines and vaccine technologies being worked on, it is hard to say which ones we will have access to and the recommendations for who should receive them.”
There are concerns that vaccines might be rushed for political reasons. Berman said fewer people are likely to take the vaccine if it hasn’t gone through rigorous, science-based testing and trial prior to authorization.
“I want the science to be done and peer reviewed prior to an authorization,” he said. “The best way to do that is go all the way through normal phase three trials. The first phase is research, safety and testing. Phase two is small-scale human trials and phase three is scaled to larger clinical trials. Occasionally, rare event reactions can occur that wouldn’t necessarily show up in a small-scale trial. But when you scale it up to hundreds of millions of people, you have to start worrying about those rare events. We saw Russians approve the Sputnik 5 vaccine after a trial with 75 people. Russia was politically concerned with being the first to offer a vaccine. All of that is to say we really need to see peer-reviewed phase three trials before a vaccine is approved.”
Wearing masks to prevent the spread of COVID-19 has become a way for Americans to signal their political affiliation. Vaccination is less visible, so Berman expects fewer people will refuse to vaccinate because of political affiliations.
“We really don’t want that to happen,” Berman said. “I think the best thing to encourage vaccination either for childhood diseases or COVID-19 is to create an environment around friends and family where it is clear what your position is. Make it safe to have two-way conversation. Genuinely listen to their opinions and then share your opinion. People don’t respond well to being told they are wrong or being sent a link to scientific studies. It is going to come down to personal conversations and social ties.”
There are studies showing an estimated 30 percent of Americans believe in one or more COVID-19 conspiracy theories. A common one is that COVID-19 is a hoax. People are less likely to believe that if they have personally known someone who has become very ill or died as a result of the disease.
“Knowing someone who has had it or getting it yourself is a very visceral experience that tends to be extremely convincing,” Berman said. “But my hope is we can find ways to reach people without that being the case.”
Some people question if the vaccine will still be effective by the time it is available. Flu mutates each year, and the virus that causes COVID-19 is also mutating. However, Berman said studies indicate the mutations that have occurred so far are not important, and probably would not prevent a vaccine from working. And vaccine technology has advanced so much that there could be rapid development of a new vaccine to match a mutated virus if that were to happen.
Berman’s book is available in electronic format or hard copy from sources such as Amazon.