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Personal and social drivers of vaccine hesitancy

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The United States is one of the few countries in the world with enough COVID-19 vaccine doses to protect the vast majority of its populace. Yet hesitancy about vaccines generally, and COVID vaccines in particular, is stalling uptake. SciLine’s media briefing covered the role of social values and personal belief systems, including religion, in people’s decisions to get vaccinated or not; the factors driving parental choices about whether to vaccinate their children; and how public health messages and policies can influence vaccine hesitancy and acceptance. Scientific experts briefed reporters and took questions on the record.

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Introduction

RICK WEISS: Thank you, Josh. And hello, everyone, and welcome to the SciLine’s media briefing on understanding and reporting on vaccine hesitancy. For those not familiar with SciLine, we are a philanthropically funded, editorially independent free service for journalists and scientists based at the AAAS, as the American Association for the Advancement of Science. Our mission is simply to help reporters like you get more scientifically validated evidence into your news stories – not just stories about science, per se, but any story that can be strengthened with an extra dose of science, which, frankly, in our view, is almost any story. Among other things, we offer opportunities to conduct one-on-one camera – one-on-one on-camera interviews with experts who we line up periodically with expertise in different newsworthy topics. I wanted to mention here that if you’re interested in talking to experts on criminal activity in our communities, including ransomware attacks, which is pretty big in the news right now, please check out sciline.org, and look under Experts On Camera, and sign up for a slot to do that. We also, of course, have our very popular matching service that helps connect you to scientists who are both deeply knowledgeable in their field and excellent communicators for whatever story you’re working on – on deadline. Check out sciline.org, and click on I Need An Expert.

OK, today’s briefing features three such experts on a topic that’s quite timely, given that we are at this amazing point in the COVID pandemic where lifesaving vaccines are almost miraculously available now here in the United States. But for a swath of the U.S. population, these vaccines are not finding quick acceptance. It’s a tricky topic, I think, for journalists because I think many of you would say, reasonably, that it’s not actually your job to convince people to get vaccinated; that kind of advocacy is really for public health officials and others. But journalists do have a responsibility to write about vaccines and the social phenomenon of vaccine hesitancy in an evidence-based way. And the speakers that we’ve gathered today are going to provide some of that evidence so your reporting can be based on actual research results and expertise. I’m not going to take the time now to do full introductions for our panelists. All that information is on sciline.org.

But I want you to know that, first, we will hear from Dr. Rupali Limaye, who is an associate scientist at Johns Hopkins Bloomberg School of Public Health. She’s going to talk about the role of health communication, like public health messaging, in addressing vaccine hesitancy and a little bit on the complicated world of balancing personal autonomy against public health needs. Second, we’re going to hear from Dr. John Evans, a professor of sociology at UC San Diego, who will focus on the intersection of science and religion, and the relationship between religion and vaccine hesitancy and, as well, religion’s potential to foster vaccine acceptance. And third, we’ll hear from Dr. Sean O’Leary, a professor of pediatrics at the University of Colorado, who will give a little historical perspective on vaccine hesitancy and tell us what the research says about parents’ views about vaccinating their children against COVID-19. And with that introduction, let’s turn it over to Dr. Rupali Limaye.

Presentations

Role of Health Communication and Policy in Vaccine Hesitancy and Acceptance

[0:03:11]

RUPALI LIMAYE: Thank you so much, Rick. I am trying – hopefully, everyone can see my screen OK. Great. All right. So thanks, everyone. As Rick mentioned, my name is Rupali Limaye. I’m glad to be here. I’m going to touch briefly about the role of health communication and policy in acceptance. So I want to start with just a little bit of historical background. Really, what is driving vaccine hesitancy within the COVID-19 context? But to get to that point, I want to take a little bit of a step back and think about, what sort of arguments were we hearing pre-COVID? So before COVID, essentially, most of the arguments as to why people were not sure whether or not they wanted to accept a vaccine were really 1 of 4. So the first real argument we’ve heard was related to vaccine ingredients. Parents specifically were concerned about the types of ingredients that were in a vaccine.

The second driver that we heard again pre-COVID was related to the vaccine schedule because most of the hesitancy work pre-COVID focused on childhood vaccines. Parents have concerns about the number of doses that their children were getting and the schedule that they were on, especially when they were younger. The third issue was focused on this misperception of a link between vaccines and sort of severe adverse events such as autism. Even though there is no link and this has been soundly refuted in study after study, this continues to be an issue and a concern that we’ve heard from parents. And again, the fourth argument that we heard pre-COVID was really related to low levels of risk perception. Many parents, when we spoke to them, would essentially say, I’ve never even heard of rubella, much less am I going to worry about getting my child vaccinated against rubella. So not only had they not heard, they did not think the disease was severe, and they did not think that their child or themselves were susceptible. So these were really the four pre-arguments that we heard pre-COVID. This has shifted a bit. We still hear some of those same arguments within the context of COVID, but I would argue that there are three sort of newer kind of arguments that are coming up. The first is really focused on distrust and lack of confidence, the second is misinformation, and the third is the polarization of attitudes.

And one thing I want to point out very quickly, as you could see on the graphic on the right, is just to make the point that vaccine acceptance is on a continuum. So we have some people that might refuse some but not others and delay some and some not others. So let me go through each of these very quickly, one by one. So the first is related to distrust and lack of confidence. I’ve been speaking to individuals from African Methodist Episcopal Zion congregations over the last several months, and I’ve talked to about 900 members. These are African Americans living here in the United States. I’ve also worked with incarcerated populations over the last six months. The concerns are very similar across both of these groups. There is distrust of the vaccine development process – i.e., the timing, how participants were recruited, what was the follow-up with these participants. There’s distrust of the health care system in general. This is not only due to historical perception of medical experimentation but also current racism and discrimination. And then there’s also issues related to the vaccine product itself. Is the vaccine safe for Black people? Is it safe for individuals that might have diabetes, et cetera? The second issue that we’re dealing with is misinformation and disinformation. So this is an issue that we’re starting to see. And some studies are really arguing that actually the amount of misinformation is outpacing evidence-based information related not only to the vaccine but other nonpharmaceutical interventions during this COVID context.

This has become a huge challenge, and I’m sure many of you are aware of conspiracy theories and a lot of the issues that are really being fueled by social media. The third is the argument of polarization of attitudes. What I’m essentially showing you here is one day. I’m looking at a snapshot of Facebook clusters in 2019. And essentially, what you’re seeing here is that those that are red are those that hold anti-vax attitudes. Those that are blue are those that hold pro. And those that are green are undecided. The issue is, is that if you compare these types of social networks to even 10 years ago, there’s not as much intermingling. And the implication of that is that, essentially – that we’re starting to see echo chambers. So individuals will look to their networks, try to get a sense of how to make a vaccine decision, and they’ll essentially just have confirmation bias – i.e., hear what other people – the same type of attitude that they have. And this really leads to a lack of innovation and inability, I would say, to get evidence-based information and correct misinformation. So how should we communicate about vaccines? What are some tried and true approaches that we’ve looked at?

One is that facts alone – and we know this – are not enough to build trust. There have been a number of studies that have looked at, if we provide corrective facts, for example, and that’s not enough. It’s important to try to build trust within the health care system. The second is this idea of using trusted messengers. We’re hearing this again and again, particularly within the context not only here in the United States but also globally. How can we get away from using health care providers and health care-based messengers and focus more on community providers – sorry – community influencers and community leaders to really talk about the vaccine? And that simply has to do with the fact that there’s been a decline in trust in the health care system over the last 20 years. The third is that the appeal itself, that the message itself should really focus – that the reason that you’re getting a vaccine is for the benefit of the community. The example that I have here is sort of earlier on in the pandemic when we were asking individuals to stay home – so thinking about how making this decision about a vaccine is not an individual choice. It also affects those that are in your community and that you likely care about.

Another interesting appeal has been this aspirational norms, meaning, how do we really focus on the desired behavior – i.e., the vaccine or the mask in this case – as really being the norm that is “powerful,” quote-unquote? And this has shown to have promise not only – this is from the state of Arizona. We tested this here in Baltimore among specific communities. The other argument I would make here is that the ask has to be concise and uncategorical. What I mean by that is when we’re having – when we’re looking at messaging, saying things like clean after yourself is rather vague. And a better option to say that exact same thing would be, do not leave dirty dishes in the sink. Finally, the last piece, simply because there’s a lot of divide with regards to political ideology, is really looking at this appeal of appealing to patriotism. And we’ve done this, and we worked with the New York City health department to try to get a sense of, could we reach across the aisle, if you will, and really come up with a universal message that would nudge people, whether or not they look – whether or not they sort of affiliate with being a Republican or a Democrat, and how they would get them to accept the vaccine?

The last thing I want to touch on briefly before I close is just the effect of regulations. There’s been a lot of discussion related to mandating vaccines, particularly within this pandemic. Right now, this is done by a state-by-state basis, so states can determine whether or not they want a mandate. One thing I will say that’s very important is that we have to make sure that any sort of mandate should only be used in situations when its reactive and restrictive measures, really – there’s an immediate and serious risk to the larger population, and other measures have been exhausted. But we can talk more about this. And that is it for me, so I will stop there. Thank you so much.

[0:10:17]

RICK WEISS: Fantastic – so much interesting information there to follow up on in Q&A. Thank you, Rupali. We will move next to John.

Religious and Social Factors Influencing Vaccine Hesitancy in the U.S.

[0:10:28]

JOHN EVANS: Great. Get my slides up, please. Thank you. OK. Thank you very much for having me. I’m a sociologist of religion by training, focusing on religion and science. And before I go further – slide, please – I want to just talk about the basic religious demography of the United States. Twenty percent, approximately, are Roman Catholics split between liberals and conservatives in one church. Twenty-five percent, roughly, are nonreligious. Twenty-five percent are white evangelicals. I’ll also call them conservative Protestants. Fifteen percent are mainline Protestants – I will also call them liberal Protestants – about 7% percent Black Protestants, and all non-Christians total up to about 8% of the population. Next slide, please. And before I begin, I should add that I’m a sociologist, so I’m making generalizations about groups of people. So when I say that a religious group tends to believe in something, you might know a member who doesn’t believe that, but I’m talking here in averages, not everyone in the group. And my general statement is to say, all large religious groups in the U.S. are more or less like the general public when it comes to vaccine acceptance except African American Christians and white, conservative Protestants.

And we should ask, why is that the case? Next slide, please. Well, there’s two different reasons. I’ll call them religious reasons and social reasons. The religious beliefs – and religious reasons is where the religious beliefs themselves argue against vaccines. There have not been studies of very rare reasons because there’s so few people who believe them, so they’re difficult to study. But from what sociologists know about these groups, we see how rare purely religious reasons actually are. So there are some Christian Scientists who otherwise reject types of medicine, but there are very few Christian Scientists. There are some traditionalist Catholics who think that the pope is not conservative enough when he determined that it was OK to use vaccines that were developed from cell lines from aborted fetuses from 40, 50 years ago, but there are very few Catholics like that. There are a few fundamentalist Pentecostals, conservative Protestants who think that the vaccination has the mark of the beast. This is sensational to hear, but when we study these groups, it’s very rare to encounter someone who thinks that human products mark people in that way. Next slide, please.

The more important reason are social reasons. Social reasons are not religion itself but rather other qualities associated with particular religions that don’t have a lot to do with religious beliefs themselves. Often, these concerns are expressed with the language of religion, but they’re not motivated by religion per se. And I’ll start with my first group – African American Protestants, which you just heard about. And studies show that African American Protestants don’t trust the medical system due to a history of racism, basically. And so that was just discussed, and I will leave that alone except to say that there really aren’t religious – purely religious reasons in the African American Protestant community for vaccine hesitancy. Next slide, please. So that leaves us with white, conservative Protestants. Now, the first thing I want to do is to address a myth that exists in the public sphere, which is that conservative Protestants do not believe in the scientific method; they have an alternative way of developing facts about nature, that Genesis said God created humans, and Darwin said the opposite. So a few years ago, I published a book-length empirical study of this topic, and it basically shows, to be blunt, that conservative Protestants believe in virology. They believe in the scientific method.

Therefore, public health officials are not going to reduce vaccine hesitancy by talking about the legitimacy of the scientific method. Rather, as we also heard, conservative Protestants don’t trust scientists, and they don’t trust scientists more than other people don’t trust scientists. And there are three overlapping reasons for that. Most importantly, conservative Protestants are more likely to be Republicans, more likely part of Trump-based communication networks. These networks have been skeptical about COVID. Therefore, it’s not religion, per se, but the conservative Protestants watch more media that is more skeptical of scientists’ efforts on COVID. I think that is what that diagram we saw is showing. Second reason is a history of moral conflict with scientists. Again, studies show the conflict between religion and science is largely about morality. I just have preliminary data from a survey in the field. It has a question that asks the respondent whether they think scientists have similar morals as they do. And conservative Protestants are far, far less likely to think that they share a moral perspective with scientists. I also asked how much confidence they have that, quote, “scientists act in the best interest of the public.” And conservative Protestants are the least likely to think that scientists are acting on the best interests of the public.

And then, finally, conservative Protestants have a generalized populace distrust of elites. The first two are related to the repeated finding that conservative Protestants are distrustful of the elites, like scientists, government officials, academics, theologians. This is baked into the DNA of conservative Protestantism. Indeed, the original split within Protestantism in the United States in the late 19th, early 20th century was about this very issue. It was essentially about whether or not “ordinary folks,” quote-unquote, needed academic theologians to tell them what the Bible said, or can they use their own wisdom to determine what it says? So the punchline here is that conservative Protestants are predisposed to be populists, to support populists like Trump, to be in those sort of communication networks and to think of themselves as in moral conflict with scientists, which exacerbates all this. Next slide, please. But there is some good news here for public health officials because the reasons that the vast majority of religious groups are hesitant – it’s not about religious beliefs themselves. No one has to give up their religion to get vaccinated.

There are also very few people who are 100% opposed to vaccines, and most people are hesitant, not, you know, endlessly opposed. Hesitancy is that you can see both sides. And so therefore, additional positive messages should help. And I agree that finding the right messenger to give religiously based messages would definitely help. If you look at theological writings about COVID, you know, a few things repeatedly come up. Theologians basically argue for, in the Christian tradition, the importance of what’s called agape, or love of neighbor. That is, to tell people that the Christian tradition would say that you might not mind getting COVID, but you could also give it to your 80-year-old neighbor, and therefore you have a religious obligation to help your neighbor. Another example is the idea that God gave humans a God-given reason to solve problems like this. And all of at least the Abrahamic traditions have some version of this that I think would help tip some people from hesitancy into acceptance. So with that, I’ll stop. And I look forward to any questions you might have.

[0:18:14]

RICK WEISS: Thank you, John. So interesting, and right away busting some myths about religion and science and vaccine hesitancy. This is going to be a great discussion. Sean, over to you.

Vaccine Hesitancy in the Context of COVID-19

[0:18:30]

SEAN O’LEARY: All right. Thank you for that introduction. That’s a – it was a great presentation, and hopefully this will complement Dr. Limaye and Dr. Evans’ presentations. So I’m going to talk a little bit about hesitancy in the context of COVID-19 vaccines. So I want to start out by just pointing out that vaccine hesitancy is really nothing new. Edward Jenner sort of made the observation that milkmaids that got cowpox seemed to be immune to smallpox. He tested that in 1796. He then started inoculating people with – using cowpox over the next few years, and it became more widespread in England in the late 1700s.

This cartoon is from 1802, I believe. And here you can see Edward Jenner inoculating someone with the cowpox vaccine. And here you can see that – this is an anti-vax cartoon – all of these people are growing cows out of their bodies. So this illustrates a few things. You know, one, vaccine hesitancy is nothing new. The themes have really continued throughout the centuries of safety, fear of side effects. But the other thing I want to point out here is certainly smallpox and cowpox vaccination had their own side effects that were very real, more so than what we see in the vaccines we give today, but one of them was definitely not growing cows out of your body, yet that was what was being spread around at the time, which I think is kind of an analogy to what we’re seeing now with COVID-19 vaccines. We have some known rare side effects with them that have been identified and in the press, but that’s not necessarily what you see gaining traction within – among the anti-vaccination folks.

It tends to be more misinformation and disinformation. And as an aside, I will point out, following up on Dr. Evans’ presentation, that one of the main – one of his main partners in spreading COVID-19 – or – sorry, COVID-19 – smallpox vaccinations throughout England was the Reverend Rowland Hill, who was very instrumental in vaccinating thousands of people in England around the early – in the early 19th century. So how much of a problem is vaccine hesitancy overall? So this is talking generally about childhood vaccines. And we know that requests to spread out the series or refusal of specific vaccines is not uncommon, and that seems to be getting more common. There was a study from last year showing that more than a third of U.S. children were not on the recommended schedule for various reasons. It wasn’t all because of refusal, though. But I want to point out that the percentage refusing all vaccines remains pretty small – about 1.3%. That has crept up a bit over the last few decades, but the point here is that most parents are getting at least some vaccines for their children. And one of the things I want to point out here – well, I’ll also expand a little bit on what Rupali said. You know, how did we get here?

Well, one, of course, vaccines is a victim – victims of their own success – loss of diseases’ visibility, loss of a sense of urgency, lack of fear of these diseases – and then also the assault on science. I mean, we’ve seen this for decades now, where facts and evidence are seen just as a matter of opinion rather than as proven truth. And that simple belief is often considered as valid as critical thinking. And I think Dr. Evans was touching somewhat on that as well. With this graphic, do not quote these percentages at the bottom. This is sort of a rough estimate of what we see from different studies, and it certainly varies by – from community to community. But the point I want to make here is that there – as Rupali pointed out, there really is a spectrum of vaccine acceptance. And the thing I want to point out here is that the people that are absolute rejecters of vaccines really represent a small minority. We hear a lot about it. It’s in the news, of course. It’s all over social media. But that’s a fairly small proportion of the overall population. On the left, of course, are all the vaccine accepters. These are the – sort of the silent majority. Most parents are getting their children vaccinated, but they don’t talk a lot about it. And part of what we’ve been doing over the last several years is trying to give a voice to those parents who actually are vaccine acceptors to help promote vaccines.

And then, of course, there are those in the middle who just have questions, and this is a really heterogenous group of people. Some of them have very specific questions that can be addressed very quickly. Others are a little bit more hesitant, but they may end up getting some vaccines. And then just to illustrate this, you know, how or where – how – when the rubber meets the road – are children actually getting vaccinated? The fact is yes. I mean, we did see some dips with – related to the pandemic that we’re still working on addressing that are going to be very important to address in the coming months. But overall, the vast majority of parents are getting their kids vaccinated. So this is showing vaccination coverage nationally from the 2018-19 school year for children entering kindergarten on the top. You can see that those numbers are close to 95%. A small percentage of kids are getting some – getting any exemptions, so that means one or more vaccines. And then on the bottom, you can see among children 19 to 35 months of age, the rates are a little bit lower. Some of that is due to parents spreading vaccines out by choice. But a lot of that is due to things like access to care issues. Now, pivoting into COVID-19 vaccines specifically, there have been a number of surveys mostly published in the lay press, some in academic journals. And among parents surveyed over the last several months, somewhere between 46% and 60% plan to have their children vaccinated.

Of the reasons for not vaccinating along the lines of what Rupali was pointing out – not sure that the vaccine will be safe, that the vaccine has been developed too quickly, that they don’t trust the information being published about the vaccine. They want someone to take a wait-and-see approach. And some just don’t have enough information. The bottom bullet there – parents – in general, if parents report intention to vaccinate themselves, they report intention to vaccinate the children. It’s pretty highly correlated with maybe a little bit of an exception. This is a slide from a recent CDC ACIP meeting, showing some results of parent surveys from January and March. And in this one, we did see some variation. In these studies, we did see some variation by race, with less intention to vaccinate among Black parents and Hispanic parents. There’s been a lot of work trying to address some of those issues over the last several months, and that may be bearing fruit, as this survey from April actually didn’t show a difference by race, ethnicity in terms of intention to vaccinate and what this more recent survey showed is that roughly around half of parents are definitely or probably planning on getting their children vaccinated with – and you can see a small percentage of parents saying absolutely not, with other parents saying probably not or, you know, maybe a wait-and-see approach. And then this is the one thing I want to point out with this slide.

So what we’ve seen as the vaccine was rolled out initially to children with the Pfizer vaccine in 16- and 17-year-olds and now down to age 12 was that there was a large surge in demand in these mass vaccination clinics. So we saw a lot of kids getting vaccinated very quickly. And as we’ve seen with the vaccination in adults, some of that initial demand has tailed off. And so we’re seeing fewer doses being given nationally as we get to some of those more harder-to-reach folks. Some of that is due to hesitancy. Some of it is still due to access-to-care issues. But one of the things I want to point out here is that as we move into the next phase of vaccinations, there’s been a lot of focus of trying to get these vaccines into primary care offices. Now, there has been some erosion of trust in physicians over the years, but they are still definitely the most trusted sources of vaccine information. And so what you can see here is that this – from this same survey from April, the place where parents were most comfortable getting their child vaccinated was in a regular doctor’s office. And so I think for those parents who are in that sort of middle ground of hesitant maybe, maybe not, that’s going to be a much more appropriate setting for vaccination, where they can get some of their questions answered from a trusted source than these mass vaccination clinics, where that’s a lot more difficult to do. And then what I want to end with is one of the things that I have observed over the years – it’s gotten somewhat better, but I still see it fairly frequently. And that’s this challenge that you may be aware of called pseudo-symmetry or false equivalence.

So I live in Denver. I still get the Denver Post and try to read it every day. This is from several years ago. And this was at a time when we had – in Colorado had the lowest rates of vaccination in measles in the country, setting – you know, setting us up very easily for a measles outbreak. And so this was a front-page story – “Stuck In Last On Measles Shots.” And so going into the meat of the story, this is on the front page. Over here on the left, we have a quote from one of my colleagues, Dr. Edwin Asturias. “We are going to have a large outbreak of measles.” And using this sort of journalistic practice of trying to get, quote, unquote, “both sides of the story,” right across on the same front page, you have a woman who was the executive director of the National Vaccine Information Center, which is actually the largest anti-vaccination group in the U.S., very well-funded. And so here, you’ve got someone who actually knows the science being put up against someone who is – represents a very small proportion of the population and being anti-vaccine quoted as if they have some kind of an equivalence. And I’ve seen that problem over and over again. I think you’re probably well familiar with it in the – in climate change – or the coverage of climate change. But that’s a real problem that we see to this day – is quoting the scientists and then quoting, say, a parent who’s anti-vaccine. And many parents are going to be much more likely to identify with the parent than they are with a scientist. So that’s an issue that we still deal with in journalism today. And I will end there.

Q&A


What are some science-backed tips and pitfalls-to-avoid for reporters covering vaccine hesitancy?


[0:29:12]

RICK WEISS: Thank you, Sean. Fantastic. And I want to remind reporters that these slides will be posted on the sciline.org website soon, so you can refer to them and get details from them. Really nice use of color on those, I’ve got to say, Sean. Good stuff. OK. So we’re going start the Q&A now. A reminder that Q&A icon is something you can click on, reporters, to send in your questions. But while those get loaded up, I want to start with the moderator’s prerogative of asking what traditionally is the first question in these briefings and something of practical value to, I think, all the reporters, which is to ask each of you briefly what you think is something that either journalism generally is doing well or failing at somewhat as reporters go about covering vaccination and vaccine hesitancy, a little bit of practical advice there, positive or negative. And I’ll start with you, Rupali.

[0:30:07]

RUPALI LIMAYE: It’s a great question, Rick. And I think I can talk about very briefly – first of all, I think it’s been really hard to cover – let’s just be very clear here. It’s been very hard to cover the pandemic. Things have changed very rapidly. It’s a dynamic situation. I think many of the journalists that we have spoken with and worked with over the last year have tried really hard to be on top of the scientific consensus and the evidence. You know, with that being said, I think it’s really hard. How do journalists – I mean, those of us that are scientists that work in this are also trying to muddle through this and understand what is new and what is not new. I think that the goal really should be is that scientists have to continue to work with journalists. I mean, I think a lot of us have been in the media a lot, and that’s not something that we typically do (laughter). And so to me, it’s really a nice partnership. I think that’s the only way that we’re going to continue. And I think continuing to build this partnership long after this pandemic will be very crucial to make sure people have the information they need to make a decision, whether that’s about a vaccine or any other type of health or medical issue.

[0:31:04]

RICK WEISS: Thank you. And John.

[0:31:06]

JOHN EVANS: I have something similar to what Sean was saying, which is back in the ’90s, I was part of a discussion with religion journalists. And the question was, why don’t you cover mainline Protestants? And the answer was, they’re really boring. They’re just like us. And so the danger, I think, is that there are a lot of extremely unusual religious practices in the United States that should be – having to do with COVID that should be, you know, reported as extremely unusual compared to the vast majority of religious folks in the United States. And so I think it’s important – even though some of these claims are probably a lot more interesting, it’s important, I think, to balance, to put that in the proper context.

[0:31:52]

RICK WEISS: Great. And Sean?

[0:31:54]

SEAN O’LEARY: Yeah. I mean, kind of going along with what I was saying before, I do really think that journalists have gotten a lot better over the years of trying not to sort of amplify misinformation, you know, trying to cover the actual science as opposed to, you know, the fringe theory out there. But as John points out, it still happens. And one of the things I’ve noticed – for example, you know, the print, the magazine or the story may be really good in the newspaper or whatever. But if you look on the website, there’s this real tendency for the website designers to do clickbait. And the really out-there stuff – that’s what people click on. That gets the clicks. That drives the advertising dollars, et cetera. And so I think there’s a real tension there between trying to, you know, do the right thing financially for your company but also risk spreading misinformation by getting people to click on these sort of kind of out-there fringe ideas and misinformation.


Has America’s experience with COVID driven the number of anti-vaxxers up or down?


[0:33:05]

RICK WEISS: OK. And we will start with some questions from our audience. And I have a question here from Eric Whitney, who’s reporting out of NPR’s Mountain West/Great Plains Bureau. Is there evidence that America’s experience with COVID has driven the number of anti-vaxxers up or down? Wonder if any of you have some stats on that. Rupali, I see you nodding.

[0:33:28]

RUPALI LIMAYE: I can comment quickly. I’m sure Sean probably has thoughts on this, as well. I think what has happened – and we’ve been studying this along with those that are anti-lockdown individuals, as well as anti-mask individuals. Before, I would argue that these groups were a bit more disparate and kind of in their own what I would consider – I’m putting that in quotes – “fringe groups,” I think what the pandemic has done is really brought them together to become a little bit more organized than they were pre-pandemic. I don’t think there’s been any change, I think, with regards to what we’re seeing, with regards to concerns of why people don’t want to get the vaccine. I think they’re very similar to what we’ve seen in the past. It’s just that we’re in the middle of a pandemic. And so I think there’s a lot more scrutiny on this vaccine compared to other vaccines that also went through the EUA process. And even though it’ll go through a full approval process, I think there are still lingering concerns because of the speed and the development of the trials. And that’s why I think we’re hearing more about sort of anti-vaxxers.

[0:34:20]

RICK WEISS: Sean, anything to add there?

[0:34:22]

SEAN O’LEARY: Yeah, the – I guess a couple things. Most of this is anecdotal, but one of the things that – I work with a lot of general pediatricians in some of my research work and advocacy work around vaccines. And I’ve heard a lot of stories from pediatricians about parents who had refused all vaccines prior to the pandemic – they, you know, had long conversations with these families – all of a sudden coming in and saying, can you get me caught up? Can you get my child caught up? So I think there is the potential for some movement in the direction of, OK, science is real. We need to understand it. But at the same time, there are some threats to that. I think some of the skepticism that has come up around COVID-19 vaccines that has kind of been aligned through politics and demographics with, you know, certain segments of the population absolutely refusing the vaccine, the anti-vaccination activists – which is, as I mentioned – is a fairly small group relative to the general population – have, in a lot of cases, aligned themselves with anti-maskers, et cetera. And the threat – the concern I have is that some of the – you know, the – most parents, as I said, of any political persuasion have accepted vaccines historically. The concern is that some of the talking points, some of the anti-vaccination maneuvers that have been used for COVID-19 vaccines could translate into routine childhood and adult vaccinations, which would be, you know, of course, a tragedy as we come out of this pandemic because, frankly, a lot of those – a lot of the diseases that we’re talking about are even more life-threatening for both children and adults than even COVID-19. So I think there is that potential threat there as well.


Should reporters write about vaccine hesitancy in terms of social or political affiliation, in addition to or instead of religion?


[0:36:19]

RICK WEISS: John, a practical question that I think for you – if religion itself is not generally at the heart of hesitancy, should reporters be more careful when writing about vaccine hesitancy not to talk about it primarily in terms of religion but rather in terms of other social or political affiliations?

[0:36:39]

JOHN EVANS: Yes. I think you – I think that’s the answer. And, I mean, I think it can be done with just a clause or two, which is to say, yes, white, conservative Protestants are more vaccine-hesitant. However, studies show that this can largely be explained by their political orientation, which is, you know, sort of not directly related to their religious beliefs. So I think that that can be done, and I think it’s important to do. And, you know, I should say that there are definitely some people in the United States who have direct religious beliefs that would oppose vaccines and medicine, et cetera, et cetera. And it’s important to report that correctly, but they are few and far between.

[0:37:25]

SEAN O’LEARY: Yeah. And I would just add to that that childhood vaccination laws in the U.S. are enforced at school and child care entry. And so every state, you can get a nonmedical – or I’m sorry – a medical exemption to vaccination if there’s – and those are generally rare. Some states, you can get religious exemptions. Some states, you can get philosophical exemptions. In some states, you can get both. In places where we see philosophical exemptions and religious exemptions, there tend to be very few religious exemptions to vaccination. In states where there are religious exemptions, those tend to be along the level of what we see with philosophical exemptions. And in states that remove their philosophical exemption and only have a religious exemption, you actually see those go up. So a lot of what you see in the data around religious exemptions actually is masquerading. It’s – those are actually personal belief or philosophical exemptions.


Is there any research on the effects of trusted leaders not getting vaccinated?


[0:38:25]

RICK WEISS: Here’s a question from Mary Landers. She’s at the Savannah Morning News. Is there any research on the effects of trusted leaders not getting vaccinated? I’m thinking of some elected officials in Georgia who have been very quiet about their vaccination status.

[0:38:43]

SEAN O’LEARY: Rupali, you probably have a lot to say about this. But one thing I will say is that I believe Gallup – it’s Gallup that’s done a survey about trust in leaders and trust in different professions over the decades, in fact. And consistently, physicians and nurses are at the highest levels of trust. And at the very bottom of the level of trust is our members of Congress and elected leaders. So I think, sure, that can play some role. But I think for the most part, people trust their medical provider, their primary care provider much more than they are going to – their elected official.

[0:39:23]

RUPALI LIMAYE: And I think, to add onto Sean’s point, I think working with African Methodist Episcopal congregations, one thing that we have learned – we did a – we’ve done a couple of surveys with the members and of the groups that we have been going to. And I’ve spoken to about 270 pastors so far. And what we are hearing is, particularly within those populations, were that – do you really perceive racism and discrimination? I think that the doctor is going to be rated – or the physician or nurse is going to be rated a bit lower. And they are really looking to their pastors to provide a recommendation and, really, information as to whether or not the vaccine is right for them and their families. And so it’s been fascinating to see sort of these changes in these groups. We’re working with undocumented immigrants as well here in Baltimore. And we’re hearing the exact same issue with these individuals – is that they don’t really want to hear from people in the health care system, as they want to hear from community leaders. And that’s really the advice that they’re going to follow.

[0:40:20]

JOHN EVANS: So Rick, if I could add to that – so let’s do a hypothetical. Imagine that you’re a pastor in a white, Protestant congregation. Almost all those congregations – the congregation decides who the pastor is, not some higher structure, not some bishop somewhere, OK? And imagine that half of your congregation is hesitant. It would take, you know, an act of courage, which is a human thing that people vary on, to stand up in front and say, yes, I was vaccinated. And so I think that there would obviously be undoubtedly people out there who lead congregations who would be reluctant to reveal to everyone that they’ve done this. So, you know, it’s an understandable response to the social conditions that some people find themselves within.

[0:41:05]

SEAN O’LEARY: And just to piggyback on that, one of my mentees, Josh Williams, has been doing a lot of work in religious communities around vaccines. And he surveyed religious leaders about their vaccine attitudes, and it turns out that they represent the general population. They – some of them are hesitant to get vaccines. Some of them are very pro-vaccine. And they – while they are willing potentially to talk about vaccines, a lot of them don’t necessarily know a lot about vaccines. And so I think there is real potential to engage religious leaders in promotion of vaccines.


How do reporters balance providing the facts about vaccine safety, while also not delegitimizing vaccine hesitancy due to the history of medical racism?


[0:41:45]

RICK WEISS: Question here from Maggie Green from WTVD ABC11 in Raleigh – here in N.C., she writes, there is strong hesitancy and fears of vaccines due to the history of medical racism, particularly eugenics, right here in our state. How do we balance listening to those fears and not delegitimizing them in our stories while also providing the facts that vaccines are safe and effective?

[0:42:13]

RUPALI LIMAYE: I think that’s a really hard one. And I think, you know, Sean and I have collaborated on several things, and one of the things that we have talked about is this idea of, how do we build empathy, and how do we make sure we come from a place of empathy? I think people have legitimate concerns, and the ways that they’re thinking about a vaccine decision-making process, it’s rational in their brain. And so I think it’s really important to make sure that – we’re living in a very uncertain time. People are going to do everything they can to reduce that uncertainty – and so I think making sure that we’re being empathetic but also being very clear on what we know and what the evidence shows, you know? And I think one thing that we have tried to do in a lot of our interactions, especially from the physician and sort of patient, is really to say that, you know, I understand that you have concerns, but here’s what I know from the science and moving forward that way. So part of it to me is really a framing issue, to be honest. The second piece to me is really making sure that we’re being humanistic and we’re – you know, we’re really understanding that people are concerned and are just trying to figure out answers to questions that they don’t know much about. And I know it sounds very simple, but I think it’s hard for people to sometimes implement that and understand that we need to take a little bit more time sometimes to explain some of this.

[0:43:23]

SEAN O’LEARY: Yeah. I mean, frankly, it takes a lot of work. It takes time. It takes building trust. And I think it’s important to validate those concerns, absolutely. But that’s where partnering with trusted messengers comes in – building on existing relationships, establishing new relationships where you need to. But it’s that – trust is going to be really important because having somebody come in and just, you know – just speak to you and deny all of your concerns as if they’re not valid is only going to strengthen resistance.


Does having a relative or close loved one who suffers from COVID-19 increase the likelihood that a person might get a vaccine?


[0:43:57]

RICK WEISS: Question that could go for, I think, any of you – for those who are vaccine hesitant or part of a group that tends to be hesitant, does having a relative or close loved one who suffers from COVID-19 or maybe any other vaccine-preventable illness increase the likelihood that a person might be persuaded to accept a vaccine? And I think we can include in that not just loved ones but maybe congregation – fellow congregation members. Does knowing someone or loving someone who has had this experience help break down hesitancy? I wonder if any of you have either research or personal experience with that.

[0:44:41]

SEAN O’LEARY: You know, I can’t quote the actual numbers, but there have been a few surveys that have shown that that is the case, that if you do have personal experience with it either in yourself or others, that, yes, that can play a role. In terms of how big of a role, there’s so many other factors contributing that it’s a little hard to sort of say in one specific instance. But absolutely, I think personal experience with COVID-19 plays a role. And there are lots of – I’ve heard plenty of stories of – you know, for example, in Colorado and other parts of the U.S., I know there’s a big urban-rural divide in terms of acceptance of COVID-19 vaccine. And I’ve heard several stories of, say, a rancher who had a really rough time being hospitalized with COVID-19 going and speaking with his friends, you know, in the grocery store or whatever and saying, you don’t want to get this. And lo and behold, those vaccinations – the vaccination uptake increases in that area. And so that’s one of the things that we’re trying to do – and others around the country – is to share those stories from people that they trust and that they know.


Will faith leaders continue to take a more active role as health care advocates? How might that manifest?


[0:45:56]

RICK WEISS: Here’s a question for you, John, from Taylor Sisk at 100 Days in Appalachia, which is based in Tennessee. Throughout the pandemic, faith leaders have taken an active role in encouraging their congregants to first observe preventative precautions, then to get vaccinated. Do you foresee faith leaders continuing to take a more active role as health care advocates? And how might that manifest?

[0:46:24]

JOHN EVANS: Yeah. I mean, I do – I mean, in general, I think that, if anything, COVID has taught many people that, you know, your individual health is not just a function of what you do as an automaton. You know, you are connected to everybody else, in this case through, you know, spread of viruses. But I do think that it probably made everyone realize that health is a more collective problem and that, therefore, I would anticipate people who think of the collective instead of the individual, which is a sort of more religious orientation, would potentially down the line be more willing to talk about collective health problems. I know it’s dangerous to predict the future, but I’ll try with that one.


How should employers handle vaccine hesitancy and how should they ensure that employees are vaccinated?


[0:47:15]

RICK WEISS: Interesting. OK. And a question here directed to you, Rupali. This is from Sarah Kim at WYPR public radio in Baltimore. Maryland hospitals are planning to make vaccinations a condition of employment. Could you speak to how Maryland workplaces, both medical and nonmedical, should handle vaccine hesitancy and how they should ensure that their employees are vaccinated?

[0:47:43]

RUPALI LIMAYE: It’s a hard question. As I had mentioned, the way that mandates occur, it’s going to be at the state level. So states have to determine whether or not – what type of flexibility a private institution specifically has compared to a public, for example, institution. I think a couple of things – you know, we just found out, you know, today that – students have always been required to have the vaccine to come to campus here in the fall in our Baltimore Johns Hopkins campus. We just found out today that faculty and staff will also be required. This was a huge debate that went on. And for those of us that have been advising on this, I think that it’s a no-brainer, that – I think that if you’re going to have a safe campus and a safe place and you want to really reduce risk of community exposure, you essentially need to apply this in a way that’s equitable. And so that would really be my argument – is that we have to make sure that we’re equitable. We have to make sure it’s not coercive. And we also have to make sure that we have exhausted all other restrictive options, as I mentioned.

A lot of bioethicists have looked at this and have spoken on this. And I think, for now, simply because of where we are in the pandemic, I think that there will probably be less – I think more companies are moving away from mandates and instead are moving towards this incentive-based process. I’m sure you all heard, but I think Washington is now giving joints for jabs. And so you can get a joint if you get vaccinated in the state of Washington. Ohio, you know, we were just – my husband and I were just there last week ’cause he’s from there, and they’re – they were one of the first states that decided to do this lottery sort of approach, that if you do, you have a chance of winning, I think, college tuition, et cetera. And so I think the less restrictive we can be is going to be better because that’s going to be less likely to erode trust. However, I think mandates for those of us that work on medical campuses – like, we’re required to have flu vaccine. It’s a – you know, it’s required for us to come on campus. And so I just think it’s making sure we’re balancing that and making sure it’s not coercive.


In some cases, does vaccine hesitancy stem from a lack of trust in scientists themselves, and their morals?


[0:49:34]

RICK WEISS: Question here from Kate Gavaghan from Sci In The Tri – that’s based in North Carolina. Can panelists please elaborate on the concept that vaccine hesitancy doesn’t come from lack of trust in scientific method but rather that people in some cases don’t trust the scientists themselves because they view their morals to be different?

[0:49:57]

JOHN EVANS: Well, I can start with that, which is that if you include method to be every aspect of all scientific activity, that would include believing that the scientists themselves aren’t trustworthy, et cetera. But that’s not how people view things. So imagine that someone tells you, oh, the people that invented this vaccine, they were cutting corners because they just wanted to get – be the first person to finish, and there was a race, and they just decided to do this quickly. If you don’t trust the morals of scientists, then you would be more likely to think that that’s the case. And therefore, you would be more likely to adopt a view that, oh, it’s not safe because corners were cut; the scientists, you know, were really rushing, et cetera. So it’s – if you don’t think the scientists have the same moral standards as yourself, you’re less likely to trust the process. It doesn’t really have to do with belief in experimental methods or, you know, how virology works, that kind of thing.

[0:51:07]

RICK WEISS: Any others want to comment on that? OK.

[0:51:13]

SEAN O’LEARY: I think, in general, it’s the – you know, it’s a tough call. I think with – for example, when I talk with pediatricians who are seeing families, highly religious families who bring up, you know, some aspect of a vaccine that they don’t want to get vaccinated, a lot of pediatricians report success if they share that they themselves are religious and they chose to get vaccinated. So that personal trust issue can play a role there. But it is certainly a challenge when you’re, like, the – where you are coming from as an authority figure, as a scientist seems to be from sort of a different world than the person you’re trying to convince, that can be really challenging.


How can journalists best convey that scientific knowledge is nuanced and complex, and not absolute?


[0:52:04]

RICK WEISS: Here’s a question for anyone from Bonnie Juettner at – freelance reporter based in Milwaukee. What are your thoughts about conveying to a layperson that scientific knowledge is nuanced and complex, not absolute, that it’s developed through a back-and-forth, through dialogue and through replicating each other’s work to make sure it can be replicated, et cetera – all the things we’re taught in many of these science communication courses to explain about how science works? It’s frustrating to try to convey this because most people don’t seem to think about the nature of knowledge or about it changing over time. Maybe you have thoughts on whether this is a hopeless mission or worth pursuing.

[0:52:49]

SEAN O’LEARY: It’s a great question. It’s an enormous challenge. You know, it starts with our educational system really training, you know, our children, frankly, and all the way through undergraduate and even graduate in the scientific method and understanding how science works because what we see over and over again is the use of either sham studies published sham scientific journals or taking a single scientific study out of context, and then that gets really circulated on social media as if that one single study taken out of context is the be-all, end-all. Whereas, you know, science is really the preponderance of the evidence. And within specific fields, whether that’s climate science or vaccines or whatever, there really is a level of expertise you need to have to be able to put the literature in its context. And that’s a really challenging thing to convey when one single study is really the topic of discussion.

[0:53:56]

RUPALI LIMAYE: I think, to add on to Sean’s point, one thing that has been very challenging for us – I teach a class called persuasive communication, and a lot of students are asking, how do we talk about this? How do we convey it? And I think some of the issues that we had last year is that, from a scientific point of view, you know, the reasons that we didn’t first require a mask, then we required a mask and we’ve changed guidelines is – that’s because we have data, and we update recommendations based on those data. So for us that work in a science space, we’re like, that means science is working, right? We are using evidence to then make recommendations that are evidence-based. However, I would argue that the majority of the public does not see it that way, and they very much perceive it as, you all don’t know what you’re talking about. And I did – I think many of us that have been working on this, we got that feedback quite a bit over the last year – is that scientists don’t know what they’re doing; they keep changing recommendations. And so I think to – it’s a great question – and to that question is that we do have to understand that it is nuanced. And to Sean’s point, you know, I have a grant that’s looking at misinformation on social media, and it is just pretty much – you know, when you kind of go on social media and you look at any of these platforms and how rampant a lot of this misinformation is how taking one study, blowing it up out of context and then it becomes viral because it is sensational – so I think having some of that public-based education to make sure people understand how to identify misinformation, how to reject it and how to make sure they’re also not disseminating it and spreading it inadvertently is going to also be critical moving forward.

[0:55:28]

SEAN O’LEARY: Yeah. And I just want to add a bit abstractly but from the religion angle, which is, in conservative Protestantism, authoritative statements are not wishy-washy. They’re definitive and complete. And the sort of more nuanced thing, that’s mainline Protestantism and Catholicism. And so this is again yet another subtle little thing working against us in this community which is, scientists can’t stand up and say, I know this fact for all time and space forevermore. And so I think this is yet another additional challenge.


What is one key take-home message for reporters covering vaccine hesitancy?


[0:56:00]

RICK WEISS: I think it’s a conflict, actually, between the philosophy of science and the philosophy of news at its heart because news, of course, is built on what’s new, what happened today. And it’s a little bit hard, I think, for journalism to be able to step back and wait until there’s a little bit more consensus. It’s a tough call. Well, we are just about at the top of the hour here, and I do want to give everyone on the panel a chance to make one last wrap-up remark and a take-home message for the reporters who are on the line. Before I do that, I want to remind the reporters that this video and transcript will be up on our website soon, and I encourage you to go to our website and, as you log off at the end of this, to please respond – it’ll take a half-minute – to a short three-question survey that we’ve got to help us continue to make these media briefings as useful as possible for you. But let’s go once around the horn at the end here and just hear from each of you one easy take-home message. If reporters don’t get anything else from today, what do you wish it were? Rupali, I’ll start with you.

[0:57:00]

RUPALI LIMAYE: Well, that’s a hard one. I think my biggest thing is that, again, you know, continue to work with scientists. I think continuing to make sure that you’re reporting accurately and that you’re trying to convey information in a way that the public understands is really going to be the takeaway. I – again, I’ve appreciated, I think, the partnership with a lot of journalists over the last year. I hope it continues moving forward not just, again, in the vaccine space but in other spaces. I think that would be my takeaway.

[0:57:28]

RICK WEISS: Great. John.

[0:57:30]

JOHN EVANS: I would say to focus on the positive religious messages for vaccine acceptance. I suspect Rupali has all sorts of great data and comments from AMEZ pastors about the messages they use, and I think that’s sort of a bit underreported in this. And so I think that would be a very interesting set of stories, useful.

[0:57:53]

RICK WEISS: And Sean.

[0:57:55]

SEAN O’LEARY: Yeah. I mean, I’ll echo Rupali. I’ve talked to a lot of reporters over this last year, and I have to say, I’ve been very happy and impressed with the level of professionalism. And the stories that have been coming out have, almost to a rule, been really well-written and balanced. But I think, going back to our previous discussion, and just – I guess what I would say is embrace the nuance. Really make every effort you can to convey that a single study does not change the science, that there is – there’s a lot more to these decisions in science than simply one or two facts. It’s not black and white. Medicine and science almost never are.

[0:58:42]

RICK WEISS: Fantastic. Well, I want to thank all three of our panelists today for a super well-organized, fact-filled and very articulate collection of ideas and information. It’s been such an interesting briefing. Thank you all. Thanks to the reporters for logging in today and for your commitment to getting the facts right and the context correct as you report on this really important public health topic. I encourage you to, again, go to sciline.org to find out how else we at SciLine can help you in your work as journalists. And we look forward to seeing you at the next SciLine media briefing. So long.


Creative Commons LicenseThe text and video on this page are licensed as Creative Commons CC BY-SA 4.0. Journalists are free to use any text or video on this page with or without attribution to SciLine.

Dr. John Evans

University of California, San Diego

Dr. John Evans is the Tata Chancellor’s Chair in Social Sciences, professor of aociology, associate dean of the social sciences, and co-director of the Institute for Practical Ethics at the University of California, San Diego. He is an expert on the ethics of human gene editing, and more generally in the ethics of science and technology. His research focuses on politics, religion, science, and ethics with a particular interest in sociologically examining questions that have largely been addressed by humanities scholars. He is also a leader in the sociological study of the relationship between religion and science, an area in which he co-leads a small scholarly network, and his most recent book is The Human Gene Editing Debate (2020).

Dr. Rupali Limaye

Johns Hopkins Bloomberg School of Public Health

Dr. Rupali Limaye is a faculty member at the Johns Hopkins Bloomberg School of Public Health, in the departments of International Health, Epidemiology, and Health, Behavior and Society and is director of Behavioral and Implementation Science at the International Vaccine Access Center, as well as the associate director for behavioral research at the Institute for Vaccine Safety. Her research examines how various influences affect health behavior and how to leverage those influences to affect positive behavior change. She also studies how health information can best be communicated to individuals in different contexts and through different channels. She has worked in more than 20 countries from both research and implementation perspectives, on topics including immunization, family planning, HIV/AIDS, maternal and child health, and alcohol, and she teaches classes on health behavior change and persuasive communication.

Dr. Sean O’Leary

University of Colorado Anschutz Medical Campus

Dr. Sean O’Leary is a pediatric infectious diseases specialist and associate professor of pediatrics at the University of Colorado Anschutz Medical Campus. Dr. O’Leary is also the director of the Colorado Children’s Outcomes Network, Colorado’s pediatric practice-based research network. His research focuses on identifying barriers to vaccination, including parental vaccine hesitancy and vaccination disparities, and developing and testing interventions to address those barriers. He serves as the liaison to the Advisory Committee on Immunization Practices for the Pediatric Infectious Diseases Society.

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