Some polls suggest that apprehensiveness is subsiding postelection, with the Food and Drug Administration having resisted Trump’s pressure and standing its ground on vaccine safety. It may not have hurt that the head of Operation Warp Speed, Moncef Slaoui, has outed himself as a Democrat and said he has “more affinity” for the incoming Biden administration than for Trump.
The branding of the vaccine has been problematic, however.
“‘Warp Speed’ was not the right way to put it,” said Oshinsky. The public “doesn’t know what it means. They know it’s coming out at tremendous speed and they don’t know what’s behind that.”
Berinsky put it this way: “Trump pushing the vaccine—speeding it up—created distrust.”
Having the drug companies—another source of suspicion—attest to the vaccines’ safety won’t cut it either. Broader transparency, about the research and who is evaluating that research, will help, if people who are broadly trusted, like Anthony Fauci, can vouch for it. But data transparency only goes so far, since ordinary people can’t assess it on their own.
And for some communities, skepticism has been decades in the making, particularly among minority groups who have ample reason to distrust the health care system from decades of being underserved.
President-elect Joe Biden picked a Yale health equities researcher and physician, Marcella Nunez-Smith, to play a prominent role in the incoming administration’s pandemic response, focusing specifically on these challenges. She’d been advising him since August, and says assuaging minority communities’ vaccine fears has been a priority from the get-go, particularly as these are the communities hit hardest by the pandemic and its economic fallout.
“The work of truly engaging community leaders—writ large, not limited to communities of color—involves partnerships,” she said in a POLITICO interview soon after Biden named her to his team. Messaging has to come from scientists—but also “neighbor to neighbor, friend to friend—the community.”
Having scientists who are themselves part of the community vouch for the vaccines will help, said Lisa Cooper, a physician who directs The Johns Hopkins Center for Health Equity. Given her own experience, she can tell apprehensive people, “I have served on a data safety and monitoring board”—in her case, for an Ebola vaccine. “I know what people have to go through in order to decide when something is safe to be administered.”
The FDA also required the clinical trials for these coronavirus vaccines to include a cross section of the population, another trust-building ingredient.
But white coats, no matter who is wearing them, aren’t enough, Cooper and other experts on health disparities and public health outreach recognize. Messaging will have to be multifaceted, multilayered, multilingual and multimedia. It will have to be national and local, political and apolitical, involving doctors, nurses and pharmacists, church and other faith groups, community organizations—and athletes and celebrities. Trusted figures have to say not only that you should get the vaccine but that they themselves are getting it. Former Presidents Barack Obama, George W. Bush and Bill Clinton have all offered to pitch in.
And that has to be layered on transparency—and empathy. Kenzie Cameron, a Northwestern University expert on health care communication, said that means being frank about both what is and isn’t known about the brand new vaccines. Data will be collected for months to come, as scientists learn more about how long and how well the shots protect people, and whether any safety problems emerge as hundreds of millions of people get inoculated around the globe. And empathy means talking through people’s fears, not just cutting them off and saying “No. You are wrong.” That’s true in community-based messaging, as well as in a doctor’s office.
“Personal narratives are incredibly strong,” Cameron said. “Someone is saying ‘I am not telling you to do something that I’m not doing.’”
Drawing on community health workers, or other trusted local people connected to health is also a good strategy—and it helps if they can speak the language of the community, said Sandra Hernandez, president and CEO of the California Health Care Foundation. A physician with roots in both the early HIV/AIDS crisis and Latino communities, she said contact tracers working on coronavirus at the community level may be good vaccine messengers.
“We’ve got five organizations in the Mission [District in San Francisco] doing contact tracing. They are trained, they are local, they are young, they are people of color,” she said. “They may end up being a workforce that is primed to be able to help.”
“The operative word is trust,” Hernandez added.
Given that even celebrities and athletes can be polarizing these days, there will have to be a mix of famous faces, some to address specific communities, others as part of national campaigns. A celebrity-laced Trump administration ad campaign to “lift spirits” before the election was canceled; a less politicized version is being revived. Cooper said she’s already engaged with the National Football League on how they can figure into a vaccination campaign. At least two Republican senators from Trump-backing states, Rob Portman of Ohio and Steve Daines of Montana, have disclosed that they volunteered in vaccine clinical trials—a helpful message to conservative voters who are skeptical of the coronavirus itself, not just the vaccines.
Messaging isn’t one and done. People will have to be reminded to get both doses. They will have to be reassured that having mild side effects doesn’t mean they have Covid—or that they shouldn’t get the second dose. If they have a friend or relative who gets the shot and still gets sick, they will have to be reminded that it takes two doses plus a couple of weeks to build resistance. Waves of misinformation are inevitable; waves of truth will have to combat them.
Yet there are also signs that the fear is abating, that the calculus for a Covid vaccine is different. People who shun a flu shot or don’t vaccinate their kids against measles may think differently about the risks and benefits of a Covid shot, noted Schwartz, the Yale historian. This is a vaccine meant to end the worst health crisis in a century, a global disaster that has upended the economy, separated loved ones, shut schools, and effectively ended theater, travel and dinner parties. It has killed more than 300,000 Americans.
Back when Ebola struck, doctors encountered people who wouldn’t get a flu shot but were frantically demanding Ebola vaccines—even though Ebola was not spreading in the United States and there was no shot at the time. For everyone who is now asking of this new vaccine “Is it safe?” many more are now asking “When can I get it?”
And once thousands, then millions, then tens of millions get vaccinated, Americans’ confidence will rise.
“They will get this,” predicted Offit, the vaccine expert and polio historian. “They will want it.”