—Jennifer A. Reich
“Surely this will make anti-vaxxers believe in vaccines, right?” As a sociologist who researches why parents reject vaccines, I have regularly been asked some version of this question since the COVID-19 outbreak began.
The short answer is no. The ongoing illness, death, and calls to socially distance will not alone change the minds of people who distrust vaccines. The longer answer is more concerning: a new coronavirus vaccine and the ways government licenses, distributes, and communicates about it risk weakening support for all vaccines.
Prior to COVID-19, a small number of parents rejected all vaccines, but as many as one in three American parents intentionally delayed or skipped vaccines for their children. The concerns they express—about regulation, for-profit manufacturers, and government overreach—may be confirmed unless public health agencies, policy makers, and vaccine manufacturers are thoughtful, communicate clearly, and keep public health at the center of their decisions.
Public Health versus Corporate Profits
Companies racing to develop a vaccine likely care about the public good. However, they also care about profit and a vaccine for COVID-19 will be sold. Should one become approved, which companies will be licensed to make it, how it will be priced, and how inspections of those facilities will happen will shape trust in the vaccine. Companies promising to manufacture a vaccine before clinical trials are complete also raise questions of how financial stakes might influence research. There are historic examples of safe vaccines manufactured badly to catastrophic outcomes and of life-saving vaccines that were available first to those who could pay full price. Since the US is one of the only countries that allows companies to set prices, even as public funds underwrote research and development, a coronavirus vaccine could become a luxury item. This too will erode trust.
Speed and Safety
Vaccines like other pharmaceutical products usually go through a multi-year review process that tests safety and efficacy—evidence they work. If successful, then the US Food and Drug Administration (FDA), the agency that approves new pharmaceutical products, evaluates the risks and benefits and decides whether to license a vaccine. Researchers aim to bring a much-needed vaccine for SARS-CoV2, the virus that causes COVID-19, to market in months, rather than years. Yet, speed may raise concerns about how thoroughly the vaccine’s safety has been evaluated.
The FDA allows for an expedited review of medical products that address a serious or life-threatening condition for which no alternative exists. Use of expedited reviews has increased in recent years, and a vaccine against COVID-19 would certainly qualify. But rapid review can undermine consumer confidence. For example, the vaccine against human papilloma virus (HPV), marketed as Gardasil, received priority review, which may have contributed to distrust and slow uptake. As one parent explained her objections to vaccines: “Not every parent considers measles a life or death issue, or HPV, yet there have been consistent efforts to force these immunizations on our children without adequate unbiased research. As long as the leaders of our government are in the pockets of big pharmaceutical industry lobbyists, parents have every right to question what is really best for their children.” How agencies communicate decisions about review and approval of a coronavirus vaccine will matter.
Disease Risks and Vaccine Necessity
When politicians and news agencies report that ‘the flu is worse than COVID-19,’ they echo many of the parents I have interviewed who downplayed the dangers of vaccine-preventable diseases. Parents reject vaccines that they do not see as necessary or as more risky than the disease they protect against. For example, most parents don’t remember chickenpox as particularly dangerous and thus refuse the varicella vaccine. Many question claims that influenza can kill or disable otherwise healthy children. Parents in my research examine each vaccine, and pick and choose depending on what they think their children need, sometimes selecting different vaccines for different children. As one mother told me, “I think that for boys it’s probably better that they either get the mumps when they’re little or if they don’t get it when they’re little then they have it before they’re a teenager, because if they get it then they’re at risk of sterilization. Measles for boys, I don’t care about. Girls, if I had a girl, I’d want her to have measles when she’s little, or if not, to have the vaccine by the time she’s a teen, because if she got it when she was pregnant, it’d be very sort of life-threatening to her fetus.”
COVID-19 is inarguably a life-threatening illness for some number of people who become infected. We do not yet know how many infected people are likely to die or need medical care to survive, a limitation stemming from our inability to test those with mild symptoms. It does seem clear that older people get sicker than younger people and that children seem least affected. As such, we can expect that whether this vaccine is recommended for everyone or for those in high-risk groups will shape perceptions of necessity and thus acceptance or rejection.
Vaccine Requirements and Personal Freedoms
For more than 100 years, a small but vocal minority of individuals has spoken out against efforts to require vaccines or make them a condition of school, work, or military entry. Barbara Loe Fisher, founder of the largest US organization opposed to vaccine requirements, cautioned before COVID-19 was identified in the US: “If we do not get up off our knees and stop worshipping scientists and doctors who have too little knowledge and have been given too much power, tomorrow we will not be able to get on a bus, train or plane; enter a store or sports arena; obtain a driver’s license or passport, file our taxes or function in society without getting every vaccine that industry creates and the government orders us to get.” Her hypothetical concern are becoming increasingly real for people as businesses, venues, and even parks close with unclear plans on how to reopen.
In the past month, political associations around the country have passed resolutions condemning public health monitoring, employment decisions based on vaccine status, and future effort to require vaccines; protesters have appeared at capitols. Although these actions are inspired by concerns about a future coronavirus vaccine, they aim to broadly undermine efforts to track disease, identify susceptibility within communities, isolate those who are infected, and ensure that key personnel in industries like healthcare minimize risk to others. Concerns about a novel coronavirus vaccine may risk consensus on all vaccines, not in any singular way, but by making tensions between personal choice and community responsibility newly visible. How (and if) communities, employers, schools, and governments enact vaccine requirements and communicate those decisions will matter.
To be clear, getting a vaccine against COVID-19 quickly has the potential to save lives, enable essential workers to work with less fear of infection, a significant issue as thousands of healthcare, transit, and retail workers have been infected, and to return to “business as usual.” The stakes are high and if leaders manage this badly, they may inadvertently lower consensus about all vaccines by confirming the worst suspicions about them.
Decisions about expedited approval need to be clear about what was hurried and what was thoughtful. Scientific assumptions must be transparent. Governments must work with stakeholders, including experts and community groups to build consensus. Americans have largely accepted that we are in this together and thus far support efforts to socially distance and wear masks to keep others safe. Those who bring a vaccine to market must make clear how they too are working for the public good. The future of all vaccines may depend on it.
Jennifer Reich is Professor of Sociology at the University of Colorado, Denver. Her publications include the award-winning books Calling the Shots: Why Parents Reject Vaccines and Fixing Families: Parents, Power, and the Child Welfare System.
Calling the Shots is the Winner of the 2017 Outstanding Book Award for the Section on Altruism, Morality, and Social Solidarity presented by the American Sociological Association; Winner of the 2018 Donald W. Light Award for Applied Medical Sociology, American Sociological Association Medical Sociology Section; Winner of the 2018 Distinguished Scholarship Award presented by the Pacific Sociology Association; and is an Honorable Mention for the 2017 ESS Mirra Komarovsky Book Award presented by the Eastern Sociological Society.Feature Image by Vesna Harni from Pixabay