Earning the public’s trust about a coronavirus vaccine

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A while ago, it now seems like an eternity ago, I had dinner with a psychologist. She is working with the WHO in a project that aims to improve infant health in villages in India. We know that colostrum (the first yellowish breastmilk) is vital for the immune system of newborns, but there is a lot of superstition surrounding it, mothers are hesitant to give it to their children.

As she said to me “One thing is important to keep in mind: those mothers want their babies to be healthy! They want the best for their babies.” Working with healthcare professionals and local government, her primary aim is to gain the trust of these new mothers, tell them about what colostrum does, dispel false beliefs about it, and help to encourage practices that increase babies’ uptake of colostrum “We are working with these moms, not against them.”

I had to think of this conversation as I am reading alarmist newspaper articles that say just under half (49%) of Americans would take a coronavirus vaccine, if it were offered.

On the face of it, it is puzzling. After all, people don’t want to get sick with Covid-19. Many people have concerns about being infected and are avoiding everyday activities, such as restaurant visits and haircuts. So the public is already on team “I don’t want to get this horrible disease”.

At the same time, the public is not well-informed, epidemiology, virology and related fields, are difficult to understand and are also quickly evolving. The public has received, in the past few months, very conflicting signals.

Consider the early recommendations on masks by the WHO and other official agencies and governments: “they don’t work” and also “don’t buy them because healthcare workers need them”. Consider also the lockdowns, implemented haphazardly and now coming to an end in various parts of the US. What is their rationale? What do we want to achieve (what does “flatten the curve” mean, and what’s our larger strategy?)

Specifically on a vaccine, people have been hearing the following very conflicting signals through the media:

  • A coronavirus vaccine is unprecedented! We never made one before! Maybe it’s even impossible to ever make one (this point keeps on popping up in the media every few weeks or so, with depressing regularity).
  • Vaccines that are not updates (e.g., your yearly flu shot) normally take years and years to develop. Time and again the public is told the timeline current vaccines have in mind is unrealistic.
  • Also firms are making vaccines with weird protocols the public has never heard about, such as Moderna’s mRNA protocols, and they’re trying to do in a timeline that has never been done before.

In brief, what the public is hearing is “it’s a rush job of a task no-one has done before”.

As Helena Miton and Hugo Mercier argue, people tend to judge doing something harmful is worse than omitting to do something beneficial. This explains why vaccine scares (such as Wakefield’s debunked and now retracted autism/MMR research) have such a big impact. People don’t want to do something they would regret. This does not mean people are intuitive anti-vaxxers, but it does mean they are vulnerable to anti-vaxx conspiracies. It’s important not to conflate the committed, relatively small group of anti-vaxx activists to a much larger group of people who are okay with vaccines if they feel they can trust them.

However, the producers of a coronavirus vaccine and health officials have one important advantage: people worry about Covid-19, they know it’s a serious disease, they don’t want to catch it. We’re all on team no coronavirus. This is something health officials and governments can work with.

You need clear honest communication, avoid sensationalism, to gain the public’s trust. This will be key once (hopefully) a vaccine is developed.

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