“Of all the liars in the world, sometimes the worst are our own fears”, the English writer and poet Rudyard Kipling wrote. The worldwide pandemic caused by the Covid-19 coronavirus spiked fear all over the world. Now we approaching a stage where joint efforts result in new vaccines, we fear the cure.
Over time many vaccines have been met with denial, anxiety and misinformation. Even before the corona pandemic, many mothers feared vaccination of their children against common childhood diseases like smallpox, measles, and mumps.
In the case of vaccination of children, social scientists say that cognitive biases are to blame. “From a psychological perspective, parents who choose not to vaccinate their children are likely falling victim to several errors in thinking, or cognitive biases,” says Dr. Rachelle M. Smith, Chair of Social Sciences and Associate Professor of Psychology at Husson University in Bangor, ME. “Cognitive biases frequently occur when an individual doesn’t have enough information or has strong emotions related to a complex decision.”.
The subject of vaccines involves complex medical science, so the mechanism of how they work and what’s in them can be hard for a layperson to understand. As a result, people are likely to fall victim to cognitive biases when deciding whether or not to vaccinate.
Cognitive biases may seem like a normal, neurological reaction to a complex problem on a strongly emotional subject. However, this should be distinguished from willfully spreading falsehoods.
Misinformation or disinformation?
There are two basic types of false information around vaccination:
- misinformation, or inadvertently drawing conclusions based on wrong or incomplete facts
- disinformation, the deliberate spread of falsehoods to promote an agenda
The two are addressed differently—misinformation can be corrected with factual information, but disinformation requires a different, more complex strategy. The second, so it seems, is not the result of cognitive bias (leading to misinformation) but rather by a deliberate attempt to bend the truth and sow distrust by spreading disinformation for selfish or political reasons, adding to a growing distrust of the new coronavirus vaccines.
Both result in distrust in vaccination and people to deny to have a vaccination. In 2019 the W.H.O listed vaccination refusal as one of the top ten global health threats.
What are the facts?
An American pro-Trump website, Newsmax, told its 264,000 followers on Twitter to “beware” the new Pfizer-BioNTech vaccine would “tamper” with your DNA.
However, it is not. “Injecting RNA into a person doesn’t do anything to the DNA of a human cell,” said Prof Jeffrey Almond of Oxford University. Pfizer counters those false statements by saying that the company’s vaccine “does not alter the DNA sequence of a human body. It only presents the body with the instructions to build immunity”.
Actually, the RNA approach that is being taken by the two most promising vaccines at the moment is quite different from the one currently used in, for example, influenza vaccination. The usual approach of making vaccines is to bring an inactivated or weakened form of a virus (in this case the influenza virus) into the human body. However, it is not able to cause disease, as immune cells encounter them, and make antibodies, fighting the disease.
Contrary to the usual approach, both the Pfizer-BioNTech and the Moderna vaccine work differently. These so-called “RNA vaccines” work by introducing “messenger RNA” or mRNA sequence into human cells which cause the body to make a harmless viral protein called a “spike”, which then stimulates the immune system to make antibodies and immune cells that can recognize the spike quickly and counterattack when needed.
The Cutter Incident (1955)
Are there any mistakes made with vaccines? Yes, the most famous one being the Cutter Incident in 1955. Cutter Laboratories produced the Salk polio vaccine (named after the inventor of the vaccine), which was supposed to contain inactivated polio. Despite safety protocols, children were given a vaccine which contained the live virus.
The cause was a fatal mistake in the vaccine’s manufacturing process. The Centre for Disease Control says “the Cutter Incident was a defining moment in the history of vaccine manufacturing and government oversight of vaccines and led to the creation of a better system of regulating vaccines.”
The Swine Flu Incident (1976)
Early 1976, two U.S. military recruits at Fort Dix, New Jersey, came down with flu-like illnesses that raised red flags for the CDC. Researchers discovered it was the swine flu. At the time they thought it was similar to the virus that caused the 1918 pandemic.
The W.H.O advised a cautious approach. Despite that, the U.S. government launched an immunization program to stave off a pandemic, fearing a repeat of the Spanish flu. Emergency legislation was signed in April 1976. The campaign to stop the spread of swine flu saw 45 million Americans vaccinated within ten months, including President Gerald Ford (who was up for reelection at the time).
In a May 2020 article in the Journal of the American Medical Association the response by the US government in 1976 was heavily criticized:
“Poorly conceived, the attempt to vaccinate the U.S. population at breakneck speed failed in virtually every respect. Safety standards deteriorated as one manufacturer produced the incorrect strain. The vaccine tested poorly on children who, depending on the form of vaccine tested, either developed adverse reactions with high fevers and sore arms or did not mount an immune response at all.”
For a complete list of safety concerns of vaccinations in the past see “Historical Vaccine Safety Concerns” by the Centers for Disease Control and Prevention.
As Heidi Larson notes in her book “Stuck: How Vaccine Rumors Start -and Why They Don’t Get Away”:
”the quality of life that most of us enjoy today is dependent on vaccines. In many ways it is one of the biggest worldwide social experiments in collectivism and cooperation in modern times. The challenge is that it depends on a social contract whose fabric is eroding in a broader context of anti-globalization, nationalism, and populism. Vaccines can, as they have in the past, serve as a form of soft diplomacy to keep at least a fundamental level of global cooperation alive and well.”
Trust is a Key Ingredient of Vaccine Acceptance
Vaccine acceptance involves multiple levels of trust: trust in the product (the vaccine), the provider (the company developing the vaccine or the healthcare professional that is involved in vaccination), and trust in the policy-maker (the health system, government, and public health researchers involved in approving and recommending the vaccine). Trust in government is also a key factor in accepting the vaccine. The less trust people have in their government the more distrust there is against vaccination.
A comprehensive overview of studies done into the relationship between trust and vaccination willingness can be found in “Measuring trust in vaccination: A systematic review“, published in Human Vaccines & Immunotherapeutics 2018; 14(7): 1599–1609.
Severin de Wit, The Hague, Netherlands
Sources for this blog:
New York Times: “Different Approaches to a Coronavirus Vaccine“
Harvard T.H. Chan School of Public Health: “Establishing the Truth: Vaccines, Social Media, and the Spread of Misinformation”
Centers for Disease Control and Prevention: “Diseases You Almost Forgot About (Thanks to Vaccines)”
Healthing.ca: “Cautionary tales from U.S. history on rushing vaccines”
The National Interest: “Four Times in History Vaccines Failed (Lessons for a Coronavirus Vaccine?)“
Immunization Action Coalition: “Vaccine Timeline, Historic Dates and Events Related to Vaccines and Immunization“
Journal of the Royal Society of Medicine (JRSM): “The Cutter Incident: How America’s First Polio Vaccine Led to a Growing Vaccine Crisis“
The Lancet, Bruce Gellin, “Why vaccine rumours stick—and getting them unstuck“
New York Times, “Mistrust of a Coronavirus Vaccine Could Imperil Widespread Immunity“
Plos One (academic magazine on biology), “Acceptance of Vaccinations in Pandemic Outbreaks: A Discrete Choice Experiment” by a research group of Erasmus University Rotterdam (Domino Determann, Ida J. Korfage, Mattijs S. Lambooij, Michiel Bliemer, Jan Hendrik Richardus, Ewout W. Steyerberg, Esther W. de Bekker-Grob)
Human Vaccines & Immunotherapeutics, “Measuring trust in vaccination: A systematic review“