Vaccine distrust could hurt virus recovery effort
Nuria Martinez is about 80% certain that she, her husband and their three children will not get coronavirus vaccines if and when they become widely available, which health officials say likely will be sometime next year.
Her children have gotten mandatory childhood vaccinations to go to school. But when it comes to vaccines that are not mandatory — such as for the flu and, potentially, for the coronavirus in the near future — she is more leery.
Martinez, who is 38 and lives in Sacramento, wants to wait to see what the side effects of the coronavirus vaccines may be, to make sure they are not more harmful than the disease itself, she
said through her brother, who acted as a translator. Martinez, a housekeeper, is concerned the vaccine is new and the potential longterm effects are not yet known. She says she has seen family members and relatives of friends have bad reactions to other vaccines, and that worries her.
Martinez is not alone in having reservations about coronavirus vaccines. An October Stat News-Harris Poll shows that 58% of Americans say they would get a vaccine as soon as one is available, down from 69% in August. California’s numbers are similar — 57% say they would probably or definitely get a vaccine if it were available today, according to a statewide survey released by the Public Policy Institute of California on Wednesday.
There are sharp differences along ethnic lines: 70% of Asian Americans say they would get the vaccine today, compared to 62% of white respondents, 54% of Latinos and 29% of African Americans, according to the poll, which surveyed 1,701 adults between Oct. 9 and 18.
Health officials and infectious disease experts expect at least one coronavirus vaccine to be authorized by the end of 2020 to limited highpriority groups, and for additional vaccines to become available to the public in 2021. Assuming the vaccines will be deemed safe and effective — the FDA requires that they be at least 50% effective — low levels of vaccination could hinder the nation’s progress toward slowing or ending the pandemic.
“I remain hopeful that once appropriate committees and experts have reviewed things, and are sure of the safety of the product, that we can do much better than ( 50% of people getting vaccinated), that many people will be reassured,” said Dr. Art Reingold, a professor of epidemiology at UC Berkeley and chair of the state vaccine review group. “But to the extent that people don’t accept vaccination, then clearly we’ll have a harder time assuring the population in general is immune to this virus, and we’ll be relying on masks and social distancing and other measures even longer.”
Vaccine hesitancy is nothing new, particularly in California, which until fairly recently was notorious for its large pockets of communities, including Marin and Santa Cruz counties, where many families refused to vaccinate their children. A statewide measles outbreak traced to Disneyland in 2015 led to stricter childhood vaccination laws and the state’s immunization rates have climbed since then.
But doubts about the coronavirus vaccine are taking on a new dimension during this pandemic, in no small part due to the unprecedented politicization of public health measures and eroding trust in institutions that once were considered nonpartisan.
“There’s so much lack of trust in our institutions, which of course have grown way stronger and so much more polarized with the Trump administration,” said Dr. Sharon Kaufman, a UCSF professor emeritus of medical anthropology who studied vaccine hesitancy following the rise of Andrew Wakefield, the former physician whose discredited research linking immunizations to autism helped energize a worldwide antivaccination movement. “The issue about taking a vaccine has been linked to the freedom to do whatever you want.”
The reasons why people are skeptical of coronavirus vaccines vary. Many are worried they are being developed too quickly. Others are skeptical of the U. S. Food and Drug Administration, the federal agency in charge of authorizing the vaccines, in part because of the Trump administration’s overall handling of the virus.
Medical experts say the vaccine development and review process, though fastmoving, is sound. Data from the vaccine trials will be reviewed by the FDA, by outside independent scientists and, in California, by a state board of infectious disease physicians and researchers.
Experts point to recent developments that signal the FDA, after previously being perceived as cowing to President Trump, is pushing back against political pressure to rush a vaccine through.
This month the FDA, against Trump’s wishes, instituted stricter guidelines requiring a longer period of followup for vaccine trial participants; the drug companies developing the vaccines are providing more transparency about their clinical trial data than is customary in drug trials; and the CEO of Pfizer, which is developing a leading vaccine candidate, said this month it will not have vaccine trial data ready to apply for FDA review until after the election.
“The rush job, the shortcuts have been eliminated,” said Dr. Eric Topol, a clinical trial expert and professor of molecular medicine at Scripps Research Translational Institute. “It was looking like it was going to be controlled by the White House and Trump and would have been all the more reason for public mistrust. ... The political interference has been put aside. That was the biggest worry I had.”
Some of the public distrust of the vaccines stems from deeprooted concerns that predate the coronavirus. Communities of color have historically been mistreated by government and medical systems, said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, a nonprofit that advocates for the health needs of communities of color. Perhaps the most infamous example is the Tuskegee Experiment, in which hundreds of Black men were knowingly not treated for syphilis as part of a governmentled study that ended in the 1970s.
“There is a certain level of mistrust of the health care system, in general, in communities of color,” said Savage-Sangwan. “That is a challenge we’ll need to overcome in order to successfully be able to distribute the vaccine.”
Others oppose most, or all, vaccines, believing they cause more harm than benefits.
“I would not get that vaccine,” said Tara Shakeshaft, an Oakland teacher who does not plan to get the vaccine for herself or her children. “My health is very important to me and my body autonomy and my child’s choice.”
Shakeshaft, 45, has received vaccine exemptions for her children, who have not gotten childhood immunizations. With the coronavirus vaccines, she is worried that a clinical trial participant for one vaccine developed a neurological illness, and feels the trials are too small to be representative of the entire population. She says she does not trust federal agencies because they have ties to drug manufacturers and stand to benefit financially from vaccines.
Health officials and community groups in the Bay Area and statewide are starting to strategize how to reach people who are the hardest hit by the coronavirus — immigrants, Indigenous populations and day laborers — to assure them vaccines, once available, would be beneficial.
These populations often avoid getting tested for the virus for fear that testing positive would mean they cannot work, or that it would bring them into a system that will report them to immigration authorities, said Dr. Anthony Iton, a former Alameda County health officer who is now with the California Endowment foundation. The foundation has given grants to groups and health departments around the state to build campaigns to get the highestrisk populations vaccinated.
Iton said he worries that the same distrust of health and government systems will mean they may not get vaccinated against the virus — a distressing irony because they are at greatest risk, and need immunization the most.
“This is the leading edge of the wildfire,” said Iton, who is part of a group assembled by Oakland and Alameda County to address COVID19 racial disparities. “If we can’t put the fire out at its leading edge, we’re destined to be dealing with it for months and months and years to come. It’d be wonderful if we could get the level of vaccination up high in this particular population. Our messaging has to convince this population there’s a benefit in it for them and that the downside is zero to as low as it could possibly get.”
Iton said that may mean offering a cash incentive to get vaccinated, similar to gift cards that some health departments have previously issued to encourage homeless populations to buy cold and flu medicines. And the messaging must come from trusted voices, he said, such as Black churches that have been acting as a critical source of information during the pandemic. The National Medical Association, a historically Black professional association for physicians, has said it will independently vet vaccines for safety — which Iton hopes will help overcome some of the distrust of the traditional medical establishment.
Dr. Bob Wachter, chair of the Department of Medicine at UCSF, said he thinks more people likely will get vaccinated than what current polls show. He said once scientists and physicians, including Dr. Anthony Fauci, get the vaccine themselves and explain to the public it is credible, more people will follow suit — especially if workplaces and other settings start asking for documentation of vaccination before letting people back in.
“At this point they’re being asked a theoretical question about a vaccine that has not yet made it to the finish line,” Wachter said. “When the vaccines do, particularly if the process remains as transparent as it has been so far, and if the FDA holds the line on process, there is going to be 10% of people who don’t take it, maybe 15%, but I don’t think it’ll be anywhere near 50%.”