Misinformation and vaccines: How public health messaging and experts can help curb distrust

Washington State Department of Health’s Care-A-Van vaccinated people in Vancouver, Wash. last week. (DOH Photo)

When Howard Frumkin first started inviting speakers for a meeting held last week on the effects of the pandemic, he thought it would be mostly over.

“When we planned this symposium a year ago, we thought we would be talking about the pandemic in the past tense at this point,” said Frumkin at the meeting, held last week online by the Washington Academy of Sciences.

University of Washington emeritus professor Howard Frumkin. (UW Photo)

He was hopeful that the virus would now be on the wane as vaccinations took hold. “But it hasn’t worked out that way,” said Frumkin, professor emeritus of Environmental and Occupational Health, and former dean of the School of Public Health at the University of Washington.

Frumkin joined state officials, misinformation researchers, and journalists at the symposium, “COVID-19: Science and Society.” And though speakers focused on different topics, each circled back to the ongoing toll of the virus amidst the slow uptake of vaccines.

‘How do we reckon with the fact that some members of our society are very skeptical about science to the point of disbelieving it?” asked Frumkin. “We are surrounded by a lot of disinformation, and how do we deal with that?”

Social media is rife with misinformation and anti-vaccination material couched as science, and large swaths of the public are susceptible. Speakers discussed the spread of anti-vaccination messages, community distrust, and solutions such as in-person engagement.

Washington’s Department of Health Director Umair Shah. (DOH Photo)

“Misinformation and mistrust is a real critical piece of this,” said Umair Shah, Washington state’s secretary of health. More than 1,000 people in the state were admitted to hospitals for COVID-19 during the week ending Sept. 26. Close to 70% of Washingtonians are fully vaccinated, but the vast majority of the hospitalized are not.

In Seattle’s King County, for instance, people who are not vaccinated are 41 times more likely to be hospitalized for COVID-19. The state’s latest wave of infections may be cresting, but strained hospitals face an uncertain winter.

“Misinformation seems to go further,” said Shah. “And when you are fighting it with Nicki Minaj and other popular figures in the in the media, I think it really becomes challenging.”

Shah is referring to Minaj’s recent tweet to her almost 23 million followers that her cousin’s friend’s testicles swelled and he became impotent after a COVID-19 shot, leading health officials to swiftly debunk her tweet.

COVID-19 hospital admission rates in Washington State. (DOH Graph)

Social media companies have taken steps to combat misinformation. Twitter and YouTube, for instance, have banned or suspended some notable purveyors of vaccine conspiracy theories.

But a lot of material gets through. Despite being rebuked weeks ago by U.S. Rep. Adam Schiff and Sen. Elizabeth Warren, Amazon still sells material such as “The truth about COVID-19,” a book by Joseph Mercola, a supplements seller with a degree in osteopathic medicine. He’s been named a top spreader of coronavirus misinformation, and YouTube recently removed his channel.

University of Washington Center for an Informed Public Director Jevin West. (UW Photo)

“The way that these systems are set up and the objectives that these algorithms are trying to solve creates more polarization, less diversified ideas and certainly less common understanding of even basic facts,” said Jevin West, director of the University of Washington’s Center for an Informed Public. And they are a major driver of vaccine misinformation, he said.

Such material reaches groups of people with poor science literacy, or with distrust of health systems because of historical abuse or inequities, said speakers.

“I find myself sometimes dispirited by the economic incentive that is in place to pick on vulnerable communities that have been victimized in so many ways,” said Stephan Blanford, executive director of the Children’s Alliance. “This is just another manifestation of that victimization.”

Close to 80% of eligible people are fully vaccinated in King County, but only 68% of Hispanic and Black people. Vaccination also varies regionally, with rates in King County double that of eastern Washington’s Stevens County. Rural Americans are twice as likely to die from COVID-19.

“The problem we have is that in certain communities you have 80-to-90% uptake and others are at 30-to-40%,” said Umair Shah, the state’s secretary of health. “That’s the biggest challenge that we have.”

Despite the prevalence of misinformation, experts still have sway, said West. Early findings from his group suggest that they can “gain a little more traction” in social media exchanges than other voices.

“Everyone seems to cite science. That’s a good thing, that there’s still levels of trust in science that are relatively high compared to other institutions,” said West.

Children’s Alliance Executive Director Stephan Blanford. (Children’s Alliance Photo)

The flip side of such trust is that providers of misinformation cherry pick sources, finding outliers who may have fancy degrees but views far outside scientific consensus, said West.

West points to a video released last year touting COVID-19 conspiracy theories, “Plandemic,” featuring a discredited and fired former researcher at the University of Nevada. The video was viewed more than 8 million times the week it was released.

YouTube removed the video, but West’s group found they could still access it through ads. “And so we let Google know, and they said ‘oops’ and they took it down.”

“This is why researchers and scientists really have to engage with the public and with the platforms that are governing a lot of the conversations,” said West. “Because they are sort of algorithmically at the front door of these conversations.”

Experts can have an effect not only on social media but through individual conversations, he said. He noted that amidst the noise on social media, scientists have delivered highly effective and safe vaccines with urgency.

“You can’t blame people for not knowing all of these things. They’re running businesses and they’re taking care of their kids and they don’t have time. Most people don’t know what’s in the Cheetos that they eat, let alone what’s going into vaccines,” said West.

“We need to invest in that dialogue and have a forum where people can honestly ask questions and not be ridiculed.” He added: “The easiest thing that we can do is just ask who’s telling you this, how do they know it and what’s in it for them.”

New York Times science reporter Apoorva Mandavilli receiving her first dose of COVID-19 vaccine. (Twitter Photo via @apoorva_nyc)

“I think it’s easy to bash the public and say oh, they just don’t understand science,” said New York Times science journalist Apoorva Mandavilli, who spoke about covering the pandemic. But there are broader systemic issues, she said.

Public health messaging has been weak for years, so people in the U.S. were not prepared to understand concepts like how vaccines protect the people around you, she said. She noted that many countries in Asia had lived through earlier outbreaks such as SARS, and more readily adapted to masking and other measures.

Long before the first shots went into arms, people who study the anti-vaccination movement anticipated broad vaccination resistance. “They were shouting from the rooftops, ‘This is going to be bad,'” said Mandavilli. But many health officials were slow to prepare. And they are facing well-funded anti-vaccination groups.

Mercola, for example, has donated millions of dollars to the National Vaccine Information Center, one of several anti-vaccination advocacy groups. Mercola.com and the center also received loans from the federal Paycheck Protection Program.

Related: We’ll explore both vaccines and misinformation during sessions at the GeekWire Summit on Oct. 4-5. Find details and tickets here.

“These people are incredibly organized, incredibly good at what they do, because their messages are really easy and simple and take root, whereas science complicated and nuanced,” said Mandavilli.

“As soon as this pandemic started, some of those groups really sprang into action,” she said. Layered on that was a political divide stoked by the election. “It was just really a tinderbox.”

The pandemic hit a populace poorly equipped to evaluate a shifting landscape of advice as scientists scrambled to figure out the new virus. “Our education system doesn’t really train people very well in science or to understand how the scientific process works,” Mandavilli said. That contributed to a host of divisions, from resistance to masking to poor assessment of information sources.

Mandavilli suggested that educators focus more on teaching the scientific process, how science unfolds through the generation and testing of hypothesis. “I think people could apply that understanding to just about any controversial science topic,” she said.

Percent of eligible people in Washington who are fully vaccinated, by county. (CDC Graphic)

New mandates are coming on line, such as Washington’s vaccine requirement for health care workers and state employees.

Lisa Brown, director of the Washington State Department of Commerce, shared her perspective. She did not specifically speak about vaccines, but she viewed mandates through her lens as an economist.

In general, “most people are thinking about what their perceived costs and benefits are to making those decisions,” said Brown. “And even if we in the public sector create a mandate to do something, we haven’t taken away that framework if we’ve only changed the way in which people will then measure those costs and benefits.”

Washington’s Commerce director Lisa Brown. (Wash. state Photo)

People who earlier spurned a shot or had trouble accessing one are still coming in to get protected. After a huge spike in the spring, vaccination rates in the U.S. increased slightly again as the Delta variant took hold.

And while some people may never change their mind, many have.

One third of people in a recent study who had expressed vaccine hesitancy in 2020 became vaccinated early the next year. “There is a clear public health opportunity to convert higher vaccine willingness into successfully delivered vaccinations,” noted the researchers in the report, from Emory University and Georgia State University in Atlanta.

In Washington, there has been a 25% increase since mid-August in the number of people getting their first shots.

That’s in line with a survey released Wednesday, showing an increase in people in the U.S. getting a shot this summer out of concern for the Delta variant. More Latinos have been getting vaccinated — but the survey also found a widening national gap in vaccine status dependent on political party.

While discussion at the symposium centered on the effects of social media on vaccine hesitancy, speakers did not explore the effects of commentators at traditional news outlets such as Fox News. Meanwhile, death rates in the U.S. are eight times higher than in other high-income countries, according to a recent analysis by The Economist.

“We’re still dealing with the many questions at the interface of science and our social and political responses to the pandemic,” said Frumkin.

Number of vaccine doses administered daily in the U.S. An average of about 595,000 shots per day were administered for the week ending Sept. 22. (CDC Chart)

100% of cases assessed for variants in Washington are from the highly infectious Delta virus, giving extra urgency to the state’s vaccination efforts.

After winding down mass vaccination sites earlier this year, Washington’s public health officials began working on ways to reach communities and individuals who still need shots.

“We have got to be in the world of engagement and communications and being a part of the very community that looks to us for that science guidance,” said Shah.

In July, the department launched Care Connect, a program to engage medical providers to champion vaccinations, “which they have been doing in droves across the state,” said Shah.

Related: How disparities for women and minorities widened during the pandemic.

The department also delivers vaccines to smaller groups like churches and community centers through its Care-a-Van program. As part of the service, the DOH assesses if trusted community members are engaged with the event.

That type of engagement is critical, said Blanford. In some communities, “there’s a huge lack of confidence and that stems from long history of mistrust of Western medicine,” he said. But such mistrust can be countered by deep social networks, he said: “Trusted advisors and advocates, people who’ve been in that community for a long time and can speak to the value of getting the shot and moving on with your lives.”

In the last few months, health department employees have been working days, nights, weekends and holidays, said Shah. DOH’s vaccination work continues on top of other initiatives, such as WA Notify, a privacy-preserving app downloaded by 40% of the state’s cell phone users that can let them know if they’ve been exposed.

Earlier this month, the DOH Care-a-Van partnered with the King County’s Afghan Health Initiative to vaccinate newly-arrived refugees. And this week the van makes stops in Chewelah and other towns in eastern Washington with low vaccination rates.

GeekWire also covered other topics at the meeting in the following stories:

Editor’s note: We’ll explore both vaccines and misinformation during two separate sessions at the GeekWire Summit on Oct. 4-5. Find details and tickets here.

Editor’s note: Charlotte Schubert worked with Mandavilli at Nature Medicine from 2003 to 2007.

Health/life sciences Apoorva mandavilli Covid-19 Covid-19 vaccine Howard frumkin Jevin west Lisa brown Stephan blanford Umair shah