During the early stages of the COVID-19 pandemic, when millions of Americans were suddenly forced to work from home or complete schoolwork virtually, all hopes for a return to normalcy depended on the development of a vaccine.
It is now over a year later, and three major pharmaceutical companies — Moderna, Pfizer and Johnson & Johnson — have each successfully distributed effective and readily accessible vaccines.
A significant chunk of the public, though, remains unvaccinated.
A New York Times article recently revealed that many experts no longer believe that the United States will reach the vaunted herd immunity threshold that is necessary for population-wide immunity from the virus, largely due to vaccine hesitancy.
On May 5, the university announced that vaccinations against COVID-19 are mandatory for all students returning to campus in the fall. Keeping with the times, the university posted this news on a variety of social media platforms, including Instagram.
Almost immediately, the Instagram post’s accompanying comments section turned into a hotbed of debate among students who argued the morality of the decision.
Some expressed concern about the morality of mandating vaccinations, for example, while others noted that the Food and Drug Administration has yet to officially authorize any of the COVID-19 vaccines.
Many students also resorted to blame and name-calling, expressing frustration with their peers’ viewpoints.
Jennifer Horney, director of the university’s epidemiology program, studies the impact of disasters and disease outbreaks on population health outcomes. Specifically, she investigates how the public prepares and responds to novel public health crises.
The politicization of basic health guidelines, though, is of no interest to her.
“Personally, I would not respond,” Horney said, in reference to the numerous politicized comments left on the university’s Instagram post. “I think that [when] engaging in a conversation with someone who is not presenting a science-based argument, you’re never going to win with a science-based argument. It’s probably not worth the conversation.”
An avid proponent of following guidance from the Centers for Disease Control (CDC), Horney acknowledged that many people are hesitant to get vaccinated due to the CDC’s reversal of its stance on mask-wearing in April of 2020.
Instead of blaming the CDC for its evolved stance on mask-wearing, though, she noted that science inherently relies on continuous investigation.
“I do understand why people would say, ‘but [Fauci] changed what he said [about wearing masks], so why should I trust you?,’” Horney said. “But we started from not knowing anything about this virus. Thousands of papers were published every week in the peer-reviewed literature, so we’ve learned a lot.”
Rita Landgraf, director of the university’s Partnership for Healthy Communities (PHC) and a former Cabinet Secretary of the Delaware Department of Health and Social Services (DHSS), agrees with Horney that science requires repeated revision and reassessment of existing knowledge.
“The science can be fluid, but viruses are fluid, too,” Landgraf said. “Scientists can’t say ‘one and done,’ because viruses don’t behave that way, either. We need to consistently stay ahead of [the viruses] as we evaluate how to keep the public safe and healthy, regardless of the pandemic.”
Landgraf, who worked in the DHSS under former Governor Jack Markell’s administration, helped oversee the state’s responses to both the H1N1 outbreak in 2009 and the Ebola outbreak in 2014.
According to her, neither epidemic was comparable to COVID-19 in terms of politicization.
“The protocols that were followed during both the [H1N1 and Ebola outbreaks] were very driven by the CDC, by the science,” Landgraf said. “That piece of this is not new. How we reacted to COVID-19 was kind of a different framing, and it was from the get-go very much politicized rather than public health-focused.”
With regards to the aforementioned university Instagram post, Landgraf said that the tension in the comments section reflects the politicization of science in society as a whole.
“What’s playing out in the general public is also playing out in the UD community,” Landgraf said.
Mandatory vaccinations are not new to the university, though. The university already requires all incoming students to receive vaccine shots for tuberculosis and meningococcal meningitis, and it also highly recommends that students be immunized against polio, Hepatitis A and B, and tetanus.
According to Kimberly Isett, director of the university’s Masters in Public Health in Health Policy program, COVID-19 has been unique in the sense that it has brought subjective ideological values and objective scientific facts to a crossroads.
“There are technical things that have technical solutions,” Isett said. “There’s very little debate on how to build a road, for example, because engineers have already settled that. With things that [aren’t technical], values come into play — even for things that some might argue should be based in science.”
As a public health policy researcher, Isett noted that the existence of an incessant news cycle has made it difficult for the public to filter out well-substantiated health information from lies.
“In the early 80’s, people watched their evening news for an hour, and that was the news they got,” Isett said. “But now there’s constant [information], and [news channels] need news, so they make news. They create controversy when there doesn’t need to be controversy.”
Horney echoed similar feelings, saying that the fear of receiving the COVID-19 vaccine is “indicative of how COVID has become really political and really about lots more than just public health over the last 15 months.”
With regards to the anti-vaccination movement in particular, Horney said society still feels the lingering effects of the campaign promoted by former British physician Andrew Wakefield, who suggested in a 1998 medical paper that the vaccine for measles, mumps, and rubella caused autism and inflammatory bowel disease in children.
“Since the Andrew Wakefield article that was later withdrawn because it was scientifically unfound, there’s been a growing anti-vaccination movement,” Horney said. “And that’s [been] fueled a lot by social media and the Internet because people can put any ideas that they would like out there without them being checked.”
Although the results of Wakefield’s study were eventually discarded on account of his study’s flawed research design (there were only 12 children in the experiment) as well as the finding that he had a conflict of interest, Horney noted how the study inspired casual associations of autism with vaccinations that persist to this day.
Even when considering the Wakefield snafu, though, Horney said that the United States has done a commendable job over the years in regard to responding to public health scares, with the exception of COVID-19.
She noted, for instance, how the 9/11 terrorist attacks united the public and helped the country invest more resources in preparedness for both intentional and natural disasters.
The policy changes of the time support Horney’s claim: following the terrorist attacks on American soil, the federal government worked quickly to create the Transportation Security Administration in November of 2001, in addition to the Department of Homeland Security in November of 2002.
Horney said the public learned to tolerate the notoriously “tedious” airline safety measures introduced by these institutions with the understanding that they serve to protect the greater good.
According to her, this makes the lack of unity around the COVID-19 vaccines feel all the more unusual.
“I think [COVID-19] has been different in the sense that usually when we have a health emergency, we see people really coming together to help one another,” Horney said. “You see that phenomenon of social cohesion. But [COVID-19] has been an instance where we’ve seen a lot of opposition to things.”
Horney said that vaccine hesitancy is also compounded by the fact that minorities and other underprivileged communities have historically had a tenuous relationship with the medical institution.
Horney cited the notorious Tuskegee Trials, in which the government studied the effects of untreated syphilis in black men over the course of four decades, as one of the main reasons people of color do not trust the health care bureaucracy.
Distrust also appears to be evident in the statistics: in Delaware, only 40% of black people have received at least one shot of the COVID-19 vaccine, which ranks last among all racial groups. In comparison, 51.4% of white people have received at least one dose of the vaccine.
When trying to devise a solution to this problem, Landgraf said that public service announcements from government officials are simply not enough.
“It’s not just about providing information, [because] we’ve already covered those individuals,” Landgraf said. “Now [the focus] is on individuals who may have a reluctance, outside of those who may have a medical vulnerability or a religious belief.”
Isett raised a related issue, saying many people are refusing to receive the vaccine in retaliation to being labeled scientifically illiterate or willfully ignorant.
“I am fortunate that I can call my friend at the CDC who does this for a living and [ask] what [he] thinks of these efficacy rates, or what he thinks of these vaccines,’” Isett said. “But the average person can’t do that, [because] they don’t have access to those studies. I understand that I’m able to do that from a very privileged position.”
Landgraf, Isett, and Horney all agreed that in order to build trust with vaccine skeptics, health officials must meet members of the community at a common ground, rather than treat them as though they are mere beneficiaries of esoteric institutional efforts.
A good way to start, according to Horney, is by simplifying the scientific jargon surrounding the virus.
As a member of the team that developed the university’ COVID-19 questionnaire that all students and faculty complete in order to access campus facilities, Horney said her team had to continually refine aspects of the survey that “we would take for granted because we’re epidemiologists or clinicians.”
“We had to rewrite a number of times the question about, ‘Have you had any of these symptoms?,’” Horney said. “The requirements of communication are different if you’re a nurse working at a hospital versus if you’re an online student who wants to go to the [Carpenter Sports Building] and work out. How do we find the right message for every possible person?”
Although the university community consists of many scientifically literate students, Horney said most of the public is not privy to grasping complex and obscure issues like disease.
As such, she said science needs to be communicated “more clearly” if accessibility to the general population is the ultimate goal.
Isett noted that name-calling or political typecasting will not solve the problem, either.
“It’s important to remember that people act on their political values — not because they’re wrong or bad or evil, but because those political values have legitimacy,” Isett said. “I really try to stress … that people are coming from a good place that they hold really central.”
Ultimately, though, the three public health experts concluded that the biggest determinant of America’s success in vaccinating the reluctant will be in its choice of community representatives to spread the information espoused by health officials.
“I think the messenger [of information] is critical,” Landgraf said. “How do we address [communities] so we can meet people where they are and have the messengers that they will respond to?”
Through her involvement in the PHC, Landgraf hopes to answer this question.
The PHC partnered with Saint Francis Hospital in 2019 with the goal of using the hospital’s mobile health van to address community health needs.
Prior to the pandemic in 2020, the van traveled to schools, community centers and churches throughout the state to promote healthy living choices and to conduct physical and behavioral health screenings for people in underserved communities.
Although Landgraf is involved with the operations of this initiative, she does not directly interact with members of the community.
According to Landgraf, this is entirely intentional.
“You’re not just landing to say, ‘I’m from the government, and I have something for you,’” Landgraf said. “That will never work. That will just promote a level of distrust.”
Instead, the PHC promotes health education indirectly by partnering with trusted local community leaders, who are then used as conduits to deliver pertinent health information to their respective communities.
Landgraf said she hopes this will allow the PHC to disseminate vital information (including the benefits of getting vaccinated, for example) to populations that are otherwise resistant to obtaining information from bureaucratic institutions such as the university or the government.
Although staunch opponents of the medical establishment may not be willing to heed the direct advice of people like Landgraf, she believes they will almost certainly consider the words of their dependable community leaders.
“[People] are not going to trust somebody like me,” Landgraf said. “But they might trust faith-based communities, for example. So every Sunday or Saturday, depending on your worship, it’s that leader who is talking about the need for vaccination.”
Isett echoed Landgraf’s sentiments, saying that building trust with local communities requires years of transparent and open communication.
“People are reacting to their lived experiences of negative treatment in the health care system,” Isett said. “We can’t minimize that.”