Front Burner - Vaccine hesitancy, the next pandemic hurdle

Episode Date: December 18, 2020

As the Pfizer-BioNTech vaccine rolls out across the country, and other vaccines await imminent regulatory approval, many public health experts are focusing on the issue of vaccine hesitancy. Canada's Chief Public Health Officer Dr. Theresa Tam has spoken out about the "moveable middle" and says it is critical that as many people get vaccinated as possible to protect themselves and others from risk. But, since conversations about vaccines can be hard, today we're bringing in an expert to explain how to have more meaningful and productive discussions with people who have questions or fears. Maria Sundaram is an infectious disease epidemiologist who studies vaccines.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. This will be both history-making and life-changing. Canada is beginning the biggest ever mass vaccination program in the country's history. 30,000 doses making a long journey from Belgium to Germany, across the Atlantic to the U.S. As we approve vaccines, we will be able to roll them out to Canadians and we're working to do

that like everyone is around the world, as quickly as possible while remaining safe. As Pfizer-BioNTech's vaccine rolls out across the country and other vaccines await imminent regulatory approval, many health experts are focusing on the issue of vaccine hesitancy, including Canada's chief public health officer, Dr. Theresa Tam. It's extremely critical. It is really important that as many people get vaccinated as possible to protect themselves and but also others who are at higher risk. We know that some people have made up their minds and others have not. We call the group that haven't made up their minds, who needs more answers to their questions, the movable middle. Since conversations about vaccines can be so hard to have, today we're

bringing in an expert to explain how to have more meaningful and productive discussions with people who have questions or fears. I'm Jamie Poisson, and this is FrontBurner. Maria Sundaram is an infectious disease epidemiologist who studies vaccines. Maria, thank you so much for coming back onto the podcast. It's a pleasure to have you back. Thanks for having me. So how do you differentiate between someone who's vaccine hesitant and someone who's like anti-vaccine? I guess another way to describe it is anti-vax. Yeah, I think it's really important to differentiate between these two groups of people. Folks who I see as being really anti-vaccine are people who already kind of made up their minds.

And if they're coming to me to have a conversation, it's usually like an argument. I'm here. I don't want to be vaccinated. I want to be free. I want to live my life. I'm definitely not going to take it. No matter what, you're not going to take it. No matter what, I believe I'm a healthy, strong person. I will fight for my right to not be injected with something I don't trust.

Whereas folks who are just curious, they want to know a little more, maybe they're a little bit on the fence, or maybe they're slightly nervous, but they want to have a conversation and they have questions. So why would you put something into your body without really knowing what's going to happen to you? We don't know any kind of side effects from them. I just really feel like at this point where it's people that's going to take that vaccine is guinea pigs. I just feel like you we don't know enough. That's the group of people that I would say are maybe vaccine hesitant. Right. And, you know, one thing

that I wanted to ask you today is, is what is it about vaccines that makes them so fraught for some people? Like, why have vaccines in general become such a target for so much skepticism? This is such a good question. I'm so happy you're asking it because I get to go tell you about one of my favorite vaccine stories about this lady, Lady Mary Wortley Montague. She was the wife of the British ambassador to Turkey in the 1700s. And she was a person who observed this practice of smallpox inoculation at the time that was used in Turkey to protect children against smallpox. Now, her own brother had died of smallpox, and she herself was disfigured by smallpox. So she wrote home to her sister, and she said, you would not believe the medical advances that

exist here. And, you know, people could be protected against this disease that killed my brother and, you know, endangers my children. I'm going to have this done for my children. And, you know, you should too. And then she kind of also correctly predicted in the same letter that probably English physicians wouldn't like it when she brought the practice back to the English court. She was absolutely dead on. The English physicians at the time were very skeptical because of where the message was coming from. They didn't trust Turkish doctors and they also didn't trust really like her perspective as a woman, even though she had a very valuable perspective of having actually had smallpox. And so this is something that has really carried through with all of the vaccines that we've had.

There's a lot of different reasons that have cropped up over the years of why people are a little bit reticent about vaccines or they want to know more. Some of them relate to not being able to resonate with the person who's telling them that that vaccine is really great for them and is going to protect them. Some of them also relate to personal fears about what's in the vaccines. about what's in the vaccines. Some of them relate to personal beliefs about freedom and where the sort of line should end between, you know, what someone tells you to do versus what you get to decide to do yourself. So these get to very deep sort of conversations about society in general. Right, right.

I mean, you hear skepticism of vaccine rooted often in mistrust of certain institutions like big pharma, for example, and certainly trust in big pharma has been eroded because of things like the opioid crisis, distrust of health authorities based on racism and sexism in healthcare, even like distrust of the media, which I hate to say, but you know, that is something that you hear as well. How have the unique circumstances surrounding the creation of the COVID-19 vaccine played into the skepticism that you're seeing right now? I think there's a couple of different things at play here. One of them is the existing level of vaccine hesitance that sort of existed

before COVID-19 really even arrived on the scene. It's been sort of increasing in recent years specifically. And then we had this global pandemic. And especially in some areas, the messaging surrounding this global pandemic, what people should do, how serious it is, was very, very variable. So one sort of trusted entity is saying one thing, a different trusted entity is saying another thing. And then, you know, pretty soon people are not certain whether they should trust, for example, the president of the United States or the head of CDC or their own sort of family member or a state department of health or a provincial department of health. And so when you have sort of conflicting messaging combined with like this underlying existing kind of like hesitancy,

that's really a recipe for disaster. And then after that happened, we had this super quick vaccine development process. Dozens of laboratories are now battlegrounds in the race for a vaccine. Potential vaccines are entering final phase three clinical trials. It's a process that usually takes years, if not decades. Pfizer's CEO calling it a great day for science and humanity. On a second vaccine, Moderna announcing its vaccine is nearly 95% effective. And I will say it's so cool for me to be able to like talk to lay people and my friends who are not infectious disease epidemiologists about phase one studies and, you know, loss to follow up and comorbidities and like all of these sort of really cool terms that are,

you know, natural to me are really entering into the vernacular of everybody. That's so cool. And I'm so excited about it. But it also has made people a little bit nervous. And I get that too. And so it really is a little bit of a perfect storm in terms of vaccine hesitancy and where we're at right now. One thing I've been thinking about, and I would love to hear your thoughts on this too, is where people are getting their information these days as well. You know, you mentioned polio before, like there was no Twitter, there was no Facebook back then, right? And you know, you've got to

think that these social media platforms where people's views are so amplified, right? And like the way that the algorithms work on these platforms, they surface certain kinds of content. And I wonder if that's got to play a role too. Definitely. What we know from existing vaccine hesitancy before COVID is that specifically parenting blogs, where a lot of parents get information and like kind of tips and also like a social environment, sometimes they can commiserate about, oh, my kid's not sleeping through the night. That's also where some of this misinformation surrounding vaccines, or even just the concern about vaccines kind of can crop up for the first time.

And because this is a resource that a lot of parents access frequently, they may be sort of exposed to it just kind of over and over. And that's part of the challenge right there. Right. So I want to learn from you today more about how to have conversations with people who are vaccine hesitant. And earlier we spoke with someone who needs more information before making a decision about the vaccine. And her name is Monte Gagne. And her children are vaccinated.

And I just want to play you what she had to say. Hi, Maria. This is Monte Gagne, and I am speaking to you from my home in Saskatoon, Saskatchewan. I'm a mother of two young kids, ages two and five, and I'm grateful to be having this chance

to ask some questions today. I have found it is extremely hard to talk about hesitancy amongst many fractions of our society. I'm somebody who has friends on kind of either side of the issue. I have many friends who are working in the medical community and then I have many friends who are living more alternative lifestyles and seeking out alternative news sources and informing themselves in the best way they know how. And their worldviews differ so vastly

and the emotions are so high around it that if you kind of are wishy-washy and in the middle and unsure, you can both feel judged. I have felt judged and the dialogue is so divisive. It's very, very hard. I think the reason I was asked to do this interview is actually because I made a post on Facebook. I had been thinking about it for a long while. And these questions and concerns and thoughts had been bubbling to the surface of my mind. And I was feeling like the information that I was coming across was so divided. And so I finally put this post up that said, I wanted only the people who were in

the medical community to respond, because I didn't want to have some huge big debate. And I said, just tell me, are you feeling confident and secure about the vaccines that are coming? And are you feeling safe? And if so, why? And it was actually pretty great, the responses that I got. I was really proud of my friends who are not in that demographic for not answering and not creating divisive dialogue. And I got a lot of really thoughtful responses. Maria, what's your reaction there to hearing Monte? I think the first thing that I'm thinking of is, wow, you know, what a

challenge to try to straddle two different groups of people that are so, as she says, so divided. I can't imagine that that is an easy thing to do. So I really commend her for doing that work to try to sort of stay connected with all of her friends. I know it can be a real challenge. Right. I think it's very brave how she's speaking about this. And we're really grateful too, that she's agreed to talk about this on the show as well. I have a couple of clips I'd like to play for you. And we'd love to hear how you answer questions. So we asked Monta if she had a few specific questions she'd like to ask you about the vaccine and here's the first one.

Yes, I would love to share my questions or fears and I'm really grateful for this opportunity, so thank you. Because I'm not a scientist myself, I don't come from that background. I may not have all the terminology correct, and there might even be some, you know, misinformation that I've taken up. So I recognize that I don't know everything, and I am coming from a place of humility and curiosity. So here it goes. So here it goes. So the fears and questions that I have relate largely to motherhood and how the vaccines interact with both unborn babies and nursing babies. So if there are ingredients present in the vaccine that are preservatives and such. Can they cross the uterine barrier? Can they go into breast milk? And what's the effect on young children? And how is it

that these kind of effects can have been studied in such a short time? So Maria, if Montaigne was here, what would you say to her? And I'll just add the caveat here. There's another question coming where we get into her concerns about ingredients in the vaccine even more. Totally. The first thing I would say is, you know, she mentioned, you know, she might not have all the terminology correct. Yeah, that happens to me too. I also don't know everything and absolutely far from it. What I can tell you is the fears and questions that she asked about in this question about motherhood, about unborn babies and nursing babies, those are really good, important questions to be asking. So the first thing that I'll say is that the Pfizer vaccine didn't include in clinical trials,

did not include pregnant women. And in general, if you are pregnant, we don't recommend at this point that you get the vaccine. And that's not because we think it's bad for pregnant women. We just haven't studied the safety and effectiveness in pregnant women. So we're saying for now, if you know you're pregnant, hold off on the vaccine until you're no longer pregnant. But that being said, there's another really interesting part of our question that I really want to get at, which is about if the ingredients in the vaccine, can they go across the uterine barrier and can they show up in breast milk? So both of those barriers, the placental barrier, and then like the barrier that goes kind of from the mother's blood to the breast milk, both of those barriers have very interesting immunological superpowers basically that prevent any kind of infection from crossing. Now

in breast milk this can fail unfortunately some people who are HIV positive can spread that to their babies through their breast milk but if their disease is well controlled then that's really a low risk. And then we know with with vaccines that's not the case but with the antibodies that protect you, it is the case. So you can give your baby antibodies across the placenta and also through your breast milk after you've been vaccinated. So as far as we know from the existing information, there's no harmful sort of things that are going to be spread to your baby through the breast milk or across the uterine barrier. But if you have gotten the vaccine previously before you got pregnant

and you have the benefit of those antibodies, you're going to be able to share those with your baby. Okay. Here's one more question. One of the things I'm especially interested in hearing addressed is about the non-active ingredients like the preservatives. I hear a lot about heavy metals like aluminum or preservatives like formaldehyde, which people say is the same as embalming fluid. That's one of the kind of inflammatory

statements that I hear a lot from people that are very strongly anti-vaccination. And it does sound, you know, nobody wants to feel like they're being injected with embalming fluid. And I just don't know if this is true, because a lot of people I know believe this. Maria? That's another really good set of questions that I think she brought up a really good point. No one wants to feel like they're being injected with embalming fluid. Luckily for us, that's not what's happening. That's not an accurate characterization of what the vaccines are. So that's probably, hopefully, a relief to everybody. So another really important good thing to know about these vaccines is that they are preservative-free, the Pfizer and the

Moderna vaccines. So there are no preservatives. There is no aluminum and there is no formaldehyde or anything else that kind of sounds pretty scary like that. So here's what is in the vaccines, that Pfizer and the Moderna vaccine. They have this mRNA. That's the bit that makes our immune systems help us develop protection. Those mRNA molecules are embedded in these tiny little fat droplets. So those are called lipid nanoparticles. And then we have some salts.

One of those types of salts is just the regular table salt that you have at home. And that's kind of to help the vaccine be the same salt level and the same pH as our own bodies. And then there's sugar, which is probably the same kind of sugar that you have at home. And maybe you've been using it to bake holiday cookies. I certainly have. Part of the reason that there's sugar in there is to help protect the vaccine at very cold temperatures. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections.

Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people, and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income? That's not a typo, 50%.

That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. Maria, we've got a third and final question from Monte here. So it's my understanding that in the new RNA vaccines, that one of the ways they work is it trains the body to recognize a specific protein that is similar to the one that exists in the COVID-19 virus and that the body will reject it based on that similarity in the proteins. And I may be completely wrong about that. I'm not a

scientist, but I have been listening to the news a lot as I do my dishes and as I chop my vegetables. So I guess one thing that came to my mind is if the protein looks similar to one in the COVID virus, does it potentially look similar to proteins in other things in the world? And if we train our bodies to reject this protein, is it possible that we're going to say, oh, oops, you know, this protein is also really similar to this other really important protein that is helpful to our health and well-being or maybe even essential. And now we're just going to turn it off and make it so that our bodies can't receive it anymore. So that's just a fear that came to my mind when I heard about because the RNA vaccine is such new technology. So this is a really good question. And the first thing I want to say, okay, kind of maybe apropos of nothing is that I hear, Vanta, that you're chopping vegetables and doing your

dishes, neither of which I am doing. And I have to really commend you for staying healthy and keeping your house clean. I really need to get on your level. Me too. Yeah. And you're absolutely right. That's exactly how the vaccine does work. It's training the body to recognize the specific protein. It is the one that's in the COVID-19 virus. And that's really good, as you said, because then we'll be able to reject the virus when we see the whole virus kind of up close and personal. And your question about does it look similar to other proteins is such a good question. This is a question that we have to be very, very careful about in the pre-clinical, so pre-phase one clinical studies of how we're developing vaccines. That question is such an important question

because exactly like you said, we don't want the vaccine to either prevent us from getting stuff that we do need, or we don't want it to develop antibodies against stuff that we already make, that our bodies are trying to make ourselves. And there have been other vaccines for which that's been a concern, and we've made sure that we've avoided that. For this particular vaccine, that's not a concern. And one of the reasons why it's not a concern is that when we make antibodies to proteins we know are harmful to us, those antibodies go through this process that is extremely, extremely specific to that one particular protein. It is pretty amazing,

this process. It's called somatic hypermutation. And it can get pretty technical, pretty inside baseball. But the gist of it is that we're making a ton of different antibodies and matching them all up, just like keys to a lock, to see which one fits. And all of the rest of them get tossed. So our body is like, you know what, I don't need this anymore. And they kind of just disintegrate. So in this case, we know that the antibodies that we're forming are very, very specific to that protein, and that we've done the work in preclinical studies to make sure that protein's not similar to other things that are really important to us. So those are really great questions. Oh, that was super interesting. Okay, great.

So I just want to say thank you again to Monte for speaking with us. Thank you, Monte. We appreciate your time. And I hope that that answers some of your questions. Thank you. And now, Maria, I want to talk to you about what just happened. And so can you walk me through your advice for talking to people who are vaccine hesitant? You know, where do you usually begin?

Yeah, I, you know, I think this is maybe like easier to show now that we've gotten to hear from Monte because, you know, it's, it's really clear to me anytime I'm having a conversation about this kind of thing that like, it's another person who's talking to me and they've got their own life and their own questions. And that's, to me, that's so relatable. I have my life and my questions and there's stuff that, there's plenty of stuff that I don't know about. If I were to, you know, suddenly need to be an expert on like astrophysics or something, I would find that very intimidating. And if someone were to say, well, you can make a decision about, you know, your ability to go to the moon based on your training in astrophysics, I would be like, but I don't have any training

in astrophysics. How am I supposed to make this decision? So it's really, really important to be able to give people the tools that they need to feel comfortable with that decision-making process and to understand kind of like, hey, we have probably a lot of things in common. For example, I also, like I was born in Saskatoon. So there's one thing right there. Right. Although it sounds like something you do not have in common is doing your dishes. But look, it sounds like what you're saying is that empathy plays a very key role here, relationship building. Oh yeah, absolutely. I think it's so important to understand that that person is another person that you got to have empathy with. They're going through an experience that you've probably already experienced about not knowing and wanting to know more and maybe even like being a little bit cautious or being afraid. Those are things that

we all I think can relate to. We talked earlier about mistrust in certain institutions. And I wonder, you know, what special considerations people should have in mind when talking about vaccine hesitancy with marginalized groups, Indigenous people, Black people, other marginalized communities. I don't even like early tech, right? When a new phone comes out, I'm like, ah, I'll wait until it works out the bugs and the kinks. And I'm kind of feeling the same way when it comes to the vaccine. I'm a little bit skeptical because I want to know how is it going to affect my immune system versus anybody else's. So I am a little bit leery. I will say I think there are plenty of reasons why members of marginalized communities wouldn't trust public health professionals, doctors, governmental officials,

I get that. I think they have a right. And I will say as well, there are certain things that I just personally cannot speak to. I'm a vaccine scientist and an epidemiologist, but for example, I'm not Black. And so I can't speak to what it's like to be black and be told these things or to have my community go through these types of experiences. I can't and I shouldn't. I will say that all I can do is sort of say as a vaccine scientist and as a person of color, you know, your communities have been hit really hard by this, more so than white communities. And that breaks my heart. It should not have happened that way. The vaccine is going to be so important for you and for your communities,

more so than other communities. And for all of the rest of it, all of the personal experiences that are very, very important, and all of the community history that's very, very important, you know, you shouldn't be listening to me because I haven't been living and breathing that. You should listen to the talented, capable scientists that are members of that community that can speak to that personal experience and that history. Is there a wrong way to talk about this? What are the biggest mistakes people make when talking to others who are concerned or hesitant about vaccines? I think the biggest mistake that people who are in my position make, who do have the experience and who do have the privilege of training, and maybe who even have the privilege of trust in

the system, is accusing people who don't have have the privilege of trust in the system, is accusing people who don't have that training or that trust, you know, being stupid. That's just not acceptable. We've been given this responsibility, and we've been given the tools to complete that responsibility. That means explaining patiently, helping people, and acknowledging, you know, where they have questions and where they have fears and doubts. That's part, I think that's part of our job. So it's, to me, I think the biggest mistake is when people say, well, you're wrong or that's stupid. You know, dismissing someone is just a very good way to get them to stop listening to you. And they probably should. I probably would. If you were to say, Maria, that's dumb. I'd probably be like, okay, have a nice day.

How can vaccine myth-busting backfire on people? This is kind of like the next step of what I was just talking about when you say, well, you know, actually you're wrong. So if you can remember the last time someone told you that you were wrong, I certainly can because it happens all the time. You know, you kind of have like almost a physical kind of reaction where, you know, your brain is like, no, I'm not wrong. How can that be? Defensive. Yeah. Right. Exactly. And, you know, what's very, very challenging is to say, okay, maybe I could be wrong rather than saying, well, this person is wrong. Because the work you have to do to say my worldview is wrong is so much more than the work you have to do to say this piece of information is wrong. And I think it's worthwhile

to acknowledge that. There are so many pieces of information that are things that I just kind of like have taken for granted. And when someone has posed like an additional piece of information or something that kind of corrects that or disagrees with my experience or my like existing belief, it's very hard for me to say, oh, oh, oh, really? You know, maybe I'll change my mind about that. It's so hard to change your mind. So I think it's better to say, hey, you know, if you have a question, let's talk about the question. The questions are different than sort of like reversing completely your worldview. Right. I mean, there's research on this too, right?

When it comes to vaccines, I know there's a study in the U.S. that when they just told people who were hesitant about getting the flu shot because they thought that the flu shot could give them the flu, that they were actually less likely to get the shot. That's right. How would you talk to somebody who's worried that the flu shot could give them the flu? Well, I mean, this is tough because, I mean, at a certain point, some of these questions do come down to myth busting.

If someone comes to you and says, I'm really worried that the flu shot could give me the flu, you know, maybe don't approach it like, well, that's dumb. Everyone knows that the flu shot can't give me the flu, you know, maybe don't approach it like, well, that's dumb. Everyone knows that the flu shot can't give you the flu. Instead say, okay, like I understand why that would be concerning. But the good news is that the flu shot doesn't have any of the live active virus in it. So it's literally, you just couldn't, you couldn't do it. Couldn't actually get a flu from the flu shot. And I think even just like that subtle difference in language might play a big role. Maria, before we go today,

if our ability to get back to a normal way of life is contingent on the majority of people getting vaccinated, how much faith do you have that come September that enough eligible Canadians will have opted in? September being the deadline that the government is currently set. Well, I will say hope springs eternal. In my line of work, there's always problems. There's always challenges. There's always things that you really wish people would do, but they just don't want to do it. And I've been part of that because I'm sure my nutritional epidemiology colleagues would wish that I had stopped eating cookies for dinner, but I just don't want to do that. I just want to

continue eating cookies for dinner. I will say that we're all sort of, we're working towards the best possible outcome. And to the extent that everyone can help with that, to the extent that people can get excited about the good that this vaccine is going to do for them, for their families, their communities, we obviously want that. And that's kind of why I said, you know, we have a responsibility to answer people's questions. They have a right to have questions. They have a right to feel uneasy. This whole year has been a collection of uneasy feelings. So we've worked, I think, very hard, and we're going to continue to work very hard to explain why this vaccine is so great, why we're all going to get it,

and why everyone else should get it too. All right, Maria Senderum, thank you so much for coming back and hope to talk to you again really soon. thank you so much for coming back and hope to talk to you again really soon. But thanks so much for answering all of our questions. Thank you so much. All right, that's all for this week. FrontBurner is brought to you by CBC News and CBC Podcasts. The show this week was produced by Imogen Burchard, Elaine Chao, Shannon Higgins, Allie Janes, and Jasmine Manny. Our sound design was by Derek Vanderwyk and Mandy Sham. And thanks to Lauda Antonelli for technical help.

Our music is by Joseph Chabison of Boombox Sound. The executive producer of Frontburner is Nick McCabe-Locos. And I'm Jamie Poisson. Thanks so much for listening, and we, go to cbc.ca slash podcasts.