The Daily - The Vaccine Trust Problem

Episode Date: July 21, 2020

Public health officials and private researchers have vowed to develop a coronavirus vaccine in record time. But could that rush backfire? Guest: Jan Hoffman, a health reporter for The New York Times. For more information on today’s episode, visit nytimes.com/thedaily Background reading: Billions of dollars are being poured into developing a coronavirus vaccine, but the rapid timetable may be creating even more vaccine-hesitant patients.Three vaccine developers report that early trials showed promising results with minimal side effects, but one researcher cautioned, “There is still a long way to go.”

From The New York Times, I'm Michael Barbaro. This is The Daily. Today, public health officials are vowing to develop a coronavirus vaccine in record time. My colleague, health reporter Jan Hoffman, on how that speed could backfire. Health reporter Jan Hoffman on how that speed could backfire. It's Tuesday, July 21st. Thank you very much, Mr. Chairman. Thank you to all of our witnesses for joining us here today. And of course, thank you, our staff, for setting up the technology so we can hold this hearing safely. So late last month, Dr. Anthony Fauci and Dr. Robert Redfield of the CDC sat down in front of a group of senators to answer their many questions about

what was going on with the coronavirus pandemic. Dr. Fauci, based on what you're seeing now, pandemic. Dr. Fauci, based on what you're seeing now, how many COVID-19 deaths and infections should America expect before this is all over? I can't make an accurate prediction, but it is going to be very disturbing. I will guarantee you that. The big news that day was Dr. Anthony Fauci saying that he expected cases to rise. I would not be surprised if we go up to 100,000 a day if this does not turn around. Right. That was a big headline. I remember that. That shocked everyone. But what was also rumbling through and was a consistent theme in the questioning by the senators was their concern that Americans were afraid of the very speed at which this vaccine was being developed. Dr. Fauci, I want to ask you about the concern that we have with certain

parts of the country where you have public mistrust of vaccines in general. And they were asking whether Americans would in fact be willing to get it. My fear is that we may get to the place where we will get to that place where we have that successful vaccine, but we still have the concern from many and a mistrust. And whether it's vaccine hesitation or vaccine confidence, I don't know what the buzz word is, but I'm worried that we don't have a plan for how to deal with that. It was not one party or the other. Both Republican and Democratic senators kept firing away at Dr. Robert Redfield and Dr. Fauci. We know this is in our future and we are not ready for it. And this could cause problems down the road if we get to a vaccine, but people don't want to get the vaccine.

So we all have to do this. Saying, what are you going to do? How are you going to prepare Americans? That plan has to combat misinformation and vaccine hesitancy. We are sensing that they are afraid of this thing. They are saying they won't take it. Dr. Redfield, do you agree a plan like that is needed?

Senator, I think it's very important that we have a integrated plan for this vaccine. And both of the gentlemen seemed somewhat disconcerted. And Jan, how grounded are these fears that these senators are expressing during this hearing? They're incredibly substantial. There was a survey done in late May by the Associated Press and a research institute out of the University of Chicago that showed that fully 50% of Americans were either hesitant or absolutely would not take the vaccine, which is really concerning. 50%. 50%.

I mean, in my mind, skepticism of vaccines in the United States has been around for a really long time, and it's somewhat meaningful, but it's not widespread. It's not 50%. It's kind of a niche. So that's not what you're describing here, a niche. No, this is a chasm. This was exponentially far greater than anything we'd ever seen before. So how do we get to that enormous widespread figure? Because we have talked a bit on this show

about the origins of vaccine skepticism. And my recollection is that it starts with questions around autism. Actually, it starts with questions around the invention of the smallpox vaccine in the 18th century. Even then, there were vaccine skeptics. Benjamin Franklin was himself a vaccine skeptic. He later recanted and saw the light. So it has

come in waves over the centuries. Probably what's most prominent in the modern memory is a study that Dr. Andrew Wakefield published in the British journal The Lancet in 1998, where he associated autism and the measles, mumps, rubella vaccine, which is given to children just around the time that they're about a year and a half. And he asserted wrongly, completely wrongly, that the vaccine caused autism. That has been completely refuted, and yet it still took hold in the hearts and minds of many, many parents. It has become the basis for political movements. For example, it's a very big movement in Texas with a politically powerful group called Texans for Vaccine Choice. They have, in fact, hijacked the language of the abortion rights

movement. This is my body. The government does not have the right to order me to put something into it. It's my body, my choice. There are people who resent big pharma, and they believe vaccines are totally a construct of big pharma to make money, when in fact, actually, it's probably the reason that most companies don't make vaccines because they don't make a lot of money out of it. There is the crunchy granola, to use a term of art, parenting movement, which basically says nothing but the natural comes into my child, therefore not a vaccine. Certainly, vaccine skepticism has been shown to be more pronounced in African American and Latino communities, particularly because of the revelations in the mid-70s of the Tuskegee

experiments in which the American public health institutions knew that something like 300 Alabama sharecroppers had been infected with syphilis. And although they had the cure for it, penicillin, they refused to cure them and instead wanted to watch the disease progress so they could learn more about the disease. When that horror broke, that reinforced nascent vaccine skepticism in the African-American community and the perception that they were essentially being used as cannon fodder for privileged white people. So if you think you have someone in mind who you think is the archetype of someone who opposes vaccines, you absolutely do not. It crosses racial lines. It crosses socioeconomic backgrounds, educational backgrounds. It crosses political affiliation.

And Jan, how does Donald Trump and his arrival on the national political scene, how does that play into this? political scene? How does that play into this? Since about 2012, he's been tweeting very skeptical comments about what he thinks are the size of the doses. He frequently would say this is enough for a horse. And then he comes on the stage while he's a candidate. People that work for me just the other day, two years old, two and a half years old, a beautiful child went to have the vaccine and came back and a half years old, a child, a beautiful child, went to have the vaccine and came back and a week later got a tremendous fever, got very, very sick, now is autistic. And he says bluntly during a major debate that he doesn't believe in the schedule and he thinks kids are getting too many vaccines. I only say it's not, I'm in favor of vaccines.

Do them over a longer period of time, same amount. Thank you. Just in little sections. Dr. Croson. And I think you're going to have, I think you're going to see a big impact on autism. He has boasted before that he never himself would get a flu vaccine.

He said he slowed down his son Barron's vaccine schedule. So he became the flag bearer for this growing movement that had so many myriad voices in it from so many different perspectives. So all of this kind of vaccine baggage, for lack of a better phrase, All of this skepticism, it predates the pandemic. But I guess I still don't quite understand how we get to that really alarming 50% figure of Americans who are reluctant to use an eventual coronavirus vaccine. So help me bridge that. coronavirus vaccine. So help me bridge that. We have a pandemic that as the weeks go by, people are dying, cases are ticking up. Our lives as we know it have changed completely. We don't even have a new normal yet. We are making it up as we go along.

And all along, the word vaccine is being held out as a holy grail. A vaccine will save us. A vaccine will restore us. A vaccine will bring us life that we knew. Right. It is topic number one. You cannot turn around without hearing the V word. It is front and center wherever we go. And that is the overlay on top of this insurgent, multidimensional questioning of the value of a vaccine. We'll be right back. Jen, when did you begin to realize that there was something about this pandemic that was influencing how people thought about vaccines, the viewer? I began to speak with doctors, pediatricians, and I asked them,

if we come up with a coronavirus vaccine, what will you tell your patients? And I was struck over and over and over again by the long, loud silence on the other end of the phone. And I thought, oh my God, what are we hearing here? I began to watch social media and I saw the amping up of vaccine conspiracy theories. Then I heard more and more from people who were beginning to say, you know, I get all my vaccines. I'm up to date. I will not take this one. These are pro-science, pro-vaccine people who are cringing and wanting to avoid this vaccine.

And I thought, we have a problem. And what do you start to learn that would explain that level of skepticism? There are a lot of different reasons, but the first profound roadblock to it are many people's objection to President Trump himself. People worry that he may have secret deals with certain pharma companies and may stand to either his friends will profit or he will profit. And so unfortunately, people are holding the product itself at arm's length and looking at it through the lens of a political situation.

In fact, a major figure from the Trump administration called me just two days ago to talk about what the government was going to try to do about vaccine hesitancy. And he said, it's unfortunate that people are wrapping their feelings of President Trump around the vaccine itself. Hmm. Is what you're saying that some number of people who would normally be inclined to take a vaccine, but do not trust President Trump,

are now thinking to themselves, well, if I don't trust President Trump, then perhaps I shouldn't trust a vaccine that emerges from a process he oversees. I just want to make sure I'm connecting the dots here. Those dots are beautifully connected because I've seen comments that go along the lines of, I'll take a vaccine authorized by President Biden. I'll take a vaccine authorized by Angela Merkel. It's Trump's association with it that is giving a certain quadrant of these skeptics grave misgivings. But is that a reasonable form of skepticism? I mean, presidents have lots of powers, but they don't have the power to mix a drug in a lab. They don't dictate what a vaccine looks like. So is that rational?

I'm trying to answer this politely because that presupposes that vaccine skepticism is inherently rational. And to some extent, I think it's understandable. Whether it's rational and logical is another question entirely. But remember, the president nominates the head of the FDA who approves the vaccines. The president assigned the head of Operation Warp Speed, which is overseeing the public-private partnership. The president doesn't mix things in a test tube, but the president certainly has a great deal of power to authorize oversight of this vaccine. What else is driving this skepticism? I think even a greater factor than the administration itself is the speed with which it's being produced. Most vaccines take about a decade to produce.

Millions and even billions of dollars are poured into research for them to prove nothing. We don't have an HIV vaccine, which has been in research for 20, 30 years. There's no vaccine against breast cancer, which has been under research for arguably even longer. And so people are thinking, well, how can you have a vaccine that is safe and effective come to market in six months? It boggles the mind. And so for someone who is a vaccine hesitant, who is a vaccine skeptic, or even is just a pro-vaccine person, they are so apprehensive about the speed at which this is being produced that they are willing to say, let someone else go first in line, not me. Is there actually any evidence that Operation Warp

Speed, the project underway now, will bypass traditional safety measures, the normal process of multiple clinical trials, lots of humans being tested, lots of assessments of side effects, adverse effects. Do we know that? It seems so far that nothing in the due diligence processes is being bypassed. It's only that it's being accelerated. But the same level of scrutiny seems to be underway. That's what we know so far. So this is quite fascinating and pretty alarming. The only remedy for this pandemic is a vaccine. And so the faster you get a vaccine, the faster the pandemic comes to an end. But from what you're saying, the faster the vaccine is produced, the more skeptical people are going to be of the vaccine and its safety. And so speed here, instead of being a

virtue, may actually be an undermining force and undermining of the original goal of a vaccine. of the original goal of a vaccine. And I think that's the tragedy because there's urgency. We need a vaccine. The world is crying out for it to stop this thing, to shut it down. Scientists are responding and saying we're working as quickly as we can.

And yet thoughtful people are saying, wait, does speed equate with haste? So that's how you get to a figure like 50%. You take a lot of generalized anxiety around the safety of vaccines. You overlay this administration and its approach to science. And then you add what the government is promising is the fastest vaccine in history. And you get a much more amped up version of existing skepticism. Let me ask you a practical question.

And you don't have to answer because, you know, I'm switching caps here. But if you polled your colleagues and friends, what do you think roughly would be the percentage who would answer the following question in the affirmative or negative? Would you take a coronavirus vaccine if it were offered sometime this year? I'd like to think that it's three quarters off the bat, but I don't know. You're asking me a question I haven't asked those friends and acquaintances and family. I guess I now should. Well, I think it's important because what happens when you engage somebody in a conversation about vaccines is you both begin to think more deeply about what does confidence mean to you?

What do you need to know to feel safe in sticking out your arm? What questions would you want answered? And as you begin to enumerate those questions, as you begin to express your concerns, you are essentially creating a sketchbook for the kind of answers that any manufacturer or the government needs to have in hand to make the public feel confident that they are getting a safe and effective vaccine. Mm-hmm. But I guess what I would have to say, now that I've had a minute or so to reflect on this,

is that all the previous science, the vast majority of the previous science about vaccines, tells us that the process is safe and that any kind of trade-off is worth it, given the public health value of people being protected against a highly transmissible disease. There's lots of ways to answer that question. I want you to think about the cultural moment we're in. We are in a time when nationalism is surging around the world, right? America first, my family first, myself first. The notion of a vaccine writ large means I protect my community. I do what I can to protect

my neighborhood, my country, people who travel across the world. It is one way to express altruism. As you say, I care about you. I will protect you so I cannot get myself sick and I will not get you sick. But we are not at a cultural moment that looks like that. We do not care as much about our community, about our neighbors, as we used to. The uptake for flu vaccine in adults 18 and older is only about 45% a year. And yet, if you ask a public health specialist, what is the safest way to protect an older person from flu, a baby from flu, someone going through cancer treatment from flu, you say, get everyone vaccinated for flu, even if they are not, because that stops transmission. And yet we only have about 45% uptake. Dr. Fauci has said, at minimum, we need 75% of people to take a coronavirus vaccine, and he would prefer to see 85%.

Right now, 50% of people are saying they don't want the vaccine. That means, even in the calculus of my mediocre math background, we are not anywhere close to what we need to causing across-the-board immunity and shutting down this pandemic. So with all this in mind, what is the plan for making Americans feel as comfortable as possible with the safety of this eventual vaccine? It seems crucially important to ending this pandemic and like something that people in public health in the federal government would be taking very, very seriously and have a plan for. During the Senate subcommittee hearing when Dr. Redfield was asked repeatedly about this. CDC is working on the issues that you said that I think are so important in building vaccine confidence. Can you tell us what CDC will be giving us their plans since CDC would be

writing the comprehensive plan? We're developing a plan as we speak. And again, to keep building... He said that the Centers for Disease Control and Prevention had been working on a plan and discussing this for 10 to 12 weeks. Priorization of this vaccine, monitoring for safety of this vaccine. A couple weeks, a couple months, the end of the year. Do you have any estimate on when we'll see that plan? Well, it's currently in development within

the group. And I'd anticipate that we'll see that plan in the near weeks ahead, Senator. When I asked them to explain what in fact they were working on, they refused to answer. So I wish I could tell you, I have no idea. Jan, what happens if we get this wrong? If the vaccine comes out and a huge number of Americans say, not me, you first, I'm not ready for this. That's probably the greatest concern of all. Because if a huge number of Americans say, not me, you first, or if they say, wait a minute, it's not working. They had the vaccine for six months,

but now they're getting sick with COVID again. What public health experts are worried about is that this will undermine the very foundation upon which our vaccine infrastructure is built, which is that vaccines work, that you need to get them, and you need to trust them. And really undermine faith in public health, in the belief that there is a superstructure that has the greater good in mind. So the stakes here are only the future, literally, of public health. Yep. Thank you, Chan. We really appreciate it. Thanks very much for letting me talk about it.

On Monday, scientists at Oxford University reported that their experimental vaccine for the coronavirus prompted a protective immune response in hundreds of people who received a dose during an early clinical trial. So far, the vaccine has produced only minor side effects like fever, chills, and muscle pain. The clinical trial involved about 1,000 people. Larger trials involving about 10,000 people are underway. And an even larger trial involving about 30,000 people is set to start soon in the U.S. We'll be right back. We'll be right back. Here's what else you need to know today. A major teachers union has sued the governor of Florida over an emergency order that would fully reopen schools there next month amid a surge of infections. The American Federation of Teachers and its Florida affiliate accused Governor Ron DeSantis of violating a state law that requires

schools to be safe and secure. The lawsuit, apparently the first of its kind, asks that local education and health officials, not the governor, have control over reopenings, and signals that teachers may take a range of actions to protest what they see as a hasty return to the classroom. And. And since we last convened and specifically on Friday, July 17th, 2020, received and answered his final summons from God Almighty and at that moment transitioned from labor to reward. On Monday, members of the House of Representatives unanimously passed a resolution honoring their former colleague, John Lewis, who brought the moral authority of his time as a civil rights leader to his three-decade career in Congress.

The clerk will report the resolution. House Resolution 1054. Lewis's death seemed to unify a body long defined by its divisions. And when the moment came for the House clerk to read the resolution, she was briefly overcome with emotion. Resolve that the House has heard with profound sorrow At the death of the Honorable John Lewis, a representative from the state of Georgia resolved that a committee of such members of the House

as the Speaker may designate, together with such members of the Senate as may be joined, be appointed to attend the funeral. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.