This week, Americans began receivingcovid-19 vaccines, with the hope that by the middle of next year a pandemic that has claimed the lives of more than three hunded thousand Americans will be brought under control. Misinformation about the virus has been a staple of both the Trump Administration’s messaging and much of the junk science found on the Internet. Now, that misinformation will intersect with an American public that is already somewhat skeptical about vaccines, potentially imperilling the effort to get a sufficient number of Americans vaccinated. (The Timesreported on Wednesday that many of the people spreading false claims about voter fraud have switched their messaging to the dangers of vaccines.)
To try to understand why anti-vaccine sentiment is so prevalent in the United States, I recently spoke by phone with Dr. Peter Hotez, a professor of pediatrics and molecular virology at Baylor College of Medicine, and the co-director of the Texas Children’s Center for Vaccine Development. In March, he will publish a book called “Preventing the Next Pandemic: Vaccine Diplomacy in a Time of Anti-Science.” During our conversation, which has been edited for length and clarity, we discussed the historical reasons for vaccine skepticism among many Black Americans, how doctors can speak the truth without appearing political, and how the fight over vaccines became so similar to the fight over every political issue in America.
When we’re talking about why people are resistant to vaccines, how much is that a question for doctors to answer, and how much is it a question for social scientists or other people to answer?
Not all vaccines are created equal, and each vaccine has its own set of issues around hesitancy. In general, when we’re talking about vaccines, we’re usually talking about vaccines for kids. And the three vaccines that are primarily targeted are the M.M.R. vaccine for measles, mumps, rubella; the H.P.V. vaccine; and the flu vaccine. What’s happened in the United States is that, historically, there has been a rise and fall of anti-vaccine sentiment ever since colonial times, with smallpox vaccinations. But the modern piece of this really started to accelerate in the early two-thousands, after a paper by Andrew Wakefield and his colleague was published in The Lancet, falsely claiming that the measles, mumps, and rubella vaccine had the ability to cause autism. Back then they called it pervasive developmental disorder.
That whole thing was debunked by a journalist for the Times of London, a guy named Brian Deer, who wrote a series of articles, first in the Times and then in the British Medical Journal, the BMJ. And that Lancet paper ultimately got retracted, but not until 2010. So that period enabled an anti-vaccine movement to flourish in the U.K., and then it took off in the United States. And in the United States it acquired its own flavor, in that, starting around 2014 or 2015, it got linked to the political right under this fake banner that they called “health freedom, medical freedom.” It started in Southern California, but it really got amplified here in Texas, and we started to see a steep increase in parents who were opting their kids out of getting vaccinated. And it coincided with the formation of these political-action committees, Texans for Vaccine Choice, Oklahomans for Vaccine and Health Choice. And they started getting money from organizations that traditionally would support the Tea Party and other far-right-wing causes. So they gave money, and power, and strength, and political alliances. And then it really took off with Robert F. Kennedy and his anti-vaccine group, Children’s Health Defense, which became one of the first major national anti-vaccine groups.
One of the things that seems interesting about anti-vaccine sentiment is that it is a far-right thing in certain ways, but it also crosses certain ideological lines. If you look at some of the places where opposition to vaccinations for children is highest, it’s places like Santa Monica and Marin County, which I don’t think of as part of a right wing—
Yeah, or in Seattle. So there’s a Pacific Northwest flavor to that, which is linked more to the health-and-wellness industry. The point is the anti-vaccine lobby doesn’t all speak with one voice. That’s absolutely true. That’s why I sometimes call it a confederacy more than one single organization. And that gets to the sources of funding as well, which we don’t really understand. Some of it’s coming from the health-and-wellness industry selling fake supplements and autism cures, while a lot of it is getting money from far-right-wing political causes. But it’s gotten very powerful now, to the point it really dominates the Internet.
You alluded to anti-vaccination sentiment rising and falling since colonial times. Is there a through line that can help us understand why sentiment rises or falls, or why distinct populations see sentiment within them rise or fall? Or is it just things like this Lancet paper, about which it would be hard to come up with some sort of historical explanation?
It comes from different causes. So for instance, because I have a daughter with autism, I wrote this book “Vaccines Did Not Cause Rachel’s Autism.” In the book, I report on doing a PubMed search, where you type in key words like autism and vaccines, and you do see one paper comes out of 1976, and a guy who was looking at smallpox vaccination and wondering, “Could there be a link to autism?” And then nothing. And then all of a sudden the Wakefield paper comes, and this thing just blows up after that.
So clearly it’s that Wakefield paper that was the trigger. But what gave it momentum, though, I think, was the political alliances and links. And again, under this banner of health freedom, we’re seeing that stuff expand this year. Because while it was very focussed on vaccines —which, by the way, started bringing people like Rush Limbaugh and Alex Jones into it—in 2020 it glommed on to the protest against masks and social distancing. So what was an anti-vaccine movement then morphed into a full-on anti-science movement.
And then the other thing that happened this year, which I hadn’t seen before, was it went outside the U.S. and North America. It went to western Europe. So you started seeing these protests in Paris and Berlin and London, again using that same health-freedom language. And we have anti-mask and anti-vaccine rallies. There are other versions of anti-vaccine activities globally, but this one had that American spin to it that I hadn’t seen before.
According to polls, if you ask people about their skepticism of covid-19 vaccines, you see that Black and Latino adults are more skeptical. At the same time, you see Republicans as much more skeptical than Democrats. The explanation for the former has traditionally been that the medical community has a very checkered history with nonwhite populations in this country and elsewhere. Is that how you see it?
It’s the thing you mentioned. I think the other is the absence of African-American health-care providers, especially physicians, especially male physicians. We really are doing a very bad job training African-American physicians. But the third piece that no one really talks about, which I think is quite important, if you start looking into it, is that these anti-vaccine groups staged anti-vaccine rallies in Harlem in 2019. So I think there was specific targeting of African-American groups. The movement targets specific groups. It went after the Somali-immigrant community in Minnesota in 2017, and it basically generated a measles epidemic. Then they went after the Orthodox Jewish community in New York in 2018, 2019. And they use very inflammatory, exploitative language, comparing vaccines to the Holocaust.
Most people in the United States in 2020 don’t have an experience with measles, but covid-19 is something that everyone has had some experience with. What are the unique challenges or unique advantages of getting Americans to buy into a covid-19 vaccine? How is it different?
Well, I think that you now have a couple of challenges. One, you have the anti-vaccine lobby, the anti-vaccine groups. One of the things that they’ve been doing the last few years is specifically targeting new vaccines. So they really went after, for instance, the H.P.V. vaccine for cervical cancer and other cancers. And now they’re going after the covid-19 vaccine and coming up with all sorts of outrageous assertions. Then on top of that, you have the fact that while the White House and Operation Warp Speed did a good job in terms of the scientific rigor and integrity of the clinical trials, they never had a communication plan. And that left a big vacuum. So I think those things really combined to work against us in a big way. Because intuitively you would think that people would be clamoring for a vaccine, and it’s surprising how many aren’t.
What can medical professionals do to ameliorate some of these things you’re talking about? And to what degree is this now a political matter, and medical professionals can’t do much?
Well, first of all, I think the federal government needs to do two things, one of which I think they’re starting, and the other, which so far they’ve resisted, and most people have resisted. The first thing they need to do is implement a communications plan. And I know it’s going to start with a series of public-service announcements. I don’t think that’s going to be adequate. I think because there are going to be issues on a regular basis, they’re going to need government scientists out there on a frequent basis, sort of like what Cuomo did in New York in March and April, but for vaccines. And I’m prepared to do that as much as possible. But I think having government scientists, people whose faces get familiar, is going to make a big difference. That’s No. 1. No. 2, which nobody seems to have the appetite for, is you’ve got to take down the confederacy, the anti-vaccine empire. You’ve got to take the content off social media, off Facebook. I mean, Amazon right now is the single largest promoter of fake anti-vaccine books. That’s got to stop.
So you’re saying that this is something that business and society need to take steps to deal with.
Yeah. I think the tech giants have done the minimum possible to give the optics of some level of social responsibility, but the truth is that they are getting a significant amount of revenue from promoting the agenda of the anti-vaccine groups. Facebook, Amazon, Twitter, you name it. And so that’s a problem. And one of the other problems is that if the U.S. government’s going to take out some of this, they can’t do it with the Health & Human Services agencies alone. They’ve got to bring in Homeland Security, they’ve got to bring in the State Department. Because the other piece to this is, besides the homegrown anti-vaccine groups, you have the Russian disinformation, or what some call weaponized health communication.
I’ve been on Zoom calls all year with various people talking about fine-tuning the message, amplifying our message, getting the word out. Then I say something which is quite disappointing for people. I say, “Look, it’s great that you’re doing this. It’s important we step up our communications plan. But all of those messages are messages in bottles in the Atlantic Ocean. And we’ve got to do something about the Atlantic Ocean.” We’re only going to get about thirty to forty per cent of the way there with all of this just stepping up the message, because it’s being drowned out by the anti-vaccine groups, both the homegrown ones and what’s coming out of Russia.
I feel like this interview is going in the same direction that a million different interviews I’ve done over the past four years have gone, where there’s some problem, and then we have the information system we have now, and the Russians and bad political actors doing their part, and businesses being irresponsible.
Well, yeah. And also, especially when I start listening to myself, you start going on about political extremism—about the far right, about QAnon—and then you start talking about the Russians. Then you get to the Murdoch media empire as well. You start sounding like someone who throws things at the TV at night. Trying to say it in a way that sounds credible, I agree—it’s not easy. But the truth is that there is this very aggressive anti-vaccine lobby that is dominating our information right now. And when you interview people about why they don’t want to get vaccines, it’s a direct replay of the major messages coming out of the anti-vaccine groups.
If I were a person who was more conservative, and I heard you talk, I might think, Oh, this guy is just another liberal doctor who’s bashing the far right, and he’s bringing politics into science and into medicine. This is why I don’t trust the medical establishment.
I don’t want doctors not to speak the truth, obviously, but is there some concern about doctors becoming too politicized? We saw this with comments that a lot of medical professionals made during the George Floyd protests.
Yeah. So I’ve been going out on the cable-news networks all year, and I was happy that I had the opportunity to be on CNN, and MSNBC, and Fox News, and a lot of conservative news outlets. And the problem was this. The White House did a pivot, and the pivot was they decided that they weren’t going to take on a covid-19 national-control effort. And they decided to go in a very ominous direction, where they, again, attributed covid-19 deaths to other causes. They discredited masks. There were these ideas of herd immunity, and what it really became was a disinformation campaign.
And then they brought on Scott Atlas to lead that disinformation campaign. So it wasn’t the doctors who linked covid-19 to politics. This was deliberately done by the White House. And the only way to disentangle it was that I had to call it out and say, “Look, this is a disinformation campaign coming out of the White House.” There was no other way to discuss it. And that was hard. It wasn’t fun. Believe me. It’s definitely out of my comfort zone talking about the political links to vaccines, and the political links to covid-19. But again, it’s not the doctors who did this. It’s the doctors trying to untangle it, and the scientists.
We’ve seen different arguments about whether kids should be able to go to school if they aren’t vaccinated. It seems possible that, at a certain point, if you don’t have a covid-19 vaccine, you may not be able to get on a plane, or, who knows, go into a shop or a movie theatre. Do you expect things like this to have a major impact on people’s willingness to take the vaccine?
What I’ve been saying is, “Look, right now, I don’t think we need to go there,” either with vaccine mandates, or you’re also seeing a lot of articles about, “Should we pay people to take covid-19 vaccines?” I don’t think we should do any of those things right now. I’m hoping that as people see their friends and colleagues and their family members get vaccinated without any untoward effects, and people see how they’re not going to the hospital and the I.C.U. because they’ve been vaccinated, that the rates will pick up.
I don’t know that for certain by any means, but I’m hoping that there’ll be some pickup in the number of people getting vaccinated so we won’t have to do those things, with maybe a couple of exceptions. For instance, in colleges. When I sent my youngest son off to college, he had to get his meningococcal B vaccination. And so they might require the covid-19 vaccine. That’s very reasonable. But beyond that, I’m hoping we’re not going to have to do this. And right now, with regards to schoolkids, we don’t even have the data showing that it’s safe and effective in kids yet. So my response is let’s not go there right now. Let’s see how this unfolds, with the hope that acceptance will start to pick up.
Do you have some sense of how that pressure has worked with other vaccines?
I can’t think of any example where we’ve had to do that for adult vaccinations in modern times. Maybe smallpox vaccination way back when. And we do it for schools, right? For school entry. And even then, that’s where the battle about health freedom comes out. That’s why I say, if you don’t have to poke that bear just yet, don’t do it. And let’s see how this evolves naturally.
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Isaac Chotiner is a staff writer at The New Yorker, where he is the principal contributor to Q. & A., a series of interviews with major public figures in politics, media, books, business, technology, and more.