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Dr. Sandra Quinn: Vaccine trust during COVID-19 and flu season

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SciLine interviewed: Dr. Sandra Quinn, a professor and chair of the Department of Family Science and the Senior Associate Director of the Maryland Center for Health Equity at the University of Maryland. Her research focuses on health disparities among racial and ethnic minorities, as well as misinformation and attitudes around vaccines.

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How does vaccine misinformation commonly spread in the United States?


[0:00:28]

SANDRA QUINN: Vaccine misinformation is not new in terms of, you know, the advent of social media. But, certainly, probably one of its primary ways of spreading right now is through all sorts of social media mechanisms – Facebook, Twitter, YouTube, etc. But it’s not just that. And indeed, in the measles outbreak in 2019, we saw robocalls to Orthodox Jewish communities because they don’t use the Internet. And so we also see it in some of that anti-vaccine advocates actually making targeted visits to communities. Some of those were during the measles outbreak to Minneapolis and Orthodox communities.

The other thing is that misinformation often mirrors myths or concerns that are there. So most recently, during COVID, in one of our Black barbershops in Prince George’s County – this is the Washington, D.C. area – they literally sent us, you know, a photo of a black-and-white 8-1/2-by-11 flyer about how COVID is a hoax, how it is caused by 5G – so replicating all the things we hear on social media, but in an old-fashioned flyer stuck in the door of the barbershop.


Are certain groups more likely to decline to get vaccinated? What factors drive these disparities?


[0:02:08]

SANDRA QUINN: Let me just say some of it – I mean, that’s a complex question, and it depends, you know, to some extent – are you talking about childhood vaccination, adult vaccinations? Let me speak for a moment to adult flu vaccine, which is something I’ve had NIH grants to study.

And yes, you know, historically, what we see are African Americans, Native Americans, Latinx communities being less likely to get vaccinated than whites. That said, if we took flu vaccine in adults, for example, the goal of healthy people 2020 – I guess now 2030 – is to have over 70% of us vaccinated. Nationally, we’d get to usually in the 40s, you know, as a nation. So nobody gets vaccinated at the rates we need them to. When it comes to childhood vaccines, it’s a little different. And, you know, what we have seen is that, you know, often minority children actually have been more up to date in recent years and in more compliance. And sort of the stereotypical perceived vaccine has some – parents have been white and often higher educated.

But, you know, we’re seeing it cutting across the board. But it’s often trust, and it may be trust or distrust that’s motivated by different reasons, depending on which group you are.


How might vaccine misinformation affect uptake of an eventual COVID-19 vaccine?


[0:03:57]

SANDRA QUINN: Well, I think many of us are losing sleep about that. And with regard to the COVID vaccine, I think that the other place we’re seeing misinformation come from, quite honestly, is some of the highest levels of the administration. And that’s really disturbing, as somebody who believes that trust of the FDA, trust of CDC is vital. And we’ve – you know, in previous research during the H1N1 pandemic, we saw that trust in CDC and trust in the FDA were pretty high.

Misinformation is going to be a real challenge here. And I think part of it is due to the fact – I wouldn’t – I almost hesitate to say misinformation for a moment – say that, you know, what the public is seeing day after day after day is stories about the vaccine trials. Most of the public never has any reason to even think about vaccine clinical trials and the complexity of the phases of the trials, the results they’re looking for, immunogenicity, safety, etc., is something that I think means that much of the public didn’t understand the process as it would normally play out, not to mention the process in this very abbreviated time period and the possibility of an approval under a mechanism they’re not familiar with, the emergency use authorization.

So there’s plenty of room for misinformation. And we’re certainly seeing it. You know, one example that we see sometimes is the, you know, sort of groups saying, well, this will be made mandatory. There’s no discussion of that. We don’t do that for adult vaccines. Even health care systems have been – some have made it mandatory for employees, but others not. So I think it’s a combination of sheer just confusion and lack of experience and misinformation and the uncertainty that’s making this really hard. All of that and the fear that many are voicing in the polls we’re seeing, that it has become such a politicized process, that can’t be certain that issues of safety – particularly safety, safety and efficacy – are really going to be the decision points for the FDA. So there are – if I may go on for a moment, I think there are a couple of things that can help us here that are starting to happen.

You know, the FDA has been very clear that they have an external advisory board that will also examine the data. The fact that Moderna, Pfizer, I think Janssen – some of the other companies are releasing their protocols that to the average person may not mean much, but for other scientists and professionals, we have to speak to it, to the media and help interpret some of that. I think those things are helpful and may help us with trust. But if it’s pushed and it’s perceived as too rushed and political, I think that we’re just going to see, you know, such resistance and worry about it that will keep people from accepting it.


Is there anything individuals can do to spot or combat vaccine misinformation?


[0:07:56]

SANDRA QUINN: I think there are a few things, and yet it’s tough. OK. So I think one of the things that makes it tough is often that misinformation is not wholly inaccurate or false. It may be partially so or, as we’ve seen during – in some of our research coming out tomorrow in the American Journal of Public Health, that what happens is, as we learn more, you know, and because we have not prepared the public for this uncertainty in the way we should have, as we learn more, things that may have been correct in February, when it first appeared, you know, in social media, now is not correct, and you might define it as misinformation. So sometimes they’re, like, kernels, and they’re something that could be factual or was factual.

But a couple things I think people need to do and can do – and then a lot of this is on platforms, the actual platforms to do. I think – I’m a big fan of the News Literacy Project. And they have a number of tools for the public to use to do fact-checking, but fact-checking’s hard. I think the other thing is, who’s doing the speaking. So before you share something, who’s doing this speaking? We know that in some of our research related that – where we found bots and trolls that you may think it’s somebody – you know, a white mother of young children that looks like you, and it’s a persona. It’s not necessarily even a real person. So who’s your source? Can you verify that source? Is it a credible source? And maybe for you, if you don’t trust the CDC, maybe you trust your local doctor, and they have their own website. Or maybe you would trust the American Academy of Pediatrics.

That’s not a government organization. So I think those are some things. I think there’s one other thing that I would say is – look at what else is – the group that’s doing the posting, what else do you see there? Because when we look at some of the anti-vaccine advocates, they may also be selling a product. They’re raising money. So they’ve got a number of other agendas that may – you know, they’re entrepreneurs in some way. So, you know, I would hope that would make you question – can you trust this? Should you verify what you’re reading there? So it’s a barrage of information, and it’s hard to fact-check it. That’s why I think – thinking about what are credible organizations, using tools like News Literacy Project tools, you know, can help.


How have public trust in and perceptions of vaccines changed in recent years?


[0:11:16]

SANDRA QUINN: It’s a critical topic. And it’s interesting because – so I was reviewing – going back and reviewing Pew Research Center’s look at attitudes toward the MMR vaccine in 2019, when we were having, you know, huge measles outbreaks. And what they reported was really high levels of trust, that people believed – 88% percent of Americans believed that the positive – that there were significant benefits to the vaccine and that the risks were – that those believing that risk were a problem had actually gone down. That’s good news, right? But it took terrible measles outbreaks for that to happen. You know, what we have right now, oftentimes and in my own research with adults on flu vaccine is, you know, we can address trust. And I think with that – some of that is also helping people understand things that worry them.

So we often talk about disease risk. What’s your risk of getting the flu? What’s your risk of getting COVID? We often don’t talk as much about – what are the side effects of, let’s say, the flu vaccine? And that’s an impediment, you know, because if people don’t trust the vaccine, they’re not likely to get it. So I think we need to do a more balanced approach to listening to people, and we need to also talk not just about the benefits but, in a realistic way, what are the side effects, which are usually minimal. I mean, I got my flu vaccine Monday, you know. I don’t even have the sore arm, and I got a high dose. So I think we have to do a lot of work to – and some of this is at the provider level, to help people trust because it has suffered in recent years. And it’s particularly suffered in Black and brown communities because they view vaccines in the context of this larger culture that they’re living in, in their daily life experiences, and those have been challenging in recent years. So I think we have to think of it as not just trusting the vaccine as an isolated thing, but it’s also, you know, affected by this broader social context.


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Dr. Sandra Quinn

Maryland Center for Health Equity at the University of Maryland

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