Vaccination against infectious disease has been recognized as one of the “Ten Greatest Public Health Achievements” of the 20th century, given the substantial impact immunizations have had globally across a range of diseases, including polio, influenza, pneumonia, measles, mumps, rubella, viral hepatitis, pertussis, and oncogenic human papillomarvirus.1 Population-level vaccination programs have resulted in significant declines of new cases of disease, decreased morbidity and mortality, lower health care costs, and improved productivity.1 However, despite the proven clinical and cost effectiveness of vaccination, vaccines have not yet achieved their full potential, as rates of immunization among children and adults remain suboptimal, leading to a resurgence of some infectious diseases (e.g., measles).

Bringing increased attention to vaccination now is especially important as the world continues to combat COVID-19, a novel infectious disease that is easily transmissible and has an uncertain disease course, disproportionately affects elderly and ethnic/racial minority populations, provides fertile ground for misinformation, and has become politicized. As an uncertain population anticipates the development of a COVID-19 vaccine to help return society to some semblance of normalcy, priming the public for vaccine acceptance is an urgent public health priority. With daily lives interrupted and vaccine discussions dominating news headlines, government hearings, and social media discourse, this urgency should be used as a teachable moment to promote vaccine literacy, address hesitancy, and build resilience to misinformation specific to a COVID-19 vaccine and about vaccination more generally. These efforts require us to reengage the public, community leaders, health care providers, public health practitioners, policymakers, and health agencies in addressing the challenges associated with bolstering vaccine-related knowledge, attitudes, and behaviors.

The fact that lack of access to vaccines is a critical driver of low immunization rates in many communities is undeniable; however, when individuals do have access, lack of vaccine confidence becomes a primary barrier to uptake. In fact, recent polls suggest that many Americans do not plan to get a COVID-19 vaccine when one becomes available. Therefore, we specifically focus on strategies and research ideas for addressing vaccine literacy and hesitancy. Given the speed at which a vaccine for COVID-19 is being produced, adequate information about vaccine development and implementation as well as safety and efficacy may be challenging for individuals to gather and process. Proactive and coordinated communication efforts (e.g., public awareness campaigns) emphasizing the phases of vaccine development, Food and Drug Administration oversight, and adverse event reporting systems could increase confidence in vaccine safety and effectiveness.2

In addition to increasing knowledge about vaccines, efforts to promote vaccine literacy should support the public’s ability to critically evaluate health information, strengthen numeracy skills, and instill an appreciation of the complexity of scientific research.3 Strategies for cultivating vaccine literacy could include tailored patient– and parent–provider communication during clinical encounters, targeted media campaigns, peer-to-peer vaccine education, school-based health and science courses, and community-delivered educational programs (e.g., churches, social services, cooperative extension programs).4

Although increasing the public’s knowledge about vaccines will be vital, perhaps the greatest challenge facing vaccine literacy efforts is the proliferation of vaccine misinformation online. For years, public health experts and vaccine advocates have tried to reverse the damage caused by reports of an unfounded link between autism and childhood vaccines, only to have these efforts undermined by the massive amount of vaccine misinformation circulating online. Misinformation has become an especially acute problem in the context of COVID-19 because there are still many unanswered questions about the disease, making it easy for rumors to take root in the absence of scientific certainty.

Alarmingly, antivaccination groups are taking advantage of this situation to actively mislead the public and engage in divisive discourse on social media, even before the development of a COVID-19 vaccine. As evidenced by recent media reports, these activists are using social media to propagate rhetoric related to personal freedoms, to try to preempt possible COVID-19 vaccine mandates, to amplify fear and distrust of vaccines, to discredit those involved in vaccine development (e.g., pharmaceutical companies, philanthropists, government scientists), and to encourage parents to skip routine vaccination appointments during the pandemic. These online dis- and misinformation efforts are especially worrisome, as research has shown that fewer children have been getting routine vaccines since COVID-19 was declared a national emergency.5

Notably, exposure to misinformation cannot simply be undone through fact checking, correcting, or debunking efforts: a large body of research has shown that retractions are rarely successful at eliminating reliance on misinformation, a phenomenon known as the “continued influence” effect.6 Mitigating the effects of exposure to vaccine misinformation requires the development and testing of novel strategies beyond traditional vaccine education efforts. These strategies could include inducing skepticism about disinformation agents modeled after previous efforts to discredit the tobacco industry and developing tools to help the public identify credible information sources (e.g., creating a symbol to indicate that a Web site or social media account is credible and has been vetted).

Other innovative ideas include combatting online conspiracy theories by partnering with former members of conspiracist communities to offer insights on the group’s beliefs and disseminate evidence-based health information to current members. Mobilizing the provaccine majority to counter online misinformation may also be considered a testable strategy to assuage exposure to misinformation. Social media platforms could also proactively monitor, flag, and remove content or accounts that promote harmful health information and reconfigure platform features that amplify misinformation.

Although strengthening knowledge of vaccines, addressing misinformation, and reinforcing literacy skills are all necessary, they are not sufficient to fully address vaccine hesitancy and uptake. Cognitive, emotional, social, cultural, and contextual factors also shape overall vaccine attitudes and behaviors.2,7 Examples of these factors include political ideology, religious beliefs, online information silos dominated by singular viewpoints, medical mistrust, stances on government involvement in individual health decisions, and disease risk perceptions. Vaccine literacy efforts must therefore acknowledge that hesitancy is not always driven by a lack of knowledge and address these drivers by creating and delivering messages that align with individuals’ values, acknowledge their concerns, and emphasize the health and economic benefits of vaccination for individuals, their families, and their communities.

Potentially effective strategies include reinforcing health-promoting social norms, engaging social media and key opinion leaders and influencers to advocate vaccines, and ensuring the provision of strong and consistent vaccine recommendations from health care providers. However, we recognize that many of these proposed intervention strategies have limitations (e.g., limited efficacy among individuals with entrenched beliefs, insufficient reach); therefore, communication efforts should be combined with policy-based approaches—such as school and workplace immunization requirements—that establish vaccination as the default option for individuals and families and disincentivize individuals from refusing vaccinations.

As we collectively face the public health consequences of the COVID-19 pandemic, we need to proactively and thoughtfully develop, test, and implement timely communication interventions to increase vaccine confidence. It is challenging enough to promote uptake of vaccination under normal circumstances, but it is particularly vital in anticipation of a future COVID-19 vaccine and the contentious discourse and pervasive misinformation that currently surrounds this topic. Going backward in the progress made against vaccine-preventable diseases is not an option; routine vaccination of children and adults cannot be compromised or delayed. We should seize the attention being given to the COVID-19 pandemic and ubiquitous discussions of a vaccine as an opportunity to explore new intervention strategies to reinforce our commitment to a vaccine-literate and vaccine-protected public.

See also Chou and Gaysynsky, p. S270.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to disclose.

References

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Robin C. Vanderpool, DrPH, Anna Gaysynsky, MPH, and Wen-Ying Sylvia Chou, PhD, MPHRobin C. Vanderpool and Wen-Ying Sylvia Chou are with the Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Rockville, MD. Anna Gaysynsky is with the Behavioral Research Program, National Cancer Institute, Rockville, MD and ICF Next, Rockville, MD. Wen-Ying Sylvia Chou and Anna Gaysynsky are also guest editors for this supplement issue. “Using a Global Pandemic as a Teachable Moment to Promote Vaccine Literacy and Build Resilience to Misinformation”, American Journal of Public Health 110, no. S3 (October 1, 2020): pp. S284-S285.

https://doi.org/10.2105/AJPH.2020.305906

PMID: 33001735