A special Forum session during the American Association for Cancer Research Annual Meeting 2021 brought public health officials, scientists, community leaders, and other experts together to discuss how to combat misinformation and build confidence in COVID-19 vaccines.
AACR Immediate Past President Antoni Ribas, MD, PhD, FAACR, and Gilbert S. Omenn, MD, PhD, moderated Building Vaccine Confidence: Best Practices to Combat Misinformation and Vaccine Hesitancy in COVID-19 Vaccines, which discussed the evidence about vaccine safety and efficacy, provided up-to-date information about public opinion about vaccination, explored strategies to build trust and address concerns about the vaccination program, and addressed special questions and concerns related to the vaccines affecting patients with different types of cancer. Panelists were:
- Francis S. Collins, MD, PhD, National Institutes of Health (NIH)
- Grace Cordovano, PhD, Enlightening Results
- Lee Greenberger, PhD, Leukemia and Lymphoma Society
- Mary Gullatte, PhD, RN, Emory Healthcare
- Liz Hamel, Henry J. Kaiser Family Foundation
- Lisa C. Richardson, MD, MPH, CDC Division of Cancer Prevention and Control
- John Wherry, PhD, Institute for Immunology, University of Pennsylvania
Collins opened his presentation with a review of how these safe and effective vaccines were created on an unprecedented quick timeline. He said that he had never seen vaccine development done with the rigor of the COVID-19 efforts. The messenger RNA (mRNA) platform used in the vaccines that gained approval first, Collins noted, was the result of a quarter-century of work in that field, so the public has no reason to be concerned that this was a last-minute idea.
To help combat misinformation, Collins co-chairs the COVID-19 Community Corps, a recently launched campaign that brings together the data and resources of the NIH, Centers for Disease Control (CDC), and Food and Drug Administration (FDA) to increase the availability of accurate information.
“We do recognize people have questions,” he said. “People are interested in knowing more about the vaccines and their possible side effects. And of course, there is a lot of misinformation out there, particularly in social media, portraying vaccines in ways that might scare people.”
Richardson discussed steps the CDC has taken to boost public confidence. She said that the CDC was “doubling down” on doing the things it has traditionally done well. That means an emphasis on epidemiology and a focus on communication to help people understand what they can do to protect themselves and their neighbors, as well as assistance to state and local jurisdictions about how to promote vaccination sites.
She agreed with Collins that misinformation and conspiracy theories spread via the internet and social media have contributed to an erosion of public confidence.
“People just don’t have the confidence that they used to have in the government,” Richardson said. “What we’re doing is looking at public perceptions and what we need to do to build that confidence and move things forward.”
Hamel said that surveys done by Kaiser have found that messages emphasizing vaccine effectiveness, particularly relating to preventing death and severe disease, resonate the most in the group of people who have adopted a wait-and-see approach to getting vaccinated. Many in that group also respond to messaging explaining that the technology used for creating the mRNA vaccines has been in development for decades, that clinical trials included hundreds of thousands of people from diverse backgrounds, and that the vast majority of doctors have taken the vaccine.
But it is about more than messaging, Hamel emphasized. Policies must address vaccine access.
“Many people are concerned about having to take time off of work to get vaccinated or taking time off work if they experience serious side effects from the vaccine,” she said. “Others are worried about difficulty traveling to vaccine sites or not being able to get the vaccine from a place they trust. These are concerns that won’t necessarily be addressed with messages, but they could be addressed with policies, for example, that give workers paid time off or make sure that vaccines are available at trusted locations in different communities.”
Gullatte said that people seeking trusted sources of information need more than a website. They want to hear firsthand from a trusted source who looks like them or has worked with them in the past on health issues. She shared an example from her 2,500-member African Methodist Episcopal Church in Georgia where she serves as the health ministry leader. Many congregants expressed reservations about the vaccine despite the fact that COVID-19 was disproportionately affecting people of color.
Gullatte, an oncology nurse at Emory Healthcare in Atlanta, reached out to her colleagues, including a professor in the division of infection control at Emory University who prepared a virtual presentation. The audience submitted questions in advance to help pinpoint the greatest areas of concern and interest. The program was so well received that it was shared with other churches. The key, she said, was to provide honest responses to the questions and avoid appearing condescending to people’s questions and concerns.
“They were very comfortable in the church. They felt safe in the church,” Gullatte said. “I received many calls and responses saying, ‘Oh, my gosh, thank you for doing this. This has been wonderful. I wasn’t planning on getting this vaccine, but now I feel confident that I can, and that it is safe. If you trust it, we trust it.’”
Wherry talked about the real-world effectiveness and side effects of the vaccines. He said that data current at the time of the session indicated that up to 30 percent of people have side effects after the first dose of a two-shot vaccine, and up to 60 percent after the second shot. Side effects include arm soreness and local swelling, headache, fatigue, myalgia, and muscle and joint aches.
Wherry said that side effects can be a common and quality indicator of immune response, but that even those who don’t show side effects are almost certainly getting good immune responses. Importantly, the immune responses from the vaccine work better than natural infection, especially in cases of mild or asymptomatic infections, he noted, which don’t leave the individual with a high level of antibodies and may decline over time.
“The vaccines are giving very high levels of antibodies that are very consistent. The other thing we know is that the vaccines are inducing good levels of neutralizing antibodies and other parts of the immune response that are important,” Wherry said. “So, it does look like the vaccines are working better than natural infection in a lot of people. And they are certainly going to be helpful to get uniformity in the populations.”
Greenberger discussed a survey done by the Leukemia and Lymphoma Society. Greenberger noted that blood cancer patients tend to be immunosuppressed, so the poll question asked more than 100,000 people in its registry of blood cancer patients about their interest and willingness to get the COVID-19 vaccine. While about 70 percent of respondents said they were likely or very likely to get vaccinated, about 20 percent said they were unlikely or very unlikely to get vaccinated.
People who are hesitant to get the vaccine also tend to be less likely to engage in protective health behaviors such as wearing masks, Greenberger said. The Society offers vaccine information and support through call centers and more information available at lls.org.
“The survey showed that there were financial concerns just dealing with blood cancers themselves and dealing with getting vaccinated, taking time off, and all of those issues,” he said. “It is a much more comprehensive problem in blood cancer patients.”
Cordovano said that in her experience as an advocate for patients with cancer, she’s seeing patient communities react with excitement about the science behind vaccine development. But that is tempered with some fear, uncertainty, and anxiety because people living with cancer were not included in the initial vaccine trials.
Cordovano said that patients with cancer and their care partners are “heat-seeking missiles” for information to help them make educated and informed decisions. Many people know the basics, but Cordovano said that doctors and others in the medical community should talk about their experiences with the vaccine and pandemic to help improve understanding in both their patients and the general public.
“We have to recognize that these conversations and questions about health are not just happening at the clinic,” she said. “I am hearing these conversations in line at the post office, in line at the store… you can hear these conversations everywhere. It is good for all of us to have these conversations and ask for permission to perhaps join these conversations informally and offer a snippet of information that we have, maybe a piece of guidance for people.”