One of the most startling lessons in public health from the height of the COVID-19 pandemic was the rise in vaccine hesitancy and the spread of misinformation at a time when immunizations were needed most. But that's not the end of the story, and experts say pharma companies need to approach this fight in different ways than they have in the past.
Vaccine hesitancy goes well beyond the pandemic — 8% of parents had previously delayed or refused at least one scheduled vaccine for their children, which did not include flu and COVID-19, according to a 2022 survey conducted by the Alliance for a Healthier Generation. The survey also showed that, looking ahead, 14% of parents planned to delay some vaccines or refuse them altogether. These rising numbers are a cause of great concern for public health professionals.
Worries about vaccine ingredients, giving too many vaccines at once, children being too young for the shots and anxiety about rare serious reactions were the top reasons for the delay or refusal.
For the vaccine-hesitant — which make up a much larger group of people than those who flat-out refuse shots — a lack of trust in pharmaceutical companies isn't something to be taken lightly, said Dr. Gregory Poland, director of the Mayo Clinic's Vaccine Research Group. He said the issue needs to be addressed at the very highest level of corporate leadership.
"When you're in the boardroom making decisions, the point is to be radically transparent and honest, and that's where big business always gets into trouble," Poland said. "It takes decades to build trust and minutes to destroy it — pick a Big Pharma company, and I can point to ways in which they've diminished if not destroyed the public's trust."
Expanding the scope of leadership
The insular nature of leadership in Big Pharma can at times make them their own worst enemy, Poland said. To combat that tendency to close the ranks, companies need to instead open leadership and board seats to those with another point of view.
"There are very few people like me who sit on their boards — and what I mean is, people who have multi-dimensional experience," Poland said. "There is almost no investment in social sciences."
Marketing from these companies is often a one-size-fits-all approach, Poland said, and that ends up fitting no one. Instead, companies should employ a model that recognizes the cognitive style differences among potential patients to understand more of the nuances of decision making.
"They don't even know that model exists because they're not reading the social science literature," Poland said, adding that companies need to think beyond a monolithic direct-to-consumer approach to change minds about vaccines.
"I don't have any evidence in vaccines that that (DTC approach) works — in fact, it may be counterproductive," Poland said. "I think pharmas are sometimes their own worst enemy in terms of their legal departments, who vastly restrict the kind of educational activities that can be done."
One of the fundamental roadblocks to increasing vaccination rates is the technical language that scientists and public health experts use, Poland said.
"Because so few people are scientifically literate out in the population, using a highly analytic cognitive style to reach them is a fool's errand," he said. "What we should do is harness what the anti-vaccine groups effectively do, and that is the power of story, the parable, the narrative imagination, the incredibly impactful human stories that are full of emotion, and use those to educate and teach."
Embracing the changing story of science
Scientists’ evolving understanding about the coronavirus and how leaders told that story over time undermined people’s trust people in the vaccines and experts' opinions, Poland said. But staying true to the science, even when it changes, is what will gain that trust back.
"I'm going to be radically, transparently honest, and that doesn't mean the science can't change — what I said three years ago may be different (from) what I say today based on the science," Poland said. "But that's part of the honesty, and the pandemic has produced a difficult set of circumstances."
"It takes decades to build trust and minutes to destroy it — pick a Big Pharma company, and I can point to ways in which they've diminished if not destroyed the public's trust."
Dr. Gregory Poland
Director, Mayo Clinic Vaccine Research Group
Knowing how to listen to patients and physicians on an individual level is one of the most important parts of gaining trust, said Judy Klein, co-founder and president of the Unity Consortium during a panel at last week's World Vaccine Congress.
"First we listen, because when we listen to different populations, different groups have different questions," Klein said. "When we talk to adolescents, we get very different kinds of questions and responses than we hear from parents."
The takeaway is that "parents are different from healthcare providers are different from adolescents are different from young adults in college," Klein said.
Another part of the solution is finding "trusted messengers" who influence different communities for better or worse — with the correct information, influence can be used in support of public health initiatives rather than setting them back, said Synovia Moss, who wears many hats, including as CEO of Moss Consulting, as well as project manager for Good Health Women's Immunization Networks and the National Council of Negro Women.
"I never thought I would have to take on Nicki Minaj," Moss said on the same panel, referring to an incident in 2021 in which the pop singer shared her vaccine-hesitant status online. "We responded by saying that we appreciate and know where she is in her position, and we gave her the space and the grace to get the correct information — so one of the things that we've tried to do is educate our trusted messengers on how to respond in real time to real issues in real ways."
And lessons from the pandemic have allowed organizations like Moss's to reach out in deeper ways not only to patients, but to the systems in place that have historically fallen short among communities of color.
"As our traditional systems keep saying we want to get married, well, let's get beyond engagement and really work together in a cohesive way to address how we deal with vaccine hesitancy to build confidence and actually fight it," Moss said. "The silver lining is that we are moving as we continue to work together — the pandemic forced us to the table."