Vaccine Confidence

Promoting trust during an infodemic

SHEYANGA BEECHER, CNP, MSN, MPH

The COVID-19 vaccine was developed under an unprecedented campaign labeled “Operation Warp Speed.” Nine months after the World Health Organization (WHO) declared the COVID-19 pandemic, a nurse from Queens, New York received the first US COVID-19 vaccine on December 14, 2020. Over the next four months, almost 900 million doses of COVID-19 were administered globally. In April of 2021, the Centers for Disease Control (CDC) and Food and Drug Administration (FDA) reported that the Johnson & Johnson vaccine had led to six cases of increased blood-clotting and one woman had died. This fueled an emerging, well-developed arsenal of COVID-19 vaccine disinformation available on various media outlets and communication platforms, including print, radio, podcasts, television, digital media, Facebook, WhatsApp, etc. Conspiracy theorists and anti-vaxxers deftly maneuvered the fear and uncertainty of the COVID-19 pandemic and helped fuel a resurgence in vaccine hesitancy. Unfortunately, the hesitation was not just regarding the COVID-19 vaccine, but also impacted attitudes and beliefs about essential childhood vaccines. Rates began to decline, leaving communities vulnerable once again to vaccine preventable diseases.

A Negative Ripple Effect

By July 2022, WHO and UNICEF called attention to this alarming trend, signaling a “red alert” for child health, evidenced by the largest sustained decline in childhood vaccinations in 30 years. The UNICEF Executive Director indicated that while they expected a lag in immunizations, the continued decline could not be attributed to pandemic related disruptions. Diphtheria, tetanus, toxoid and pertussis vaccine rates as well as the first dose of measles vaccine rates dropped to their lowest levels since 2008. In addition, there were notable gaps in HPV and polio vaccine series.

This global trend directly impacted the health of Americans. In June of 2022, an unvaccinated adult in New York contracted polio and became paralyzed. This was the first documented case of polio in America in nearly a decade. The single case was enough to declare a public health emergency, and wastewater samples indicated that polio had been circulating for several months. The virus was able to spread because of the greater frequency of international travel and lower immunization rates in particular New York communities.

Nationally, there was an increase in measles cases, including here in Minnesota. Last year, 22 children in the Twin Cities were infected with measles- fourteen of these children had traveled overseas (Denmark, Kenya, Somalia) where measles was common and circulating. These children then infected an additional eight unvaccinated children. In all, at least nine of these children were hospitalized.

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To establish herd immunity and control the spread of measles, at least 95 percent of a community needs to be vaccinated. However, the rates of measles vaccination vary widely across neighborhoods and schools. Some are well covered at the 95 percent level, and others are concerningly low, at 50-60 percent. Pockets of under-vaccinated communities always pose the greatest risk for outbreaks of vaccine-preventable diseases. Although numbers in Minnesota for the 2022 measles outbreak (22 cases) were not as high as the 2011 outbreak (26 cases) and the 2017 outbreak (75 cases), public health research shows we are at definitely at risk of another outbreak knocking on our door. How do Minnesotans prevent this, especially during a time when misinformation is readily available and shared?

Defining an Infodemic

In 2020, the WHO coined the term ‘infodemic’ to describe too much information, including false or misleading information, in digital and physical outlets during a disease outbreak. Can we attribute the resurgence in vaccine hesitancy and declining immunizations to the infodemic? What role does such a phenomenon have for declining childhood vaccine coverage and does this phenomenon impact all populations equally?

In 2022, the Hennepin Healthcare Pediatric Mobile Health team partnered with the United States Office of Assistant Secretary for Health (OASH) to determine factors that improve vaccine confidence and increase vaccine uptake. The Pediatric Mobile Health (PMH) team interviewed community leaders representing public health agencies, the education sector, media firms and Black Indigenous and People of Color (BIPOC) facing organizations. The team also held focus groups with Latino and other community members and surveyed PMH patients. Results from the community assessment, over eight months, indicate that increasing access to vaccines and promoting trust are key strategies to promote vaccination, especially in BIPOC communities residing within Minneapolis and the neighboring cities.

Early in the pandemic, the ability to access health care was highlighted a significant barrier for many families. Due to shelter-in-place orders and restricted capacity of health facilities, families fell behind in routine preventative care. One community leader noted, “parents fell behind on their children’s vaccinations due to COVID. Also, the modes through which they would typically receive important health care reminders and education have been unavailable because of the lockdown and social distancing.” Of course, access to preventative care such as immunizations was only exacerbated for some high-risk populations who had always faced challenges with reliable transportation, child care, etc. As another community leader noted, “Even if there was adequate supply, lack of access to vaccines has made it difficult for my community members to maintain their vaccination status.” In addition to vaccines being more accessible, participants requested that accurate information about vaccines should be more readily available. Information should be shared in the communities and relayed from trusted community members who looked like them and preferably spoke the same language.

In addition to barriers to access, some participants expressed that safety and efficacy concerns influenced the decision to vaccinate themselves or family members. Some of this shift in thinking was a result of the infodemic associated with the COVID-19 vaccine roll out.” As one community member noted, “It’s a lot of information to absorb”, and often, misinformation is more available than accurate information. A community leader noted, “I could depend on the reliability of early childhood vaccines to persuade people to take the COVID vaccines. Now people’s resistance to COVID vaccines is driving mistrust of early childhood vaccines.”

In general, participants were aware vaccines are important and effective in preventing disease. One person said the inoculations she received as a child have maintained her health into adulthood: “the effectiveness grows with you. I don’t have too many ER stays. I rarely get sick.” A patient who identified as Latino said, “I know a person in Honduras who was not able to vaccinate her daughter, and her daughter was infected with polio. Her daughter did not recover from polio and is now paralyzed.

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