On September 8, 2020, Bruce Gellin, MD, MPH, president of Global Immunization at the Sabin Vaccine Institute (Sabin), participated in a panel titled, “The Science of Vaccine Confidence,” as part of the 2020 Virtual National Health Research Forum hosted by Research! America. Dr. Gellin was joined by Phyllis Arthur, MBA, vice president of Infectious Diseases & Diagnostics Policy at Biotechnology Innovation Organization; Sandra Crouse Quinn, PhD, senior associate director of the University of Maryland School of Public Health’s Center for Health Equity; and Todd Wolynn, co-founder of Shots Heard Round the World.

The panel explored why investments in behavioral and social research around vaccination decision-making are critical, how health care providers can address misinformation and how vulnerable communities can be reached and immunized.

Here are nine key takeaways from the panel. The full recording of the live panel can be viewed here.

  1. Successful immunization programs rely on trust

Successful vaccine uptake is dependent on public trust; in the system that develops and manufactures vaccines and in the providers that administer them. Maintaining and strengthening public trust should be a central priority as COVID-19 vaccines progress in clinical trials and ultimately enter a rollout stage.

“We are asking people who are well to come and get a medical treatment that is going to prevent something down the road that they may not see. So trust and competence are central to this. The idea is that you're trusting everything from the integrity of the research, the quality of the science, the regulatory apparatus that ensures that only the products that are deemed safe and effective go forward and trust in those who make recommendations. So I think trust is central to it, and that's not just an American thing, that’s central to all immunization programs,” – Dr. Bruce Gellin

  1. Health care providers should lead a coordinated response to address vaccine misinformation and disinformation

Health care providers, especially pediatricians, are trusted advisers for health decisions, including those related to vaccines. Local health care providers could therefore play a critical role in addressing the proliferation of vaccine misinformation. This moment calls for a coordinated effort to spread fact-based information to minimize the effects of misinformation.

“We have two things we need to know. One is, what are the best strategies to respond? We still need significant research on that. Secondly, how do we help our institutions like local and state health departments in responding to misinformation?” – Dr. Sandra Crouse Quinn

  1. Data must be accompanied with narrative to address vaccine hesitancy

Studies show that statistics alone do not change minds when it comes to vaccines. Empathy and narrative may be more effective tools in provider-patient interactions.

“The science is important, but the data don't speak for themselves and the data are not terribly compelling. It's the stories that are. That's where we get into the broader science and the importance of social science and behaviors. Because you can tell people all the facts you want and you can get louder and louder but the emotional side is what will lead to real understanding” – Dr. Bruce Gellin

  1. Health care providers must be trained as advocates

Communication is an essential component of practicing as a health care provider, yet providers are not often trained in best practices to communicate about and advocate for vaccination. In order for a future COVID-19 vaccine to be taken up successfully, health care providers will need to receive resources on how to be an advocate prior to the arrival of a vaccine.

 “We need to make a concerted effort now to ensure that the people who are going to be holding the syringes know everything they need to know…[about] the science that’s going on now about clinical trials, the data going forward to the FDA for consideration; and everything needs to be packaged in a way so that the practitioner can answer questions and express confidence” – Dr. Bruce Gellin

“We need to start building the ranks of vocal health care providers. They already have community connections and trust. People are waiting to hear from us and we aren’t leveraging social media like we could be” – Dr. Todd Wolynn

  1. The public needs to better understand the parameters of Emergency Use Authorizations

The Emergency Use Authorization (EUA) authority allows the FDA to use medical products that are not formally approved to diagnose, treat or prevent serious or life-threatening diseases under specific circumstances, including if there are no adequate, approved and available alternatives. There is a possibility that EUAs could be granted for COVID-19 vaccines. For more information on EUAs please visit the FDA’s frequently asked questions.

“It is very possible that the vaccines that are first out and safe and effective are emergency use authorized vaccines. I totally agree that all of these providers need to be cognizant and ready to talk about the vaccine, but they also need to understand what that means” – Sandra Crouse Quinn

  1. Transparency is important, particularly around COVID-19 vaccine allocation

When a COVID-19 vaccine does become available, the rollout process will need to be communicated clearly to the public. The National Academies of Science, Engineering and Medicine are coordinating a Framework for Equitable Allocation of a Vaccine for the Novel Coronavirus; this effort must be translated for the public to understand and accept the phases of distribution (getting the vaccine from one place to another) and allocation (deciding who gets the vaccine first and why).

Equity in allocation is important because those most at risk for getting COVID-19 will need to be prioritized. People of color have been disproportionately affected by COVID-19 and face an additional burden of systemic racism. Phyllis Arthur cited the framework for vaccine allocation developed by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) as logical in its categorization of prioritization.

“What I think is strong about the way the ACIP is talking about allocation is that they're looking at it based on risk and the way that overlays occupation and health, and therefore leads to some discussion of racial and ethnic risk or underserved population risk, as opposed to going out and saying everyone who's a certain race is at risk. Part of the reason why we're seeing so many Black Americans impacted is partly because of the jobs they have that don't allow them to stay home during the COVID-19. So I think ACIP took a very logical approach that doesn't lead to racial targeting but to prioritization.” – Phyllis Arthur

  1. Watching the scientific process in real time can be daunting. Uncertainty must be acknowledged as part of this process

As researchers and scientists undertake the complex process of developing, manufacturing and distributing a vaccine, there will be some unknowns that will need to be acknowledged and communicated in real time.

“We should tell people what we know, what we don’t know and what we are working on to fill those gaps. We should expect the science to evolve and not dismiss uncertainty from the narrative” – Dr. Bruce Gellin

“It is really helpful if our leadership—be it scientific or an elected and community—were able to recognize [that uncertainty is difficult] and say with some empathy: ‘we know that's hard. We know that's going to make people uncomfortable. We recognize that…We will keep telling you what we know’” – Sandra Crouse Quinn

  1. Vaccination campaigns are successful when driven by trusted community leaders

Trust is what sets a successful vaccination campaign apart from an unsuccessful vaccination campaign. When the health benefits of vaccination are communicated by a trusted community leader, such as a Baltimore-based pastor who is communicating the importance of immunization to his congregants, uptake of vaccines can be improved.

“When I look at [vaccination] programs that are successful, it really falls upon the community and partnerships” – Phyllis Arthur

  1. Social and behavioral research is key to identifying promising interventions to increase vaccine acceptance

Once a vaccine is developed and approved, its success is dependent on how many people take it up. Thus, the scientific and social and behavioral research communities should collaborate to identify and advance effective behavioral interventions designed to improve immunization uptake

“The amount of science that's gone into where we are right now is incalculable…we need to make sure that we are addressing the behavior parts of health equally with the science part…marrying these two will lead to the outcome we are looking for” – Dr. Bruce Gellin

Thank you to Research!America for hosting this panel. To see the full discussion, watch the video.