Bridging the Gap: COVID-19 vaccine hesitancy, with Dr. Boden-Albala

Introduction by Vice Chancellor Steve Goldstein

Well into year two of the COVID-19 pandemic, we know much more about this dangerous virus and its impact. Health organizations worldwide, including UCI, have directed multiple resources to studying the illness, developing therapies, and caring for patients and communities. Among key findings, the unvaccinated are now over 98% of the patients who are hospitalized and die when infected. The unvaccinated also have higher viral burdens fostering development of viral variants like the more infectious Delta strain, further increasing the risk of disease for the most vulnerable, including children under 12 years who are too young to be vaccinated. Despite these measurable observations, there is still a large segment of the population who are hesitant or resistant to being protected by vaccination.

In this installment of our Bridging the Gap series that focuses on health equity, Bernadette Boden-Albala, Dean of the future UCI School of Population and Public Health, calls upon healthcare professionals to do more to counter vaccine hesitancy. She offers specific strategies that providers can utilize to educate and encourage vaccination and to reach those in underserved communities where the pandemic is having an outsized impact. A related editorial by Dean Boden-Albala recently ran in The Hill.

Five ways public health professionals can help battle vaccine hesitancy

By Dr. Bernadette Boden-Albala

We live in a time in which science naysayers seek to overturn established medicine that conflicts with their beliefs. Bombarding the American public with conspiracy theories about magnetic forces and microchips in vaccines, COVID-19 as a government-manufactured means of control, and vaccine development as merely a money-grab scheme, these individuals who doubt the science, exaggerate potential harm, or appeal to personal freedoms to prove their point are getting away with it largely because we public health leaders let them.

Even though approximately 72 percent of the U.S. population ages 12 and up has received at least one dose of a COVID-19 vaccine, and roughly 61 percent are fully vaccinated as of Aug. 25, we still have many Americans who are hesitant or resistant to vaccination. A June poll conducted by Gallup indicates that 14 percent to 26 percent of Americans ages 18 and over say they have not been and do not intend to be vaccinated.

As the back-to-school season got underway, we experienced a rise in COVID-19 infection rates among children. Until there is an approved vaccine for young children, we will not put the pandemic behind us.

As a public health professional and academic leader at a research university, my biggest fear lies with the struggle we face to reach the vaccine-resistant. Science-denialism represents an organized, anti-establishment movement to reject mainstream science and legitimize falsehoods. Never before in modern history have we seen this degree of lack of trust in our health institutions, support for demagoguery, or the discrediting of evidence-based science and plain fact.

Take, for example, the latest threat to our welfare: Delta variant of the coronavirus, officially known as B.1.617.2 , first detected in India in February. Its global spread has made this variant the dominant source of new infections in the United States, with outbreaks in the South, breakthrough cases among the fully-vaccinated, and hospitalization, critical illness and even death among the unvaccinated. Indeed, the risk of future outbreaks is most pronounced in parts of the country with low vaccination rates, which is why we must actively address denial or misinformation of vaccines and their efficacy.

How do we effectively respond to science denialism? The scientific community has debated this question, struggling to decide whether to continue fervently defending the field, to better understand opposing views through an empathetic approach, or to simply refuse to engage with those who encourage and spread misinformation.

Here’s what we need to keep doing:

• Generate evidence to battle misinformation. Clinical research is part of the scientific process, and within the research lies evidence-based data. Public health professionals, researchers and scientists must keep researching for answers to the most pressing questions.

• Develop effective communication strategies. We can respond to science denialism and increase public awareness about the scientific process, emphasizing that there are mechanisms in place to preserve scientific integrity — e.g., requirements for large, representative samples in clinical trials, rigorous evaluation, and review of hypotheses. It is critical that the public understands the unbiased, rigorous process behind evidence-based science. Good science yields good vaccines.

• Push forward with action. We continue to inform the public of the validity of the vaccines and the benefits of a mass vaccination campaign, for both individuals and society. We can address vaccine-access barriers with accurate information and a defined, accessible pathway to receiving a vaccine.

• Reach groups facing disparities. We can and should do more to address health disparities and equalize access to vaccines and state-of-the-art clinical treatments. For example, public health professionals can work within their communities to offer culturally appropriate materials in different languages; deploy mobile vaccination units in neighborhoods with “pharmacy deserts”; and tap into networks of churches, schools and businesses to help disseminate evidence-based information.

• Understand that “unvaccinated” doesn’t necessarily mean denialism. By and large, the disparate, burdened communities of color that remain unvaccinated are not science denialists. Many of them remain unvaccinated not because of resistance but because structural barriers hamper access to public health resources and information.

Denialism and the rejection of the scientific method represent an assault on truth. Groups perpetuating falsehoods threaten our progress in reaching herd immunity and protecting the health of all Americans. Their efforts to sow confusion, create distractions or garner support for vaccine opponents could directly impact public health policy.

Much like the virus itself, science denialism is a threat to our collective well-being, both mind and body. As public health officials, we must stop the infiltration of misinformation into the minds and psyches of Americans, or we will continue to see the unnecessary loss of life spanning generations.