Call to Action: CSIS-LSHTM High-Level Panel on Vaccine Confidence and Misinformation
The United States’ health crisis continues unabated, amid profound uncertainty.
Confirmed cases of Covid-19 in the United States exceed 8.1 million, while deaths exceed 219,000. Daily confirmed cases across the nation are running at a 7-day average of 55,000 or higher, while the 7-day average for daily deaths remains near 700. The Institute for Health Metrics and Evaluation (IHME) forecasts a surge, turbocharged by the arrival of winter, that will raise daily death counts to more than 2,200 and result in nearly 390,000 deaths by the beginning of February 2021.
Covid-19 has triggered multiple compounding crises that threaten the national security of the United States.
People living in all regions of the country are experiencing severe economic dislocations: furloughs, layoffs, underemployment, poverty, and food insecurity. An intensified housing crisis is unfolding in major metropolitan areas. The disruption of schooling is pervasive, including the persistence of remote schooling for students at all levels. The United States is witnessing a deepening political polarization, community instability, and aggravated social and racial tensions.
Hope rests on the promise of a Covid-19 vaccine and improvements in therapies and testing technologies, combined with continued vigilance to prevent the spread of the virus through the use of masks, handwashing, and social distancing.
The U.S. government, through Operation Warp Speed (OWS), has invested more than $11 billion in accelerated vaccine research, field trials, and production, with high-level assurances that a product will be approved and available soon. Safe and effective vaccines may become available in sufficient volumes in early 2021. If so, with adequate preparations for the prioritization and distribution of vaccines and concerted efforts to build public trust, it is conceivable to immunize upwards of 70 percent of people living in the United States in a relatively short time frame. That goal should be enough to achieve herd immunity, an essential step to permitting the population to return to some form of regular congregational life at work, home, school, theaters and restaurants, places of worship, and in recreation and travel.
Yet the United States’ hope of escaping Covid-19 is at grave risk, with implications for U.S. stability and national security.
Today, the successful introduction of safe and effective vaccines to prevent infection with
Covid-19 is increasingly in doubt, given the precipitous decline in public trust and confidence in science, health authorities, Washington, and vaccines. A leading cause is the White House’s contradictory and erratic messaging, falsehoods, and persistent efforts to manipulate the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC). The politicization of the Covid-19 response unfolds amid an already acutely polarized country and toxic electoral cycle. The decline in the public’s trust and confidence is coupled with a digital information environment that has become ever more polluted, chaotic, fragmented, and confused, providing a hospitable situation in which a variety of anti-vaccine forces can flourish.
Polls show that just slightly more than half of respondents say they would be willing to get a Covid-19 vaccine, with numbers over the past four months dropping for all demographic groups.
The Kaiser Family Foundation poll released September 10, 2020, shows that 62 percent of people are “worried that the political pressure from the Trump administration will lead the FDA to rush to approve a coronavirus vaccine without making sure that it is safe and effective.” But there is considerable partisan divide, with 85 percent of Democrats saying they hold that opinion, compared to just 35 percent of Republicans. The poll also found that nearly “half of adults hold at least one significant misconception about coronavirus prevention and treatment, including one in five who say wearing a face mask is harmful to your health, and one in four that hydroxychloroquine is an effective treatment for coronavirus.”
And a Pew Research Center poll from September 8–13 of this year shows that 78 percent of respondents were concerned that a Covid-19 vaccine will be rushed to approval before it has been proven safe. The study revealed that “about half of U.S. adults (51 percent) now say they would definitely or probably get a vaccine to prevent COVID-19 if it were available today.” That number is a precipitous decline from 72 percent in May of this year. Indeed, the number of people who say they would “definitely” get a coronavirus vaccine dropped to just 21 percent, half of what it was four months ago. The survey responses also reflect a divergence of attitudes among minority groups when it comes to the vaccine, with 56 percent of Hispanic respondents indicating they would definitely/probably get a Covid-19 vaccine, and only 32 percent of Black respondents indicating the same.
Many have stepped forward recently to boost public confidence and trust.
In early September Moncef Slaoui, head of Operation Warp Speed, assured publicly that he will not “be swayed by political pressures to rush an unsafe or ineffective vaccine, and that science will carry the day” stressing, “I would immediately resign if there is undue interference in this process.”
The U.S. government agencies responsible for vaccine review and approval have also released guidance and statements to build public confidence in the Covid-19 vaccine review process. Steven Hahn, commissioner of the FDA, released a statement noting that “We are committed to making decisions that are guided by science and data regarding the authorization or approval of COVID-19 vaccines.”
Nine vaccine manufacturers, including some that have received Operation Warp Speed funding, took the unprecedented step in September of issuing a “safety pledge” to emphasize the importance of rigorous regulatory standards and to assure the public they “will not submit vaccine candidates for FDA review until their safety and efficacy is shown in large clinical trials.”
Individual companies, including AstraZeneca, Moderna, and Pfizer, have released statements and details of large coronavirus vaccine trials to promote greater transparency regarding how they assess products’ safety and efficacy and respond to public fears that vaccines are being rushed forward.
Former federal officials, including former FDA commissioners appointed by both Democratic and Republican administrations, have signaled their concern over the administration’s statements that it might take action to influence the “scientific standards for vaccine approval.” Acknowledging that “despite recent political actions, we continue to have confidence in the integrity and high-quality scientific work of FDA staff,” the writers warn that the White House’s pronouncements could ultimately put at risk the agency’s ability to “make the independent, science-based decisions that are key to combating the pandemic.”
The recently released National Academies of Sciences, Engineering, and Medicine Framework for Equitable Allocation of COVID-19 Vaccine recommends that the U.S. Department of Health and Human Services (HHS) create and fund a Covid-19 vaccination risk communication and community engagement program to support public understanding and “two-way” dialogue regarding the benefits and challenges associated with the vaccination effort.
And some social media companies have taken steps to strengthen engagement with the public health community. Facebook recently announced that it will reject advertisements that “discourage people from getting a vaccine” and collaborate with nonprofit organizations seeking to increase immunization rates globally. And YouTube announced that it will remove videos that spread misinformation about Covid-19 vaccines from its platform.
Congress has also taken initiative. In August, Senator Gary Peters (D-MI), along with Senators Amy Klobuchar (D-MN) and Jack Reed (D-RI), introduced the COVID-19 Misinformation and Disinformation Task Force Act of 2020. The proposed Task Force would be “charged with coordinating the government’s analysis and response to false and misleading information that conflicts with official government health guidance and pandemic response efforts.” The task force would be situated at the Department of Homeland Security within the Cybersecurity and Infrastructure Agency (CISA) with inter-agency representation, including Homeland Security, the U.S. Department of State, the Federal Bureau of Investigation (FBI), the CDC, the National Institutes of Health (NIH), and the Federal Emergency Management Agency (FEMA). It would be required to make an unclassified summary of its work publicly available and to brief Congress every 30 days. At the time of publication, however, no Republican members had joined as cosponsors, and there had been no movement on the legislation.
The effort builds on the VACCINES Act of 2019, a bipartisan effort introduced in the House of Representatives in May of 2019 which proposed amending the Public Health Service Act to “provide for a national system for surveillance of vaccine rates, to authorize research on vaccine hesitancy, to increase public understanding of the benefits of immunization and for other purposes.” However, there has been no movement on that legislation since December of 2019.
But additional steps are still urgently needed—now.
More is needed to redress the decline in popular trust and confidence and the dissemination of mis- and disinformation related to Covid-19 vaccines. The current crisis calls for a strategic and bipartisan approach focused on rapid and responsive communications to address public questions and concerns, leveraging digital media platforms to help mitigate the amplification of risk and interrupt the spread of harmful mis- and disinformation. It also calls for accelerated efforts to ensure the effective, equitable delivery of vaccines, combined with other services, that supports individuals as well as larger communities in moving beyond the devastating aspects of the pandemic.
The CSIS-LSHTM High-Level Panel recommends:
1. The rapid launch of an independent panel on vaccines and misinformation.
An independent panel could be mandated by Congress or convened by independent academic or philanthropic organizations. Its mission should be to stir a new national conversation and carry out a swift assessment of the decline in popular trust and confidence in vaccines, public authorities, and science, as well as the root causes and implications.
The independent panel should be charged with recommending concrete priority measures to be taken at the national level to strengthen the work of federal health agencies and advisory bodies focused on immunizations, and at the state and local levels to provide a wary U.S. public with accurate information and realistic expectations about immunization programs and boost its faith in safe and effective vaccines.
This body should be comprised of diverse opinion leaders drawn on a bipartisan basis from Congress and state and municipal officials; representatives of the Black, Latino, and Indigenous communities and other underrepresented groups; parental and other citizen groups; medical and public health experts; universities; religious groups; industry; and social media.
The panel’s work should start shortly after the November 2020 national elections and extend through the inauguration of the next administration and next Congress. It could be further extended as circumstances warrant.
In its work, it should put front and center credible and trusted medical, scientific, and public health experts, but it should also spark a much-needed national dialogue on vaccines and values, creating opportunities for communities at highest risk to share their views and concerns while also setting realistic expectations about the benefits and limitations of vaccines within a broader public health approach to Covid-19.
The panel should focus on the measures that will be most effective in curtailing dis- and misinformation in the digital world and bring reliable and quality scientific knowledge to a wary U.S. public through updated, innovative, and tailored communications.
It should map out a bipartisan strategy for understanding the extent to which ill-intentioned actors, whether domestic or foreign, are waging disinformation campaigns or deliberately amplifying misinformation about Covid-19 to deepen anxieties and political divisions related to Covid-19 vaccines.
The panel should prioritize ways to increase understanding and redress disparities in vaccine awareness, access, and equity within Black, Latino, and Indigenous populations.
It should prioritize empowering states and municipalities to lead, identifying what forms of financial support and technical expertise will be most valuable.
2. Innovations in reaching diverse and underserved populations with vaccines and other health and social services support.
The public sector should lead at the national, state, and local levels in ensuring that the delivery of safe and effective Covid-19 vaccines is integrated into a broader platform of support for health and social services that can help mitigate the negative effects of the pandemic, including the negative economic impacts that have left millions unemployed, underemployed, and unable to afford housing, food, and other necessities.
Covid-19 vaccines can be offered through physicians’ offices, pharmacies, and health facilities, as well as through houses of worship and community centers, and can reach remote populations through the use of mobile facilities. Beyond the familiar need for adequate supplies, cold storage facilities, and personnel trained to provide the new vaccines, the provision of additional services to diverse populations can significantly raise public awareness and motivation.
Counseling about Covid-19 vaccines should be offered to provide target populations with the data and support they need to make informed choices for themselves and their families. In addition, provisions should be made to ensure the vaccines are covered by publicly funded programs and available at little or no cost to seniors, families receiving federal or state assistance, people with disabilities, and others whose ability to obtain a vaccine may be limited due to financial resources and transportation or mobility constraints.
Services could be bundled to facilitate applications for unemployment or distribution of basic nutrition supplements or food items during Covid-19 vaccine appointments, as appropriate.
3. Pledges and actions by mainstream and digital media.
Much like the pharmaceutical companies’ joint statement pledging their commitment to vaccine safety and full testing of any experimental products, traditional media outlets and digital media companies should jointly and/or individually commit publicly and voluntarily to enhanced action to improve the information climate related to Covid-19 vaccines.
They should make verifiable, concrete commitments to proactively stop the spread of mis- and disinformation and instead amplify accurate and reliable scientific content on Covid-19 vaccine safety and efficacy.
They should make enhanced and verifiable efforts to curb use of their platforms by individuals or organizations promoting incorrect information about vaccines. As outlined in a report by the Sabin-Aspen Vaccine Science and Policy Group in June of 2020, the media outlets should take immediate steps to collaborate with health providers and the global immunization community to identify postings that experts in the field consider to be erroneous.
Social media platforms should commit to changing their content selection algorithms to prevent the automatic spread and reinforcement of mis- and disinformation (e.g. “filter bubbles”) and to develop and optimize other automatic processes that serve to amplify and disseminate accurate information.
4. Greater activism by key social and economic sectors.
Leaders within critical social and economic sectors should step forward and speak, loudly and often. Those who have the most to gain by a successful Covid-19 vaccine introduction—and the most to lose if that effort fails—should be encouraged to expand their activism, regularly raising their voices and marshalling their influence to engage their respective communities in a sustained dialogue on the merits and risks associated with vaccines.
Beyond overseeing the logistical challenges of distributing approved vaccines through Operation Warp Speed, the U.S. military—which remains one of the most trusted institutions in the United States—has an important role to play in adopting early vaccination for members of the armed forces and leading through dialogue and example.
Iconic cultural figures with substantial media presence and bipartisan reach could be enlisted to support dialogue and disseminate messages to a broad audience. Much conversation is already under way, but far more is warranted among educational institutions, businesses, healthcare providers, the farming sector and food processing industries, grocery stores, and the security/law enforcement communities, both about the Covid-19 vaccine and the importance of vaccines in general.
5. Federal reform.
We cannot lose sight of the pressing need for critical reforms over the medium term.
The CSIS Commission on Strengthening America’s Health Security highlights, in its November 2019 report, “the crisis in confidence in science, medicine, and vaccines [as] an emergent and intensifying health security threat that the United States is not yet equipped to address.” It lays out several relevant recommendations.
The White House should establish a new capacity under the auspices of a National Security Council (NSC) directorate for global health security and biodefense that can lead collaboration across agencies and sectors to address this fundamentally multisectoral issue. That office’s efforts to monitor and counter online misinformation around science and medicine and engage with social media platforms and technology companies, independent media, biopharmaceutical companies, health care providers, citizen groups, and cybersecurity experts to inform policy formulation should be closely linked to broader interagency work addressing misinformation and disinformation. The office should also contribute to analysis regarding what strategies work best for bolstering vaccine confidence and improving awareness about the benefits and limitations of vaccines.
An empowered and strengthened CDC should take the lead in devising a strategic health communications initiative informed by social and behavioral science research to understand the determinants of group belief systems. It should work closely with state-level officials and civil society organizations to identify communities with low vaccination coverage and at high risk of outbreaks related to vaccine-preventable diseases, to better understand the root causes of under-vaccination and to design and evaluate interventions to address those root causes. The insights gleaned from federal-state collaboration should inform targeted and culturally and linguistically appropriate communications campaigns in such communities.
That strategy should, on a rapid and regular basis, provide consistent, science-based information to all audiences, both domestic and global, to counter misinformation and disinformation across multiple media platforms. The CDC should oversee expanded technical expertise to U.S. states and municipalities and partner governments, while the FDA should maintain authority over vaccine review and approval processes, discouraging the establishment of separate state and local level efforts.
Outside its borders, the United States should increase its support to global immunization partners to more effectively convene public health officials, international organizations, social media companies, and civil society organizations to mobilize vaccine demand globally. When it observed in February of 2020 that the global response to the outbreak of the novel coronavirus was being hampered by an “infodemic” of misinformation, the World Health Organization (WHO) emphasized the central importance of concerted international action. The United States, while working with the WHO and its member states to implement meaningful reforms within that body related to disease detection and outbreak control, can also provide significant, timely support to the WHO, UNICEF, and Gavi, along with the Vaccination Demand Hub, in forging a strategic coordinated response to the spread of mis- and disinformation related to Covid-19 vaccines.
These are the CSIS-LSHTM High-Level Panel’s brief and urgent thoughts on the crisis that our nation faces, considering the precipitous decline in public trust and confidence, and the polluted mainstream and digital media environments. As safe and effective vaccines become available in the coming months, a broad, diverse, and bipartisan set of U.S. leaders, communities, and sectors will need to engage in new forms of active sustained engagement if the hope of escaping Covid-19 through mass immunization, better therapies and tests, and continued behavioral vigilance is to be realized.
This statement conveys the majority consensus of the members of the High-Level Panel who are participating in their individual capacity, not as representatives of their respective organizations. No expert is expected to endorse every single point contained in the document. Language included in this report does not imply institutional endorsement by the organizations that participants represent.
The panel’s work is supported by a grant from the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.
Heidi J. Larson
Professor of Anthropology, Risk, and Decision Science and Director, Vaccine Confidence Project™, London School of Hygiene and Tropical Medicine
Senior Vice President and Director, CSIS Global Health Policy Center
Katherine E. Bliss
Project Director and Senior Fellow, CSIS Global Health Policy Center
Program Manager, CSIS Global Health Policy Center
Congressman Ami Bera (D-CA-7), U.S. House of Representatives
Mollyann Brodie, Executive Vice President, COO, and Executive Director, Public Opinion and Survey Research, Kaiser Family Foundation
David Broniatowski, Associate Professor of Engineering Management and Systems Engineering and Associate Director, Institute for Data, Democracy, and Politics, The George Washington University
Frederick Chang, Chair, Computer Science Department, Lyle School of Engineering, Southern Methodist University
Renée DiResta, Technical Research Manager, Stanford Internet Observatory, Stanford University
Bruce Gellin, President, Global Immunization, Sabin Vaccine Institute
Denise Gray-Felder, Founding President and CEO, Communication for Social Change Consortium
Margaret “Peggy” Hamburg, Former Commissioner, U.S. Food and Drug Administration
Johnny Heald, Managing Director, ORB International
Rebecca Hersman, Senior Advisor and Director, Project on Nuclear Issues, CSIS International Security Program
Kathleen Hicks, Senior Vice President, Henry A. Kissinger Chair, and Director, CSIS International Security Program
Kate Johnson, Program Director, Center for Best Practices, National Governors Association
Juliette Kayyem, Senior Belfer Lecturer in International Security, Harvard Kennedy School
James Lewis, Senior Vice President and Director, CSIS Technology Policy Program
LaQuandra Nesbitt, Director, District of Columbia Department of Health
Joe Rospars, Founder & CEO, Blue State
Umair Shah, Executive Director and Local Health Authority, Harris County Public Health
Sarah Shirazyan, Stanford Law School Lecturer in Law and Content Policy Manager, Facebook, Inc.
Julia Spencer, Associate Vice President, Global Vaccines Public Policy, Partnerships, and Government Affairs, Merck & Co., Inc.
Claire Wardle, Co-Founder and Director, First Draft News
Elizabeth Wehr, Strategy and Policy Advisor, Parsons Corporation
Ed Whiting, Director of Strategy, Wellcome Trust
Juan Zarate, Chairman and Co-Founder, Financial Integrity Network
Commentary is produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).
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