Why building trust in vaccines is good for protecting public health

It’s impossible to measure the true impact of the COVID-19 pandemic, but we know that its effects are profound and far-reaching. In addition to grappling with a disease that has taken more than three million lives, we are now facing additional public health crises that have been triggered or amplified during the pandemic: vaccine hesitancy and a decline in routine immunizations.

I watch in horror as routine childhood vaccine programmes are slowed, paused or stopped altogether in more and more countries around the world. Even in some of the most developed countries, pediatric and adolescent vaccine coverage rates are declining. In my mind, measles looms large as the “canary in the coal mine”, and I would not be surprised to see outbreaks and tragic setbacks in global progress toward eliminating that disease.

In our global efforts to curb one infectious disease, we have inadvertently lost ground in ensuring adequate protection against other infectious diseases – diseases that can be prevented with proven vaccines that are widely available. Over the past year, the unprecedented disruption to routine immunization programmes around the world has left an estimated 80 million children under the age of one un- or under-vaccinated, a worrisome trend that leaves our next generation unnecessarily vulnerable to serious and potentially life-threatening infectious diseases.

This setback could reverse decades of progress in improving vaccination coverage. Building trust will be critical to help people feel safe in accessing the healthcare system for various health needs, including preventive care and recommended vaccinations.

Trust is a precious commodity but is becoming scarce in too many communities around the world. In early 2019 – nearly a year before COVID-19 was first reported – the World Health Organization identified vaccine hesitancy as one of the top 10 threats to global health. Though hesitancy is not new, it has gained ground with the rapid proliferation of mis- and disinformation and increased over the past year for many reasons, chief among which is declining trust. A recent Edelman survey of more than 33,000 respondents across 28 countries found that public trust is declining across government, media, and non-governmental organizations.

We are at a critical inflection point in our battle to respond to the COVID-19 pandemic, address increasing vaccine hesitancy and revitalize public health infrastructure to recover routine immunization coverage. One key element of success will be our individual and collective ability to build trust – trust not only in vaccines themselves, but also in the people and the systems that discover, manufacture, approve, recommend, distribute and administer vaccines. We can start by listening and understanding the questions and concerns of the patients we serve, the employees we lead and the people in our communities.

We must approach vaccine hesitancy with compassion and understand that there are often historical or other contextual reasons why people may distrust vaccines, some of which may have nothing to do with vaccines themselves. People might not understand how a new vaccine could come to market in less than one year when other vaccines have taken much more time, and they might not realize that the groundwork for developing COVID-19 vaccines was established years ago.

To be trusted, messages need to be consistent and easily understood. In the context of COVID-19, this is difficult but essential as the science continues to evolve. We must continue to reinforce our utmost commitment to patient safety while being transparent with people about what we know and what we don’t yet know. The messenger is equally – if not more – important than the message itself.

To build and sustain trust, a diverse, multi-sector set of partners and collaborations is needed at global, national and local levels. These messengers could include the government, a local public health agency or a health care provider, or a community organization, a faith leader, an employer, a family member or perhaps a celebrity or popular social media influencer.

While today’s challenges may seem daunting, they are not entirely new. As we’ve learned from past infectious disease outbreaks and public health crises, we must be at the ready – prepared to act and to communicate – decisively and rapidly. In my former role leading the US Centers for Disease Control and Prevention (CDC), I learned that no matter how good the science was, effective emergency responses depended on translating that science into trustworthy information that people could understand, believe and use.

In my current role, I witnessed this same requirement in one of the most challenging outbreak situations we’ve encountered – the Ebola virus outbreak in eastern Democratic Republic of the Congo (DRC). At the beginning, trust in anything was almost non-existent. People were under daily threat from a brutal civil war, unfamiliar with western medicine and fearful that seeking healthcare would result in catching the Ebola virus.

Nevertheless, through effective communication and outreach by community leaders, heroic health worker engagement and agile global partnerships, trust was built and medical outbreak response measures, including administration of vaccine, were accepted by many. Through the efforts of numerous partners, that outbreak was finally contained. The many lessons learned in the DRC can help us solve many of the challenges we now face with SARS-CoV-2.

Despite the pandemic and its tragic consequences, I remain optimistic. Academia, governments, multilateral agencies, the private sector and public health partners have come together with urgency and a shared sense of purpose to exchange information, launch new partnerships and respond. What we learn as we solve this pandemic will also help us to strengthen our broader immunization programmes that safeguard our communities and our economies against health threats. We must lead the way in unity for immunity.