Anti-Vaxxers and Anti-Maskers: A New Coalition?

“If the people cannot trust their government to do the job for which it exists - to protect them and to promote their common welfare - all else is lost.”

- Barack Obama

“When Covid-19 vaccines are eventually approved by the FDA, their success in Black and other communities will depend on whether members of these communities not only trust that they are safe and effective, but also believe that the organizations offering them are trustworthy.”

- Reuben C. Warren, Director, Tuskegee University

Previously, I underscored the fundamental importance of trust in the doctor-patient relationship. Similarly crucial in winning the battle against SARS-CoV-2 (i.e., the coronavirus that causes COVID-19), is trust in other arenas of human activity, e.g., science, government, and public health. The focus of this week’s Germ Gem post is on the issue of trust and the lack thereof by two groups that are major threats to controlling this virus: the anti-vaxxers and the anti-maskers.

Vaccines are on the near horizon—let’s not blow it! In the 1960s, the science fiction television show Star Trek popularizedthe expression “Warp speed,” a term that ultimately came to mean “the highest possible speed.” On May 15, President Donald Trump borrowed this term and announced Operation Warp Speed (OWS), a U.S. government/private sector partnership with a goal of producing and delivering 300 million doses of safe and effective vaccines by January 2021. This looked like an impossible promise. Moreover, from its inception it was recognized that OWS would fail if the American public didn’t trust COVID-19 vaccines.

It now appears that OWS is on the verge of reaching one of its major goals, the production of a safe and effective vaccine. In fact, the Food and Drug Administration (FDA) is currently reviewing not one but two vaccines that could be released within a matter of weeks. Nonetheless, two movements united in their deep distrust of the federal government—Anti-vaxxers and Anti-maskers—threaten two key strategies for preventing the spread of this devastating disease.

Americans are divided over the COVID-19 vaccines. In a November Gallup poll, 42% of U.S. adults said they would not get a FDA-approved coronavirus vaccine. This number is an improvement from September when 50% of adults said they would not get the vaccine. Nonetheless, for public health officials this number remains a concern because vaccinating between 60%-80% of the general population will be required in order to achieve herd (community) immunity. Therefore, many public health officials view establishing public trust in COVID-19 vaccines as the next major challenge in stemming the tide of this pandemic. (I reviewed the history and reasons for vaccine hesitancy in two of my earlier Germ Gems posts on September 6, 2019 and June 6, 2020 respectively.)

As it did in the past, social media is again playing a major role in sowing misinformation about COVID-19 vaccines. Moreover, a recent study by George Washington University’s Institute for Data, Democracy & Politics detected a shift in the anti-vaxxer narrative against COVID-19. No longer are anti-vaxxers just arguing against the safety and efficacy of any and all vaccines, they are now also claiming that vaccine refusal is a civil right. In the Institute’s study, published on October 1 in the American Journal of Public Health, the researchers examined more than 250,000 posts on 204 Facebook pages expressing opposition to vaccines. They found vaccine opponents were coalescing around a “civil liberties” argument claiming that individuals have the right to refuse to take a vaccine. By doing so, these vaccine opponents can sidestep science, and instead debate about values, especially the value of freedom of choice (even though in this case one person’s exercise of that freedom can have devastating effects on others).

Another major concern regarding sufficient acceptance of COVID-19 vaccines relates to skepticism among Black Americans—one of the high-risk groups for severe COVID-19. Recent data show that although Blacks make up only 13% of the U.S. population, they account for 21% of the COVID-19 deaths. Despite this relatively high percentage, only 3% of enrollees in vaccine trials are Black. The barriers to greater participation of Blacks in COVID-19 vaccine trials, as well as the legacy of distrust of the Black community in the American health care system in general, are discussed in an article published in October in the New England Journal of Medicine (“Trustworthiness before Trust—Covid-19 Vaccine Trials and the Black Community”). The authors suggest, “Trust could be earned more quickly by a collaboratively designed Operation Build Trustworthiness that matches the seriousness and scope of Operation Warp Speed.”

Challenges that lie ahead for COVID-19 vaccines. On average, a vaccine takes about 10-12 years to develop. It is therefore absolutely astounding that around the world there are currently 67 vaccine candidates in various stages of clinical trials. More important, two vaccines (produced by Pfizer/BioNTech and Moderna), each with about 95% efficacy, are currently in early stages of review by the FDA for Emergency Use Authorization. A third vaccine candidate, produced through a partnership of the pharmaceutical company AstraZenca and Oxford University, that is about 90% effective, may be short-circuited in the FDA review process because of concerns about irregularities in their clinical trials. Nonetheless, the Pfizer/BioNTech vaccine was approved in the U.K. on December 2—a first in the West, and its home grown vaccine from AstraZeneca/Oxford University is likely to follow suit in the near future.

Almost as mindboggling as is the development of the vaccines themselves are the complexities of decisions about their equitable distribution, prioritization (who goes first?) and the herculean task of worldwide dissemination. Consider this example—it is estimated that 8,000 fully filled cargo planes would be needed to distribute a single vaccine dose to the world’s 7.8 billion people.

Be prepared. To foster trust, doctors and public health experts agree that the general public needs to be informed about the regulatory processes involved in reviewing the efficacy and safety of each vaccine. It is also suggested that the public must be told about and prepared for the side effects of any vaccine; a vaccine won’t necessarily be a “walk in the park.” Finally, the public needs to be informed about many things that remain unknown, such as, the long-term safety and efficacy of the vaccines, whether they reduce contagiousness of the virus, and, very importantly, when they will be available for children.

Coalition of anti-vaxxers and anti-maskers. All experts in public health recognize that even if we have one or more safe and effective vaccines by mid to late 2021, additional measures are needed to prevent the accelerating spread of SARS-CoV-2. As pointed out in an article in the Journal of the American Medical Association in October (“Preventing the Spread of SARS-CoV-2 with Masks and Other “Low-tech” Interventions”), wearing masks, physical distancing, hand hygiene, prompt testing (along with isolation and contact tracing), and limits on crowds and gatherings are all items in our “tool box” that we can use against the spread of this virus. The Centers for Disease Control and Prevention (CDC) strongly endorses these behaviors. And the CDC along with other public health institutions continue to provide evidence of their value as well as to remind us that we will need to engage in these behaviors for some time even after vaccines are made available.

Anyone familiar with the anti-vaccination movement could have predicted its opposition to a COVID-19 vaccine. But the Anti-maskers and their fight against wearing masks came as a surprise. In her September article in Medscape Medical News (“Dangers Behind Anti-maskers and Anti-vaxxers: How to Combat Both”), the journalist Alicia Gallegos points out how groups such as “Million Unmasked Patriots” (one of dozens anti-masks groups with social media platforms) share the anti-vaxxer’s view that their civil rights and personal liberties are being violated.

Where do we go from here? As I’ve suggested in previous Germ Gem posts, based upon what’s been learned from previous pandemics and on the astonishing advances in developing vaccines and treatments for COVID-19, Homo sapiens will win the war against SARS-CoV-2. Personally, I trust the multidisciplinary forces working under the leadership of a new administration taking office in January 2021. I’m also confident that enemies within our camp who spread misinformation, falsehoods, and conspiracy theories, such as anti-vaxxers and anti-maskers, will be countered by campaigns by the CDC, National Institutes of Health, and the World Health Organization delivering transparent messages for the general public about occasional setbacks as well as future successes. The good news is that these institutions are all trustworthy.