Boosting trust in vaccinationHesitancy is contributing to poor vaccine coverage compared to vaccine availability.
Public trust towards vaccination is arguably the most critical investment in modern public health, yet strategies to optimise it remain elusive. A spectrum of reactions to reject vaccines is termed vaccine hesitancy. Vaccine hesitancy was listed as one of the top 10 global health threats by the WHO in 2019 and continues to pose imminent adversities globally. Vaccine hesitancy in low and middle-income countries (LMICs) neither echoes with high-income countries (HICs) in terms of the social contributors nor is the magnitude of the problem comparable. In fact, vaccine hesitancy is another layer contributing to poor vaccine coverage when we compare that to the availability of the vaccine.
The Covid-19 pandemic exposed the existing global health injustice. The vaccines were largely unavailable to LMICs, mostly because HICs prioritised the vaccines for their population, and some even hoarded them. Hoarding of vaccines occurred against a stark backdrop of having people in LMICs suffer from Covid-19. While the availability of the vaccine indeed is a tangible and major contributor, vaccine hesitancy is not less, as it often remains veiled and lurks in the population. Underestimating its impact can prove detrimental.
Vaccine hesitancy depends on the context and largely varies by time, place and person, including myriad unanticipated factors. Vaccine hesitancy reflects how society responds to the vaccine and science in general. The social narratives around vaccines and their uptake are unique to the population. The reasons for vaccine hesitancy also demonstrate the relationship of the population with the state; for instance, black people in the USA express their resentment towards the discrimination through non or under-participation. Vaccine hesitancy is thus dependent on the institution, and the latter can represent an academic institution, the state itself and the producers of scientific tools (medicines, vaccines, and the measures).
Time and again, scientific studies have shown the relationship between vaccine hesitancy with trust. Nonetheless, 'trust' is a nebulous term, although it can be categorised into 1. Trust towards the vaccine (trust towards the product); 2. Trust between the persons who advise for the vaccine (interpersonal trust); and 3. Trust between the potential vaccines and the institution that endorses the vaccine (institutional trust). As nebulous as the term trust is, so are its contributions to vaccine acceptance or rejection. The uptake of vaccines has a precarious reliance on trust, and therefore any acts, remarks or coverage in news and media have an enormous impact on the population.
Western countries, including the USA and the UK, have already experienced the detrimental impact of misleading media coverage and continue to experience it even today, where the trust towards vaccines and science is endangered. One overlooked issue is how we consider media coverage a cross-sectional event. In fact, even a cross-section of media coverage is adequate to trigger a response that could go intergenerational.
A notorious incident that haunts us today is a fraudulent scientific paper by Andrew Wakefield published in The Lancet in 1998. Andrew Wakefield, a British doctor, deceived an entire scientific community by fallaciously demonstrating an association between the measles mumps and rubella (MMR) vaccine and autism. It took almost 12 years for the scientific community to identify one of the biggest scientific frauds that led to the ultimate retraction of the paper.
Thanks to reporter Brian Deer of Sunday Times, a British newspaper known for his investigative approach, to expose the fraud of Wakefield. Nonetheless, as victorious as it may have sounded when the paper was retracted, the harm and damage to the population because of that particular paper persists. Wakefield's fraudulent paper remains an indelible scar in science, whose impact cannot be entirely undone even today—25 years after the incident.
Yet another adverse impact has been inflicted by the fraudulent papers on Covid-19 published in The Lancet and New England Journal of Medicine (NEJM) in May 2020. These two fraudulent papers published by the world's leading journals have been the latest significant blows to the credibility of science and the journal. Media accidents like these will likely occur more as the current generation has the privilege of having (social) media on their smartphone.
Several such accidents in various proportions have repeatedly scarred science and its credibility, and inevitably, the media has a prominent role. So, the central question is how can the press redress the harms already inflicted or, more neutrally, how can the media promote trust towards science? Just like how media can impose itself on trust, media also can build it, not just in reversing the damage, but in fact, in creating an entirely new scenario for the population to place their trust on.
All media outlets, whether they are health specific or not, should have a science expert board to support health journalists. Any health-related issue requires a thorough and detailed methodology to synthesise the evidence and options to maximise the methodology transparently. As has been demonstrated by the Brian Deer of the Sunday Times in exposing the fraudulent science, a well-invested strategy does not only serve as an investigator and publisher but also reassures the entire population and that too, at the global level.
Apart from the suspicions and questions on the fraudulent papers related to Covid-19 from doctors and researchers globally, another illustrative investigation by the British newspaper The Guardian-Australia created history by exposing the flaws in data collection. The investigative approach by The Guardian in Australia again demonstrated the power of pointing out the fraudulent acts in science and the role and contribution of media outside the currently employed ‘peer review’ system in the scientific journals.
The power and pivotal roles media play also come up with the responsibilities, specifically social duties, to maintain the harmony between the population and science and its institutions. Scientists, including journalists, are beneficiaries of the science and its products (vaccines, medicines and health care). The reverse of not trusting science is more if not equally detrimental when products such as vaccines suffer disregard, mainstream health care is unattended, and health workers face mistrust. While the media has a central role in exposing the flaws of science if and when found, it equally has a responsibility to save uncountable lives by subscribing to science and its products by promoting public trust.