This story was updated Dec. 17.
Dec. 15, 2020 -- Gen. Gus Perna, the chief operating officer of Operation Warp Speed, has been planning for months to rush the first shipment of vaccines against COVID-19 from manufacturing sites and into the arms of Americans at risk.
It is a massive logistics operation, the kind our military is good at handling. The vaccines must be kept cold -- in some cases at subzero temperatures -- throughout their shipping and distribution. Perna has a plan for that. They have to go to urban sites and rural hospitals, places that have paved roads and those that don’t. Perna has planned for all that, too.
“At the end of the day, we have an excellent plan that has been well-coordinated, well-synchronized, and well-rehearsed, and well-collaborated with everybody from the total government through commercial industry down to the governors at the states. I am very confident in it,” he said in a Dec. 12 news briefing.
What the federal government has not planned for is vaccine hesitancy, stoked -- in large part -- by social media.
On Dec. 4, for example, Candace Owens, a conservative author and political activist with more than 2 million followers on Twitter, posted a clip of an anti-vaccination rally in London where the crowd sings “stick the vaccine up your a**.” It was liked more than 71,000 times and retweeted more than 20,000 times.
That Google and YouTube outage the morning of Monday, Dec. 14? It was caused by microchips in the new Pfizer vaccine using up internet bandwidth, according to several posters on Twitter.
On Facebook, a viral post, which has since been removed by the site, falsely claimed the Pfizer vaccine could sterilize women. On Friday, FDA officials presented data showing that 23 women had gotten pregnant in the Pfizer vaccine trial -- 12 in the vaccine group and 11 in the placebo group. These pregnancies began after vaccination since women were screened for pregnancy before the trial and excluded if they were, a fact that further disproves this particular theory.
“I’m really, really worried about it,” says Joe Smyser, PhD, the CEO of the nonprofit Public Good Projects. Smyser has been watching internet chatter about the COVID vaccines for months now through a tool he built called Project VCTR, which stands for Vaccine Communication Tracking and Response. Through VCTR’s dashboards, it is possible to see the conversation about vaccines in real time, including how many people are posting, what they’re talking about, and who the biggest influencers are.
The First, Not the Last
Smyser says the first conspiracy post about the vaccines that they can find through the VCTR tool went up on Jan. 20, 2020. It claimed Bill Gates owned a patent for the coronavirus and would benefit financially from the vaccine.
“There’s a vacuum of information, and it’s been filled for the last 6, 8, 9 months with misinformation -- just massive amounts -- to the point where it now almost feels insurmountable,” Smyser says.
A $250 million campaign, designed to boost trust in the vaccines and encourage people to get them, from the U.S. Department of Health and Human Services will finally run its first ads this week, after it was delayed by congressional investigations into financial mismanagement, as first reported by Politico. A $15 million plan to produce celebrity spots has been canceled. A separate national campaign with scientifically reviewed messages, which has been led by the Fors Marsh Group since August, will continue, according to Mark Weber, deputy assistant secretary for public affairs for HHS. The department announced Tuesday that the first ads will feature Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, and perhaps the most visible public supporter of the vaccines.
Surveys done by the Pew Research Center show that as of mid-November, 60% of Americans said they would get the vaccine, while 39% would not. But within those groups, the survey shows there’s a hefty chunk -- 31% of those who said they would get vaccinated, and 21% who said they wouldn’t -- who indicated they were still on the fence about their choice. Weber calls this group the “moveable middle” and says the ads will focus on swaying them.
Private Groups Step Up
A separate vaccine information campaign -- a partnership between the COVID Collaborative and the nonprofit Ad Council -- will run its first ads in early 2021. That effort, billed as “one of the largest public education campaigns in history,” is funded by $50 million in private donations. It’s not getting any government funding.
“It's not the way it should have gone,” Smyser says. “Everybody feels like [the public information campaigns are] behind the eight ball. It's hopefully not too little, too late, but it's you know, it's definitely much later that it should have been.”
He says communication to the public about the COVID vaccines, everything from how they work to who should get them first, has been treated as an afterthought. He says even the name of the Warp Speed campaign was ill-conceived.
“‘Warp Speed’ is a horrible name, because no one associates speed with safety,” Smyser says. “Then there was no messaging around why it was called that or any top-down messaging around the safety protocols in place for how this all was supposed to work. So I think the public hears this thing and they just think rushed.”
“This should have started, you know, at the beginning of the pandemic. We should have certainly started talking about this at least 6 months ago,” he says.
Delayed information may have eroded confidence in the shots. A summary of data, collected by 26 surveys and compiled by the CDC, shows intent to get an eventual COVID vaccine has dropped since the spring. In April, about 80% of Americans said they intended to get the vaccine, compared with 60%-70% in November. Those surveys found Black participants had the lowest acceptance of the vaccine, with Asian respondents reporting the highest levels of vaccine acceptance.
Even health care workers -- who have been prioritized for vaccination -- have their doubts. A CDC survey of health care workers done in September and October found 63% said they would get an eventual COVID vaccine. The data was shared at the Nov. 23 Advisory Committee on Immunization Practices meeting.
A separate survey, from the American Nurses Foundation, found nurses are almost evenly divided into three groups: 34% said they would take the vaccine; 36% said they would not; while another 31% said they were unsure. Almost half said they weren’t yet comfortable talking to patients about the vaccines. The foundation said its findings indicated an “urgent need” to educate nurses about the vaccine.
Data compiled by Project VCTR show vaccine hesitancy has soared in the U.S. over the past year. From November to December, there were 424,400 mentions of negative attitudes about vaccinations on social media, compared to 182,600 from November to December 2019, -- an increase of more than 130%.
Vaccine Hesitancy Surges
Vaccine hesitancy is not new. But it is growing at a rate that has alarmed public health officials.
After nearly being eliminated around the world, measles has been surging again in many countries -- rising by 30% worldwide -- as more parents refuse to vaccinate their children.
Vaccine hesitancy has become such an urgent problem that the World Health Organization named it one of the top ten threats to global health in 2019.
“The whole digital landscape we’re in has amplified this issue in ways I don’t think anyone could have imagined,” said Heidi Larson, PhD, a professor of anthropology, risk, and decision science, who directs the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine.
“I felt like it was going to get bigger. I didn’t realize it was going to get this much bigger,” she said in a recent interview.
“Who would have thought that facing the next pandemic, when you would have thought even the most vaccine-critical person would get the value of the vaccine, and instead, we’re seeing anti-vaccine sentiment rising,” she said.
The problem isn’t that people have questions about vaccines. It’s that credible information about vaccines gets outcompeted by misinformation on social media -- by a mile.
A 2018 study by researchers at the Massachusetts Institute of Technology found that false news spreads significantly faster on Twitter and penetrates many more users’ feeds than facts do. False news stories are 70% more likely to be retweeted than true stories are. It takes true stories about six times as long to reach 1,500 people as it does for fake stories to reach the same number.
Rumors Take Hold
Some social media companies -- like Facebook and Twitter -- have recently started to more aggressively police the content that’s spread on their sites, flagging statements that have been fact-checked and proven to be false. This week, Twitter announced it would remove "the most harmful misleading information," and will soon label tweets that "contain potentially misleading information about the vaccines."
But sites like Facebook, Twitter and YouTube are so large, it’s hard to catch everything.
“Some of these rumors, as we know, can take hold, and the misinformation and disinformation can run rampant,” says John Brownstein, PhD, chief innovation officer at Boston Children’s Hospital.
Brownstein published a study in October highlighting of the things associated with willingness to take a COVID vaccine. He and his co-authors found the effectiveness, serious side effects, and how long a vaccine’s protection might last were among the important considerations for people when weighing whether to be vaccinated.
“All the science in the world is not going to make a difference if we can't get people to get this immunization,” Brownstein says. “I think we need to be putting much more investment both at the national scale and the local level into communications.”
While the government has spent a reported $18 billion to develop and deliver the vaccines, it has spent far less educating the public about them.
And historically, government hasn’t done a great job grasping or responding to the threat posed by misinformation on social media.
“CDC, in its good days, did many things spectacularly well. Public information and communication that grab the public has never been one of them,” says Barry Bloom, PhD, a professor of global health at Harvard University.
“One of the things we’ve learned in public health … providing people with public service announcements is the equivalent of putting them to sleep,” he says. “It doesn’t motivate anybody, and it usually doesn’t stick.”
He says the March of Dimes, which was a small private foundation before it took up the cause of polio, became a grassroots movement that galvanized a nation to vaccination.
“It was a pure social marketing from a private foundation with no government backing at all,” Bloom says.
Though it is not clear in our divided social and political moment who could repeat that feat.