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Vaccine Hesitancy is Declining (& Science is Missing It)

Matt Yglesias wrote an astonishing pair of sentences the other day: “Nobody actually listens to the CDC,” and “Normal means ignoring Dr. Fauci.”

Yglesias points out that, on alcohol consumption, the cooking of egg yolks and the cooking of hamburgers, CDC guidelines exist, recommending very spartan indulgence of these activities. And even devout believers in science live their lives — eating runny yolks, ordering Big Macs and chasing it all down with an occasional six-pack.

Normal means science messaging is background noise.

Are we approaching that state with COVID-19 public health messaging faster than anyone could have imagined?

Consider the robust debate over whether discouraging messaging about the COVID-19 vaccines is discouraging people from getting vaccinated. That debate goes something like:

A: The messaging is depressing. It must be discouraging people from getting vaccinated.

B: There are no data to support your assertion.

A: But it’s so depressing! How could it not discourage people? Aren’t you discouraged?

B: I’ve been depressed for a while. But there still are no data to support your assertion.

For 200-proof examples of A) see here and here. For B), see this thread by virologist Angela Rasmussen, who called A) “pearl-clutching about ‘messaging,’ as if vaccine hesitancy is something new caused by dour, pessimist scientists being honest about uncertainty.” Rasmussen accused A)ers of ignoring all the studies showing that vaccine hesitancy is complicated, and anti-vax messaging one of the biggest culprits. To her credit, Rasmussen also pointed out that vaccine hesitancy was declining.

She really undersold that point, though. Vaccine hesitancy is declining dramatically in the United States, especially within previously vaccine hesitant communities such as Blacks, Hispanic/Latinos and White Democrats:

While White Republican vaccine hesitancy continues to stubbornly hold above 50%, these other groups are becoming remarkably less vaccine-hesitant. I mean — the percentage of Blacks who are vaccine-hesitant has basically been halved, which is a stunning story.

And a story we’re not hearing much about at all. What’s going on? What is working? If someone outside the frontlines of vaccine distribution knows, they’re not writing or tweeting about it.

Media reporting and Twitter discourse (not to mention new science, these papers coming out with data dating back to August on vaccine hesitancy in various groups) are all way behind the curve. A Kaiser Family Foundation summary from which the above chart is drawn got some pickup earlier this week — but otherwise, this story is uncovered.

So you’d be forgiven for missing that, as KFF’s Drew Altman writes, between those who have gotten the vaccine, those who say they’ll get it as soon as they can, and those who say they’ll wait and see how it’s working, we might already have enough adults (73%) in the United States to achieve herd immunity, even without convincing the hard-core hesitant:

None of this is to suggest that the battle to vaccinate is over, or that there are deep and appealing inequities in access to vaccination and vaccine information that need to be addressed immediately and in force.

But toward those efforts, wouldn’t it be useful to understand these success stories so we can scale them further? To understand what is happening in these communities in as close to real time as possible?

  • There are clearly many trusted community ambassadors doing an amazing outreach job in some of these previously hesitant communities, and their stories and tactics need to be told and discussed.
  • We might also hypothesize that white conservatives are so comparatively politicized about science compared to these other previously hesitant communities that that politicization has snuffed out any trusted ambassadorship among conservatives about vaccines — that vaccine hesitancy will stubbornly remain a badge of identity. Indeed, state levels of vaccine adoption correspond with the political leanings of that state. But do we know how this is actually happening and if there might be any specific mechanisms to counter it?
  • It might also be helpful to have insight as to whether “the discouraging messaging around vaccines” has, in fact, had very little to do with any of the above — the erosion of hesitancy, or its persistence among white Republicans.
  • And it would probably be helpful to understand how much the hunger to reopen across all groups — the vaccine-ready as well as the vaccine-reluctant (because some understand the vaccine as the fastest path to reopening) overrides any public health or science messaging.

Science doesn’t move this quickly, however. (Marketing research does, but that’s another discussion.) In a response to Rasmussen’s thread, Alexandra Freedman, executive director of the Winton Centre for Risk & Evidence Communication, said she had just completed a study showing that communicating different levels of vaccine efficacy made no difference in vaccine intention. (Still waiting for that paper to appear.)

Back to Yglesias — he writes:

The nature of modern social media tends to polarize everything. And throughout the pandemic, the discourse has been pulled between “it’s just the flu” and public health stridency. And for most of the year, stridency has been approximately correct. But the more light there is at the end of the tunnel, the more tempting it becomes to eat the marshmallow, while at the same time the gap between public health stridency and reasonable cost-benefit analysis also grows. It’s not really the job of Fauci or the CDC to strike that balance, but it is the country’s elected leadership’s job, and you can’t just outsource it to them.

Normal means: In the absence of political leadership and conflicting messages from science and public health, we’re all now making those “reasonable cost-benefit analyses” in our own ways.

And normal means: Expertise natters on, increasingly ignored, like a CDC guideline.