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Intervention Strategies: Bonus Episode - Busting myths and restoring trust in vaccines

• European Scientific Working Group on Influenza (ESWI)

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What are the causes for the steady and at times dramatic decline in vaccine confidence seen since the mid-90’s across certain age-groups and communities? Why has the public discourse changed? And how did the persistent and lingering myth linking vaccines to autism take hold? 

In this insightful episode, a panel of accomplished experts tackle these pressing questions, offering astute explanations and powerful counter-strategies to combat misinformation and restore trust in vaccines. 

Join Ted van Essen, TV doctor, GP and ESWI Board Member with many years of experience in public health work as chair of the Dutch Immunisation Foundation; Heidi Larson, Founder and Director of the Vaccine Confidence Project, author of “How vaccine rumours start”, and named one of the 100 most influential women in the world by the BBC in 2021; and, Sue Saville, former Medical Correspondent at Britain’s ITV News, now an independent health communications specialist bringing a wealth of experience as a speaker, writer, trainer and more. 

Clare Taylor:

Welcome to ESWI Airborne. This is the podcast of the European Scientific Working Group on Influenza, otherwise known as ESWI. It's a bonus episode that we have here today, folks, all about communication and the most effective strategies for talking and educating and reaching people with regards to prevention, vaccination and other non-pharmaceutical interventions. I am so pleased to welcome our first three guests today. First up, we have the very famous Ted van Essen, tv doctor and influenza influencer, GP and ESWI board member, with many years of experience in public health work, both as a chair of the Dutch Immunization Foundation and as a GP. It's so good to see you again, Ted.

Ted van Essen:

The

Clare Taylor:

And I'm particularly delighted to welcome Heidi Larson, founder and director of the Vaccine Confidence Project. Heidi is working at the global level and rather thrillingly. In 2021, the BBC named her as one of the top 100 most influential women in the world. Heidi is the author of how Vaccine Rumours Start. Welcome to ESWI Airborne, Heidi.

Heidi Larson:

Thanks, nice to be here.

Clare Taylor:

Lastly, we have Sue Saville, a former medical correspondent at Britain's ITV News and now an independent health communications specialist. How are you today, Sue?

Sue Saville:

Very

Clare Taylor:

Great Folks. Let's jump in and with a big question to open this up how has the public discourse, the conversation around vaccination changed in recent years? Ted, do you want to say something about this?

Ted van Essen:

Oh, yes, for sure, because a lot has changed. As a matter of fact, I've been a general practitioner for quite a long time and in the 90s I just sent my patients a letter saying well, you can get a flu shot. And they just did it without any question. And the thing is now they say why do you ask me? What is the reason that I need that? I've heard a lot about the side effects. Does it really work? I mean, they ask questions and I was not used to that because I thought always that they would think the GP knows best. Well, this is not anymore the case. People have questions and want answers from their doctors.

Clare Taylor:

So that's since the 90s, Heidi. Have you been picking up on any more recent changes?

Heidi Larson:

Well, there's been a pretty dramatic drop across a lot of vaccines in confidence of vaccines since COVID. I think it's a bit of a reaction to feeling like there was too much of a push on vaccines, but I have to say, at the very beginning of COVID, we've been monitoring vaccine confidence across Europe for the EU since 2015. So 2015, 16, 18, 2020, 2022. And we saw in 2020, which happened to coincide with when COVID was initially announced we didn't have vaccines yet. It was pretty low confidence in flu vaccines, but with the announcement of COVID, there was a 17% increase in willingness and confidence to take a flu vaccine, and I think that was partly I would say largely because there was no COVID vaccine.

Heidi Larson:

But COVID was a respiratory illness that people were afraid of, and they thought I'll get what I can. Also, there was a lot of talk about the threat of a twindemic that you definitely don't want to get COVID and flu. So they probably thought if I can at least protect myself from flu. But over the course of the pandemic, as people got more and more worn with a lot of the kind of sometimes aggressive or feeling aggressive and even mandate vaccination campaigns, they kind of lost their enthusiasm. I have to say, though it was primarily in the 18 to 34-year-olds where that we saw a significant drop. I have to say, particularly in the Netherlands it had the absolute biggest drop in confidence in that younger age group across all of Europe. But the over 60, 65s it was pretty stable actually. I wouldn't say it jumped up high, but I think there was a different appreciation of the flu vaccine in that age group than the younger ones.

Clare Taylor:

And this is really interesting what you say, because I start to get the sense of some of your expertise between different populations, different age groups and so on. But, Sue, maybe you can help us out here. And what do you think is driving these change? I mean, we're picking up on, were vaccines pushed too hard, you know? But what is kind of sowing this doubt that Ted has also commented on?

Sue Saville:

Well, I think what I've seen across the media is a polarisation. We've seen conspiracy theories, we have seen the politicisation of vaccinations. As Ted said in previous years, the doctor, doctor knows best? Well, that isn't the case. People are querying it. The social media impact, it seems to me there's been something of an erosion of trust in public institutions. And with that politicisation there's the aspect of it's my personal choice, it's my freedom, don't dictate to me nanny state, and so on. So I think these are some of the factors that can play into the change in the discourse.

Clare Taylor:

And Ted, how have you seen the the rates, the vaccination rates change over the years.

Ted van Essen:

Well, as a matter of fact, it started a little bit earlier than the covid pandemic. In the Netherlands we had a very high coverage rate for flu about the highest of the world 75, the who goal really. That was reached, but in the first decennium it was starting to decline, and two things were important there. One thing was that the dutch government decided that people between 60 and 65 also could have a flu shot, and they said, well, I'm not old, I don't need a flu shot. And they said, well, I'm not old, I don't need a flu shot, I'm not 65 yet.

Ted van Essen:

And the second thing was, of course, the Mexican flu in 2009. And people thought that it was just a wimpy pandemic, which in the end, it was indeed not that serious as we were afraid of. Not that serious as we were afraid of. But then after that date, the vaccination coverage rates for flu did go down, and the same thing we have been seeing in pediatric vaccinations the coverage rate is going down also. We had always a very high coverage rate, about 95%, and now it's going down below 90% and in some areas, in some groups, it's even like 60% or 70%. So it started earlier than the COVID, but it's really a problem since COVID pandemic was there.

Clare Taylor:

And do we see similar patterns for other types of vaccinations?

Sue Saville:

Well, in adults, flu was the only one for a long time In Holland, that was, we didn't use the plamococcal vaccine until 2019. We were very late with that and the zoster vaccine is still not in use in Holland because of budget reasons. So flu was the only one and that's where the GP came in, because the GP invited his patients and that was a really good method to get people to get a flu shot. Now the COVID vaccinations are done by public health. People don't know public health at all, so they say why should I go there? And it's not close to my house and there's indeed some lower vaccination coverage rate for COVID than it is for flu right now,

Clare Taylor:

Sue or Heidi, do you want to come in there?

Heidi Larson:

Yeah I mean to your question about is this an issue across vaccines? It definitely is. We've seen it globally. We did because we've been monitoring vaccine confidence for a decade now. We had pre-COVID data and of the, I think we had 55 countries where we had kind of pre and I don't want to say post-COVID, because we still have COVID, but post-pandemic, between like 20 and 2022. 53 out of the 55 countries had a not insignificant drop and some of them I would say 40 probably were over a 10% drop in confidence. And that was just. That was particularly on the question the perceived importance of vaccines for children.

Clare Taylor:

Okay, that kind of brings us to common misconceptions. Sue, do you want to take some of these on?

Sue Saville:

Oh, so many out there. When you look at social media, you'll see completely false suggestions that vaccines cause autism, which perhaps goes back to the Wakefield false report, back in what was it 1998. There have been stories out there about they're toxic, they're dangerous, saying that vaccines were only developed to make profits for the pharmaceutical companies, vaccines were only developed to make profits for the pharmaceutical companies, that they cause infertility, or that it's my personal choice. So some of these drivers are out there and they're proliferating, particularly among some particular groups. That might be the younger, or it might be in some particular communities. So these misconceptions need to be identified and tackled head on.

Clare Taylor:

So, Heidi, you've written a book about disinformation and how vaccine rumours start. Where do you see the opportunity for change?

Heidi Larson:

Well, the second part of the title is how vaccine rumours start. But then the other part is then why they don't go away and I think a lot of the roots of, like Sue had just mentioned, sterilisation. That's really an age-old anxiety and particularly, as you mentioned Sue, in certain communities. It's kind of an existential threat for communities that feel marginalized. They don't feel like the government has really paid attention to them and they've been neglected. When there's a campaign that comes around with vaccines and they feel like, well, wait a minute, you're not taking care of anything else in my life, why can we trust this vaccine? And it is an anxiety about fertility and will it have an impact, and it's one of the various rumors that kind of hangs out. And when there is an anxiety it comes up again. And we've seen that also with, for instance, anxiety about technology. I think during COVID people were anxious about 5G. Well, with H1N1, it was 4G and with SARS it was 3G, so it was just much more this. You know what's about this sudden different thing that we're not familiar with and why now? And there must be some other cause. So people kind of are trying to find causes for things. Find causes for things.

Heidi Larson:

What has really become almost a myth, persisting myth, despite all the evidence of the link between vaccines and autism. And the reality is that, I mean, I'm from the US and I had moved to the UK where I was for 12 years, and I was in the US the anxiety was the Marisol and the preservative, not in all vaccines, but particularly in ones that are in poorer countries that don't have good cold chains. It's a very tiny, tiny thing that preserves and protects vaccines from getting contaminated, but it's ethylmercury, not methyl, which is the really bad one and it's less than, as they say, a tuna fish sandwich, but still there was huge anxiety that that was the cause of autism. And when I came to the UK, people were talking about the MMR vaccine, which doesn't even have the Marisol. And really what has been going on is that parents, seeing that more kids seem to be developing autism, looking for the cause and they're looking for whatever they can.

Heidi Larson:

And I think that's one of the things about rumors is that people are seeking answers to things that are either unfamiliar or that they have a preoccupation about and for all of the problems and challenges with the new health department in the US one of the positive things is that the head of HHS RFK Junior has thrown the net much wider in the search for the cause of autism. His background is as an environmental lawyer and he's had a much bigger history of trying to get toxins out of the environment than he has been having any issues with vaccines. So he's thrown the net wide to say let's look in the environment, let's look at vaccines, let's look at other things. So that's been helpful for the vaccine community in the sense of taking the singular focus off of vaccines. But again, people are particularly in times of uncertainty, like COVID, like other emergencies, so people are seeking answers. So as long as we don't really have a clear answer and to be honest, we've got some explanation, but there's no simple answer to what causes autism and until we do we're going to have continuing rumors. For sure I guess it's, it's not. There's no simple answer to what causes autism and until we do, we're going rumors have continuing rumors

Clare Taylor:

For sure, I guess it's part of of human nature in a way, and I think what you're describing there, that you know from naomi klein's doppelganger getting the feelings right but the facts wrong you know, that's something that then becomes a very sticky concept. But of course I mean this is a public health issue and I suppose, is it a necessity to depoliticize the issue in some way or Sue what's in the counter strategy playbook?

Sue Saville:

Well, there are lots of good examples of where things have worked very well. Here in the UK we had the example of real-time digital data. So the pharmacist report because we have our vaccinations for flu and so on in the pharmacy is reported real-time and then we can use digital and technology for nudges, for reminders, for scheduling of appointments. That's been really successful, as was highlighted at a recent EU flu day. Another thing that's really important is to go to where people are. I had a lovely example of this.

Sue Saville:

I was making a film in Liverpool and the young mothers, a lot of single mothers, were not getting their kids vaccinated with the childhood immunisations. So what they looked at was the structure of the families and there were quite a lot of single mothers who were single mothers, parents and so on. They'd go to the grandmothers and they'd say get vaccinated and it would trickle down through to the single mothers and that was a really effective strategy. So localising it using very positive language. So some of the campaigns in the UK there was one that said stay well this winter, which is for flu. So you keep the language positive, which feels like you're empowering people, not telling them what to do. So that can be really helpful, and also when celebrities get involved. When it was something like the flu campaign or COVID, we had the Royals having their COVID jabs. We've had celebrities having their jabs for the winter flu and that's really positive. It sets the example, it normalizes. So those are just some of the strategies that have worked well here.

Clare Taylor:

Ted, what do you think works well?

Ted van Essen:

What we do in the Netherlands is starting special sessions where nurses are discussing the topic with the people if they want to, and that is very effective, but it costs a lot of time for the nurses and the doctors, especially for the pediatric vaccinations. General practitioners say, well, we don't have the time for that, so we send them a letter and if they come, okay. If they don't come, well, just too bad. And that is a problem, that nobody has the time to listen to their patients. And that's something we really should do because and of course, some people have this opinion about autism that's not that big an issue anymore in the Netherlands, I guess. But it's just questions like does it really work? What's in it? What kind of chemicals are in it? My father-in-law died a week after he got his flu shot. I mean questions like People want answers for that, if they are taken seriously, and that's something that really costs time and so it costs money, and that is the problem right now.

Clare Taylor:

What have you seen, Heidi, that you think really works?

Heidi Larson:

Well, what has really worked is the influence of healthcare professionals and that healthcare professionals still seem to be the most trusted. But the challenge is one that Dr Ted just mentioned, which is a lot of the healthcare professionals are saying please, you know, don't put us in the hot seat in terms of having to be the main person influencing parents. One you know it takes a lot more time than it used to. They're asking a lot of questions. Two, a lot of the questions they're asking, to be honest, we can't answer, particularly during COVID. But you know, the reality is there's not a massive amount of training on vaccinology in medical school, but that's less of the issue than you know. Obviously, doctors aren't the best informed of all and certainly the most trusted, but there is.

Heidi Larson:

We're hearing more and more in surveys, in focus groups, frankly, globally I just heard the same in Japan, africa that healthcare professionals are saying we will give the information, but we don't want to get into a conversation or be pushed to have to be in a persuader mode. We've got a lot of other things these people come to us for. We don't want to lose that trust because we raise a contentious thing and some of them have even said we don't want to bring it up as a topic. If people ask, we'll answer. So that to me and that's been an increasing trend and part of it is the practical reality of, as we just heard, the time it takes is much more. But it's also it's challenging because there's and sometimes it can get quite aggressive from the side of the parents and that's hard. I think we need to broaden the support to help and support the healthcare protection Community. Pharmacists could play a valuable role, among others.

Clare Taylor:

That is an interesting one. Yes, because it was interesting how you talked on. Once it becomes politicized, then it is more difficult to have a conversation and it is more time consuming. Sue also mentioned this kind of digital nudges. You know, I think everyone's getting used to those on their phones, but I'm also kind of interested in what we know about public health campaigns, communication campaigns and as part of, I guess, informing the surrounding culture. You know, in between the sort of front line and the digital nudges, what else can be done? Sue, do you have a view on this?

Sue Saville:

Yes, and I think the media has a role here to play, because I think medical correspondence or the media more generally can amplify public health messages. We always told stories on the news through the patient's lens, looking at the impact, something like, if you haven't got your measles jab, some of the things that can happen. Perhaps that's a negative message, but sometimes scaring is a good way as well, but amplifying the positive messages, having expert commentary, so we would use really top experts like yourselves, heidi and Ted. But perhaps on the news and reaching people, the media can reach out through schools and they can use these fact checking which I think you will have come across in a whole range of different areas. But that can be really, really helpful to try to bust some of the myths that are out there.

Clare Taylor:

And do you think you know, touching again on the different professionals in this arena, scientists in particular are very highly trusted Doctors, other healthcare professionals and the pharmacists, of course Do you think that the associations, the professional bodies, should be playing more of a role?

Ted van Essen:

Can I answer that? Because I think professionals are not that used to having that kind of conversation and there's also a lack of knowledge there. In our nurses' education for four years, educating their bachelor, there's a total of one hour on vaccination. So they don't have any knowledge about the subject and that makes it of course course later on in their life they can learn more, but they don't learn that much I. I do some some work at medical students. They don't know a lot about vaccines because it's not interesting.

Ted van Essen:

I mean it's very more interesting to to get people better after they are sick than preventing them. So doctors don't like prevention that much. So there's a problem. At the professional side. On the other hand, I think that people still have questions and if they can't get answers from their doctors or nurses, why not use a chatbot? I mean there's a very good experience with the RSV chatbot for young parents. I tried that one and the chatbot was very nice much nicer than my doctor probably is, because he is in time constraint and I think using AI to give people answers and stay nice to them and give them nice answers knowing, I mean, you have to be sure that they give their right answers also, but using chatbots might perhaps be a method to help people there.

Clare Taylor:

That it's accessible and affordable. Sue, what do you have to say on that?

Sue Saville:

I would very much endorse that. I think that the younger generation are using chatbots all the time. They're checking with AI and therefore, if the information out there is valid is good, they're going to believe that because it's digital, perhaps. So I think Ted's point is a good one.

Clare Taylor:

And so how can healthcare professionals themselves stay informed? I mean, Heidi, you talked about asking questions that can't be answered. Do you think there's a particular sources, particular points that they should go to?

Heidi Larson:

Well, I think you can develop chatbots for different functions and I think having some for doctors and healthcare professionals could be really valuable as well, as for. I mean, obviously, the language and how you communicate would be different, but you know, I think that that could be also a valuable way. We've been developing a number of chatbots, but it's been more for the public. But we've also been hearing from some health care professionals that that would be and it's real time, and part of the challenge that we've heard from people is more from the public is that you know when, in Facebook and Twitter and these things, they pop up. When anyone asks a question about vaccines, they say go to your CDC or go to your NHS or go to WHO.

Heidi Larson:

But a lot of parents have said to me we've been there, they don't have the answers to our questions, and so one thing about chatbots is that they ask their questions One on the other end, you're collecting those questions and you have to keep training your system to have the answers, but you do get a read of what are the nature of the concerns and, you know, get feedback, and I think we can do the same for making at least making it quickly available to healthcare professionals, but that will also involve finding ways to get them to let us, as the back end, know what are the burning questions that they're struggling with, so we can I mean it'll take a dialogue.

Sue Saville:

If I may come in there. I think another factor that can be good is the peer to peer education. I have a role as lay chair of a patient group at a big NHS trust across London and there they have fantastic lunch and learn sessions online for 50 minutes. They'll do conferences, they'll do webinars and podcasts and that is then disseminating latest research tools all the online information and it's supporting peer to peer. It gives help to patients, but it very much gives help to the healthcare professionals themselves.

Clare Taylor:

Okay, that's great. A last word, a last message, Ted, what's your soundbite for this episode?

Ted van Essen:

I think much more attention should go to prevention in general. In Holland the budget for prevention is about four or five percent of the total budget for healthcare and we should start earlier in life giving people the good messages how to prevent disease. And that will cost money, because people think prevention saves money. That is not true. It costs money but it keeps people longer, healthy and happier.

Clare Taylor:

Invest in prevention. That is a good one, Sue. What have you got for us?

Sue Saville:

I would say engage, don't preach, in order to build trust and drive action towards a wider acceptance of vaccinations.

Clare Taylor:

Okay, that's a pretty good one. How about you, Heidi?

Heidi Larson:

Well, I certainly endorse that one. I'm a big fan of listening and engagement and making it more of a dialogue than a top-down. Just reiterating what Sue said. But I think that, just picking up on one of the points earlier, we really need to have more friends in this nation.

Heidi Larson:

I worked a lot in AIDS and sexual health before and somehow we had everybody and their brother in the kitchen sink somehow engaged, particularly during HIV. But I find that in the vaccine community it's very narrow and even people do like I do flu vaccines, you do measles vaccine, you do polio whatever. So I think we need to broaden our network of friends and supporters, take some of the stress off of the healthcare professional, care professional, but do it in ways that it's not just getting people jump on board, but find out ways we can get more public, more people in the public fluent in what the facts are. We really fell behind with social media. I think there was a lot of anxiety in the health community to jump on board. It's a toxic space and it got ahead of us and I think we need to have more engagement online and there was some innovative stuff during COVID. Doctors and researchers in the UK I know did some great work with personally going online and being there, and you know.

Clare Taylor:

Yeah, that's right, it really it will take a broad church, all right, a much wider group than those working on the front line. Let's say that was really interesting conversation. I could chat with you all day, but unfortunately I have to leave it there and just say thank you so much for joining me here today, and so a reminder to our listeners that this bonus episode on communication is part of this year's SWE series on intervention strategies, and I highly recommend that you tune in to the others in the series. There's a fantastic range of topics covered.

Clare Taylor:

You can listen in on a super group of global experts talking about vaccine production platforms. You can listen in on a super group of global experts talking about vaccine production platforms. You can also learn more about HMPV, the most important virus you've never heard of, and dive deep into intervention strategies for RSV, influenza and SARS-CoV-2. So stay up to date, stay tuned to ESWI Airborne and keep getting your news, insights and all the latest info directly from the good people in the SWE network, because these are the people that know the most about viruses, vaccines, intervention prevention and a whole lot more. So until the next time, dear listeners, stay safe.

ESWI Secretariat:

ESWI Airborne is brought to you by ESWE, the European Scientific Working Group on Influenza and other acute respiratory viruses. These episodes would not be possible without the team's efforts and we would like to extend special thanks to our ESWI secretariat, our technical and IT teams, our arts team and our host, Clare Taylor. The podcasts are recorded virtually and we thank our guests for their participation in this inspiring series. Talks are adapted to a global audience and are intended to be educational. For any specific medical questions you may have, these should be addressed to your local general practitioner. Many thanks to our sponsoring partners and thank you for listening.

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