Should I trust this vaccine?
Why it's crucial to focus on safety.
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There’s a lot of talk about vaccines right now, without full visibility on the evidence, and I hesitated before adding to that with this post. But the promising results look like a turning point in this pandemic. And rarely does the public keep such a close eye on a scientific development—the questions I was asked tipped the scales.
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The Worldwise View
The questions started coming in very soon after Pfizer announced that its coronavirus vaccine is over 90% effective.
What do you think, I was asked—should we take it? Can we trust it?
When asking the question, a friend told me they had watched this YouTube clip, and also read that the CEO of Pfizer sold 62% of his shares the day the news about their vaccine was announced.
An ellipsis of doubt followed the sentence.
I took a look a the clip. It’s produced slickly, and linked to a source that calls itself a “resistance platform”: an anonymous and independent source that fights the misinformation put out by the establishment.
You can’t get to the ‘What is It’ tab on the website—it’s overlaid by the ‘Join the Movement’ button. Considering the polished production values, this is clearly a design feature rather than a fault.
But of course the average person who watches this video wouldn’t take those extra steps to vet it, or necessarily know what to look for.
What they would have seen is a well-produced video, narrated in an authoritative voice pulsating with restless energy, presenting evidence after piece of evidence to paint a picture: that this vaccine business isn’t to be trusted.
Truths and omissions
One of the reasons this video is effective in sowing doubt about the vaccine is that it's based on truthful evidence. Evidence that pharma companies, including Pfizer, market aggressively—and sometimes improperly—because of the profit imperative. The CEO's sale of shares on the day is true too, and was widely reported.
What this clip doesn’t talk about is safety, either in general terms or explicitly about a coronavirus vaccine (more on that later). That’s no accident. The clip doesn’t say a vaccine won't be safe, because there's no evidence for (or against) such a claim.
But what it does very well is create a narrative of doubt using true statements that are unrelated to safety—leaving people to draw their own connections and fill in the blanks.
Making that connection between questionable big-company practices and an untrustworthy product is especially easy when the product is completely new, at a time when anxieties run high.
Side effects are among the public’s top worries about a new coronavirus vaccine, according to a recent analysis by the Economist. The speed of clinical trials is another. Both points of anxiety are backed up by a World Economic Forum/Ipsos survey released earlier this month.
Low confidence backdrop
The scepticism also comes against a backdrop of waning trust in vaccines.
Around 36% of people in Britain say they are uncertain or very unlikely to agree to be vaccinated against COVID, according to a recent report by the British Academy and the Royal Society. There are similar levels of hesitancy in the US: the New York Times reports that a Gallup poll shows 58% of adults are willing to be vaccinated—this is 8 points higher than earlier in the pandemic, but lower than pre-pandemic.
Some time ago I co-produced this SciDev.Net interactive visualisation that explored findings from the first study of public attitudes to science and health on a global scale. One of the key messages was that although confidence in vaccines had been dwindling worldwide, low-income countries are generally less sceptical than high-income countries when it comes to safety.
But things change fast in the world of vaccine confidence. In a follow-up study published in The Lancet in September, the largest to look at global vaccine confidence to date, confidence appeared to be improving in Europe and dropping in some developing countries.
Healthy scepticism exploited
Being cautious in circumstances like this one is a legitimate reaction. A degree of scepticism is healthy. It protects people from the unfamiliar—something that might put us in harm’s way.
But it can be easily exploited.
What’s missing from the narrative of mistrust put forward by that video clip is information about the not-so-sexy subject of safety procedures and regulations.
The public needs to know that running alongside—but separate from—companies’ vaccine research and development is a process of rigorous testing and regulation that makes sure the vaccines that enter the market meet standards of safety and effectiveness.
Companies’ focus on profit doesn't mean they—or government regulators—compromise on vaccines' safety. In fact, companies know that marketing an unsafe product could seriously harm their bottom line. They also know that right now, the whole world is watching. Very closely.
What the public also needs to better understand is that no vaccine is 100% risk free—not even those that you and I and millions of others have had since childhood. Think about the fine print on the label of any drug. There may be a low percentage of adverse effects. But if a drug or vaccine is approved it’s because the probability is small, and the nature of the risk not serious. It's a matter of weighing risk and benefit.
And if someone’s worried about the fast pace of development, this thread will reassure them 👇
But things can get murky
That’s how the script usually plays out. Where things can get murky is that questionable conduct on medical products does exist.
The most recent one is the anti-COVID drug Remdesivir, which has been approved by the US regulating body in spite of evidence that it may not be doing much good, and against the advice of other medical experts (Reuters + Reuters). In the 2010 ‘swine flu’ pandemic, the drug Tamiflu was mired in controversy for a similar reason. Beyond pandemics, the latest scandal involves Johnson and Johnson pushing opioids that fuelled an addiction epidemic in the US.
These cases are in the minority. Crucially, they don’t involve products that are unsafe. But they can be exploited to exaggerate what can go wrong in the system, and plant seeds of mistrust.
The fact that Pfizer and Moderna have yet to release the data behind their vaccine claims doesn’t help.
To protect against mistrust, regulators need to tread carefully, and journalists need to focus more on communicating—and scrutinising—safety procedures. The public needs support in order to trust.
If procedures are tweaked to facilitate speedy deployment of the vaccine, in what way is that happening—and does it have a bearing on safety?
Some journalists are already focusing on this issue and asking good questions.
This piece by Suzi Rig on Bloomberg quotes Emer Cooke, the head of the European Medicines Agency, who said the positive results of candidate COVID vaccines won’t take away the need to monitor closely.
“Pharmaceutical companies have been pushing for exemption clauses”, reports Ana Lázaro Bosch on Euronews, raising worries that lack of transparency could lead to a lack of trust. Members of the European parliament want to see what the contracts say about liability.
In MIT Tech Review, lawyer Clint Hermes argues that the US regulating body shouldn’t rush approval through by granting emergency authorisation, citing the declining public confidence.
The public’s confidence in a coronavirus vaccine—and other vaccines—hinges on clarity and transparency about safety.
LONG READ | 'It’s a razor’s edge we’re walking': inside the race to develop a coronavirus vaccine - Guardian
A final note from the week’s soundtrack 🌎
Worldwise is written by Anita Makri. You can help keep the project going for the cost of a cup of coffee—or spiced chai, or why not, something more potent.
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