Ending the COVID-19 pandemic will require decisions that are science-based. It will require the public to trust the evidence supporting those decisions and trust that decisions are being made in the interest of protecting the health and well-being of all people representing the diversity of our American culture and the communities in which they live. Unfortunately, confidence in both science and public institutions is declining at a time when we need it most. Physical distancing and other public health measures were slow to catch on in some settings, with some areas of the U.S. even staging defiant anti-mask and “health freedom” protests. Currently, surveys suggest nearly 30% of Americans would decline a COVID-19 vaccine if offered, citing mistrust as a major reason for vaccine hesitancy. Another challenge is ensuring that people who got their first dose of vaccine come back for the second and aren’t dissuaded by misinformation or practical concerns.
The U.S. is far from alone in confronting issues of anti-science and public distrust. The anti-science movement is a global issue. It is also not new. Conspiracy theories have propagated inaccurate and unfounded claims for as long as medicine has been a profession. And, like any profession, our field is not immune to people who exercise poor judgment or who promote anti-science agendas for self-gain.
What we are facing now is not only a pandemic but an infodemic, a wave of misinformation that is false and/or misleading, and unsupported by scientific evidence. Misinformation campaigns, particularly related to anti-vaccination positions, attack the legitimacy of science-based recommendations and question the motivation of health professionals. In some cases, these attacks on science have become individualized, with public health officials subjects of myriad forms of harassment, from doxing to death threats.
At Baylor College of Medicine, we have proactively worked to debunk myths about vaccines through both individual efforts and broader College statements. Yet the COVID-19 pandemic and ongoing skepticism toward public health leaders and expert advice have underscored that we, at Baylor College of Medicine, have a larger role to play. Combatting misinformation about COVID-19 has been a primary motivation for filming weekly videos with Baylor President, CEO and Executive Dean Dr. Paul Klotman, and sharing extensive weekly updates from our Incident Command Center. But we can and must be bolder and broader, involving our entire community in improving health and restoring trust by serving as a source of accurate, transparent and trustworthy evidence-based information. Below are efforts we support, building off of existing recommendations from Dr. Peter Hotez, dean of Baylor’s National School of Tropical Medicine. We pledge to take these steps to ensure that people have clear, scientific evidence so they continue to engage in safe practices to reduce virus spread, and to combat COVID-19 vaccine hesitancy. Public trust in science and scientists will grow if we insist on transparency and diligence.
- Spotlight misleading and false claims, while providing shareable, credible information. We know people are increasingly turning to social media and other online forums of varying quality for health information. We support and commend groups like the American College of Physicians and leaders like the American Medical Association’s Dr. Susan Bailey, among others, who actively seek to correct misinformation through public statements. Furthermore, many of our own faculty, departments, and centers have stepped up to serve as a source of credible information by growing their social media presence, taking time to speak regularly to the media, contributing to our blog network, and getting involved in local organizations like the Community Enhanced Alliance Against Covid-19 (CEAL) consortium that focuses on dispelling misinformation. Mobilizing the healthcare workforce has proved beneficial in vaccine acceptance in the past. For example, physicians helped drive uptake of the shingles (herpes zoster) vaccine in older adults, and numerous studies show that physicians are the most important influencers of vaccine decision making, especially in children. Vaccine discussions are particularly effective if healthcare professionals share personal anecdotes or experiences. We encourage more people within, connected to, and around the Baylor College of Medicine community to engage their networks directly to share and promote fact-based science, especially as it relates to the COVID-19 vaccine. The CDC has created easy-to-use resources and toolkits to help encourage and reinforce confidence in COVID-19 vaccines on social media and other communication platforms for the general public, healthcare professionals and employers, business owners and community leaders.
- Support policy based on best available evidence from scientific and public health experts. We believe in the power of science and technology to assess, direct and improve policy. During this pandemic, we have recognized the important research that has guided policy recommendations, such as the effectiveness of frequent handwashing, mask-wearing and physical distancing in curbing community transmission of SARS-CoV-2. We also will dispel dangerous ideas unsupported by scientific evidence, such as obtaining herd immunity through natural infection (letting the virus run its course to the point at which enough of the population is immune that it becomes difficult for the virus to spread) as an approach for ending the COVID-19 pandemic. It’s through powerful collaboration between researchers, healthcare professionals and public health experts that vaccines have been developed to help protect our communities from COVID-19. As they continue to become available, we will need ongoing analysis of vaccine efficacy, safety and benefits to further guide vaccine efforts.
- Further emphasize science communication, outreach and advocacy in teaching, training and research. It is both a skill and an art to be able to formulate and articulate information in a compelling yet accurate way that breaks through the clutter. Many groups and initiatives within Baylor already focus on developing this skillset. We have piloted programs to increase communication and collaboration focused on including ideas of action and empowerment into our community health engagements. We helped create the nation’s first high school for health professionals and launched an array of education initiatives. We embedded these topics into our curriculum in programs like our Health Policy Pathway, researched how to effectively and appropriately integrate medical online resources into modern healthcare practices, and analyzed misinformation campaigns, to name just a few. But, until now we have not specifically addressed the need for effective science communications to spread science-based recommendations and combat misinformation, especially on social media. We must work together to enable and empower our community to communicate persuasively as agents of change. This includes calls to promote science communication in doctoral and postdoctoral training, as well as involving students and faculty in public engagement. We must involve our communities and local organizations as partners early and often, knowing that people rely on their direct social networks, family and friends for guidance on medical interventions such as vaccines.
- Commit to the principles of scientific integrity and to transparency. Scientific inquiry can sometimes produce uncertain or even conflicting results, particularly in the face of an emerging crisis. There are also trade-offs that some health policies impose – the pandemic has brought many of these to light, but they exist in any healthy public health decision or regulation. We need to promote the importance of transparency, reporting negative findings, the possibilities and probabilities of side effects and being forthcoming about inherent uncertainties in science and medicine. This includes communicating the “why” behind decisions — including the current state of the evidence driving that decision, and the potential for revision in light of new evidence. We must also recognize and reinforce that values, contextual dynamics and individual factors such as level of education, health literacy, language barriers and cultural attitudes toward care impact health decision-making.
- Ensure just allocation of the vaccine and ethical response to vaccine hesitancy. Important decisions have been and are being made about vaccine allocation. We need to ensure just allocation (and corresponding implementation strategies) to ensure equitable access to those who can directly benefit. We also need to promote that there is a moral obligation of individuals in a community to take reasonable actions to prevent harm to others (in this case, via receiving a vaccine). It is essential that ethical values drive these decisions and also any decisions made around the concept of proof of immunity requirements (e.g. mandates, certificates or passports).
An anti-science movement that accelerated in the U.S. in 2015 is now globalizing and threatening to undermine public health. In this new era, our entire Baylor College of Medicine community needs to be involved in changing the conversation – to debunk myth and misinformation, to engage and not shame, to be clear and transparent rather than circuitous, and to ignite, inspire and reward action and proactive agendas. We hope to take everything we have learned over the past year about protecting the health of our community and work together to help get our community vaccinated against COVID-19, to end this pandemic and to restore trust in science and professional expertise now and for the future.
Thank you to our entire community of partners who are making a real difference in the fight against COVID-19 here in Houston and around the world. For more information on how to join our efforts: help support research and frontline workers, share information from trusted-sources, and get vaccinated and encourage your network to do the same.
Contributors: Stephanie Morain, Ph.D., M.P.H.; Amy L. McGuire, J.D., Ph.D.; Peter Hotez, M.D., Ph.D.; Mary E. Dickinson, Ph.D.; Janet Allen; Robert Atmar, M.D.; Hana M. El Sahly, M.D.; Prathit Arun Kulkarni, M.D.; Jill Weatherhead, M.D., Ph.D.; Pedro A. Piedra, M.D.; Chris Amos, Ph.D.; Mary Andrea Calo; and Clarice Jacobson