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Description

Andy is joined by Heidi Larson, Founding Director of The Vaccine Confidence Project, for a conversation about, well, vaccine confidence. They discuss what causes vaccine hesitancy, how to boost confidence in the COVID-19 vaccines, and how to convert those who are on the fence about taking it. Plus, the particular trust issues among communities of color.

 

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

 

Follow Heidi Larson on Twitter @ProfHeidiLarson.

 

In the Bubble is supported in part by listeners like you. Become a member, get exclusive bonus content, ask Andy questions, and get discounted merch at https://lemonadamedia.com/inthebubble/

 

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• Livinguard masks have the potential to deactivate COVID-19 based on the testing they have conducted from leading universities such as the University of Arizona and the Free University in Berlin, Germany. Go to shop.livinguard.com and use the code BUBBLE10 for 10% off.

 

Check out these resources from today’s episode: 

 

• Learn more about the The Vaccine Confidence Project: https://www.vaccineconfidence.org/
• Watch Heidi’s 2020 TED Talk about why vaccine rumors spread — and how to rebuild trust: https://www.youtube.com/watch?v=iZpGjzEwlOA
• Read this New York Times profile on Heidi: https://www.nytimes.com/2020/10/13/health/coronavirus-vaccine-hesitancy-larson.html
• Pre-order Andy’s book, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response, here: https://us.macmillan.com/books/9781250770165

 

To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-the-bubble shortly after the air date.

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia. For additional resources, information, and a transcript of the episode, visit lemonadamedia.com.

Transcriptions

SPEAKERS

Andy Slavitt, Margaret Keenan, Heidi Larson

Margaret Keenan  00:01

I’m ready.

Margaret Keenan

Governor Coleman, feeling well, I would like to thank all the frontline workers, all my colleagues who’ve been doing a yeoman’s job to fight this pandemic, all over the world. I feel hopeful today, relieved. I feel like healing is coming. I hope this marks the beginning to the end of a very painful time in our history. I want to instill public confidence that the vaccine is safe. We’re in a pandemic. And so we all need to do our part, to put an end to the pandemic. And to not give up so soon, there is light at the end of the tunnel, but we still need to continue to wear our mass and social distance. I believe in science. As a nurse, my practice is guided by science. And so I trust science. What I don’t trust is that if I contract COVID, I don’t know how it will impact me, or those who I come in contact with. So I encourage everyone to take the vaccine.

Andy Slavitt  02:00

Welcome IN THE BBULE, this is Andy Slavitt. What you just heard is kind of what we’ve been waiting for. The Pfizer vaccine, and it will begin rolling out, it has begun rolling out across the country. And it’s going to start to get to people who are healthcare workers and people in long term care facilities, and it’s going to save people’s lives. And it’s also going to help bring an end to this pandemic over time. But it will only do that if people take it. And that is why today, we’re focusing on the topic of vaccine confidence. The question of confidence is a complicated and important one. And as I’ve said on the show, I think once before, your confidence in a vaccine is just as important as the effectiveness of the vaccine. And as you’ll hear, we’re going to talk with Heidi Larson, who 10 years ago, as an anthropologist started something called the Vaccine Confidence Project. If you like me, you’ll find her absolutely fascinating.

Andy Slavitt 

And it really, I think is in some of our better shows it kind of demystifies a topic that we all might have an emotional reaction to, it makes us step back and jump to conclusions and become a little more understanding about how people think about vaccines. She’s thought about this more than anybody in the world. She wrote a book called Stuck: How Vaccine Rumors Start — and Why They Don’t Go Away. And she had a global immunization communication at UNICEF, and served at the WHO, doing workup on vaccine hesitancy. So I think you’re gonna find it. enormously important. I think you will hear a framework for where we are, and I will not spoil it. But one of the things we’re going to get to is will enough people take the vaccine for us to get where we need to get and she has an answer to that question. So let’s call Heidi.

Andy Slavitt  04:09

Heidi?

Heidi Larson 

I’m here.

Andy Slavitt 

Hi, there.

Heidi Larson

Hi there.

Andy Slavitt 

Welcome.

Heidi Larson 

Glad I could join.

Andy Slavitt 

You’re in London?

Heidi Larson

Yes. How bad is it?

Andy Slavitt 

Well, so how long you’ve been there?

Heidi Larson 

Ah 10 years going on 11.

Andy Slavitt 

And how bad is it?

Heidi Larson

It’s pretty bad seems to be getting worse. And I think with the winter, I mean, just on the COVID front well, don’t get me started on Briggs. But anyway, it’s been good. I mean, good for me. And this is where I launched the Vaccine Confidence Project. I thought it was a good global hub. And it’s been really important.

Andy Slavitt

It was an important thing when you when you launched it. It’s obviously one of the most important things that people are thinking about right now. And I think we’ve got a lot to learn from you. I’m impressed that you don’t allow us to fall quickly into the very easy stereotypes that I fall into and fall into by thinking about the people that are anti vaxxers. And therefore, they’re from the stone age’s. And then there’s everybody else who’s enlightened. You want to talk a little bit about your overall approach that you’ve taken and why that is?

Heidi Larson 

Well, in the last decade, and actually, for the last two decades, I had been working on trying to address some of the emerging concerns about vaccines globally, when I was still with UNICEF, and was hired to be very doing very proactive communication, but ended up doing mostly crisis management. And I spent a lot of time going into situations where they were confidence breakdowns. And I sat with really people in all kinds of corners of the world and say, What went wrong? What’s the real issue behind it? And more and more, I mean, I started to hear what were very reasonable concerns, sometimes not always. Some of them were historic anxieties. Some of them were, you know, I mean, I heard a group of Nigerian mothers who just said, you know, what we really upsets us is hearing on the radio, that we’re not taking these polio vaccines, because we’re ignorant. And they said, We wouldn’t be questioning if we were so ignorant. And, you know, I thought, Oh, my goodness, these are some of the poorest women in the world, and they’re standing up for their voice.

06:42

And in a lot of situations, there was some felt issue. And then, you know, when I decided to launch the confidence project, to try to build that broken, what felt to me like broken confidence, I started to see it in high income countries as much as in low-income countries, it played itself out differently. But yeah, and so that’s how I got to the fact that we have to listen more, because if you just take it at face value, you’re totally missing the point. In fact, my new book Stuck: How Vaccine Rumors Start — and Why They Don’t Go Away, the working title until about eight months before went to press was missing the point. But the editor thought that I needed, these days, you need a one word punchy one.

Andy Slavitt 

Absolutely, absolutely. You know, because judging really works. Like when you glare at people for not wearing a mask, that’s gonna make them want to wear a mask. That’s kind of what I try to get people to sort of understand on the show is, we will push people into their corners if you don’t give them some agency and help them feel heard. So you started this to really study and understand and how to build confidence. You started with just talking about polio. And I wonder, just as a historical reference point, I’ve heard you talk about the cost of a lack of confidence, both in terms of the inability for us to eradicate a disease and in terms of the financial cost. Can you talk about that just to give people a sense of what it means when there isn’t enough confidence in vaccine?

Heidi Larson  08:20

Sure, well, the boycott of the polio vaccine in 2003-2004 is one of the examples where they actually did a costing of the number of well, aside from the number of polio cases that rebounded globally because of the one state boycott in northern Nigeria, and also cost the global Polio Eradication program $500 million dollars to regain the progress lost because of a one state, one-year boycott of the polio vaccine. And that was only because of a rumor. There was no adverse event, there was nothing that had actually gone wrong. There was no experience of a problem. There was just rumors of deep distrust, that set that whole thing in motion. And I just was so struck by the power of just a rumor that is so often brushed off by the public health community as fringe and focus on the positive don’t listen to the crazies.

Andy Slavitt 

So what do we know about where the US is where it ranks across the globe in confidence? I think we know that Europe has some of the most skeptical towards vaccines, where is the US and what’s the trend been over the last few so getting worse is it saying the same, getting better? By worse and better I shouldn’t say that I should say is confidence growing? Is confidence declining?

Heidi Larson  10:03

People were asking me that a lot like a decade ago, well, how bad is it? Is it getting worse? And I said, we can’t, I can’t tell you if it’s getting worse, because we don’t really have a baseline, we’ve never measured it. And that was one of the first tasks I set out to do with the confidence project has developed the vaccine confidence index. And we actually just published a couple months ago, in October, big Lancet article that was looking at our vaccine confidence measures between 2015, 2018 and 2019. And looking at because it’s it, we we’ve been using it as a globally consistent metric on confidence in the importance, safety, effectiveness, does it work? And is it compatible with my religious beliefs. And what we see is the US, the US has actually gotten it’s hard to believe, but a little more positive, at least that was up until about 2018. And then  if we saw this map again, for now, I am pretty confident that that would have gone down a bit. But it’s kind of in the let’s see, we have probably 70, mid 70s level, confidence in the importance of vaccine, when it comes to effectiveness, that’s more like 50% to 60%. And when it comes to safety, that’s also about 50% to 60%. So we see consistently around the world, people are much quicker to believe in the have confidence in the importance of vaccines more generally. But when you ask them about safety, that’s a whole different story.

Andy Slavitt 

Does that imply a vaccine for the but not for me?

Heidi Larson 

That’s a nice way to say it. I think they get that yes, yes, it’s a good thing, but I’m not sure if it’s safe. And that often is about one or two vaccines. It’s very rare. I mean, there’s the rare and as they call them an anti-vaxxer. That is against all vaccines. I mean, usually it’s a particular vaccine, or it’s a particular vaccine ingredient, or it’s a mandate. It’s rarely about all vaccines.

Andy Slavitt  12:29

So and you may or may not have studied this specifically. And if not, maybe you could speculate, tell us what you what you’ve studied, which is speculate, when you look specifically at ammonium in the US for the time being, what the top three or four issues related to COVID-19 vaccines are in the US that are that are causing hesitancy, what do you think they are?

Heidi Larson 

I think they are anxieties about safety, libertarian sentiments, free voice free choice, don’t tell us what to do. That’s a big one. That might be towards the top actually. And you can see it converging now with the kind of anti-masking, anti-lockdown, it’s all part of the same. Don’t tell us what to do. We have you know; we are who we are, we have our choice. So that libertarian sentiment and that goes back to the 1800s.

Andy Slavitt

Is that unique to the US?

Heidi Larson 

Not at all. Actually, that was the it’s more a phenomena in higher income countries, although not uniquely. But the first organized group that called themselves, not just the anti-vaccine league, they were the Anti-Compulsory Vaccine League. And this was with the first smallpox vaccine, and it was the only vaccine at the time. And they although people had their concerns about the way smallpox was administered, I mean the vaccine and thought it was a bit against God’s plan. And it wasn’t natural. The tipping point for organized resistance was when the government said you have to take it. So these things go way back. I mean, the UK is a very strong libertarian, they don’t have, they don’t even have requirements for vaccinations in school because they’re very nervous about doing something like this given the kind of deep libertarian sentiments.

Andy Slavitt 

But we don’t see those sentiments in developing countries

Heidi Larson

In some, I mean, I think there’s a growing amount of we want our own choice, but not at the levels that you see in the West as it were in the in Europe in the US and to a certain extent Australia.

Andy Slavitt

So the top two so like their safety issues and libertarian concerns are there others?

Heidi Larson  14:56

I think the other one is really the pro-nature, the anti-chemical, anti-non-natural, that’s a really strong one. And that gets more into the values issue. I mean, some of these moms who are really, it’s about a lifestyle choice, it’s about, you know, some of them are like homebirth, gluten free or vegan, not even taking contraceptives using rhythm method. And in that bundle is vaccine free childhood for their children. So it’s not about the vaccine specifically anymore. It’s about kind of a holism. And that’s another really big one. And that goes even in some of the poorer countries this kind of tradition back to traditional medicine. And it’s, you know, not natural to nature.

Andy Slavitt

To nature. Yep. She’s talking to you people live in Marin County in giant houses just talking to you. No, I’m kidding. But you know, it’s interesting, because you make the point, it’s all over the spectrum. It’s not, it’s hard to characterize this as politically left or politically right, isn’t it? It’s there, because there’s different reasons. And the it tends to; it tends to exhibit itself in different places. It sounds like.

Heidi Larson  16:20

Yeah, absolutely. And I think the other big thing is, issues around trust and distrust. If you’re a marginalized group, you know, and you just don’t trust the government, or if you feel like you’ve been mistreated, there’s a lot of trust issues. I mean, when you think about it, vaccines are hugely mediated by government, we’re pretty much dependent on big business, which is not nonprofit, they are profit. And, you know, the fact that everyone’s being counted all the time, how many vaccines they’re taking, and that’s all reported to the World Health Organization. Some people get really spooked by all that, and actually quite angry.

Andy Slavitt

Right. So if you’re inclined to see conspiracies, or if you’re..

Heidi Larson

A good place to go.

Andy Slavitt 

It’s a good place to go.

Heidi Larson

It’s a good platform.

Andy Slavitt 

And then there’s got to be tons of confirmation bias. Because if you find people if you don’t like, you know, you want to, you have a suspicion about a vaccine, you go on the internet, I’m quite certain you can find absolute proof of other people who are concerned about the exact same things.

Heidi Larson

Absolutely.

Andy Slavitt 

Just as we’re laying out the landscape, one final thing, this is a novel virus, therefore, a brand-new vaccine. Does that create more hesitation? More concern? Around safety?

Heidi Larson  18:04

Oh, it certainly does. I mean, it was already an issue around the H1N1 vaccine, that in 2009, when we had the H1N1 pandemic, people just because that strain had come up after the seasonal flu vaccine was made, because every year, it includes what are the most frequently circulating strains. And this H1N1 had come up after they had already completed the production of the seasonal flu vaccine. So they quickly made another vaccine just with the H1N1 strain in it. And people felt Oh, that was way too quick. That was way too quick, can’t be safe. And that was a very familiar vaccine. It was not a novel method; it was the same method they always use for a flu vaccine. And the strain was not even new. I mean, that was the H1N1 was the strain that you know, killed a huge amount of people around the world in 1918. So there was even anxiety then with a much more familiar situation.

Heidi Larson

With COVID. It’s, as you said, brand new virus. It’s also not only just a new vaccine, but their the way these new vaccines are being made have never been used before for vaccines. So that’s another level of newness. And I think we have to have a little bit of empathy with the public for having their concerns and wanting to wait a bit longer. And feeling also they’re feeling like, wait a minute, don’t vaccines take 10-15 years to get out there? And you’re doing this and I don’t know, pretty quickly.

Andy Slavitt 

Pretty quickly, pretty quickly. Look at and I think the point of this part of the conversation isn’t to make people nervous. It’s to just establish that there’s legitimate questions that people are going to have and that we’re going to need to be good at addressing and listening to and communicate, I can think of one other one. Heidi, when I asked my wife, Lana to marry me, you know, we’ve talked about making a tough decision, right saying yes to marry me. Boy, that’s got to be like, up there. But you know, she only had to say yes, once. Once she said, Yes, I would, I’d locked her in. She was no escape. But you got to say yes, twice to this vaccine, you got to get it. And then you got to come back three to four weeks later, and get it again. And in the interim, you know, you may have had a little bit of swelling in your arm, you may have felt a little feverish for a day, those are signs, those are good signs, those are signs that the vaccine has activated your immune system, those aren’t bad signs, but they could discourage people.

Heidi Larson  20:43

Yes, that’s for sure. But I think that, you know, the second time, is also a time to check in on people and see how they’re doing. And I think it is important to make the first experience as comfortable and so that people feel like, you know, when they were there the first time, people were open and understood their concerns or their questions, if they had them. Not everyone has concerns, a lot of people are just eager to get the vaccine because they see the value of it like the 91-year-old who was the first public person outside of a trial to get a vaccine here in the UK, what they featured, and I think that was a good, a great thing. Was that her talking about why what motivated her and it was to see your grandchildren. So I think there are people who see the value of this vaccine in particular, the freedoms I mean, I thought we should have a campaign vaccinate liberate. There’s all these people saying that vaccines are, you know, controlling. Well, I see them as being quite liberating, or the potential there.

Andy Slavitt

That’s a perfect place to go in this conversation next, which is that, okay, we’ve established that there are challenges to people’s minds. And we’ve established I think, quite articulately, you said, Let’s not treat these as unreasonable. They come from sincerely held places, whether they’re political, religious, safety, what have you. They’re there, whether you want them to be there or not. It’d be wonderful to be able to say, Hey, 100% of people are going to take the vaccine, all good. But since that’s not true, and one of the things that you should know about me, Heidi, is I’m excellent at math. I’m so good at math. here’s how I’ll prove it to you. If there’s 100% effective vaccine, and only 50% of the people take it, it’s exactly the same as having a 50% effective vaccine that 100% of people take. Aren’t you impressed with my math skills?

Heidi Larson 

That’s pretty impressive. Yeah.

Andy Slavitt  22:49

Pretty impressive. Pretty impressive. Yeah. I try not to show off my math skills that often.

Heidi Larson 

She already said yes.

Andy Slavitt

Yeah, that’s right. That’s right. She said yes. Yeah, that’s I was doing stupid math tricks for that’s how I got it to say yes. But that’s about as heavy as my math gets. So my point is, we talked about safe and effective at the FDA, safe, effective and trusted is the full equation, because safe and effective by itself doesn’t get you there. So let’s talk about solutions. And let’s talk about best practices around campaigns. I don’t know if that’s the correct word. But around efforts at vaccination in environments, wealthy country like the US and the UK, what do you suggest are some of the solutions because the math would suggest in all seriousness that you do need for sure, the majority of people, if not 70%, of people looking at the effectiveness of this vaccine, to want to take the vaccine? What percentage of the adult population do you think will? You know, they’ll take it anyway. They don’t have those concerns. And then what are the strategies for getting the rest of the way there in your mind?

Heidi Larson  23:58

Well, our most recent survey showed 54% in the UK and 41% in the US would definitely take the vaccine, at least that’s what they say. It’s pretty low in the US, but not high in the UK either. To get more acceptance. I think, for some people, it’s only going to change if they see enough other people getting vaccinated, they’re kind of open, but they want to see other people get it first. And when that’s the sentiment, I say, I remind people that it’s not like the 91-year-old was the first person to get a vaccine, there have been 10s of 1000s of people around the world who have been, you know, taking this vaccine for the last, you know, many months in different corners of the world to show that it’s, it works and it’s safe. So, you know, there have been a lot of people already who have taken it but I mean, I do understand it’s not to undermine their point, but I do remind them of that.

Andy Slavitt 

Sure, and in Russia and China.

Heidi Larson 

Oh, yeah, yeah, that was a little less willing. But that’s anyway, that’s a whole other thing. But there have been a tremendous number of people who have taken these vaccines. And we haven’t really seen any very serious side effects. And I think that that’s really amazing. I mean, it’s inevitable with the numbers of people we’re trying to reach that at some point, we’re going to see coincidental deaths, for instance, I mean, especially if we’re aiming for the most elderly, serious illnesses or deaths, that would have happened to anyway. And we’ll have to kind of make it clear when that happens, that it’s not because of the vaccine, assuming it’s not. But I think that we need to bring people along the journey more, we haven’t been, I think we can do a better job in communities of being out there of asking people, you know, let’s talk about your questions, concerns, hopes for these for this vaccine, you know, where it would be easiest for you to get just as somehow engage local communities in discussions about the vaccines, because it’s a lot of them feel far from the decision making, distrusting and if they feel like somehow you care about their views, you’re already a step closer.

26:31

They may not want to take it. But there will be people who will, but they just need a bit of assurance, or some information that they’re not getting in any kind of official website. One of the things we’re really trying to address is what I see is a real gap between the kind of information on official sources, and the nature of the questions that people have. We do a lot of social listening globally and in 100 languages. And we hear the kinds of questions and concerns people have. And you know, I’ve even looked for some of the answers to their questions on formal sites. And it’s just not there. I mean, the WHO’s and health authorities in the world put out what they think is real is the important information. And fair enough, we need that, but it’s not enough. So I think the more we can make an effort to be responsive to the concerns of communities, and they hear that we care about their concerns, or their you know, issues. I think it can only help.

Andy Slavitt

Well, in these days, if you don’t create formal information sources, informal information sources will naturally develop. So you’ll get it on Reddit, if you don’t get it on the CDC site, you’ll get it somewhere, you know, there’ll be a place where you can ask your question, and the only thing will be who’s going to answer it? Do they have any qualifications to do that?

28:02

Could we talk about race in the US, in particular, this is a potentially racially charged question. And I’m not sure I’m going to do a great job of explaining this. But I think you’re more than familiar with the issue. But let me just lay it out for the audience. First of all, I think the level of trust between racial minorities and white people adds a layer of mistrust to all the other issues that you’ve started with. Secondly, a lot of that mistrust has been earned over historic periods of time specific to vaccines, as we know, with experimentation, and third, there are among black populations and Latinx populations, very high levels of death, largely because a large percentage of essential workers are people of color, and not to mention indigenous people, etc. So any thoughts on how to approach this issue in the most respectful and correct way?

Heidi Larson

Well, these are some of the communities that I had in mind when I was talking about being out there and listening to their concerns. I mean, these are exactly the groups that I would start with, I mean, I would go to the local church, and, you know, say, we’ll be here on Tuesday from you know, three to five or five to seven, whatever they find out is the good time you can talk to the local Imam or preacher or whatever and say when’s a good time where people like together and make yourself available or you do it at a local school, you can say, send something out to all parents that, you know, for anyone having any questions, we’re going to have x from the local health authority or the local university to be available to answer your questions and talk with you or, you know, wherever somehow the town hall, literal town hall, if not the, and I think having those kind of discussions and if you can’t do it in person, you know, there are ways to have the online set up. I mean, I live across the street from an incredibly dynamic, it’s dominantly, Nigerian, but it’s a pretty multi ethnic church. And they were one of the first to when COVID was announced, shut their doors, but they had banners up in like two hours, about different ways that they were going to be there for their community. We’re still with you, we’re gonna be there for every single one of you. You can reach us online here, here’s our hotline, you can, you know, and immediately offering options. And these are the kind of efforts and people we need to get on board, at least to reach out and listen. And I think just that gesture will make a big difference.

Andy Slavitt

When you think about I think about this 41% number, who are the definites. What percentage would you say are fence sitters? And what percentage would you say are definite knows? Do we know that?

Heidi Larson

Yes. Let’s see. And this was a little bit before that last study, but there it’s about half and a half. If you if we say that there’s about 65% say 60% in the US 60% to 65%. That are if you add the unsure, but probably will, you know I’m leaning towards getting it. I think we’d get up to like 60%, maybe 65%. And the definite knows are the strongly disagrees. We found were about 10%. And then there was another group that said they’re uncertain, but leaning towards not taking it. And then there were about 15% that were just don’t know and that I understand. So the reality is across all the countries we’ve been serving, aside from India and China who are outliers in their positive sentiments, and that those are national, and I’m sure there’s if you break it down to sub national, as you would in the US, you’ll see deeper pockets of resistance versus others more willing. But overall, we’re really wobbling around herd immunity. If we had all the people in the world who say they would definitely or probably but not certain take it, we may just make it to herd immunity or someone on another program I was on called a crowd immunity. Anything better than herd. And what we did we just did a control trial. Because one of the other questions I get a lot is, you know, there’s a lot of misinformation out there. But does it make a difference? Does it really change people’s behavior or their intentions to take a vaccine?

So I had heard that question so many times that I really thought it was a good idea to do a control trial. And we did 8000 people and 4000 representative sample in the US 4000 in the UK. And we interviewed all of them about just their whole COVID experience. And within that asked, Would they be willing to take a COVID vaccine, and then with 1000 of them, and that’s where we got the 54% and 41%. It was in that round of interviews. Then we showed 1000 of them kind of straightforward fact base information about the COVID vaccines. And for 3000. In each country. We showed them the five most frequently circulating misinformed pieces of misinformation. And then we went back we did a general discussion on COVID and then plugged in another again, we asked “would you take a COVID vaccine if offered?” The impact of the fact-based information had zero impact. It didn’t improve anybody’s willingness and it but it didn’t undermine it either. It was just kind of neutral.

34:46

But for the misinformation in the UK, there was a 6.4% drop, percentage point drop in willingness to take a vaccine it went from 54% to 48%, just under 48%, that’s pretty low. And the US dropped less, but it started lower. So we went down, I think 2.1%. But what that says to me is okay, even if it’s only a small drop that get, you know, a small number of people, and that’s actually not a small number of people that get nudged, to not take a vaccine or get concerned that, to me, that’s a tipping point phenomenon, we are wobbling at the edge of a possible herd immunity, all it takes is a couple of percent’s, to decide. They don’t want to go there and interrupt the crowd immunity. That’s just for you.

Andy Slavitt

No, it’s good to see now that I didn’t take the 201 courses, I just took the 101 courses. But I was able to follow. So, how sophisticated do you think a disinformation campaign is likely to be? Do you think it’s likely to be organized and well-funded? Do you think it’s likely to be sort of social media rumor? disorganized, do you think it’s likely to be and since it’s more effective than a factual campaign is? How do you see it going, and what should be done to anticipate that or to get up front?

Heidi Larson  36:20

Well, I think that some of them are highly sophisticated, and also well-funded. I think there’s a lot of accidental misinformation out there that people just not getting it right, or getting bits and pieces of information and misinterpreting it. But there are highly organized sophisticated disinformation campaigns, where frankly, they could care less about yes or no about vaccines, they’re just seeing the vaccine sentiment landscape as one more opportunity to polarize societies. And you’ll see them occupying and agitating both the pro and the con, they’ll go to the pro side and get stir people up to be against the other side. And then they go on in the anti-side and they stir that fire them up even more to go against the and they’re equally inhabiting both extremes, but trying to agitate further polarization. But they also are very sophisticated in the sense of, there’s a lot more pro people in terms of individual numbers.

There’s a fascinating study with Facebook groups, 100 million of them, and found, you know, that there were a lot more pro people in terms of the size of the groups, but they were all kind of clustered together, versus the anti-groups who had less numbers, total numbers, but they would splinter into smaller groups where it’s like, think of it the I you know, the IBM central model versus Silicon Valley startups, you know, and different brands, a lot of different, you know, things, flavors, tastes, whatever. If you’ve got 100,000 pro, and 1000 anti, but they’ll splinter into 10 groups of 100 and are out there listening to and responding to a lot of different types of concerns. They’re reaching and a lot more people. I mean, they’re tipping a lot more undecideds.

Andy Slavitt  38:34

Yeah. So let me tell you two quick anecdotes. One is I got a call yesterday from I won’t say who but it’s a well-known person who’s a former governor and a physician sticking out participate in one of the trials, but was very concerned about something that he was over interpreting as a potential side effect. Now this is about as sophisticated and connected the person as you could imagine, but was overreacting to something I would say overreacting. And I think he would not agree to something he had thought he’d read, also married to a physician. So you can imagine how easily one piece of information to someone is nothing to do with your intelligence. This is just all new stuff can get into in spook you. The second thing I think about is, you know how easy it will be when there is as you say, a coincidental death. Right. When someone gives, you give it to 500 people in a nursing home. And you know, later that week, someone in the nursing home passes away, how easy it will be for someone on social media to make kind of a murder after the fact out of some person and use that to scare people or anything else that they think scares people. And it’s just the point about how these lies can travel which people learned in this country the hard way over the last four years.

Heidi Larson

Well, I think it just reflects the fact that personally and you’ve heard this in, in my TED talk that I think we have, there’s a disproportionate focus on the misinformation. And we’re not looking at that I think we have more of a relationship problem than a misinformation problem, that misinformation really is a symptom. And rather than just trying to debunk a lot of these, I mean, not to say we shouldn’t be correcting things that are factually incorrect and potentially harmful. But I think that’s just not enough. We need to look at what’s driving, what’s driving people to gobble this up the way they do. And I think that’s where we need to as a public health community, look in the mirror and say, what can we do better, to be more trustworthy, to be more present to be more engaged? Because we’re losing our audience.

Andy Slavitt

Well, I’m going to put a link to your TED talk in the show notes, and encourage people to watch it. Here’s what I think I heard you say on that, which is the cure for misinformation, is not information, it’s trust building.

Heidi Larson

Absolutely.

Andy Slavitt

As we finish up you’ve been so kind with your time, and so helpful with all of your perspectives and all of your research. Are you feeling optimistic? Are you feeling pessimistic? Are you a fence sitter?

Heidi Larson

As say in my book, I’m a patient optimist. But I think COVID is a huge opportunity for us. We have never, and I don’t know, if we will, again, in any certainly in any near future, have such an opportunity to see the value of vaccines way beyond just health. And if we don’t use this opportunity, and also use it as a trust building opportunity, it will have a tremendous value add for vaccine confidence more broadly and trust building. If we mess it up, it’s not going to be great. I mean, it will be remembered for a long time. And I’m afraid to say risks undermining vaccine confidence more broadly, never mind trust in the system. So I think it’s worth every minute of our time that we can manage to really listen to people to work on the relationship, ask people how they’re doing, not just what they take a vaccine, but how are you coping in these times? Tell them you care. I mean, people are really in a rough place right now. And it’s been a long time. And they’ve been some of them admirable and others angry. But I think we have a huge opportunity here.

Andy Slavitt  42:48

Sure. If we’re honest. I mean, you could feel multiple conflicting emotions at the same time. I mean, you could feel angry that you’re not higher on the list to get the vaccine, and also a little cautious. At the same time. Our brains are capable of putting both of those ideas in our head, even though they feel like they’re in conflict. Right?

Heidi Larson

Certainly. It’s a flurry of emotions.

Andy Slavitt 

Yeah, difficult time for people. Thank you for what you contributed; you’re obviously going to be such an important voice over the next year plus as it relates to COVID-19.

Heidi Larson

Thanks. And I’ll vote for hope.

Andy Slavitt 

How do y’all feel after listen to Heidi, Do you feel better? Do you feel worse? Do you feel? I feel like I know, more, maybe a little bit nervous, I would say that we are at this tipping point that she describes. But it also helped me understand how we’re always better if we’re patient at dealing with these things. And that there is precedent, try not to get too angry about people who are out there trying to cause trouble. Anyway, thank you for listening. Let me tell you what we have coming up. Our next show is a TOOLKIT. And it is a toolkit on getting back to work. We’re going to talk about essential workers and non-essential workers. I’m very clearly non-essential. You should understand that by now. This podcast, as much as I like doing it is not considered essential by the US government. But you know, people saw they take the train, they have to take the car, to get to work to do all these things. And so let’s talk about that as people get back to work next year. Then on Wednesday, Anthony Fauci from the NIH will be on. We’re gonna have a good conversation with him. All right. Thanks, everybody, for listening. We’ll talk to you next week.

CREDITS

Thanks for listening IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. My son Zach Slavitt is emeritus co-host and onsite producer improved by the much better Lana Slavitt, my wife. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen, but still tell them at a distance or with a mask. And please stay safe, share some joy and we will get through this together. #stayhome