Why vaccine hesitancy may be the next big COVID-19 fight

This story is part of an ongoing series — The Road to a Vaccine — that looks at Canada’s quest to secure a amid the global pandemic, as well as the hurdles and history it faces to do so.

While most Canadians would likely wish a vaccine for into existence, oh, yesterday, if they could, there are many who won’t be rolling up their sleeve when one eventually arrives.

Vaccination is always an emotional topic. Though vaccines are considered one of the most successful public health stories of the past century, vehement anti-vaxxers have seeded doubt about their safety, while many more people just have a lot of questions about how they work and why.

The conversation has been dialed up by factors swirling during the COVID-19 pandemic. There are those worried about the safety of what would be a brand-new vaccine, as well as those who fear politics might push one into use before it’s been shown to be safe. Fewer than half of Canadians say they’d get a vaccine as soon as one became widely available, suggests a poll released by on Friday.

On the frontlines of this conversation is Dr. Cora Constantinescu.

If you find youself face to face with the Calgary pediatric infectious disease expert, two things are often true: You’re a parent, and you’re struggling with the decision to vaccinate your kids.

Constantinescu runs a public vaccine hesitancy clinic — one of the few of its kind in Canada. Other doctors refer to her people who want to talk the decision through. Her appointments are an hour, and can often go longer, she says.

“There is such an emotional tie to this decision.”

As Constantinescu sees it, walking into her clinic takes guts: “I think it takes a lot of courage to actually come in and talk about something that I know, based on the people we’ve seen, they’ve researched for so long.”

Experts say the coming months will require politicians, public health experts and even pharmaceutical companies to work together to convince people that a vaccine will be safe. While the decision to roll up your sleeve is personal, enough people are going to have to make that choice if Canada stands a chance of stopping community spread or achieving herd immunity.

While a poll in July found 46 per cent of people would get a vaccine right away, that number has since dropped seven percentage points, according to the survey results released Friday.

The online survey was conducted from Sept. 23 to 25, among 1,660 Canadian adults who are members of AngusReid Forum. A probability sample of this size would carry a margin of error of 2.5 percentage points, 19 times out of 20, the pollsters said.

Much of the reluctance seems to be spurred on by worries about side effects, which almost three quarters of respondents said were a concern.

Worries that U.S. President — who has now himself tested positive for COVID-19 — is putting pressure on pharmaceutical companies have also made their way across the border.

During the first presidential debate Wednesday, Trump said that we were “weeks away from a vaccine,” and said repeatedly that it was a “possibility” that a vaccine could be ready to deploy by early November — before , in other words.

He said that vaccine-making companies had told him they could go faster, but, “It’s a very political thing.”

That statement contradicts Robert Redfield, director of the Centers for Disease Control and Prevention, who has maintained that most Americans will have to wait until sometime next year for a vaccine.

The disconnect has stoked fears in some. There have also been competing headlines from China, about that country’s government rushing out a vaccine to front-line workers before it has completed clinical trials.

The biopharmaceutical companies working on vaccines have repeatedly stressed that clinical testing will not be rushed, and any potential vaccine used in Canda would have to be cleared by Health Canada first.

Vaccines have an established track record. According to , the reported cases of serious diseases such as rubella, diptheria and polio all dropped by 99 or even 100 per cent in the years after a vaccine was introduced.

Most experts recognize a difference between anti-vaxxers, who are adamantly against vaccines in any form, and people who are open, but feel uneasy, or need more information. It’s this second group that public health experts say are going to have a lot of questions in the coming months.

Canada has tapped a pool of experts, leaders in fields such as epidemiology and pharmaceuticals, to provide advice on locking down a vaccine as soon as possible, but even the Vaccine Task Force realizes that just securing a successful vaccine is not enough.

“Pretty early on, we realized we could find all the vaccines in the world, as safe and efficacious as they might be, but Canadians have to want to take them,” says co-chair Dr. Joanne Langley, a professor in the departments of pediatrics and community Health and epidemiology at Dalhousie University in Halifax.

The issue of addressing hesitancy is something the task force has talked about a lot, added fellow co-chair J Mark Lievonen.

But despite allegations of political interference in the United States, he said, it’s imporant to note that Canada has a totally separate regulatory system.

In practice, that means that regardless of where a vaccine is developed, or by whom, it still has to pass Health Canada’s bar.

And while this vaccine is coming along very quickly — up until now, the fastest vaccine ever developed was for mumps, and it took a comparatively glacial four years — he says COVID-19 has also seen an unprecedented level of co-operation and collaboration.

even banded together earlier last month and vowed to uphold “the integrity of the scientific process,” and pushed back against the idea that their products could be rushed.

Lievonen, who is also a former president of Sanofi Pasteur Ltd., an arm of Sanofi, whose CEO signed the letter, said on the one hand, it’s positive that all these competing companies took a stand together, but on the other, it’s notable that they felt they had to.

“Up until now, that would have been the assumption that companies would (uphold the scientific process), it wouldn’t have been called into question,” he said.

He said that companies are taking steps to speed up the vaccine, but not by cutting corners on safety. For example, some are running multiple clinical trial stages at once, or scaling up manufacturing capacity before their vaccine candidates are approved so that if they get the green light, they’re ready to start pumping out doses.

In Canada, the regulator is also planning “rolling submissions” for COVID-19 vaccines, which means companies can submit the paperwork from their clinical trials for inspection as they go, rather than waiting until the end to hand in all their results, Lievonen said. Think of it as Health Canda looking over the shoulder of vaccine makers as they work.

“We are very comfortable and very confident that science will rule the day in Canada,” he said.

Still, if we don’t have the same legitimate concerns about political interference in Canada, the question becomes, how do you communicate that?

“The thing that alarmed me, was that even in the height of a pandemic, the likes of which we haven’t seen in a century, we didn’t see a major switch on vaccine hesitancy, we didn’t see people being swayed,” said Sarah Everts, the science journalism chair at Carleton University.

Everts has on Canadian attitudes toward an eventual COVID-19 vaccine. One survey of 2,000 Canadians, released in May, found that more than a quarter of people who responded either opposed a vaccine or were hesitant.

The survey also tested people’s beliefs in a series of myths and conspiracy theories, such as debunked claims that COVID-19 is a bioweapon birthed in a Chinese lab, or is being spread to cover up the harmful effects of 5G technology.

While almost half of Canadians believed at least one myth, Everts says they found that people who believed a false claim were more likely to say they were also skeptical of vaccines.

“At least in Canada, we found that there was a lot of trust in public health,” she said. “I think the reality is that we are, at least when we were in lockdown, spending an obscene amount of time in our homes looking at the internet, which is a firehose of information; good, bad and ugly.”

But there’s a message here, she argues, for public health communicators tasked with getting out the vaccine message.

She points out that being vaccine hesitant is not one size fits all. A lot of critics are dismissive of people who are skeptical of vaccines, and assume that any concerns stem from the debunked claim that they’re linked to autism.

But Everts argues that focusing messaging on that may cause people to shut down if they’re concerns are more around the role of the pharmaceutical industry, for example, or the use of live virus in some vaccines.

In fact, her study found that almost three quarters of those who weren’t sure they’d get a vaccine were interested in science-based news stories, and more than half said they were very or somewhat interested in stories that debunk conspiracy theories or unscentific arguments.

Especially in a conversation that has become so polarized, she says, it’s important that officials try to reach people where they’re at.

“More listening, and not talk down preaching an important way forward,” she said.

“Shame has never ever gotten anybody anywhere in terms of influencing opinion.”

At the vaccine hesitancy clinic, Constantinescu says those she meets just want to do what’s best for their kids.

It’s always a good thing when people want to be informed about their own health, and Constantinescu argues that the people who come to her are courageous: “I mean, bravery is doing something you’re afraid of, and they’re afraid to talk to health-care professionals about it, they’re afraid to expose their insecurity and their thinking about it, and they’re afraid to do it,” she said.

“It really is about their lack of trust, and their fears around this decision. And ultimately, and parents have actually said that this to me, is they take what they perceive as a leap of faith, towards protecting their children.”

As a result, correcting misinformation is a relatively small part of her job — it’s more about addressing the emotion tied to making the decision to vaccinate.

After all, smokers continue to light up despite knowing the cancer risk, she notes. Instead, anti-smoking campaigns target the way people feel about smoking in a bid to change their behaviour: think the graphic images of diseased lungs that have replaced branding on cigarette packaging.

There’s emotion here for medical providers, too, she notes, who realize that the need for information and guidance on vaccines will soon be greater than ever before.

“I’ve felt passionate about vaccine hesitancy for 10 years,” she said. It was a fire ignited when she became a parent herself. “You do feel this call to action, you know? That we have to use all of our abilities and knowledge and skills and will and dreams and put it into something that’s going to help the Canadian population.”

To that end, she’d like to see the conversation focus less on just feeding people information and more on recognizing that this will be a major personal decision for many people — but that there’s a major common goal here, too.

At the end of the day, everyone just wants the pandemic and the lockdown and the business restrictions to end, she said.

“Conversation needs to change around this vaccine. We need to stop talking about problems and concerns and worries and talk about this common goal of ending this. I’m not saying we’re not going to do the science, or saying we’re not going to be as rigorous as possible,” she said.

“But here’s our chance.”

is a Calgary-based reporter for the Star. Follow her on Twitter: