During the first presidential debate, moderator Chris Wallace mischaracterized Kamala Harris’s concerns about vaccinations under Trump. I wrote about it recently: “Harris did not promote any conspiracy theory; she chose her words carefully: ‘*If* the past is prologue, [scientific experts] will be muzzled. They’ll be suppressed. They will be sidelined because he’s looking at an election coming up in less than 60 days and he’s grasping for whatever he can get to pretend that he has been a leader on this issue.'”

Here’s my article on this: 

While some may think that protests about vaccinations are a recent phenomenon, in fact the concerns date back centuries. There was resistance to the first smallpox vaccine, created in the late 1700s by Edward Jenner. Parents and the public—unfamiliar with medicine and how vaccination works—were horrified and disgusted when they learned that the vaccine was created by taking pus from the wounds of infected cows. That procedure was effective and saved countless lives, but still the British Anti-Vaccination League was created in 1853, asserting that the smallpox vaccine was dangerous, ineffective, and an infringement on personal rights. Over 160 years later, that theme continues to resonate strongly with anti-vaccination activists. 

‘‘Millions of human lives … have been preserved by the fruits of Jenner’s genius; yet today, thousands upon thousands of men, some intelligent though designing, some intelligent though deluded, the great mass of them fanatical and ignorant, decry vaccination as not only being of no service to humanity, but positively a nuisance injurious to health and life, while millions of our fellow men are utterly ignorant of, or indifferent to the matter.” This was published in the Journal of the American Medical Association in 1896 by Eugene Foster.

Foster’s breakdown of the reasons people reject vaccination remain salient 125 years later: “Some intelligent though designing, some intelligent though deluded, the great mass of them fanatical and ignorant.” The demographics of vaccine refusal reveal an interesting pattern: despite overwhelming scientific evidence that vaccines are safe and effective, it is the more educated parents who tend to reject them through requesting exemptions for school-age children. As Nicholas Bakalar of The New York Times notes, “Exemption percentages were generally higher in regions with higher income, higher levels of education, and predominantly white populations. In private schools, 5.43 percent of children were exempt, compared with 2.88 percent in public schools. In some suburban areas, rates of exemption were near 50 percent.”

Part of the reason the anti-vaccination theme is so persistent is that it contains a strong conspiracy theory element. The belief is that the dangers and risks of vaccines are being intentionally hidden from the public by doctors and drug companies, in collusion with the government, for big profits. Joseph Uscinski and Joseph Parent, in their book American Conspiracy Theories, note that “Conspiracy theories about vaccines are partially to blame for decreased rates of vaccination and an increased incidence of disease.” (For more on this see Uscinski’s recent talk “Conspiracy Theories and COVID-19”.)

Vaccine Concerns among Progressives

Historically, the anti-vaccination movement has been rooted in fears of contamination as well as complaints about infringement of personal choice. Both are rooted in distrust of the government and often embraced by conservatives. A recent twist reveals educated liberals who embrace and endorse vaccination in general but reject (as-yet nonexistent) COVID-19 vaccinations, specifically under the Trump administration. 

This is partly in response to Trump’s urging of health officials to speed the vaccination development process and promising voters a vaccine by the end of the year—or, he suggested, by November 1, a few days before the presidential election. Trump believes, with some justification, that his popularity and re-election chances hinge on his visibility of getting the virus under control and ending the pandemic.

In recent weeks, many social media posts and memes have circulated among progressives that urge vaccine hesitancy, at least in the case of an eventual coronavirus treatment. Typical examples include: “I would absolutely not take a coronavirus vaccine approved and administered under a Trump administration” and “I don’t trust this administration with my health at all. I won’t be getting a vaccine if Trump is still president unless some experts can convince me that it’s safe and effective.” 

 

These fears are based on several factors including the demonstrable incompetence of the Trump administration in containing the virus and Trump’s clear efforts to politicize the disease while often undermining medical experts. Yet Donald Trump isn’t a medical doctor and has little or no role in the development of vaccines; that’s not a function of the Executive Office. Instead, the vaccine development is being done by a variety of independent medical institutions, non-profit organizations, and private pharmaceutical companies around the world, following well-established guidelines for demonstrating safety and efficacy.

All eventual COVID-19 vaccines will, by definition, have been developed (and funded) during Trump’s administration. Trump is willfully antiscience and partisan, but that doesn’t logically mean that any vaccines developed under his tenure are necessarily of dubious safety and efficacy. 

One recent article in Foreign Policy noted that “If a vaccine comes out before the election, there are very good reasons not to take it.” Of course, there’s nothing magical about the election day as a marker of vaccine safety. A vaccine made available on election day, or even a few weeks later, would be just as safe as one that came out shortly before election day. The time required to conduct the research and analyze the data is the same, and if it’s been rushed into production, then a few weeks on either side of November 3 isn’t going to be relevant. As a practical matter, of course, a vaccine wouldn’t have a single national release day or timeframe. Front-line doctors and those at highest risk, for example, would likely get a vaccine before the general population. Due to inevitable logistical vagaries and practical reasons, the vaccine would be made available to different people in different circumstances at different times. 

Politics and Posturing

The larger question is why people would assume that Trump was telling the truth when he promised to have a vaccine ready so quickly. Trump and his administration have been characterized by routine falsehoods and exaggerations. On topics both insignificant and globally relevant, Trump seems incapable of telling the truth. Trump has made a laundry list of unrealistic, unachievable—and arguably unwise—goals ranging from buying Greenland to being added to Mount Rushmore to banning Twitter to building a Mexican-funded border wall. The Washington Post has catalogued over 20,000 false or misleading claims made by Trump, and The Atlantic has dedicated coverage to Trump’s extensive false and misleading claims about the coronavirus specifically. 

It’s curious, then, that his transparent electioneering promises and false statements about the virus are taken seriously. Overall, a recent PBS/Marist poll found that most Americans trust the information they get from, respectively, public health experts (84 percent); state and local governments (72 percent); news media (50 percent); and in last place President Trump (37 percent). 

 

If most people don’t trust Trump to give them accurate information about the virus (and polls show most people don’t), then why would they believe Trump’s campaign promise that a vaccine will (or may) be available before the election? 

If Trump had the political power to force the creation and distribution of a COVID-19 vaccine regardless of safety and efficacy, why hasn’t it already been done? America is in its eighth month of the pandemic; surely if Trump had the ability to override the process and rush out a vaccine—any vaccine, good or bad—for political benefit, he’d have done it months ago. It would appeal to his base (not to mention his ego, allowing him to crow about how he had made America great again after the evil, foreign “Wuhan flu” had attacked the country) and likely help cement a victory over Biden. If Trump could do what his critics fear he’s doing, he’d likely have done it by now.

Trump has long bragged about his popularity, power, and influence—claims that many of his critics have accepted and taken at face value. As a practical matter, the office of the president has less influence than most people assume (or fear). Even a president who has ran roughshod over many norms and usurped powers not afforded the office has been unable to implement many of his stated goals, stopped or slowed by many factors ranging from the Supreme Court to institutional inertia. Trump’s difficulty in getting his way is multiplied when dealing with private industry. 

The question is not whether the Trump administration has tried to, or even had some success in, influencing the vaccination development process or the messaging around it (for example, in one case a Trump letter had requested that state governors expedite not drug development but instead permits involved in setting up distribution sites.) The question is instead what effect, if any, it has had, or will have had, in doing so.  

We need not look far to see examples of vaccines (apparently) rushed into production based on political pressure; Vladimir Putin is a prime example. In mid-August, he announced that a vaccine for COVID-19, nicknamed Sputnik-V, had been approved after less than two months of testing on humans and that mass vaccinations would occur in October. As BBC News reported, “Venezuela’s President Nicolás Maduro has announced he will be asking for volunteers to test the Covid-19 vaccine developed by Russia. Russia was the first country to officially register a vaccine against the coronavirus on 11 August. But experts have questioned whether it has undergone the necessary testing. The Venezuelan government, which has received billions of dollars in loans from Russia, said it would be willing to take part in clinical trials.”

The concern raised among health officials (non-Russian ones, that is) is that the vaccine went ahead without what’s known as a larger-population study known as a Phase 3 trial, which vaccines in America and elsewhere are currently undergoing.

 

The situation in the West, and in the United States specifically, is markedly different. Not only are drug companies such as Pfizer, Moderna, and Johnson & Johnson actively recruiting tens of thousands of volunteers for Phase 3 trials at this moment, but they are unlikely to risk their reputations—not to mention bottom lines, through class action lawsuits—by rushing out a vaccine that’s ineffective or dangerous. In other words, they have a strong financial incentive to cover their own asses, not to cozy up to a politician who may well not even be in office in four months. There are myriad medical experts, pharmaceutical companies, and public health organizations that have far more to lose by producing a rushed ineffective (or, worse, harmful) vaccine than annoying the current president. As noted, whether Trump has been, or will be, significantly successful in influencing vaccine production to the detriment of vaccine safety remains unproven.

Fueling Vaccine Fears

MSNBC recently reported that about three in four adults around the world are willing to be immunized against COVID-19. A poll of nearly 20,000 adults from twenty-seven countries found that most would do so once a vaccine is available. “China was the most enthusiastic country with 97% of respondents indicating they would want to be vaccinated, while Russia was the least willing with only 54% interested to do so, the survey found. Still, it’s concerning that roughly one-quarter of people globally not intending to get a vaccine, said an expert from the World Economic Forum. ‘The 26% shortfall in vaccine confidence is significant enough to compromise the effectiveness of rolling out a Covid-19 vaccine,’ said Arnaud Bernaert, head of shaping the future of health and healthcare at the WEF.” 

The concern over Trump’s politicization of the vaccine can unfortunately easily be conflated with concern over the safety of the vaccine itself. Indeed this has already happened; the vaccine reluctance by some liberals hasn’t escaped the attention of right-wing pundits and news media. The conservative Daily Caller, for example, recently offered a profoundly misleading headline claiming that “Kamala Harris Promotes ‘Dangerous Conspiracy Theory’ About Coronavirus Vaccine.” 

In fact, Harris did not promote any such conspiracy theory; in an interview, she chose her words carefully: “I would not trust Donald Trump, and it would have to be a credible source of information that talks about the efficacy and the reliability of whatever he’s talking about. I will not take his word for it.”

Harris’s position is in fact mainstream; as noted, most Americans agree with her that Trump is an untrustworthy source of information about the virus and that respected public health officials should be listened to about the matter. On that note, Harris did say that “If the past is prologue, [scientific experts] will be muzzled. They’ll be suppressed. They will be sidelined because he’s looking at an election coming up in less than 60 days and he’s grasping for whatever he can get to pretend that he has been a leader on this issue when he has not.” 

In other words, if the president continues a well-documented pattern of ignoring, contradicting, or overriding medical authorities, then there is reason for concern about suppression of good science about COVID-19. Harris’s statements, while likely (and unfortunately) fueling vaccine hesitancy in this particular circumstance, hardly rise to the level of “dangerous conspiracy theory.” Harris pointedly did not say she would not take a vaccine if it were available before the election, and Joe Biden has said he’d take a vaccine as soon as it’s available. The Daily Caller piece is especially ironic given that Trump himself has repeatedly pushed misinformation and fears about vaccinations, including the long-disproven claim that vaccines cause autism. If anyone running for president can fairly be said to have a history of promoting dangerous anti-vaccination conspiracies, it’s Donald Trump. 

 

Yes, Listen to the Experts

The many who say they will put their faith in medical experts instead of Donald Trump are not engaging in conspiracy theory but instead critical thinking. And what do those experts say? 

World Health Organization Head Tedros Adhanom Ghebreyesus said that “I would like to assure the public that WHO will not endorse a vaccine that’s not effective and safe.” The Surgeon General of the United States, Jerome Adams, said in a recent Senate hearing that “I’m using my bully pulpit as surgeon general to make sure the entire country understands that vaccines are safe and effective. And this COVID vaccine, I’m telling people to focus on the process over the politics and the people because the process is what will assure us that these are safe.” Joining him was Dr. Francis Collins, Director of the National Institutes of Health, who echoed his sentiments. Federal Food and Drug Administration Commissioner Stephen Hahn issued a statement that “We feel the urgency at the FDA just like everybody else does. We want a vaccine that is safe and effective, as soon as possible. But we’re not going to cut any corners.” 

Then there was the joint statement by the CEOs of nine vaccine makers that read in part, “We, the undersigned biopharmaceutical companies, want to make clear our on-going commitment to developing and testing potential vaccines for COVID-19 in accordance with high ethical standards and sound scientific principles,” pledging among other things to “continue to adhere to high scientific and ethical standards regarding the conduct of clinical trials and the rigor of manufacturing processes and only submit for approval or emergency use authorization after demonstrating safety and efficacy through a Phase 3 clinical study that is designed and conducted to meet requirements of expert regulatory authorities such as FDA.” Dr. Anthony Fauci, among many others, has also pledged that any eventual vaccine made available to the public will be safe and effective—and expressed doubt that it would be ready in the next few months anyway.  

Unless all these respected experts and companies are secretly colluding with Trump to falsely portray an eventual vaccine as safe—which would indeed be a remarkable conspiracy theory—we can be fairly certain that procedures are indeed being followed in vaccine development and thus fears about vaccine safety are as yet unfounded. 

There have been several acknowledged missteps by America’s public health agencies, from mixed messages about mask wearing to invalid testing kits. However, we should be careful not to throw the baby out with the bath water and to avoid impugning legions of career medical experts who are doing their best amid political pressure to produce a COVID-19 vaccine. A stance that “we can’t trust the experts” is not only cynical but counterproductive. We can—and indeed must—trust medical researchers even if we don’t trust the administration they labor under. 

The anti-vaccination rhetoric is also a slap in the face to those volunteers currently in Phase 3 trials for the vaccinations. Are they stupid for having signed up? Is the implication that they’ve foolishly put themselves and their loved ones at risk by taking an “unproven” vaccine? Are their lives any less important than yours or mine, or someone who might take the vaccine on, near, or months after election day? As people of color have been disproportionately hit by the pandemic, volunteers from those communities are especially needed to participate, and the messages that vaccines may be dangerous (from any source) can only do harm.

Yes, of course the vaccines being tested are by definition “unproven” when they are still in clinical trials. But that doesn’t mean that they’re likely to be harmful—just that researchers don’t have enough data, don’t have a large enough sample size, to demonstrate safety or effectiveness to the usual standard. Even if a vaccine is rushed, the likely outcome would be a less effective vaccine than is optimal, not a less safe vaccine, because of the way vaccines are developed. Vaccines using inactivated (dead) or attenuated (weakened) pathogens, for example, are very unlikely to cause harm in otherwise healthy individuals. 

Those who oppose vaccinations can always point to (or, more often, cherry-pick) isolated cases in which a vaccine was later revealed to have been harmful, rushed into production, or have rare side effects. No medical intervention is 100 percent safe or effective, and vaccines are no exception. However, the overwhelming evidence is that overall, vaccines are both safe and effective, and as of now there is little or no evidence to suggest that COVID-19 vaccines under development—regardless of when they eventually become available—are any exception. 

A far greater danger is scaring people away from getting vaccinated in the first place. The chorus of those raising fears about vaccine safety (for whatever reason ranging from genuine fears to belief in conspiracies to virtue signaling and scoring political points) may be doing more harm than good. Vaccine hesitancy is a legitimate threat to public health, and it should go without saying that we should trust medical expertise over political promises.