A demonstrator taking part in a protest march holds a sign reading "Health is not found in a syringe"

Vaccine confidence needs a boost in high-income countries.Credit: Young Kwak/Reuters

The past few weeks have seen an explosion in misleading claims about COVID-19. These are mostly online, and many are intended to sow doubts about vaccination as a way to protect against infection. For the individuals and organizations involved in such disinformation, the pandemic is a gilded opportunity. They are capitalizing on both the many unknowns about the SARS-CoV-2 virus and the disease it causes, as well as the many legitimate questions about safety and efficacy as vaccines are being developed at unprecedented speed.

Vaccines must be safe and effective. Once (and only once) this is proven, immunization campaigns need to be comprehensive to succeed. But this presents many challenges. For low-income countries, and in those without universal health care, a key obstacle is ensuring that vaccines are available and affordable. For certain higher-income countries — for example some in Europe — the challenge for coronavirus will be to overcome scepticism about vaccines, which is being fuelled by false information.

Researchers can play a part. Knowing what to do in the middle of a pandemic isn’t straightforward. But for those considering how to respond to the kinds of questions that everyone is asking, and what to do about disinformation, there are ways to help.

Tackling disinformation

As Nature reports this week, misinformation (false information) and disinformation (information that is deliberately misleading) are complex. Some politicians are spreading virus disinformation to burnish their image and influence among their supporters. There are organizations that have set up disinformation websites — including money-making scams. Very little, if any, of this information will have been put through an open process of verification and review. For consumers, it can be a double whammy — they are paying, and also being misinformed or misled.

Public-health agencies and technology firms are aware of the harm being done and are working to respond. To their credit, platforms such as Facebook and YouTube are more active in taking down posts where there is a clear risk to public health. When questions such as “are vaccines safe” are typed into Google, the search algorithms are listing sources that provide evidence-based information. But for every item of misinformation and disinformation that are dealt with, more pop up. Moreover, sites have discovered ways to circumvent artificial-intelligence tools and harried moderators, and that makes the role of human fact-checkers more important.

One thing that researchers can do is to work with organizations that are responding to disinformation. They can support or join in the work of professional fact-checkers, journalists and academics, doggedly following bots and disinformation-news sites, flagging their content to the media organizations and social-media firms that host these sites. Groups all over the world are involved in this response — including professional bodies, learned societies and media-facing organizations. The work they do is labour-intensive and can seem never-ending, but it is needed now more than ever.

Public engagement and transparency

Many people are asking important questions on subjects such as the safety of proposed vaccines, the security of contact-tracing apps and how intellectual property rights and profits from new drugs and vaccines will be shared. These are questions that researchers from fields such as public health, data security and health-care finance are also asking. If they are not already doing so, now is the time for these and other researchers to expand their public engagement.

It might be that a definite answer isn’t known, or that there are a range of possible answers. That is often the case in science. The study and practice of public engagement in science has shown that involving communities in the kinds of conversations that researchers have — conversations about how scientists search for evidence, and being transparent about what is known and not known — all helps to create and maintain trust.

A year ago, the UK biomedical funding charity Wellcome published the results of a large global survey into vaccines, involving 140,000 participants in 140 countries. It found that around 80% of respondents considered vaccines safe and effective. Confidence was highest in low-income countries — notably Bangladesh and Rwanda — where public-awareness campaigns against infectious diseases such as malaria, typhoid and hepatitis are common.

By contrast, confidence in the importance of vaccines was lower in Europe, where populations are comparatively free of infectious diseases, but now have some of the highest deaths and infections from COVID-19. Some 22% of respondents from Europe are not confident that vaccines are safe, and this figure increases to 33% for France. Wellcome’s findings reflect those from the European Commission’s own State of Vaccine Confidence report from 2018. Across the European Union, health ministries are unable to meet their own target — set after the 2009 H1N1 swine flu outbreak — of vaccinating 75% of over-65s against flu.

Last November, Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine — and a co-author of the European Commission report — warned in an interview with Nature that if there is “another very serious influenza pandemic sooner or later, and if the public opt to forgo vaccination the way they did during the 2009 swine-flu pandemic, we’re in deep trouble” (S. el-Showk Nature 575, S57; 2019).

That is why there is work to be done. When it comes to communicating emerging information on research, the lessons from studies and from past practice are clear: not to over-promise, nor oversell and to emphasize what is known and what isn’t. In the case of vaccines, it means being as transparent as possible about how vaccines are made, how they work, what they contain and how they will be tested, and always being upfront about the evidence for their effectiveness, possible risks and side effects.

Researchers should play a part — no matter how small — in the response to misinformation and disinformation. We need to build a society that is resilient to falsehoods about COVID-19, a task that will only become more vital as vaccines near.