Heidi Larson: Why Is Trust In Vaccines Just As Important As Vaccines Themselves? In 2003, polio reemerged in twenty countries that had long been declared polio-free. Anthropologist Heidi Larson says to stop the spread of disease, we need to first build trust in vaccines.

Heidi Larson: Why Is Trust In Vaccines Just As Important As Vaccines Themselves?

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It's the TED Radio Hour from NPR. I'm Manoush Zomorodi. And today on the show, ideas about inoculation.

In a perfect world, a vaccine for the coronavirus would be available tomorrow. Everyone would get a shot. And the disease would die out. But even if it was available, there are people who would refuse to get it simply because they don't trust vaccines in general.


UNIDENTIFIED REPORTER #1: Opponents of vaccinations staged a protest today at the New York State Capitol.

UNIDENTIFIED REPORTER #2: Hundreds of parents and so-called anti-vaxxers rallied in Albany.

UNIDENTIFIED PERSON #1: There are pockets of the country where vaccines aren't happening.

ZOMORODI: And they're not happening because of religious beliefs or misinformation.


UNIDENTIFIED REPORTER #2: Health authorities blame misinformation for the outbreak.

UNIDENTIFIED REPORTER #1: A well-funded misinformation campaign.

ZOMORODI: And these campaigns continued despite what the science says.


UNIDENTIFIED REPORTER #2: The CDC says the measles vaccine is safe and effective.

UNIDENTIFIED PERSON #2: I think it goes down to individual identity of people for whom it's important to believe that they're smarter than doctors.

ANTHONY FAUCI: You have to tell them that the overwhelming scientific evidence over many, many years and decades indicate that the vaccine is very safe.

ZOMORODI: So how do you convince more people to get vaccinated? Well, it requires more than developing a way to fight the virus. It requires finding ways to stop rumors.


HEIDI LARSON: Not tabloid gossip or the kind of rumors that are making stock markets crash, but the kind of rumors that affect your health and the world's health.

ZOMORODI: That's anthropologist Heidi Larson on the TEDMED stage recently.


LARSON: Rumors have a bad reputation. They're seen as not fact, wrong. But I've studied rumors for years. And one thing I've learned is that they all have a story.

ZOMORODI: In 2003, while working on a vaccine strategy for UNICEF, Heidi traveled to northern Nigeria, where a rumor about the polio vaccine was fueling a national health crisis.


LARSON: The rumors were suspecting that the polio vaccine was actually a contraceptive. It was controlling populations. Maybe it caused AIDS. Maybe it's the CIA spying on them or counting them. I mean, why else would they have people knocking on their door again and again with the same polio vaccine? This wasn't about getting the facts right. This was about trust. It was about broken trust.

ZOMORODI: And by broken trust, Heidi means between Nigeria and the West.

LARSON: This program was perceived as being imposed by Western governments. And it was two years after Sept. 11. And that heightened the distrust of particularly American supported interventions.

ZOMORODI: So what happened? Like, how did people react?

LARSON: Well, the governor of the state boycotted the polio vaccination campaign. The mothers were not the ones that were refusing the vaccines. It was the governor who had declared the boycott. It was religious leaders who were discouraging the vaccination. And it was the fathers who decided. And the fathers were influenced by the religious leaders. And even though some of the mothers really would have been happy to vaccinate, they said I don't decide.

There was no adverse event following a vaccine. There was no specific problem. It was just a rumor and suspicions that this was funded by the West, you know, questioning the motives that led to over 20 countries being reinfected with polio that had been declared polio-free. And it cost the global polio program $500 million...

ZOMORODI: Oh, wow.

LARSON: ...Just to regain the progress lost because of the 11-month boycott and how far that Nigerian strain of the polio virus traveled.

ZOMORODI: Just in 2003 and the years after?

LARSON: Between July 2003 and the following summer, 11 months later, that 11-month boycott caused that much damage to the program.

ZOMORODI: And that's just one example, presumably.

LARSON: Absolutely.


LARSON: The Nigeria episode was one of many episodes that I investigated when I was with UNICEF. At that point, I realized I never really had enough time to understand what was driving, not just the individual episodes, but why was there an epidemic of these happening around the world? I left UNICEF. And I set up in 2010 what I called the Vaccine Confidence Project. In 2015, we developed a Vaccine Confidence Index. It's a survey trying to get our finger on the pulse of confidence and trust but also, more importantly, looking at when that trust goes up or down. And one of the things we've learned is in our global monitoring that Europe is the most skeptical region in the world. France won the prize actually (laughter) by far. I thought the U.S. was really - had some of the most skepticism, but boy, I was wrong.

ZOMORODI: So how exactly does this confidence index you've developed measure public trust in vaccines?

LARSON: Well, we've come down to four core questions from strongly agree to strongly disagree. Vaccines are important. They're safe, they're effective, and they're compatible with my religious beliefs. So we get those metrics, and we track it over time. And the whole objective of our group is to basically be more anticipatory because I felt like with the Nigeria situation, we kept brushing it off as rumors, and we weren't really listening to people and understanding what were really the grudges at a point before it had become so damaging.

ZOMORODI: And, you know, I really feel like I do understand why some Nigerians were suspicious, but I cannot help but feel frustrated at people who don't vaccinate their children, frankly because it puts my children at risk. And even though we don't have a vaccine for COVID-19 now, when we do have one, we will have to take collective action for everyone to stay safe, right? And that is something we don't always think about enough, I think, especially in Western countries.

LARSON: Absolutely. And I think this cooperative sentiment that you're talking about, kind of altruism, is going to be fundamental to how we handle his current pandemic because it is requiring more than ever that we can cooperate with each other.


LARSON: We don't have a vaccine. We don't have a cure. I mean, all we have is human behavior right now, I mean, aside from the treatments for the serious implications. But it's going to be a real test for us, and it will have huge implications for things like vaccines and other areas.

ZOMORODI: Do you think it's possible - I mean, look. Who knows where things are going to go with the COVID-19 vaccine? But in terms of eradicating or inoculating the world against some of the more old-school viruses and diseases out there like polio, can we do it? Can we inoculate the world? Can we get rid of those things?

LARSON: Well, inoculating and getting rid of are kind of two different degrees. I think we should be able to get enough people vaccinated that we can keep most of these diseases under control. There are a number of people in the world who can't be vaccinated because of underlying health conditions and - which makes it even more important that people who can be vaccinated are. But it's going to take a planet that wants to cooperate. I think, you know, we need to remind people how vulnerable we are - I mean, reminding people of the risk of not vaccinating and that it's worth having a second thought before you turn it down.

ZOMORODI: That's Heidi Larson. She's a professor of anthropology at the London School of Hygiene and Tropical Medicine. She also runs the Vaccine Confidence Project in London. You can check out her full talk at tedmed.com.

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