Seeing COVID rates hit another high, and vaccine uptake remain low, doctors don’t have an antidote for something they see as an ongoing risk factor: the spread of misinformation, including on the presidential campaign trail.
This week, speaking before a crowd of Republicans in New Hampshire, Florida Gov. Ron DeSantis laid out another falsehood about COVID vaccines.
“Every booster you take, you’re more likely to get COVID as a result of it,” said DeSantis, one of several political leaders who have consistently and without evidence challenged the safety and efficacy of the vaccines.
Public health experts and doctors are worried that this kind of misinformation is still shaping how people perceive the virus and tools designed to protect individuals and communities against COVID’s worst outcomes. In recent weeks, U.S. wastewater surveillance data has shown that COVID cases have risen to second-highest levels since the pandemic began, fueled by a new dominant strain, an omicron subvariant called JN.1, that is not as well understood as past surges. According to the World Health Organization, around 10,000 people died from COVID in December and hospitalizations rose by more than 40 percent in the Americas and across Europe.
Just 17 percent of eligible U.S. adults and children have gotten the updated vaccines, according to the Centers for Disease Control and Prevention.
Misinformation and disinformation are fueling “a vaccine revolution right now” in ways that Michael Osterholm, an epidemiologist who directs the Center for Infectious Disease Research and Policy, has not seen in his 50 years of work as an epidemiologist.
Up until the early 2000s, Osterholm said vaccines were “largely trusted” and “the public followed the recommendations of the public health community about what vaccines to get and when. Overall, safety was accepted.” But for a small but growing segment of the population, maintaining public safety is no longer a driving concern, he said. “It’s about, ‘I don’t want to be told what to do.’ It’s an area where we don’t know how to respond to that. It’s the fallout of the pandemic itself.”
Even as we’re in “a significant wave, and all the numbers are going in the wrong direction,” the public is battle-weary with pandemic fatigue, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
“Everybody’s sick of it,” he said,
Misinformation plays “a major role in vaccine hesitancy and the extent to which people trust institutions and the media,” while also shaping people’s personal health decisions, said Sander van der Linden, a social psychologist who directs the Cambridge Social Decision-Making Lab at Cambridge University. A small group of social media superspreaders are generating much of the misinformation that infects people’s understanding of the world around them, he added.
“There is a complex interaction between trust and misinformation, and it creates a feedback loop that’s very difficult to get out of,” said van der Linden, author of the book, Foolproof. “People are stuck in this loop.”
SARS-CoV-2, the virus that causes COVID, mutates over time as it is transmitted from one person to another. So far, it has managed to stay one step ahead of public health efforts to contain it, and the virus is far from being a seasonal illness, Osterholm said. COVID is also surging in nations throughout the Southern Hemisphere where it is currently summer, he added.
“We have an ongoing evolutionary battle between the virus and us,” Osterholm said. With the virus’ ability to produce subvariants capable of evading immune systems, he said that humans may be vulnerable again every six to 12 months.
There is a silver lining: though the virus is widespread and worsening in communities nationwide, an immunity wall composed of millions of infections and vaccinations has led to fewer hospitalizations compared to last winter, said epidemiologist Katelyn Jetelina. At the same time, some people who are initially sick with COVID are still developing long COVID symptoms.
An erosion of trust
When COVID vaccines first became available, the federal government had funded and given out doses through public health departments and health care providers. But this latest COVID vaccine has been the first to be distributed through commercial insurance. Now, most patients and providers have to work with insurance companies for reimbursement. The CDC has stood up programs nationwide to help uninsured or underinsured Americans access vaccines, but demand has been sluggish.
“A vaccine, until it’s administered, is nothing,” Osterholm said. “That’s what we’re looking at right now.”
Public health officials are facing a different reality with this latest surge than with some that have come before it. Loss of funding with the end of the public health emergency has hampered data collection at local, state and national levels. At-home COVID tests can be quick and effective, but few people report positive cases to their public health departments.
“The issue we have right now is we have lots of infections,” Osterholm said. “There’s no way to know how much just because we’ve dismantled all of our surveillance systems, but everybody seems to know a lot of people who are infected right now.”
Some health systems in the United States are again requiring masks to prevent spreading the virus to patients and staff within facilities, but the response is scattered and enforcement inconsistent.
Vaccines remain a safe and effective way to protect people against the worst outcomes of COVID. The risk for severe illness, including long COVID, and death is higher among unvaccinated people. In September, about half of U.S. adults said they would likely receive the updated COVID vaccine, according to a KFF survey. But current uptake of the latest vaccine is far off-course, compared to what people had once said. In the same survey, most parents said they did not intend to get their child the latest COVID vaccine. And parents overall had more confidence in the safety of the RSV and flu vaccines.
Experts say some of the misinformation coming from social media and political leaders draws on rhetoric and fears long used by anti-vaccine advocates. Hotez said there have also been efforts “to rewrite history,” including during recent Congressional hearings with Dr. Anthony Fauci, when part of the debate focused on the false idea that vaccines — not the virus — killed Americans.
According to the KFF survey from September, 57 percent of Americans said they were confident in the COVID vaccine’s safety. While these vaccines have been administered billions of times worldwide and have been shown to be safe and effective, clear partisan divisions emerged with 84 percent of Democrats, 54 percent of independents and 36 percent of Republicans expressing confidence in the vaccines.
Researchers reviewing COVID-related deaths in Florida and Ohio found that excess deaths after vaccines were made available to all adults were higher among Republican voters than Democratic voters, as detailed in a July study published in the journal JAMA Internal Medicine.
“These findings suggest that differences in vaccination attitudes and reported uptake between Republican and Democratic voters may have been factors in the severity and trajectory of the pandemic in the U.S,” the study said.
Van der Linden said Republicans continue to be the audience for anti-vaccination conspiracy theories. Some of those theories are amplified by political leaders, including on Dec. 6, when Florida Surgeon General Dr. Joseph Ladapo made debunked claims about COVID vaccines and called for an end to their use. These messages follow a dangerous pattern, van der Linden said.
“Targeted misinformation can negatively impact communities that are repeatedly exposed to it,” he said. With platforms, including X (formerly known as Twitter), allowing the return of superspreaders of misinformation, van der Linden said addressing and preventing the spread of misinformation has become more difficult.
The American public needs to hear from higher-ranking political officials, Hotez said. “Right now, we’re not hearing from the White House,” which can promote the importance of getting vaccinated against COVID and refute misinformation, Hotez said.
But as the 2024 campaign heats up, he expects to hear more political messages “weaponizing health and science communication that will work against public health,” he said.
“After that,” Hotez said, “I don’t know what happens.”
Why patients are hesitant
In Jackson, Alabama, Dr. Steven Furr has served generations of local residents as a family physician, answering questions, diagnosing illnesses, prescribing treatments and administering vaccines. Then, COVID came along.
Some unvaccinated patients are not hesitant about the science, but simply overwhelmed, said Furr, who also serves as president of the American Academy of Family Physicians. With vaccines available to prevent dire outcomes for COVID, flu and RSV, Furr said some patients have “just lost track” of what they have received.
But over the years, Furr has identified vaccine-hesitant patients. He said the best way to approach those patients about the latest COVID vaccine is to bring it up when they are in his office for something else, such as a wellness visit or if they need a check-up. For him, it has been important to keep the conversation going and to listen to the patient. He also tells them that he has taken the vaccine himself and administered it to his wife and his mother. That sometimes makes a difference, Furr said.
“The biggest thing is not to cut them off or get angry or frustrated,” he said. “It’s a chance for us to educate people. Now that they’re asking questions, we shouldn’t be afraid to deal with questions.”
One of Furr’s patients, Asbury Daffin III, age 67, said he and his wife got vaccinated against COVID as soon as possible, lining up in a drive-thru early in the pandemic to receive their first doses. But his children and grandchildren initially rejected the vaccines. “They thought it was something the government was trying to do to try to kill them” and that the government was specifically targeting Black people, Daffin said.
He said he disputed those claims and tried to assure his family. In the end, they got the vaccines, after seeing that he and his wife had no adverse effects, and aided in part by more fact-based information. He added that it was hard to counter posts his loved ones read or shared on social media, especially Facebook: “It don’t take but one of them to say it, and all of them believe it.”
“It’s a new beginning,” Daffin said. “It’s a new way of living now.”
Betty Bounds nearly lost her adult son to COVID in late 2020. After months of being careful, Bounds, a 78-year-old retired schoolteacher, said she heard people begin to dismiss the severity of COVID, comparing it to the flu. Soon, people returned to the pre-pandemic rhythms of life, including her son, who thought he was healthy and could take precautions later. But “COVID came before later,” Bounds said.
For a week, her son was treated in an intensive care unit in Birmingham, more than 170 miles away. He was hospitalized for two weeks. Years later, Bounds said he still experiences brain fog and struggles to catch his breath when he walks outdoors.
The experience made most of her family recognize the importance of getting vaccinated and that COVID was not a “fly-by-night virus that was coming through,” she said.
“We really thought we might lose him,” Bounds said.