Bioethics Forum Essay
A Secret to Restoring Trust in Vaccines
Seventy-seven Nobel laureates signed a letter in December urging the Senate not to confirm Robert F. Kennedy Jr. as Secretary of Health and Human Services. They warned that his lack of credentials, vaccine skepticism, and endorsement of conspiracy theories would put the “public’s health in jeopardy.” A spokesperson for Donald Trump’s presidential transition team responded: “Americans are sick and tired of the elites telling them what to do and how to do it.”
I know the laureates are correct. But the spokesperson is also correct—Americans really do feel this way about experts.
The laureates have all made incredible contributions to human progress, most importantly in medicine and public health. A message like this is rare for them and out of character, violating an unspoken rule in the sciences to avoid politics. RFK Jr.’s nomination seems to have made them feel that they had no choice but to cross this line. We need more messages from scientists and health professionals that do this.
I am a bioethicist who became a local pro-vaccine activist in New York City to protect vulnerable communities from dangerous misinformation—to save them from easily prevented illness and death with a positive, factually correct message about vaccines.
My work takes me to communities throughout the city that experience health inequities. They are mostly low-income, mostly of color, and they have reasons—histories of abuse and exploitation—not to trust medicine. People in these communities are at risk of believing misinformation about vaccines. Meeting them on their own terms—speaking at rec centers, senior homes, high schools—I try to give them accurate information about vaccines and maybe earn enough trust to convince them to get vaccinated.
RFK Jr. has been interfering with the kind of work that I do since well before I started in 2023, with the world crawling out from the pandemic. I have spent much of my time trying to convince people not to believe what he has said. I have had to tell them that vaccines are safe, they are clinically tested, they do not cause autism, they do not target your race.
My voice, as loud as it is, is not enough. We need medical experts to talk directly to people in their communities. I believe that this simple gesture can help repair people’s trust in medical experts and in vaccines. For two years I have asked health professionals to join me. So far, only a few have done so.
This month another letter came out warning against RFK Jr.’s nomination, this time with the signatures of over 15,000 doctors across the nation. This letter, like the one from the Nobel laureates, has the right message but wrong audience. It will not reach the communities I work in that are targets of RFK Jr.’s lies. A signature is not enough when it is on a letter that most people won’t read, posted on the website of an organization that they’ve never heard of.
Folks in the communities I work in rarely see a doctor. They don’t know how to trust medicine. They could if they heard from doctors, nurses, and pharmacists working in their communities who are willing to speak outside the clinic. We need experts to be vocal and visible—at community events taking people’s questions about vaccines seriously and answering them in language that the people can understand. Health professionals need to start talking to people as peers, not as patients—something that anti-vaxxers have been doing successfully for years.
Nathaniel Mamo, MA, is a program coordinator in the Division of Medical Ethics at the NYU Grossman School of Medicine, and associate director of the #GiveOneTalk Vaccine Information Project. He acknowledges Lisa Kearns, MS, who helped edit earlier versions of this manuscript. LinkedIn: linkedin.com/in/nathaniel-mamo
Twitter @mamo_nate
The Big Pharma cartel approves this message. You did hear that the letters against RFK Jr. were fake, right? Funded by Bill Gates? There are lots of reasons why people have stopped trusting vaccines, including healthcare providers themselves. You touched on none of these. There is an awakening happening to the incredible deceit of our government and Big Medicine. Vaccines are the only product that have legal protection for manufacturers against harms done. Hm, coincidence that the gene therapy was labeled vaccine so it could by bypass animal testing without financial or legal consequence? People are waking up.
I totally agree, Tina. Congratulations!!
Thank you for your urgent and passionate writing.
You are working in a urban setting. Yet it is not off that your ideas resonate well in very rural settings. Here, also, as you say
folks rarely see a doctor: it they can or do go to primary care it will likely be a nurse practitioner or physician assistant (excellent professions!), and not likely be the same provider from visit to visit. So, that any trust that might have been built with a previous visit is lost. It is common to hear the belief the system as failing them as the whole persons that they are.
Across rural America we have endured generations-long provider shortages. Not years, but generations. Distant ivory towers are apparently unwilling or unable to resolve these shortages. Some schools are helping – https://www.usnews.com/best-graduate-schools/top-medical-schools/graduates-practicing-rural-rankings – while elite schools, with the greatest endowments, are at the bottom of the list. Some of these elite schools are in or near where you live. I suppose I have an answer to my question to them about helping out provider shortages in rural America: they apparently – by your account – DON’T EVEN CARE about NYC. My my my.
Fortunately, here in Virginia, a select legislative committee toured the Commonwealth for the past year, meeting in local rural and small town communities: Select Committee on Rural and Small Town Health Care. It was established by our House of Delegates Speaker, the first Black Speaker in Virginia, who represents a very urban community. But he developed friendly alliances with several very rural legislators who asked him to go and see how much rural communities are left behind. We’ll see what legislative the bipartisan legislative group can get passed in our current ‘short’ Session (less than 45 days).
In their last formal meeting before the Session they highly praised what they had found out about roles of community health workers. I’m sure that NYC has many. How are you using them in your campaign? And can they help you pull in more highly trained experts to build a sound base of community knowledge that regards vaccines as one of the most powerful tools for health that we have?
Thank you.
Thank you Edward for the thoughtful response! Community health workers (CHWs) have been an incredible help to getting the pro-vaccine message out. They do this with what many professionals in health lack–trust! I think they can also be great advocates for physician outreach, vouching for them and giving them community platforms to speak. A model that I’d like to see more of is physicians regularly teaming with CHWs to deliver health messages, instead of using CHWs just as proxies.
I am a retired NP, as part of my 45-year career in nursing, worked 12 years in public health and did a lot of teaching for a lot about vaccines and giving them. Back then, though, nobody was out there actively campaigning AGAINST vaccines. AND there was a memory of what it was like when we had no vaccines for MMR and polio and we had no vaccines that we have today for other diseases. Are there efforts out there to provide education to patients in public settings, with orientation for people like me who would volunteer to help w/ this, but need some updating on the info that needs to get out there??
Hello Phyllis George,
We’re opening an online program that’ll train people in the basics of vaccine communication. It’s a free, online class consisting of two 1 hour sessions. If you’re interested, you can email me at nathaniel.mamo@nyulangone.org.
Thank you for reading,
Nathaniel Mamo
I am a primary care doctor and someone who does community-based health policy research. While I agree more messaging needs to happen for trust in science and healthcare to improve (i.e., trustworthiness to improve), this DOES happen. Pediatricians and their organizations, Internists and their organizations, the CEAL teams across the country, are all trying to get the message out. In clinical practice I find it easier to persuade traditionally mistrusting patients to get vaccinated than to persuade the ones that have swallowed the MAGA and RFK Jr Kool-Aid.
It’s not always as simple as we think it is. Professional organizations such as the European Medicines Agency (EMA) which consider themselves on the right side of this discussion should take their responsibilities much more seriously. They can be really sloppy in terms of the information that they make available to the public and should instead take care to inform the public properly. I’ll explain what I mean by that.
I am on the other side of the world and in the middle of the Covid pandemic, right after the first vaccines were being approved and administered, someone who others might perhaps call a conspiracy nut let me know that many people had become very seriously ill after they had gotten the vaccine and that this was being kept from the public. (Note that this person is a lawyer and that her dad had a PhD in veterinary medicine and used to work on the development of veterinary medicines.)
Instead of rejecting this as nonsense I asked her how she knew this.
She then sent me two links of which she later admitted that she had found those on a conspiracy website.
Both those links turned out to be for pages on the website of the European Medicines Agency (EMA). Side effects of vaccinations were being reported. While the source for the assumptions made by the people who run these conspiracy sites that posted these links was clearly legit, their interpretation was flawed and in my view, this was caused by sloppiness on the part of EMA.
EMA runs the EudraVigilance system, which it calls “one of the largest pharmacovigilance databases in the world and a powerful tool for regulators in the EU to monitor the safety of medicines”. EudraVigilance collects “adverse drug reactions”. On its site, the EMA defined an “adverse drug reaction” as “a noxious and unintended response to a medicine”. That is very unfortunate because “noxious” is similar to “deadly” and “toxic” and “pernicious” and “dangerous”.
This database also collected data on the three Covid vaccines.
In my interpretation, the information in the database for these vaccines appeared to concern mostly mere relatively harmless reported side effects to the vaccines, such as swelling and redness at the injection site and generally feeling a little unwell. (I later found that confirmed in two earlier tweets by @EMA_News ) That this was not made clear on the website caused people to draw the wrong conclusions.
The highest number (reports) were for “General disorders and administration site conditions”. I pointed out that according to EudraVigilance, the Netherlands had a very high percentage of adverse reactions (namely about 28% for AstraZeneca and 34% for Moderna, though only 12% of cases for Pfizer, whereas Italy reported this for 35% of cases for Pfizer) and that this did not add up. (If a vaccine were to cause serious illness, it would not discriminate between countries, so this reflected something else.)
The UK was included for Pfizer, but not for AstraZeneca, which struck me as odd. That the UK was not included for Moderna made sense as the UK was only starting to offer Moderna in April back then.
So this database was not representative and was a random collection of reports of mostly minor side effects dressed up in very serious, deadly-sounding terms. The information might also reflect cultural differences such as how diligently side effects were being reported and how pain and illness are experienced differently in different nations/cultures.
What I did not see clearly reflected in this database back then was the reported potential clotting issues with the AstraZeneca vaccine. There were fewer reports than for the two other vaccines.
In the same period, I also caught two California doctors spouting dangerous hogwash about the pandemic and I reported this to the platform where they were spouting this nonsense; so did others and the misinformation was taken down. The two doctors appeared to have commercial/monetary motives. They had built a new clinic especially for COVID, but while NYC was already awash in cases, California was not yet at the time and they must have panicked about the investment they had made. (I checked out their various websites.)