A HASTINGS CENTER CONVERSATION WITH

RHEA BOYD, MAYA GOLDENBERG, AND MILDRED SOLOMON

The Hastings Center hosted “Vaccine Access, Vaccine Hesitancy: Challenges to Herd Immunity,” an online discussion of the ethical issues related to vaccine access and hesitancy in the United States.

This Hastings Center Conversation featured:

• Dr. Rhea Boyd, a pediatrician, public health advocate, and scholar who writes and teaches on the relationship between structural racism, inequity, and health.
• Dr. Maya Goldenberg, Associate Professor of Philosophy in the Department of Philosophy at the University of Guelph and author of the recently published Vaccine Hesitancy: Public Trust, Expertise, and the War on Science (Science, Values, and the Public).
• Mildred Z. Solomon, President of The Hastings Center and Professor of Global Health & Social Medicine, Harvard Medical School. 

[Transcript follows]

Isabel Bolo, The Hastings Center moderator So I think we’re going to get going now. Hello and welcome to today’s Hastings’ Conversation. Vaccine access, vaccine hesitancy, challenges to herd immunity. We plan to spend the next hour delving into how we might move forward in the next stage of the Copenhagen pandemic. To help us think through this task, we’re privileged to be joined by Dr. Maya Goldenberg and Dr. Rice, who will be in conversation with Hasting Center president, Dr. Bill Sullivan. We want you, our audience, to engage as much as possible today’s topic and with our guests. So please ask questions as you have them by entering them into the Q&A box at the bottom of your screen. The discussions will stop a couple of times during the hour to address your questions. And though you may have the option to raise your virtual hand, we’ll only be taking questions through that format. If you have a comment or if your question doesn’t get answered, I’d encourage you to head over to Twitter. You can see the hashtag we’re using on the slide that’s currently being shared and you can engage with the Hastings Center and our discussions there. A recorded version of today’s webinar will be available on the Hastings Center’s website later today, where you can also find recordings of our previous webinars. We began these online forums almost exactly one year ago, a year and a day ago. And so there’s an archive with all of the wonderful speakers we’ve had the privilege to talk with. So now it’s my pleasure to introduce Dr. Solomon, who’ll be leaving today’s discussion.

Mildred Solomon Thanks, Isabel. Hello, everybody. Good afternoon and thank you for joining us. If the United States is to achieve robust community protection, in other words, herd immunity from covid-19, at least 75 to eighty five percent of the population will need to be vaccinated. Yet so far, only about 60 percent of adults say they intend to get the shot or shots. The remaining 40 percent seem to be split between outright knows and people who are waiting to see. Some people have called those people swing voters because they may convert or go one way or the other. Among those who are most skeptical, there are many different kinds of barriers. Some. Object to the speed with which the vaccines were developed and are concerned about their safety. Others distrust government or believe in widespread conspiracy theories. Views about the vaccine also differ based on religion and political party affiliation. And many times the barriers are not beliefs and attitudes, so much as access to sound information, access to transportation or to convenient places for getting the vaccine. To help us sort this all out, I’m here today with two esteemed guests, Professor Maya Goldenberg and Dr. Rhea Boyd. Professor Goldenberg is a philosopher of science based at the University of Guelph in Canada. She’s the author of an excellent and very timely book. It’s called Vaccine Hesitancy Public Trust Expertize and the War on Science. You can go to the University of Pittsburgh press to find it, and I hope you will. As we’re about to see, Dr Goldenberg has reframed vaccine hesitancy not so much as a war on science and not even as the consequence of poor levels of scientific literacy, but rather as a problem of public trust. The Hastings Center has is particularly interested in her trust work because we’ve just launched a new effort to help undertake research and public engagement and work on trust that’s funded by the Ohman Darling Fund for Trusted and Trustworthy Scientific Innovation. And it’s the Olman Darling funds that are helping to support this event, so which we are very, very grateful. My second guest is Dr. Rhea Boyd. Dr. Boyd is best described as a force of nature, committed to finding powerful strategies to enhance access to and uptake by communities of color. In fact, she was called away at the last minute. You are going to hear from her. She’s going to be joining us in a few minutes. But she was called away by some urgent requirements of some of the community based projects that she’s working on. But I’d like to tell you about her now and then. She will join our Zoom in just a few minutes. Dr. Boyd is a pediatrician based at the Palo Alto Medical Foundation. She served on American Academy of Pediatrics committees, on child health and on public communications. She has a blog so you can look her up that way. Rhea, M.D.. And this blog looks at the intersection between race, gender, politics, technological innovation and health. She has many accolades, but I wanted to give a particular shout out to the fact that she was a twenty, sixteen, twenty seventeen Commonwealth Fund fellow, which is a very prestigious and important fellowship from the Commonwealth Fund. Most recently during covid, she launched something you may have seen, and she did this well before any vaccines even had emergency use. Authorization called the conversation between us. For us, it features well-known and highly respected African-American leaders answering questions and endorsing vaccination. Rio will be with us soon. So, Dr. Goldenberg. Let’s let’s start, Maya. Hesitancy isn’t a unitary phenomenon, I tried to indicate that in my opening remarks. So what’s your perspective on the several reasons why so many people are uncertain, uncertain or hesitant about getting vaccinated?

Maya Goldenberg Well, I characterize vaccine hesitancy in my research, which I should mention was all done before covid it was on pediatric vaccine hesitancy or parents who hesitate about vaccines in industrialized countries. I came to see vaccine hesitancy is a very localized phenomenon and it is responsive to peoples and communities, historical and immediate relationships, to to scientific institutions, to public health infrastructure and to political forces. So vaccine confidence and hesitancy largely reflect how much people trust the system. And of course, that’s a very different answer than the usual thinking that people hesitate about vaccines because they don’t understand the science. And if only they understood the science, they’d follow expert advice on vaccines. The social science research really doesn’t support this claim. Some of the most vocal vaccine had hesitations, are highly educated. And also this idea that the public misunderstands the science is not responsive to research coming out of science, communications and social psychology into how people incorporate scientific information into their beliefs and into their decision making. So vaccine hesitancy incorporates many of those things. To answer your question, what are people most concerned about regarding pediatric vaccines? It’s very clear that there are many, many parents who hesitate about industry industry funded research into health care and health technologies. They could not be clearer about it, that they don’t think that the system is properly governed when industry can influence so much and governments largely stand back and let industry create their own run their own trials and sometimes even seem to have some sway over regulatory processes on that. So that’s a major source of of of mistrust cited often by parents. And that goes into covid vaccine hesitancy to there is concerns about the sort of global and more immediate justice around vaccines and whether science in general is being done for the people or whether it is being done in corporate interests. That’s pervasive. I also found in my research that the characterization of your your average vaccine hesitant parent was always thought to be white, affluent, usually mothers, just mothers, because they tend to make health care decisions for families. And I don’t think that that characterization properly captured how much hesitancy can exist in other communities that don’t have that kind of privilege and resources. And that’s become more apparent around covid vaccines. But I’ll say that just a few years ago, you wouldn’t see that characterization of of of a vaccine hesitant or or refuser,

Mildred Solomon that characterization being so. Who’s a white mom, a privileged white mom,

Maya Goldenberg and that they are that there are other sources of hesitancy and that experience is found in other communities, too. It’s not just sort of the frivolous worries of affluent mothers.

Mildred Solomon So you’re you’re kind of describing a hesitancy on the left with concern about corporate profits that are to be that are to be made. Do you see that? I don’t I don’t see that group being hesitant about covid-19 vaccines or am I missing something there?

Maya Goldenberg They are present there. But at least in the American media, that’s being drowned out because right now the vaccines are so politically tied to whether you’re a Trump or a Biden supporter. But there is always been vaccine resistance by both the left and the right for very different reasons. They tied different ideological commitments. It can be mistrust of government on the right and more libertarian and individualistic values. But on the left, there was concerns about regulatory capture, as you just mentioned, a desire for national living, especially on the West Coast that was found on the left, too.

Mildred Solomon Can you unpack regulatory capture for us?

Maya Goldenberg Oh, it’s the idea that the governments and regulators are beholden to industry interests through their lobbying and through their economic power.

Mildred Solomon How do you see that playing out now? I mean, the obviously these companies are going to make money there. They’ve got advanced marketing contracts with all these governments to purchase their vaccines to the user. They’re going to be free, but to the companies, they’re going to be a source of revenue. But that is certainly been a motivation for the unbelievable speed at which these nearly I don’t think it’s it’s hyperbole to call them miracle drugs have been developed, so. Are you seeing debate on the left around around this in a in a prominent way? Because I really I just you’re right that if it’s there and then we’re not seeing it in the media,

Maya Goldenberg I think right now the media is more concerned with the immediate, for example, are Americans going to get adequate coverage? But it won’t take long before we turn our eyes more towards the global perspectives and people that work in global health or the noticing that the patent protections around vaccines are not providing the coverage we need in the global news and that this means that we are going to prolong this disaster of covid for years to come. There are strong calls to waive intellectual property protections. It’s called the TRIPS waiver for for the for the World Trade Organization. And the pharmaceutical companies are resisting it, even sort of gates foundations there. They’re more committed philanthropy, capitalism. So they don’t want to do things like increase domestic production in countries that could actually vaccinate vaccinate their their population very, very well. So it’s more on the global level that you’re seeing these kinds of concerns.

Mildred Solomon I’ve read that. Eighty seven percent of Democrats intend to get vaccinated, but something only like 50 percent or less, maybe forty five percent of Republicans do. Which is why I was giving you something of a hard time on the on the concerns coming from the left, because I think in this case, in regard to Koven, the major those that last 40 percent of people are disproportionately made up of non Democrats, let’s put it that way, of Republicans.

Maya Goldenberg We always need to take survey research with a grain of salt. People say things to when they respond to surveys that may not reflect everything that’s going on. So right now, to say that you support covid vaccines is to say that you are providing pro, pro progressive and that kind of thing. That has not always been the case around vaccines. And it may not actually follow through in terms of action. Intention and action don’t often don’t often match up. So I have no evidence to tell you otherwise. But I question if it is true that all people on the left are fully resolved on vaccines and will will partake in vaccination.

Mildred Solomon Many of us, and I will include myself, have have bemoaned what seems to be a lack of respect for expertize. And your book spends an awful lot of time saying that you don’t buy that we’ve had a lack of debt. What did you call it? That there’s a fear that there’s a fear of science or a misunderstanding of science and that that there’s. There is, in fact, the death of there is not the death of expertize, there is not your claiming that there, I’ll let you say what you’re claiming, that that there was a. I’ll stop, I’m not characterizing you right, but would you would you speak to that point, are we really losing our confidence in experts? Is that the nature of the problem? Have we, you know, deserted scientific literacy and now just embracing. Have you thought about anything and not going to any authority at all?

Maya Goldenberg I don’t think that people have given up on experts. However, the traditional experts are not trusted to the extent that they were before. So if you follow through on this metaphor of the death of expertize which you can attribute to the political science, Tom Nichols, the idea was, is that was that no one listens to experts anymore and they think they know as much as experts do. And that part I don’t think is true. When I again, going back to the research on vaccine hesitant parents, it did not look to me that people were claiming that we’ve got this sort of epistemic leveling where everyone knows the same thing. Instead, these, let’s call them alternative epistemology are arising where people are looking to different experts. So there is mistrust of expert institutions for the same kind of corporate interests, regulatory capture that that I that I said before. And because of that, those trusted experts are not as trusted as they used to be. But what we do have is a growth of alternative experts. Some of them look a little bit questionable to us. They may not have the traditional the traditional credentials that that expertize you do the M.D. or the or the Ph.D., but you also see a lot of trust in these alternative experts who do have traditional training, let’s say MDs, who tell the minority view that vaccines are not safe for children. I’m thinking of Dr. Bob Sears. I spent a lot of time talking about Andrew Wakefield as the sort of maverick, these the anti-hero where he’s trusted by vaccine refusers, partly because he actually has all of the epistemic credentials until his license was taken. These scientists, he’s a doctor, but because he’s willing to bravely speak truth to power as they see it and go against the Orthodox view, he’s trusted even more. And that says something about what we how we characterize experts. There’s a big sociology of expertize that I drew from to to make this claim. But we trust experts for their epistemic capacity that they’ve got some education and skill set that exceeds our own. But we also trust them in their moral capacities, too. We need to think that they are honest and they have our interests at heart when they pronounce or give us advice. And there is a lot of questioning whether our traditional experts do have the interests of the public at heart.

Mildred Solomon So do you see this as a failure of public trust? Or, you know, a criticism of it sounds almost like you I thought when I when I read your book that you saw this as a problem of public of trustworthiness in institutions. Is that a fair way to put it then, then that is a problem of public trust or public belief in science,

Maya Goldenberg it is at minimum a credibility problem. So so in in the epistemology literature, they distinguish between trustworthiness. You’re trustworthy if you are actually someone that deserves to be trusted. But credibility is the perception of trustworthiness by others. So, you know, we don’t need to argue about whether pharmaceutical industry actually deserves the bad reputation that that’s some people attribute to it. But we can agree that large swaths of the public do not find pharmaceutical industry funded research trustworthy. So that’s a credibility problem. And if you find yourself in the middle of a pandemic and you want to stand out as a, let’s say, a public health advocate and bring the public along with your advice and your directives, you need to be perceived as trustworthy. And right now, we’ve got these fractures in our health care system and health care in relation to the public around this at minimum credibility problem. You have to be trustworthy, but you also have to be recognized as trustworthy by your stakeholders.

Mildred Solomon OK, thanks, Rhia. Believe it or not, my screen had you blocked. I just got a text that I was saying Wonderware Reia is and all along you were here. But I don’t know, I can’t, I can’t actually quite see you so. But I’ve been told that you’re here. Are you here. Here. Hello.

Rhea Boyd Hi.

Mildred Solomon Sorry I didn’t acknowledge you when you when you joined us. So you’ve read some of this dialog between me and me.

Rhea Boyd I have. This is

Mildred Solomon fascinating. OK, all right. Great, great. Well, you know, we’ve been talk she and I have been talking about the role of trust in all of this. And I know that you I know that many people have have talked about African-American distrust of the health care system. And in fact, in bioethics, we’ve often applauded ourselves for acknowledging that there is justified distrust, a kind of awareness of systemic bias in the health care system and egregious failures in to protect human research participants. The infamous Tuskegee study, for example. So there’s been a lot of discussion in bioethics and in other forms about justified distrust among African-American community. But I know that that you have a different take on that. Do you think trust is is playing an important role in the extent to which African-Americans are seeking and accepting the vaccine?

Rhea Boyd First, thanks again for having me. I’m sorry I was a little bit late, everyone. There are multiple vaccine events going on today and I think this is a really important question. And I have been critical publicly of the ways that black Americans in particular and black folks in this country, in the US have been kind of pegged as quote unquote, vaccine hesitant. I’ve been critical of that because if we look at vaccination rates among black folks kind of throughout history in this country, you see that every time there is an effort to actually eliminate barriers to access vaccines, like to eliminate cost for barriers for kids to access vaccines or to eliminate barriers of health insurance to access vaccines, black folks then become just as likely to get recommended vaccinations as any other population. And so then when we came into the pandemic and the issue of the covid vaccines arise, we all of a sudden saw these headlines labeling black people in particular as vaccine, hesitant, as if they one were kind of vaccine hesitant at baseline, and two, as if that was a reflection of their, quote unquote, mistrust of the health care system. And so my first point is to say, you know, historically, black folks have not been averse to vaccination as a population. We when barriers again are addressed, black folks have high rates of vaccination, black children and black adults. And so if we know that, then I then want us to think more critically about why we turn to turn to kind of analytics or frameworks to explain why black folks might have lower covid vaccination rates again, turning to their, quote, unquote, mistrust. I think it truly does a disservice to black folks who, from my vantage, instead of being only mistrustful, are simply mistrustful, instead have an incredibly sophisticated critique of the US health care system. And that critique has made them discerning consumers of US health care. And so it’s not simply an emotion they carry. It’s a structural analysis they carry that must be addressed. And so if we want to talk about what it takes to increase covid vaccination acceptance among specifically black folks in this country, then we have to talk about what it takes to actually address their structural concerns. And health care providers like myself and others have been working to do that. And as we do throughout the covid Vaccines Emergency Use authorization, we have only seen an increase in increase in COBRA vaccination among black populations such that now upwards of 80 percent and more of black folks say they are interested in getting the Koven vaccine as soon as they are eligible. Just yesterday, everyone 16 and above became eligible. And that is truly a victory, right? We only need 80 percent of our general population to be vaccinated to reach herd immunity.

Mildred Solomon So the 80 percent of the African American community in the latest research is saying that they are supportive of vaccination.

Rhea Boyd Yes. And I am they citing the Kaiser Family Foundation? I think there are wonderful reference. They have a vaccine monitor where they do regular polling where they actually oversample underserved groups. So they oversample Latin and Spanish speaking populations and they oversample black folks in this country so that we can better understand their feelings around vaccination and their vaccination rates.

Mildred Solomon So it’s not beliefs and attitudes. It sounds like it’s access. You mentioned structural concerns that we have to address structural concerns. Can you say what those concerns are that may be blocking access?

Rhea Boyd Absolutely. So, again, turning to Kaiser Family Foundation research, which I have to say, I also in full disclosure, I partner Kaiser Family Foundation on one of our covid vaccine information projects specifically targeted towards black communities. But again, turning to the Kaiser Family Foundation to research what they found is that, you know, half of folks who said that they are waiting to see so they’re not that slice of folks in that 10 to 15 percent who say we will definitely never get the covered vaccine among the like a third of Americans who said, you know, we want to wait and see how this vaccine goes before we get it. 50 percent of people were concerned that they couldn’t afford it. That’s when a long time concern about health care consumption among black populations and communities of color who have lower rates of health insurance know bankruptcy related to medical costs is the number one cause of bankruptcy in this country. It is a legitimate concern. And so if we look historically at vaccination rates, we saw that when the US government created the Vaccine for Children’s Program, that in the nineteen nineties MAID vaccinations for children completely free. That then narrowed racial gaps in recommended vaccinations for children in this country. And since 2005, there haven’t been any gaps in vaccination for children, for recommended vaccines like MMR and polio. So I think it just underscores how cost and access to health insurance is a major barrier to people getting a number of preventative services. Vaccines including.

Mildred Solomon What about transportation and locate the location of where we are distributing vaccines, what’s your what’s your take on that?

Rhea Boyd I think there are also concerns that we live in a country that has a health care footprint, like the distribution of our health care services, leaves people out. There are many communities of color, people who live in rural parts of the United States who don’t live proximate primary health care centers where you might access other types of vaccine that are now MAID distribution sites for the covid vaccine. And so if you didn’t live close to primary care health care site before now, you may be you may have an additional barrier to actually getting the covid vaccine. I think the federal government, it seems, has tried to overcome that barrier by partnering with pharmacies, which tend to have a more tend to be more broadly distributed than the rest of our health care system is. And to create these mass vaccination sites in areas that don’t have good access to primary care services, I think that is an attempt to kind of close that gap. But some of the work that I’ve been most inspired by is the mobile work that literally just brings vaccines nearly door to door. I mean, there are examples of people going in housing facilities for the elderly and literally taking the vaccine door to door for people who are indigent or who are homebound. And I think that model where you bring it into somebody’s neighborhood, where you make sure it’s within walking distance, where you make sure if you cannot walk, that we literally come to your door and offer it to you. That’s the level of access people need for something of this of this urgency. And frankly, I think it’s the level of access people will need to primary care services going forward in this country.

Mildred Solomon Thank you. Well, it’s time to open the floor to questions from the audience. So, Isabel, do you want to let us know what kinds of questions you’ve been receiving?

Isabel Bolo So I think one of the dominant things we’ve got a couple of people say they really agree with what you’re saying, Dr. Boyd, it really kind of resonates with just kind of people’s senses of the media narratives. So I think that raises the question if media coverage is kind of really emphasizing this mistrust narrative, particularly for minority communities, in a way that’s not totally parallel to what to what the barriers are, how does one change the media coverage? What would it look like to change the media coverage? And how do people in this space, whether they be academics, practitioners, kind of just people in the community, go about doing that?

Rhea Boyd It’s a great question and something that we’ve been working really hard on, so I have been writing op ed about the topic to try to change a bit of public discourse, to say why are we what is our investment as a society in labeling black folks as a population, as vaccine, hesitant or elevating these narratives about mistrust when we really have access barriers in this country to equal health care services? I think one of the ways I’ve tried to do that is both in lay media that captures broad general audiences and in black media in particular, because when we put these narratives out, it does work in the world, not just for how people see black folks, but how we can come to see our own selves. And so I think it’s really important that we also have internal conversations, honestly, within our own communities and in our own media outlets to say, why do people always focus on trust and what else have we been saying that folks aren’t acknowledging? That’s really critical to us considering getting the covid vaccine or accessing other health care services. I’ll give one example. There’s a piece I wrote in The Crisis, which is the periodical of the NAACP specifically about trust, where I acknowledge that trust is neither necessary nor sufficient to procure any medical service in this country. It’s not a ticket to health care. And so even if black folks were to trust our health care system, that would only mean that we carry an emotion without any guarantee, that that emotion means that we would be served with dignity, that we would be served with equal access, or that we would be served in the ways in which we would like to be. And so by saying that in a black journal for the NAACP, what I’m hoping is, is that in addition to myself, that black folks push back. I’m not hesitant. I have an analysis and the health care system really needs to contend with that.

Mildred Solomon Wow, that was very interesting and it also I also thought about it in relationship to my research on parents, they might say the same thing, that they don’t have stress so much. They have an analysis that she described where there was concern about a lack of research in the public interest. Just I think at the heart of that, Maya, any comment on that? And then we’re going to go to another public with another question from the public audience. But did you want to add anything to that?

Maya Goldenberg I appreciate his thoughts and analysis so much. I think it’s wonderful work being done here. I don’t find the term trust to be as loose and in actionable as as as as Dr. Boyd does. So I think we we agree on on sort of the the situation here. But I I think that the issue of trust isn’t separate from the lack of access, the lack of dignity, the lack of respect. People have very personal relationships to health care providers and even to, in some sense to the system. And without some guarantee of dignified quality care, there wouldn’t be trusted. So I I’m actually trying to imagine that situation where people say, oh, I trust the system, but that doesn’t mean I’m going to get treated with dignity, because if I don’t see how you could have one without the other.

Mildred Solomon Trust me, be a part of the picture, but it’s not sufficient, and it calls out to me that that Dr. Boyd’s comments are asking us to be the system, the health care system in the scientific enterprise, to be trustworthy and to focus on that as much as to focus on some attribute of the of the black community. So very interesting the way these things fit together. OK, Izabel is do we have another question from the audience?

Isabel Bolo So what are the same kind of come several times is concerns about how how we should think about side effects, especially rare side effects, and how we should help those around us think about side effects. So one person’s writing in some kind of a rural area and saying that actually what a lot of people are seeing that’s scary is you see someone get the vaccine and they get a bit sick from that. And then we see in the media recently. Right. Pauses on the use of the vaccine because of our side effects. So how does that interact with kind of what we’re talking about here today? And how can we kind of think through that?

Rhea Boyd I could go first, I would say here, I think transparency is really paramount, so it’s important that people understand all of the wealth of evidence we have that. Tell us about common side effects for the vaccines that are side effects, that are not life threatening, and that we understand the safety protocols that are in place so that we can catch serious, potentially life threatening side effects. And so for that person who recognize that some people who get vaccines might feel a little bit sick on the other side, it’s critical that people understand why that is so, particularly for the Marnay vaccine. That’s Pfizer and Moderna. Those platforms tend to stimulate a really robust immune response. That means your immune system kicks up all of the work that it does to make a memory to the kind of just little segment of that spike protein of the covid virus that it’s exposed to. And so when it’s making that memory, those are the side effects that you feel. You can feel some aches and pains, maybe you have chills, maybe you have headaches. Some people even have fevers and those are short lived. They typically last twenty four to 48 hours. They’re treatable. You can take Tylenol or ibuprofen if those medications are OK for you to take and then they go away. And that protection that you get then because your immune system went through that process then is long lasting. But we also have safety protocols in place to notice when there are side effects that are potentially life threatening. And so I think what really heartened me honestly, to see the CDC and the FDA put the Johnson and Johnson on a pause was to say that we are willing to do that. As you know, the government who has sponsored this entire vaccination program, even when it’s exceedingly rare. Right. They put that pause on when we notice that serious side effect, blood clots after recipients have received the Johnson and Johnson vaccine and there were only six people out of at that point, I think it was six million, six point eight. Five million people have received the Johnson and Johnson vaccine. Like that’s how closely we are watching. Only literally one more than a handful of people had that side effect and nobody else got it for a period of time where we determined who is it safe for and who may not be the ideal candidate for that vaccine. So people should understand that we as a health care system are trying to be incredibly transparent about those side effects so that people can make the right choice for themselves. And these are exactly the questions that you should ask your health care provider before you get any health care service. Make sure you know the side effects. Make sure you know how to treat them and make sure you know how to recognize signs that you could be having one of the exceedingly rare, more dangerous side effects.

Mildred Solomon I wonder what both of you think about the pause on the JMJ vaccine. I mean, we’re going to learn, I think, on Friday whether that’s, you know, whether it’s being reinstated or whether it’s in perhaps reinstated with a warning or perhaps a continued pause. But you’ve just described a risk factor of one in I mean, a risk of one in six million and one one in a million. So is there something skewed about our human notions of risk perception? You know, the the rate of death from an automobile is much higher than one in a million. And yet we’ve decided to use our cars. We don’t stop using our cars because a much higher number of us are killed that way every single day. So what’s your take on this policy? Should we be denying the globe the use of the JMJ, which was going to be such an important source for so many people and places? My idea of a view and then we’ll go to Reha.

Maya Goldenberg I have a view I agree with with Reha that taking a pause to investigate and as some kind of signal is the right thing to do around vaccines, the worst thing you could do is say everything’s fine, don’t worry about it, and then it ends up not being like that. So we’ve already experienced this. The U.S. kind of sent all their AstraZeneca us to Canada. So we’re contending with AstraZeneca right now where there was worries about a blood clot. They seemed rather rare. It was enough for the U.S. because they had enough supply to just send it off. And then we received them in Canada, where our vaccine rollout is not going as well. We are far behind. And it became we we suddenly had to deal with this this vaccine that was sort of considered second rate. We weren’t sure if it was as effective. And people who are sort of in that age group that could that could wait a little longer to get the money. We’re saying maybe I don’t want this, but what I’ve been able to watch is how the Canadian narrative has transformed. So we had to sort of it was it was given to 55 and up. Marnay was for 60 and up. The 55 year olds were largely saying, I think I’ll just wait. The MRN is better now. Meanwhile, there was more investigation being done and we unposted and opened it up to a younger cohort. So now 40 and up as of today can access this vaccine. And the 40 year olds are showing up because we didn’t have that sort of maybe this one, maybe other one. So it shows that a pause doesn’t need to completely damage things. It can certainly slow it down as it did. So this might happen with Jansen, too, but it doesn’t mean that investigating bringing it back is going to ruin the entire thing. And I hope they do that investigation and are very transparent about it, because people can deal with uncertainty and they can understand that new new information will change. Perception will will change a regulatory approval of of a vaccine.

Rhea Boyd I agree with everything I have said, and I would only add to it. You have opened right now is that while it looks like one in a million, when you look at six out of six, upwards of six million, actually, the folks who had those side effects are a very specific slice of that population. All six folks were women and they were relatively young. They were between the ages, I believe, of 18 and 38 or forty eight. So there women of childbearing age. And so that can become concerning. And that kind of narrows the risk then for women who are considering Johnson and Johnson to close it around like one in a hundred thousand is what I’ve been hearing. And so we do as a public have to become really discerning. And I think people are about, you know, risk benefit analyzes. And so right now, I feel like the messaging that’s really helpful from other health care providers is to help people determine the risk benefit for themselves. So if you are a man who are well outside that age range, we haven’t seen a red flag signal that you may be at risk for those same side effects. So I think part of the pause is to help us know who should we say, you know, you should actually think twice about whether this is the right platform for you and who should we say? Actually, we haven’t seen any concerns that somebody of your age group or, you know, who takes the medicines that you take has any risk factor if you receive this vaccine. So hopefully will be able to really just tailor who we recommend it for as a result of the.

Isabel Bolo Yes, I completely agree. For the record, I

Mildred Solomon completely agree with that. I was playing devil’s advocate in a way, because I have heard people make the claim that I voiced. I wanted to give it some space so you could react to it. But I think some of the rationale for waiting was to see that that there were. Additional people, they could watch over several more. Oh, another period of time, about 14 more days, who had already been vaccinated to see what was going to get more cases to be able to see what these patterns really are. OK, Isabel, do we have another question from the group

Isabel Bolo or so one question that keeps coming up several times as people are interested in how we think about social media here. So it feels like vaccination is kind of the case in point where we see kind of mis and disinformation being spread around social media. And just several people have asked in the chat, like, what do we do about that? It seems that people feel a little discouraged about that kind of rampant spread and the feeling of helplessness that we can’t really do anything about it.

Maya Goldenberg I’d like to say first that sometimes people want to say, we want to think about social media as the cause of all these problems around vaccines, but social media is really just a platform for amplifying these concerns and sometimes misinformation and of course, disinformation, too. That’s active, active efforts to to provide wrong information. So when I think about why it is, I say, let me say this differently. We should be asking why people go to social media at all to to get information, because presumably people know that this is not a place for reliable information. Why is it that the CDC website doesn’t answer everyone’s informational needs and they feel the need to look further? It suggests that we’ve got a more complicated situation here and the expert sources are just not providing what people are looking for. So we need to pay attention to what people are looking for. It might be the nuanced accounts of, let’s say, who’s getting blood clots and who isn’t. It might be other factors that are contributing to community or personal concerns around vaccines. But social media is amplifying the situation, making it worse. But that’s not where it’s rooted. It’s rooted in people looking for alternative sources and that’s where they’re finding it.

Mildred Solomon What other reasons might people have to do that? I mean, there’s also isn’t there also a sense of being left behind that might or and and looking for camaraderie and a sense of identity with others who may feel that the economy has left them behind? I don’t know whether what the situation is in Canada, but I think that there’s a growing sense in rural, poor, rural America that the economy has left them behind and that in some important ways, the country has left them behind. And there’s a sense of turning perhaps to other people who also feel that sense of vulnerability. Which is fueling a attraction to social media, where people can share their I don’t know what the right word is for that, but share their concerns and find camaraderie and identity.

Maya Goldenberg I think that’s correct. That certainly was happening before covid around a vaccine hesitancy within mommy groups and and parenting forums where you come for the camaraderie and you leave with far more radicalized views than you started with. And it doesn’t need to be about vaccines. So people find communities, they find people who are like minded and they might end up with more intense views about, let’s say, vaccine refusal than they came with. So that’s that’s a feature. We call it an echo chamber now. It’s a feature of online media landscapes.

Rhea Boyd But only add that while certain people might be looking for alternative sources of information, we also see clear evidence that certain people are being targeted. And that was one of our concerns with black folks. I mean, we saw people posting about misinformation about the COBA vaccines before they were even out on social media sites that are geared toward social justice issues that we’re talking about, prominent cases of police violence, places that attracted large, predominantly black online audiences, and then just sowing the seeds of doubt about vaccines for which there wasn’t widespread information yet for which the CDC had not released the full, you know, and the FDA had not released the clinical trial data. And so when we see that, I also I also want to take to task the social media platforms who don’t do the work that it takes to tamp down those more predatory sources of disinformation, the type of information that is intentionally seeking to mislead people about the covid vaccines. And I honestly think those, when we call them black folks, just mistrustful. We can in some ways then be dismissive of the ways that people are actually being targeted with this information that makes it harder for them to suss out fact from fiction. And so it’s why there have been intentional campaigns like the one that I’m a part of to actually go online, be a part of social media platforms and give people a healthy rabbit hole. You can go down about the Kovik vaccines with information that is vetted, that is given not by experts that you can trust, but that is backed up by evidence that you can and analyze in your own right. I think being more holding these social media platforms to account, I think is really critical for us, not just for the vaccines, but for political misinformation, for all of the forms of misinformation that have now found home on those sites. I think it’s critical for them to be doing more.

Mildred Solomon My view is that these have become what journalism used to be and aspires to be, which is platforms for information. And therefore, we used to have journalism ethics which and protocols where, you know, you didn’t publish things until you did the research to be sure that they were trustworthy. And the platforms don’t see themselves as performing a journalistic or publishing function in our society. I don’t think they see, you know, they’re not drawing their leadership is not drawing parallels the way I am to journalism ethics or publishing ethics where truth actually matters and basic research to figure out the trustworthiness of the information they’re about to disseminate. So they’re not congenial to that necessarily, although they have been the major the major companies have been building their own methods for trying to take down inaccurate information. How do you how did the two of you answer the the the retort that, you know, it’s a violation of freedom of speech to take down these sites, which I think is not defensible. But I’d like to hear how you how you handle that protest. The protests that this is you’re violating my my my free rights to to speak.

Rhea Boyd Really? I could go first one, I would just say we have to be really transparent about the business model of these platforms and why they may publicly report that they’re not journalistic entities. They make their money off of selling ads on the off chance or the very predictable chance that they can influence people’s behaviors on what they send them ads around and on the ways that they use influence or platforms to basically suggest things to you when you don’t even know that that person is clacking into the Internet as a job and not just sharing some of their hobbies at home. So because these platforms know that they are sites for influencing, they have a responsibility to be they have a responsibility to be accountable to all of us as users of those websites to ensure that we are not being influenced in ways that are known to be harmful to people, particularly around what happened during our elections in this country and particularly around what’s happening with the covid vaccines. I think for them to hide behind the idea that they are the pillars of freedom of speech is laughable. In a sense, it’s it’s outside the actual constraints of what freedom of speech really is protecting, which is not their fiscal right to make an enormous profit off of influencing all of us. And I think it’s more broader completion. We sometimes see in society about like a freedom of speech, which means you can just say anything anywhere at any time, regardless of how it harms people. That’s not true. And when we know that there are things that are happening on your side that you have control over, you know, they need to have more accountability. And I hope our government, honestly, instead of asking them for accountability, I hope our government regulates that accountability because they don’t have a financial incentive in actually doing this work, which is why they’re not doing it. From my perspective.

Mildred Solomon My anything to add

Maya Goldenberg is there’s really nothing more to that was absolutely right that this is a business model that sort of hides behind freedom of speech claims. But there’s freedom of speech has never been absolute. It is always rights are always positioned against a competing rights such as the harms that come from from speech that that that can target and misinform and even harm people. So that’s not a very compelling case at all.

Mildred Solomon You know, one of the things that one of my takeaways has been how important it is for different kinds of targeting, different reasons that people are hesitant and different problems of access, what and looking at what the specific needs are very local communities are. I was struck, for example, by an effort by. Somebody whose last name is Choung, I’m just forgetting his first name, who is an evangelical minister who wanted to do in his community similar things to what you’ve been doing in the black community. He was concerned that there are 40 million white evangelicals in the United States and they are roughly split between wanting to get a vaccine and start saying that they’re not interested in a vaccine. Almost forty five percent of white evangelicals in the United States are have, according to several surveys, are saying that they’re either wait and see or oppose vaccination. And Chong became very concerned about this. And he crafted a really respectful program, not dissimilar in some of its key features from the conversation that you created, Rhia, where he researched what their questions were and took the questions very, very seriously and answered them inside of the religious frame. That was a part of their beliefs in their community. And he tried to show he tried to stop binary thinking, the notion that you can hold beliefs that are true to your religion and get vaccinated. And they answered their questions inside their own terms. And apparently this has become quite an important resource in that community. So my takeaway is that we need many, many, many very robust efforts that are based on an understanding of the particular situation, whether it’s beliefs or access or structural concerns, but the particulars of what a community is facing and then craft something that listens to what they care about. That’s one of Maia’s lessons to listen to what those what the the parents were worrying about. Take the worries legitimately. Don’t pooh-pooh them and then try to answer them in a way that people can think in a less binary way. In other words, people tend to think, well, if I’m a if I believe in a natural way of living in an organic approach, then I shouldn’t give my baby, you know, a vaccination. You can be both or, you know, have those attitudes and vaccinate. You can be have evangelical religious beliefs and vaccinate. You can be on the political right and see ways to to do this or on the political left. So nonbinding rethinking growing out of real careful, careful listening and respect for the actual questions and concerns that people have. Are we doing that in the United States and also in Canada? Are we doing that in the US? Yeah, you’re very involved with what’s going on at the federal level. Do you do you see resources and talent being put to designing specific campaigns targeted to specific communities?

Rhea Boyd Absolutely, and I think it’s a reflection not just of trying to bring people out of non binary thinking, I think it’s also a way that we that we reflect the structural analysis we have of why people land on these false beliefs about vaccines. Like one of the structural analysis for black folks is that you’re targeted with misinformation, that you haven’t had equal access to information about the vaccines, about vaccines in general leading up into the covid vaccines. And so information campaigns that specifically address your concerns are like a solution. I think similarly for Evangelical’s, a structural analysis of why white evangelicals might not understand, might have reticence to get the covid vaccines or might want to wait and see, I think should also question the type of information universe in which they live and what other things do they believe that might not be based in reality or might not be linked to the truth? And how can you help people better be discerning of the information that they receive and and then respond to concerns that arise from kind of this alternate information base that some people can come from, both because of their own choice to participate in and and because of the ways that I think those are populations that are also targeted with disinformation around science and around our political process in ways that we should be more transparent about with that population and in efforts that seek to address their needs. I’ll just say the other population that we are intensely focused on through our efforts at the conversation is also Spanish speaking populations and actually have the lowest access to the Kovik vaccines in our country right now. And I think it’s partly because of the information gap that has existed, because there haven’t been Spanish speaking resources available at a national level to answer some of these common concerns.

Mildred Solomon And so there’s an effort at the federal level to help design local programs and local messages and messengers, local messengers.

Rhea Boyd Absolutely sorry, I was talking about our effort, which is a national effort, but there is a one hundred percent an effort by the Biden administration and the White House covid task force to focus specifically on populations who have been disproportionately burdened by the pandemic. Some of that work is led by Dr. Marcella Smith, who is doing the equity work of the task force to ensure that the information, access and the access to the covid vaccines is being equitably distributed throughout the population and groups like our group. At the conversation between us about us, we are working on just kind of adding to and complementing that work that is coming from the federal government as well.

Mildred Solomon Wonderful. Both we’re we’re almost out of time, but both Canada and the United States have large indigenous populations, Native American populations and native peoples and. I wonder if either of you may be aware of vaccine uptake in those communities and efforts to support access to vaccination for those communities.

Maya Goldenberg I can speak to the Canadian situation, First Nations people have been prioritized in terms of vaccine access. So right now, 18 and up, anyone who identifies as indigenous in Canada can access the vaccine. And that’s that’s that age bracket has not been hit by it by the rest of the population. And where it’s gone well is when they when local health authorities partner with indigenous leaders and communities and they can actually bring services by the people to the people. That’s where it goes. Well, there’s a lot of reluctance around health care for for First Nations Canadians. So we’ve heard of its successes in I know in the province of Alberta, where they’ve set up some vaccine clinics that are run by First Nations people and they can bring in ceremony and practices. And importantly, they’ve got their local ambassadors, the people that can speak about vaccines. And they are trusted sources because they are part of these communities and they are trusted because they share their values and their histories.

Mildred Solomon Thank you. It is two o’clock, I think the zoo might disappear us, but I’m going to try for a last question, which is what last message you would like to send especially. There are many health care providers, I think, in this audience as well. And so if there’s anything that health systems can do, leave us with a parting thought, Maya, and then Reia

Maya Goldenberg to the health care providers. It has been such such a difficult year and this is a people are stretched beyond capacity. Now isn’t the time to get frustrated though. People if you encounter people, this is true for anyone. If you encounter people that are more hesitant about vaccines, this is the time to speak patiently and openly and be responsive to questions and concerns rather than get frustrated and certainly don’t throw facts that people, that gets people, that gets people’s backs up.

Rhea Boyd And I would say if you have questions about the covid vaccines and you want to learn more, you can visit our website. The conversation between us, about us, between us, about us, dot org. That website was created by black health care workers for black populations. We will have a Spanish speaking platform that will launch in May. So tune back if you want to hear from Latin providers speaking to Latino communities about the covid vaccines. All of our videos are free to download and free to use. So if you also want to post them to your social media or your own website, take them. They are yours.

Mildred Solomon Well, join me in thanking Dr. Boyd and Dr. Goldenberg for a really great hour and for all the work you’ve been doing in your own research and in your own public programing. Thank you for helping our societies manage this pandemic. Much obliged.

Rhea Boyd Thanks for having me.

Isabel Bolo So thank you so much, everyone, for joining. I just put the link that Dr. Boyd mentioned into the chat. If you’d like to access that, this recording will be available in the Hastings Center’s website later today. And thank you so much for taking your day to spend with us by.