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We are entering what seems to be the third peak of the pandemic, or perhaps it’s the second wave after a double-peaked first wave. In any case, 220,000 people have died of the virus in the US alone, with about 60,000 new cases per day. Worldwide there are almost 400,000 new cases per day, and the curve is still going up. We can’t just extrapolate current trends into the future, because things can change. The pandemic can be somewhat unpredictable. But the data does not reveal any imminent end. We are still very much in the middle of this pandemic, and may not even be over the hump.

As I discussed recently, natural herd immunity is not going to end this, and we don’t want to take that path in any case. There was some hope that aggressive measures, such as social distancing and mask-wearing, might allow the pandemic to wash over us while minimizing the death and disease, but this virus is tenacious. When societies open back up or relax these measures, the pandemic comes right back. That doesn’t mean they don’t work – they flatten the curve, as intended, relieving stress on the medical infrastructure and buying us time.

The world seems ready to end this pandemic and get back to some semblance of what previously passed for normal, but that doesn’t mean we can just pretend it’s over. At this point it seems clear that our best hope is an effective vaccine. Right now there are 11 vaccines in advanced “Phase 3” clinical trials. Six have limited approval, but zero have approval for full use. The first vaccine to get full approval may make it over the finish line by the end of this year, or at least early next year, but it will likely take a full year to get widespread distribution. That is – if everything works out well. This is a tricky virus, with a complicated immune response, and so there are no guarantees.

Given the situation we are collectively in, you would think that the world would be clamoring for a vaccine. Make no mistake – many people and countries are. But given that this is our best hope out of this pandemic hell, it is amazing that large numbers of people are resistant to taking a vaccine when it comes out. A recent Axios poll of Americans found that the percentage of the public “likely to get the first generation COVID-19 vaccine as soon as it is available” is only 39%. This number has also been dropping recently, down from 47% in August.

A recent global survey found:

Of these, 71.5% of participants reported that they would be very or somewhat likely to take a COVID-19 vaccine, and 61.4% reported that they would accept their employer’s recommendation to do so. Differences in acceptance rates ranged from almost 90% (in China) to less than 55% (in Russia). Respondents reporting higher levels of trust in information from government sources were more likely to accept a vaccine and take their employer’s advice to do so.

Further,

In the U.S., 76% of respondents answered positively, 11% were negative, and 13% had no opinion.

Surveys like this can be tricky – how questions are phrased and the options offered can have a huge impact on the answer. A positive response in this survey was “somewhat” or “completely” agree with getting a vaccine, while negative was either complete refusal or hesitancy. It’s hard to predict what percentage of the public will actually get a vaccine once it’s out, but these figures do give us a glimpse. A lot will depend on the specifics of the vaccine, how it is approved, and how it is presented to the public. It also remains to be seen what level of acceptance will be necessary for herd immunity. If it is high, this level of vaccine hesitancy may be critical.

What I think all this points to is the need for any society to attend to its scientific literacy and critical thinking hygiene. We have allowed an anti-vaccine movement to simmer in our midst. We have allowed anti-science and conspiracy mongering sentiments to flourish, and we have allowed “alternative medicine” to take root in our institutions. These all erode the public understanding of science, public critical thinking skills, and trust in the institutions that underlie the scientific enterprise. There is no simple cause or solution to this chronic problem – we have literally written thousands of essays on this topic, and I cannot summarize them all here. I mostly want to point out that something like vulnerability to a deadly pandemic gets added to the list of “what’s the harm” when we talk about tolerance of pseudoscience, especially in medicine.

We also have to confront the fact that we elected a flagrantly anti-science president, who is, as I write this, fighting with and denigrating his own experts on dealing with the pandemic. Further, I first wrote in 2012 that Trump was an “anti-vaccine crank”. At the time I characterized him as a “celebrity” – but now he is the president. He only seems to have changed his tune on vaccines now that he thinks it will save him from his failed management of the pandemic.

Even worse, when the FDA came out with their guidelines on safely approving a COVID-19 vaccine, Trump and the White House pushed back on their guidelines, threatening to overrule them. This was a transparent attempt to politicize the process, rushing it through before election day. The FDA is already balancing safety with an emergency approval process; pushing them to rush further to meet a political timeline was disastrous. Eventually the Trump administration blinked, while the FDA stood firm, and their original recommendations will stand.

But all of this has had a negative effect of public confidence in the approval process. The public already knows that vaccines are being rushed through the scientific process. This is appropriate, as we are in the middle of a deadly pandemic. Everything in medicine is a risk vs. benefit calculation, and we simply cannot take years to approve a vaccine for SARS-CoV-2. But the public needs to also know that every care is being taken, so that the accelerated vaccine development process will be as safe as possible. In fact, in response to perceived government pressure, the pharmaceutical industry has responded with a pledge to not rush the process or to ask for approval before the scientific evidence is ready. The fact that such a pledge was even necessary speaks to the perception that governments are putting their thumbs on the scale.

We need to not only quickly develop a safe and effective vaccine, and then quickly manufacture and distribute this vaccine, we also need to do it in such a way that public confidence in the outcome is high. It will not help us if we push out a vaccine and not enough people agree to get it.

But we are also paying the price for decades of allowing conspiracy theories and anti-science to rot our public perception of and trust in scientific institutions. This is exactly why the scientific community must pay attention to such things. They need to understand and confront pseudoscience, which should be an integral part of academia, along with promoting the public understanding of science. The pandemic is just one of many ways in which the failure to do so can have dire consequences.

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Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.