Many articles and blog posts arguing for the vaccine-autism link have the trappings of genuine academic research: tables, graphs, citations, and scientific jargon. Some of the authors have credentials such as M.D. or Ph.D. degrees. None of these things is a guarantee of scientific value, as the history of science is full of crackpot theories (e.g., AIDS denialism) that are the heavily-footnoted products of people with letters after their names. But most people will not be able to spot the scientific weaknesses of such work. Outside of academia, few understand concepts such as peer review. Jordynn Jack describes one dubious article that appeared in a non-peer-reviewed publication: “Regardless of the scientific validity of the article, though, the writers perform the writing style quite effectively. It would be difficult for the layperson to distinguish this article from any other scientific research paper, especially if one did not investigate the nature of the journal … or of the scientific response to the article.”
Growing narratives emphasize using primary care physicians as leaders in efforts to promote COVID-19 vaccination among the vaccine hesitant. Critically, however, little is known about vaccine confidence among primary care physicians themselves. The objective of this study was to assess both physician confidence that in general, vaccines are safe, effective, and important, as well as physician confidence in each COVID-19 vaccine in the United States.
We rely on data from a national survey of primary care physicians conducted from May 14-May 25, 2021. We assess the influence of demographic, social, and political factors on physician beliefs that in general, vaccines are safe, effective, and important, as well as physician confidence in the safety of the Moderna, Pfizer, and Johnson & Johnson COVID-19 vaccines.
10.1% of primary care physicians do not agree that, in general, vaccines are safe, 9.3% do not agree they are effective, and 8.3% do not agree they are important. While 68.7% of physicians were ‘very confident’ in the safety of the Moderna vaccine and 72.7% were ‘very confident’ in the safety of the Pfizer vaccine, only 32.1% of physicians were ‘very confident’ in the safety of the Johnson & Johnson COVID-19 vaccine.
A troubling proportion of primary care physicians lack high levels of vaccine confidence. These physicians may not be well positioned to actively promote COVID-19 vaccination even as political and media narratives push physicians to lead this effort. Interventions aimed at improving vaccine confidence among some physicians may be needed so that all physicians can fulfill needed roles as trusted vaccine communicators.
As much as we physicians would like to view ourselves as immune to the effects of ideology, emotion, and belief that doesn’t flow from science and reason, we are not. Indeed, it is hubris on our part to think that we are less susceptible to unreason than anyone else, but that doesn’t stop us from thinking that. Worse still, because we as a group tend to think of ourselves as more reasonable and less susceptible to conspiracy theories, misinformation, and disinformation than the average person, when we do fall for them we tend to fall hard. Worse still, because we as a group tend to be highly intelligent, we tend to be very, very good at motivated reasoning indeed. Specifically, we are very skilled at asymmetrically seeking out evidence and arguments that support our preexisting beliefs and finding flaw in evidence and arguments that challenge those beliefs, all while reassuring ourselves that our training as physicians means that our beliefs about medicine are all strictly based on science.
It’s also difficult not to note that physicians as a group have now long been primed to be more willing to accept magical thinking in the form of “complementary and alternative medicine” (CAM), which is now more commonly referred to as “integrative medicine” or “integrative health” It’s an indoctrination process that over the last 30 years has led to a disturbingly high percentage of physicians accepting the validity of rank quackery, including acupuncture and homeopathy and the creation of expensive infrastructure to practice and “study” magic like homeopathy. This led to some embarrassment for a major academic medical center, the Cleveland Clinic, when its director of integrative medicine publicly went full-on antivax three full years before the pandemic hit.
If I sound pessimistic about the likelihood of reversing these attitudes, it’s because I am, at least in the short term. There’s another aphorism—a somewhat sarcastic one—that disproven treatments don’t really disappear from medicine until the last physicians who used them retire or die. Likely, the same will be true with vaccines and physicians doubting them. We can try to educate existing physicians with better science, and doing so likely won’t be entirely ineffective, but it can only go so far. We need to inculcate medical students with critical thinking skills and the ability to evaluate science, but even that is not enough. Medical students need to be taught to recognize misinformation, conspiracy theories, and disinformation, which is something they aren’t taught at all. (In fairness, neither are most college students, and then only if they seek out such learning.) It is true that medical school is arguably too late for this, but it’s the earliest point in physician education that we as a profession control.
Even more importantly, while I welcome physicians who were blissfully unaware of the problem of pseudoscience, quackery, and the disinformation and conspiracy theories used to support them, I also challenge them to actually try to do something about them. I can understand how, not paying attention before the pandemic, you were shocked to learn that about one in ten of your fellow physicians is vaccine-hesitant or even antivax. What I won’t be able to understand is if, now that you know, you don’t try to do anything about it.