On December 26 in Wisconsin, a box of 570 doses of Moderna’s COVID-19 vaccine was found sitting out at room temperature. Five days later, Steven Brandenburg was arrested for intentionally removing the vaccine from the refrigerator for 12-hour chunks of time, prosecutors said, with the goal of making the vials' contents useless.
What many find alarming about Brandenburg's actions is his job: He is a pharmacist.
Despite his medical and science background and profession, according to court documents, Brandenburg believed incorrectly that the vaccine could alter human DNA. He later admitted that he purposely destroyed the vaccines because of his belief that the vaccine would harm people, VICE News reported.
While Brandenburg’s story is an extreme example, it points at a larger and more worrying trend: vaccine skepticism among medical professionals. All over the country, reports have emerged that some healthcare workers have been refusing or deferring the vaccine when it's offered to them.
The L.A. Times reported in December that at St. Elizabeth Community Hospital in Tehama County, fewer than half of the 700 people who worked there were willing to receive the vaccine when it first became available. Jeremy Boal, the chief clinical officer of the Mount Sinai Health System in New York City, told Gothamist that the number of high-priority staff members accepting the vaccine ranged from 25 percent at one medical facility to 65 percent at another.
A recent survey from the Kaiser Family Foundation found that 29 percent of healthcare workers were “vaccine hesitant.” The percentage in the general population was around 27 percent. And a survey from October from the American Nurses Foundation found that about two-thirds of the nurses polled were unsure about receiving the vaccine, or said they would not voluntarily get it.
The reasons are varied: Some say they distrust the speed at which the vaccine was developed and approved; some are wary of being "guinea pigs," as the first outside clinical trials to receive the vaccine; and others express commonly-held conspiracy theories about the vaccine—that it can mutate human DNA or cause COVID infections to become worse, for example
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COVID skepticism among healthcare workers is also playing out in a very public way on social media. Accounts with names like The Holistic Nurse are proclaiming that they won’t get vaccinated, and strongly implying their followers should do the same. It’s a uniquely risky situation, where people claiming medical expertise are working to undermine trust in a vaccine, just as it becomes clear that a majority of the population worldwide will need to get it in order to keep us all safe.
COVID denialism and vaccine skepticism among healthcare professionals might seem especially unusual, or illogical. But it points to how we're all vulnerable to misinformation and conspiracy-like thinking, independent of our background, experiences, or even our professions. We need to better understand the sources of mistrust and vaccine hesitancy in healthcare workers—rather than assuming they should know better.
Anti-vaccine healthcare workers are unfortunate proof that medical professionals aren’t any more immune to bad ideas than the rest of us, David Gorski said. He’s a surgical oncologist and researcher at Wayne State University; he’s also the author of a blog, Respectful Insolence, and the managing editor of another, Science-Based Medicine; both sites routinely take aim at pseudo-science, medical misinformation, and the anti-vaccine movement.
“Physicians are human beings like any other,” Gorski told VICE News. “We are just as prone to the errors in thought to which all humans are prone, including logical fallacies, confirmation bias, confusing correlation with causation, and the like. Similarly, we as a group are just as prone to letting political, ideological, and/or religious beliefs influence their actions as anyone else is. I wish it were otherwise, but it clearly isn’t.”
At first glance, it can seem as though we’ve been here before, during the world’s last global pandemic. In 1918, as a vicious and deadly flu began to spread, a debate about vaccines erupted among the world’s medical professionals.
“They started making vaccines pretty early on—as soon as people had admitted there was an actual pandemic—but most doctors in the world thought they were dealing with a bacterial disease,” said Laura Spinney. She’s a science journalist and the author of Pale Rider, a renowned book about the 1918 pandemic. “A virus was a pretty new concept and it took them a while to realize that’s what they were dealing with.”
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The flu vaccines being produced addressed some of the secondary, bacterial infections that resulted from the flu, but did not cure the flu itself, leading to extremely mixed results from the vaccines being produced. “It’s similar to the confusion we see today about what vaccines work in what doses,” Spinney said. “Some of those problems are perennial to science in a mass emergency situation.”
As those mixed results of the vaccines became clear, Spinney said, a debate quickly emerged about whether the vaccines were useful, and if they should be rolled out in larger populations. “The American Medical Association came out publicly against the vaccines that were being produced and said ‘Don’t use these vaccines.’”
“A pandemic is as social and political as it is biological.”
But that’s where the similarities end, and Spinney cautioned against trying to interpret too much about the current wave of anti-vax healthcare workers by looking at the past. “It was a very different era,” she said. There’s not much evidence of healthcare workers spreading misinformation, though we also didn’t have the same access to individual people’s every thought, as social media has provided.
But one of the critical lessons of the last pandemic, Spinney said, is how non-medical factors influence how a deadly disease is discussed or addressed. “A pandemic is as social and political as it is biological.”
In more recent years, healthcare workers spreading vaccine misinformation isn’t exactly new, said Jessica Malaty Rivera. She’s an infectious disease epidemiologist and science communicator; among other things, she’s currently the science communication lead at the COVID Tracking Project at The Atlantic.
Rivera has worked on vaccine education and advocacy for years, and has seen “a good amount of science-denying doctors and nurses” with social media platforms. “Now it's spread into COVID misinformation, largely because of how politicized it’s become.”
On social media, the medical misinformation influencers all have “a few topics they all subscribe to,” said Rivera. They promote hydroxychloroquine, a debunked coronavirus treatment, and argue against any broad lockdown measures, saying only the elderly and immune-compromised people, an idea that’s proven fatally ineffective. They claim that data is skewed, that hospitals are profiting off of COVID deaths, that they’re miscalculating by inflating the numbers in order to get more money,” Rivera said, reeling off the false arguments she sees being promoted every single day. “They are saying that deaths from other situations are being described as COVID and saying there’s an increase in things like suicide and those deaths are being called covid deaths. They are also very much against masks. There’s an offensive term they used called ‘medical autonomy,’ as though tyranny is on the other end.”
One organization, America's Frontline Doctors—which held a press conference in July riddled with misinformation on hydroxychloroquine and the efficacy of masks—has been spreading inaccurate claims about the vaccines with particular vigor.
MedPageToday noted that the majority of the physicians who are part of this group have no experience treating patients with COVID-19. Yet that didn’t stop various members from sharing on social media that they believe the vaccine to be dangerous for various reasons, or that it is not a "vaccine" at all.
“The first point that we want to bring out is the fact that this is an experimental vaccine, and not a vaccine at this point," said Simone Gold, the doctor who founded America's Frontline Doctors in a video on Twitter. Another member of the group, James Todaro, tweeted, "For anyone considering the Pfizer vaccine, know that you are getting an EXPERIMENTAL vaccine." The group also published a white paper expanding on their false concerns about the vaccine. (Todaro has a medical degree, but is not a practicing physician; according to MedPage Today, he was an ophthalmologist in Michigan, but his “educational limited” medical license expired in 2019. He’s part of the management group of an investment fund focused on Bitcoin; on the company’s website, his bio reads, “Joseph previously withdrew from medical school at Wayne State University to focus full time on blockchain.”)
Other seeming medical professionals have made similar, widely shared claims on social media, to disastrous effect; one of the biggest social media sensations of the pandemic has been the pseudo-documentary Plandemic, which promoted an addled but highly toxic mixture of lies about the pandemic’s origins and how it should be treated.
“This has been one of the more harmful aspects of the pandemic for a variety of reasons,” Angela Rasmussen told VICE News. She’s a virologist and non-resident affiliate at the Georgetown Center for Global Health Science and Security who also frequently looks at viral misinformation. “It not only contributes to vaccine hesitancy but it’s underlied all the bad public health decisions people are making individually and at a policy level.”
The effect of the Trump Administration and the president himself spreading conspiracy theories about COVID-19, along with people like medical professionals who appear at first glance to be trustworthy, means that “ultimately, people don’t know what to believe,” Rasmussen said. “When it comes to public health we need to be getting clear consistent messages out to people about how they can protect themselves and their families. I never thought I’d be living in a time that wearing a mask is thought of as a political statement or someone like Tony Fauci is a hugely polarizing figure. It’s the wildest sort of public discussion about a public health crisis that I’ve ever seen.”
When doctors, nurses, or other frontline workers disseminate or harbor misinformation about COVID-19 or the vaccines, one of the first questions it can provoke is: Why? That's the sentiment of one nurse on TikTok, Rebecca, who said she worked at a “prestigious hospital in a big city."
“My co-workers don’t wear masks outside the hospital,” she said in a video from December. “And they don’t want to get the vaccine…I don’t think they’re bad people. And I don’t think they’re stupid. Can anybody tell me why this is happening?” The only way she could describe the feeling was “incongruous and out of body."
“It's taken me off guard," LaRay Brown, the CEO of One Brooklyn Health, told Gothamist. "I would've thought with so many people having seen, having experienced, lived through, cared for patients with COVID that we would've had a much more enthusiastic response initially—and it hasn't been."
Back in 1910, the physician William Osler expressed bewilderment with anti-vaccination doctors. “I do not see how anyone who has gone through epidemics as I have, or who is familiar with the history of the subject, and who has any capacity left for clear judgment, can doubt its value,” he said in a lecture to students at the University of Edinburgh, later published as Man’s Redemption of Man.
The assumption here is that seeing the effects of an illness first hand, would stop someone from refusing the vaccine or refuting evidence about COVID-19. In some past experiments, this has even proven to be an effective anti-vaccination intervention. One study from 2015 found that people showed pictures of children with severe side effects of measles, mumps, or rubella were more likely to support the MMR vaccine.
With healthcare professionals working during the pandemic, they're arguably closer than the general population to COVID-19 patients—seeing it all, front and center. So the question remains: “Why would people work in a science based field, who see covid all around them, and see the consequences, still act this way?" as the nurse on TikTok said.
But this line of questioning makes some incorrect assumptions about the ways that people make decisions and form beliefs about vaccinations. We continue to think about vaccine decision-making as a lack of information, said Jennifer Reich, a sociologist at the University of Colorado Denver and author of Calling the Shots: Why Parents Reject Vaccines. “It’s easy to believe that if people have access to the correct information, they'll make the correct decision," she said.
Reich has found in nearly a decade of research that decision-making about vaccines is based on more nebulous and heterogeneous influences, like emotions, values, intuition, culture, traditions, family, trust in the government, and the community you’re a part of. (Among vaccine-hesitant healthcare workers who are people of color, there are other factors. Black Americans have higher rates of vaccine hesitancy overall, because of the long history in this country of medical experimentation and exploitation against Black people.)
Matthew Hornsey's research, a professor in management at the School of Business at the University of Queensland, has found that the biggest predictor of whether people have vaccine-hesitant views is the extent to which they are prepared to believe conspiracy theories—not their jobs.
“Beliefs, by definition, do not need to be externally validated. It is what people believe to be true. It's personal to them.”
In one study of 5,323 people in 24 countries, Hornesy and his colleagues didn’t find a significant association between socioeconomic status or educational level and people’s attitudes about vaccines. The better predictors, alongside a propensity for conspiratorial thinking, were those who more easily thought their individual freedoms were being violated, those who had a strong individualistic worldview, and those who were sensitive to needles or blood.
“It may look irrational to have people who are incredibly knowledgeable about disease reject something that sounds like a miracle,” Reich said. “But it's only really illogical if you assume that information is what drives decision making.”
Panayiota Kendeou, a professor of educational psychology at the University of Minnesota, said there’s a distinction that we often fail to recognize between beliefs and knowledge. Even if healthcare workers have access to the facts about a vaccine’s risks and benefits, when something enters the domain of belief, the rules change.
“From a psychology point of view, we perceive knowledge as information that is externally validated,” Kendeou said. “You can say whether it is correct or incorrect. Beliefs, by definition, do not need to be externally validated. It is what people believe to be true. It's personal to them.”
There's a need to understand how we are all—including healthcare workers—susceptible to conspiratorial ideas, according to Joseph Pierre, a professor of psychiatry at the David Geffen School of Medicine at UCLA.
While individual personality traits and demographic factors are still relevant, the susceptibility to such beliefs overall can be understood instead through two more universal factors: mistrust and access and vulnerability to misinformation. He recently published a paper on this theory, which he called the “two-component socio-epistemic model” of conspiracy theory beliefs.
When it comes to mistrust, people who work in healthcare settings may have been exposed to the aggressive marketing of pharmaceutical products, or been part of movements by medical students and residents that pushed back against such promotions, like No Free Lunch, Reich said.
The vaccine review process was often politicized in the fall of 2020, and Donald Trump has said he could overrule scientists when it came to authorizing vaccines—all of which didn’t help with trust.
“‘Operation Warp Speed’ was a name that seemed to prioritize speed over safety,” wrote Stephanie Lee in BuzzFeed News. There’s an attitude amongst some healthcare workers, Lee found, that by being first in line to receive the vaccine, they are acting as “guinea pigs,” to risks. This echoes what was found in the recent Kaiser survey: people said that they didn’t trust the government when it came to vaccine safety, or that politics had somehow interfered with the authorization process.
“A healthcare worker might believe in germ theory and even see the effects of COVID firsthand, but still have deep-seated mistrust of the pharmaceutical industry or of vaccines more generally,” Pierre said.
It’s tempting to think that healthcare workers are surrounded by pro-vaccine evidence in their daily lives, that may not be the case either. “Vaccines are designed to make something not happen in the long-term,” Hornesy said. “No one can see what does not happen. But taking a vaccine carries a very small risk that there would be a bad reaction, and presumably nurses do see those. So, just like for the general population, there’s an asymmetry there. The vast success of vaccines is invisible, but the one-in-a-million failures are in your face.”
Mistrust and misinformation can influence and bolster each other, Pierre said. If a person starts to feel mistrust, it can provoke them to seek out more misinformation, thereby heightening their distrust.
“Misinformation travels faster and more widely online than factual information and peddling misinformation is a for-profit industry,” Pierre said. “So, regardless of education or career choice, people can easily come to believe in misinformation that’s “out there” in the world.”
From talking with parents, pediatricians, naturopaths, or chiropractors, Reich has also found that vaccines have come to be viewed as a consumer product that can help support or optimize health—but one that is up to an individual to decide if they want or not.
“That sort of cultural logic makes sense because over the last several decades, we’ve spent a lot of energy talking about disease avoidance as a process of personal behavior,” she said. There are echoes of this in all areas of health: When someone gets cancer, we ask about their lifestyle history. In addressing obesity, there's often a focus on individual choices, rather than environmental pressures. We have apps and technology to track our blood pressure, our step, or our calories, with the underlying assumption that an individual can entirely manage their personal health.
“What I find in listening to parents is that they've taken this logic to heart," Reich said. "Vaccines can become something they're supposed to be skeptical of as a consumer and make informed decisions as an individual.”
This means that vaccine decision-making can come down to an individual person’s notion of their own risk rather than a consideration of public health and duty. In other words, how much they personally fear getting infected with COVID compared to dealing with potential side effects from the vaccine. “Those are really emotionally driven and subjective processes,” Reich said.
When people evaluate risk when it comes to medications, they can often believe that less is safer, Reich said—a concept called therapeutic nihilism. (This is not true for many medications, like insulin for example—if you have diabetes, taking less insulin is not safer.)
“The challenge with the moment we're in, though, is that our usual sense of ‘waiting and seeing is the more cautious perspective’ may not be accurate during a pandemic," Reich said. Delaying or deferring the vaccine could keep levels of community spread high, healthcare systems overwhelmed, and people and businesses out of work.
Reich said that she doesn't think we should conclude that all healthcare worker vaccine hesitancy is irrational or conspiratorial. "I think these are really hard decisions,” she said.
All of the available information points to the vaccines being very safe. The speed at which the vaccine was developed is remarkable—but its development was built upon decades of basic research around messenger RNAs. The vaccine can come with side effects, but those are typically symptoms that indicate that the immune system is responding as it's supposed to.
All medications come with a risk of allergic reactions, and the vaccine is no exception. The most up-to-date rate of anaphylaxis cases is around 5.5 per 1 million vaccine doses given, according to the CDC—which has not changed their recommendations for who should be vaccinated. To compare, 10 percent of people report having an allergic reaction to penicillin—yet penicillin remains a critical and important medicine.
Still, both the Moderna and Pfizer vaccines are under emergency authorization and using a technology that’s never been used in healthy people for a vaccine platform before. Rather than dismissing everyone's concerns, Reich said, “We need to be actively listening to people's concerns, their potential fears, arguments, acknowledging those concerns and try to elicit a positive response,” Kendeou agreed.
It's important we do so because there may be a connection between a healthcare worker's personal attitudes about vaccines, and their recommendations to a patient, or how they talk about risks and benefits to patients. In France, studies have suggested such a link.
One of the best predictors of which parents don't vaccinate their kids is how many people they know who also don't vaccinate their kids. “We know that vaccine refusal clusters,” Reich said.
When we make decisions, we tend to look toward people who share our values, or those who we have similarities with. Widespread vaccine hesitancy might impact other healthcare workers who see their peers expressing vaccine hesitancy or denial. The best-case scenario is for government agencies to confront mistrust with transparency in the monitoring of the vaccine's safety and effectiveness, Reich said, and continue to make such data public.
The good news is that Reich thinks that over time, some of the initial hesitancy we're observing will dissipate. Hornesy agreed, and thinks that cases of “radical activism,” like the Wisconsin pharmacist's destroying vaccine samples, will be rare.
“I’m also prepared to bet that the initial hesitation among healthcare workers will start to melt away once more and more people they know take the vaccine,” he said. “As with any health measure, people have a tendency to look around to see what others are doing. Once something becomes normative, it has a gravitational pull, and psychologically it becomes harder and harder to hold out.”
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