Politics

How Vaccine Hesitancy Turned Into Vaccine Hostility

A sign featuring a U.S. flag and reading "Stop Forced Vaccine. Freedom."
Anti-vaccine rallygoers hold signs outside of Houston Methodist Hospital in Houston on June 26. Mark Felix/AFP via Getty Images

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A while back, Dr. Michelle Fiscus, the top vaccine official at the Tennessee Department of Health, sent out a memo telling state health providers who offer COVID vaccines that they were legally allowed to give shots to some minors without their parents’ consent. GOP lawmakers were not thrilled with this legal interpretation. The Health Department commissioner tried to explain to state Republicans why this rule and memo were really no big deal—but this information did not matter. On July 12, Fiscus was fired. She’d long expressed frustration with the way state politicians were stymying her work—dictating what she could say and even which vaccines she could distribute—but it hadn’t previously escalated to this point. And Fiscus isn’t the only public health official to get burned by conservative messaging on vaccines, masks, and social distancing. Having to fight so hard to protect the public, to get them accurate information, has had consequences.

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Dan Diamond, the national health reporter at the Washington Post, has been reporting on these dynamics for months. Back in March, he came on What Next to talk about vaccine resistance among Republican voters; many of the people he spoke with back then were skeptical of shots but still fearful of getting sick. But public opinion has hardened in recent months, from hesitancy to full-blown culture war. It’s been on full display on Megyn Kelly’s podcast, and at last week’s Conservative Political Action Conference, where vaccine hostility became an applause line for far-right Colorado Rep. Lauren Boebert. On Tuesday’s episode of What Next, I spoke with Diamond about how vaccine hesitancy curdled into vaccine hostility—and how that’s affecting the national campaign to get shots in arms. Our conversation has been edited and condensed for clarity.

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Dan Diamond: There has been an unfortunate band of usual suspects, whether it’s Rep. Marjorie Taylor Greene or Rep. Madison Cawthorn—these newer congress members on the right who’ve cloaked themselves in Trump’s shadow. They’ve gone after President Joe Biden in new and aggressive ways. They see political gain in this. They can get headlines. They can annoy the right people.

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There is an entire generation of older Republicans who identify closely with the health care industry, which has donated quite a bit to their party, especially through the drug industry. There are Republicans who spent billions of dollars in congressional funding after 9/11 into emergency responses. So there’s this strata of the GOP that cares deeply about vaccination, but some officials are biting their tongues because they’re sensing that their base may be going in a different direction.

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Mary Harris: I’m struck by the similarities between what’s happening now in terms of vaccine hesitancy and misinformation and what happened in November when it came to election misinformation. We’re seeing these individual government workers take the heat for carrying out straightforward public health campaigns. The way Dr. Fiscus caught so much heat and was terminated for what she was doing in Tennessee—that reminds me a lot of election workers who ended up bearing the brunt of all of the complaints that somehow the election was unfair. But then there’s also something else, which is the fact that so much misinformation about vaccines is coming from very few, very loud places, like One America News Network or Facebook, where just 12 people are spreading the vast amount of misinformation about vaccines that’s going around the Internet. I wonder what you think about that similarity and if you see it, too.

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I completely see it. I think it’s an absolutely accurate comparison. There was a Politico piece by Zach Montellaro, who looked at election issues and all the election workers who had tried to protect the election results last year—they’ve now become targets of conspiracymongers. Some of these election workers have said, Forget it, I’m getting out of this line of work, it’s not worth it to me. It reminded me so much of what is happening in public health, whether it’s officials being fired by lawmakers who oppose what they’re trying to do, or folks on the ground harassing those public health officials. It is a similar playbook.

There’s a connection between some of the people questioning the election and the people questioning the coronavirus response: I think so much of this rests on Donald Trump, not just what he’s doing, but regarding the lawmakers trying to court his support. There’s a Missouri congressman named Jason Smith who’s been in the House of Representatives about eight years. He made news this past weekend by alleging on Twitter that Joe Biden’s coronavirus response team was going door to door like the KGB, knocking down doors, and forcing people to get vaccinated. I mean, it’s not true. He probably knows it’s not true. But this congressman is making this claim at the same time his district in Missouri is experiencing a severe COVID uptick, at a moment most of his population is not vaccinated. And Smith has his eye on higher office. He’s likely going to run for Senate. He recently met with Donald Trump, trying to get his endorsement. These are lawmakers who see political gain in questioning the coronavirus response. And the longer that Biden owns the response, the more these lawmakers are seeing an opportunity to distance themselves from what the government is doing, even if it means running down the public health benefit for the people they purportedly represent.

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As we speak, the Delta variant is spreading around the country, scaring a lot of public health experts who are calling it a crisis of the unvaccinated. Is there any evidence that this surge in infections is affecting how people feel about the vaccines?

I think it’s too early to know that for sure. It certainly is raising questions. There are increasing reports of breakthrough cases. The fear from the White House is that we are getting into a moment when the Delta variant is going to spread really quickly and there are still 100 million–plus people who haven’t been vaccinated at all. That’s a lot of people who could be at risk of serious complications if COVID barrels through them. And we’re also in a season when we can do a lot of things outside during the summertime. Where are we going to be in the fall, in the winter, if schools come back? We’ll be doing more things inside. How do we untangle all these factors that we didn’t necessarily have to deal with last year when so much of the country was shut down?

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Biden threw a party on July 4 celebrating all the progress against the vaccine. Leading up to that, we were asked the White House, how do you make sure that we are actually at a place where we can be celebrating the nation’s progress on the vaccine and fighting the coronavirus? The Biden administration has a story it wants to tell: that it came into office, that it corrected the vaccine effort, that 150 million–plus Americans have gotten protected, that COVID cases have plunged, which is all true. So there is a degree of political calculation involved with the next public health steps.

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Regarding the similarities between what’s happening now and the back-and-forth over the election and the information networks, it doesn’t feel like the Biden administration has learned from what happened last time.

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What the White House has done again and again is walk up to a line but refuse to cross it. This White House is very worried that the more it is perceived as doing, the more political resistance it will spark. It is a difficult line to walk in this country that was so politicized and divided even before the pandemic.

Three months ago, I wrote a story about takeaways from Republican focus groups and holdouts who didn’t want the vaccine. The lines were like: Stop using Tony Fauci to sell us the vaccine. Don’t talk about booster shots. They didn’t believe that Fauci was an effective messenger for them—he’d been villainized at that point. And yet here we are, months later, and the White House is still pursuing a lot of the same tactics that it’s used since coming into office. So the White House has yet to figure out how to thread all these tricky needles.

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Because different parts of the country are having different reactions to the Delta variant, there seems to be an “information mismatch” emerging, one that’s not dissimilar to the kind of confusion many people felt a year ago under President Donald Trump.

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I talked to a physician named Kavita Patel who worked in the Obama administration and is now at Brookings. She pointed out that during the Trump era, there were messages that were constantly misaligned, whether it was the Centers for Disease Control and Prevention wanting to say something and the White House coming out and saying something totally different, or Trump himself coming up with some public health message that didn’t match with the facts on, say, hydroxychloroquine or masks. We are now in a moment where local governments may be increasingly pushing mask mandates, like we see in Los Angeles County, or at least encouraging the wearing of masks again. The CDC, meanwhile, has drawn a line that we don’t need masks if we’re vaccinated. It’s creating messaging mismatches. That’s where these conspiracy theories or simple doubts can spring up, because Americans don’t necessarily know what they should be listening to. They have to go out and figure it out for themselves. That’s not a place where we want to be, especially at this point in the pandemic.

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Whom do you blame for that? Do you think this is inevitable, or do you think the White House should be coordinating more with local governments?

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All of the above? I mean, there’s an element of human error. No matter who’s in the White House, people are going to be exhausted and tired. And there’s almost a reaction to what happened last year: The Trump administration was accused of meddling with the public health response. I should know, because I wrote a lot of stories about interference, about what career government experts were trying to do last year. So this White House has gone very much the other way. It doesn’t want to step on the CDC. That makes it that much harder, though, to align the message, if the White House is just as surprised as people around the country as to what the CDC is coming up with. I think there’s a happy medium that we haven’t been able to reach.

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France took this step that wasn’t quite mandating a vaccine, but the president came out and said, At private businesses, you’re going to be required to have a health passport, which either has a negative COVID test from a certain amount of time before you show it, or proof of vaccination. That’s how you’re going to get to go to a restaurant, to go to a show, to go to a shopping mall. It changed the game there. All of a sudden the health websites were crashing because so many people were trying to get vaccinated. I know it’s a different political environment there, but you can do things to change the game rather than just fiddle at the margins. So I wonder if anyone in the White House is considering other measures that aren’t quite mandates but still could change the game.

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The idea that we would have a pass in the States was kicked around a few months ago. The White House got a barrage of criticism, including from some Democrats. But the White House wasn’t even going to issue its own pass—it was more about setting standards for businesses that might want to do it.

The move in France did rapidly increase vaccinations. It also rapidly increased anti-vaccine rhetoric and action. There have been protests in France since that move. I believe there was a vaccination center that was burned in a case of arson. The policy triggered both a positive response and a negative one. If you look at the percentage of Americans who say they’re not planning to get a shot, it’s still at something around 3 in 10—some have said, “If I’m required to do it, I’ll do it,” but there are plenty who have dug in their heels. I think the White House is really worried about amplifying that by a trigger point.

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Are we watching a real shift in how people feel on vaccination, or have we turned our attention to new people? I wonder if the conservatives you spoke to initially have hardened their opinions.

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They’re all over the map. Some of the folks we spoke to did end up getting vaccinated. They were won over by the arguments of public health or by having longer conversations with their doctors. There was one woman I talked to who was motivated, she said, by Yankee Stadium requiring proof of vaccinations. Clearly, there are people who have changed their minds. At the same time, there’s a lot of evidence that people who believed a certain thing about the vaccine earlier this year still believe it. The Kaiser Family Foundation just had a poll out looking at people who staked out an opinion on the vaccine back in January. Where were they six months later? Overwhelmingly, the people who said they wanted to get a shot got a shot. People who didn’t want to get a shot, many of them still had yet to do it.

Yu did follow up with one person in particular who fascinated me, Republican pollster Frank Luntz, who had very personal reasons for wanting folks to get vaccinated—he’d had a stroke and felt that he was medically compromised. He arranged these focus groups where Chris Christie showed up and tried to persuade people to get vaccinated—and he did convince some people. But what he told you is that we always ask, what will be the last straw? What will be the moment we lose the ability to communicate and cooperate and get things done?

In the case of Frank Luntz, he’s been a fascinating figure for me. He has come to be someone that the Biden White House has relied on. Officials have told me, We know his track record, but for us, he’s been really good. Talk about odd bedfellows: This is bringing Luntz, who helped the messaging effort against the Affordable Care Act, together with a bunch of people who oversaw the Affordable Care Act. It says to me that we are in a serious-enough public health crisis, that these long-running partisan fights don’t matter as much—what matters is getting people the protection they need in the face of a pandemic that’s sweeping the world and is going to come back and bite the U.S. It helps the more we can be ready for the next surge, even if that means teaming up Biden with Frank Luntz and Mitch McConnell with Democrats.

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