Vaccine hesitancy: How physicians can help restore trust amid shifting public health guidance

Vaccine hesitancy has reached unprecedented levels in the United States, with declining public trust in health institutions creating significant challenges for primary care physicians. The confusion stems from multiple sources: organizational changes at the CDC, conflicting guidance from different authorities, and a flood of misinformation on social media. Parents and patients are increasingly uncertain about which vaccines to accept and whom to trust for guidance. The landscape has become further complicated by political divisions and questions about the vaccine development and approval process. Meanwhile, physicians on the front lines face the daily challenge of counseling hesitant patients while navigating incomplete or conflicting information themselves. These challenges have prompted medical organizations like the AMA to launch the Vaccine Integrity Project, an independent initiative to provide evidence-based vaccine recommendations. Medical Economics spoke with David Dodd, president and CEO of vaccine developer GeoVax, about these challenges.

(Editor’s note: Transcript has been edited for brevity and clarity.)

Medical Economics: Can you talk about the Vaccine Integrity Project and why you see it as a necessary step?

David Dodd: I think it's an important step because it continues to underscore the importance of having different groups such as the AMA involved in the process of decision-making and guidance related to decisions parents have to make, people have to make, on a daily basis of the utilization of vaccines and what the guidelines should be for those. So, I think it's absolutely critical to have such a program or a project as the Integrity Project.

Medical Economics: The organizers behind the initiative said that the CDC vaccine review process has 'effectively collapsed.' From your perspective as a vaccine developer, are there specific gaps or failures that you've observed in the CDC's current approach?

Dodd: I would not agree that it has effectively collapsed. I think certainly as you see changes being made to the process, it's creating uncertainty, and it has resulted in confusion. And because of that, it ultimately has an impact on timelines of being able to progress and bring forward new vaccines or new uses of vaccines. All of that creates uncertainty, it creates confusion, and on a practical matter, the bottom line is that we're seeing almost unprecedented declines in acceptance of vaccines among the public, either people who are doing this as an individual or their caregivers, their parents, they may be caring for their elderly loved ones or relatives. But for all of that, you have this uncertainty that is having this impact of people wanting to know just what should we be doing and whom should we trust. There's been an unprecedented decline in the trust of what has been coming out of what has historically been the public health sector, where we had great faith and respect and regard. There's just a lot of questioning of that.

From a development standpoint, it requires you to relook at how you make decisions. Do you invest in a particular area or not? What do you set as your priorities? We have multiple programs across different indications—COVID-19 for immunocompromised patients, a new vaccine that would be additional to the supply for mpox and smallpox worldwide. We have to make decisions which we place as a priority. So, we try to follow and monitor that. The more that we can have the involvement of entities such as the AMA, and at the same time, I think there'll be engagement with the CDC—and I know that the CDC is also having its own internal organizational challenges, we read about them on a continued basis—but all of this needs to be coming together. I'm an optimist. I think ultimately it'll sort out, and not everybody will be pleased with how it sorts out, but I think we'll have a defined process that is better than what we have as a somewhat ill-defined process currently. Once we have a defined, accepted process that enables us to know how decisions are going to be made, how we interact with that process, things will go forward much more positively and successfully than what we may be experiencing right now.

Medical Economics: Do you see that both systems can coexist effectively—the federal government and the independent review?

Dodd: I do. And in fact, I think there'll be a convergence at some point. When that'll be, I don't know. I wish I did, because I'd probably be making a lot of money as a consultant. But I do think there will be a convergence. The reason why I believe that is it's not the first time that you could see different pathways being pursued by not only government entities on a federal, state and local basis, but also in this case, different medical related organizations, patient advocacy group organizations, even the industry associations such as BIO (Biotechnology Innovation Organization). I think all of this is eventually going to go through a process of convergence and integration into a new process.

Medical Economics: What are some of the most damaging myths or pieces of misinformation that you've seen, particularly around the vaccines that this initiative will review, like flu, COVID-19, or RSV?

Dodd: For me, at the top of the list is the continuously repeated statement that Secretary Kennedy is totally anti-vaccine. I think that's not true. I think there are perceptions that have come out of individualized statements. Our own interactions with his office and related ones—we've been “DOGE’d” (eliminated by the Elon Musk-led Department of Government Efficiency) by some of the programs for which we've been funded, so I'm not speaking this as a hard line supporter. I'm saying as someone who's tried to look at it and figure out, how do we work together?

From that standpoint, we have seen statements made that we need more than mRNA as vaccine platforms. We completely agree with that, because we don't believe that any single platform for vaccines will do the job for every vaccine that's needed. Coming out of the pandemic, there was a very strong position coming out of decision-makers that if you weren't doing mRNA, you were using an outdated platform. That's not necessarily the case. We've heard Secretary Kennedy express that, in his opinion, his preference, and HHS's preference for multi-antigen vaccine platforms. That is something which mRNA is not. It's not multi-antigen. They can only work with one part of the virus at a time. We actually use a multi-antigen platform. So from that standpoint, we were very pleased to hear that.

At the same time, we heard that as a statement of preference for how to approach vaccines, especially respiratory related type of vaccines. We also ended up being part of a program where we had received a major funding grant—$400 million—and we're in the middle of that, getting ready to start vaccinating individuals in that program, when that program was DOGE’d. So, I have to say that we're not satisfied by everything, but I'd say the thing of taking a blanket statement—how do you exist in an environment where the head of HHS is anti-vaccine?—because, first of all, I don't accept that he is totally and undeniably anti-vaccine. I think there are ways, challenging ways at times, to be able to have a platform of common discussion and to progress and move things forward. If I didn't believe that, then we wouldn't be doing the vaccines that we have.

In one case, we have a vaccine for which we have been given an expedited development path by the European Medicines Agency, the EMA, which is the equivalent of the FDA, and we're proceeding in an expedited manner to having a product on the market within 18 months, perhaps, versus five to seven years. So, I think there are ways to work through that. It's challenging and it's frustrating. We'd all been told that the FDA had turned down Moderna's path for going forward with their flu vaccine, and then today, we're reading that they have now come to some form of an agreement that they're going to be able to proceed and go forward with reviewing the flu vaccine, which I think is a great outcome. When I look at it, I say that there have been statements made. If people are asking me, well, how can you be in the vaccine industry trying to raise money when the federal government is against all vaccines? I would say I don't agree with the word 'all.' I don't agree with 'against.' I think there are a lot of questions being asked. Sometimes they may be questions that I find a little frustrating to have to address and deal with, but I have to figure out how to work within this environment.

Medical Economics: Are you worried that with the fragmentation in public health guidance, we're going to end up with a set of guidelines for red states and a different set of guidelines for blue states?

Dodd: I certainly hope not. And again, I think we won't. I think we'll see things sort out, not in an ideal manner, not in a way that is quickly done. So here we are, a year after an inauguration, and we all would have hoped that by now we knew what the new normalcy was. Yet we're still sorting through some of these things. I think it would be totally impractical to see the difference between red states and blue states. And hey, by the way, let's not forget the purple states that are out there also—they may have their own guideline. So, I think we will sort things out.

I think, quite frankly, that certain medical organizations have stepped up to fill the void. I think that may be viewed negatively in some settings, that it's overreach on their part, but what they're trying to do is fill a vacuum. Because at the end of the day, you have parents, you have individuals, non-medical professionals who have so many questions. I speak to investor groups all the time, as you might imagine, because we're a pre-revenue company, always out there talking to potentially interested parties. They're asking me, ‘so how do we make a decision about whether or not to get a vaccine or not to take a vaccine? I don't believe in any of these vaccine makers anymore.’ So you hear these things. The best I can do is try to listen, to be transparent, to communicate and answer what I can answer, keeping in mind and underscoring that I'm not a scientist, I'm not a physician. I'm someone who's a general manager that's been in this industry for 40-plus years, so I've picked up a lot of know-how and learning, practical learning along the way. So, I try to help people understand. But there are a lot of different areas in which we have those—it's a shame, because there's been a lot of energy expended dealing with issues that we could be working on more important issues and moving things forward at this point.

Medical Economics: So many people now get their information from social media. They're not listening to doctors who have spent their entire lives studying these vaccines for safety. How can we battle that? How can truth win out over these very powerful social media messages?

Dodd: Well, first of all, the challenge is that all of us, we're human beings. We all have our own beliefs, prejudices, whatever we believe in, and it's hard to always separate those. But we have to try and do that and focus on what do we know from the science, and what do we not know? I think there's a lot that we don't know, and sometimes we focus on only on what we think we know. So, we have to listen and be guided by scientific clinical evidence, by the transparency of what we learn and what we know.

Part of this has been bred because when we heard about these vaccines in November of 2020, we were told that there are these vaccines, they're 94%, 95% effective against this virus, COVID-19, that if you receive the vaccine, you wouldn't get the COVID-19, and that they would last a year. In reality, we've learned that, depending on how you define efficacy, they're less than 50% efficacious. We see the virus continues to evolve, because that's what viruses like to do. Because of that, we have to keep updating. For many of the technologies, especially mRNA, you have to keep reconfiguring and coming up with a new one, which means more and more boosters. We know that they really don't totally prevent you from getting it. They hopefully, and what their main reason is, reduce the severity so that we see true reductions in hospitalization and the risk of death. We were told and guided to say—and people will tell me, I just spoke to a group last week, they said, well, we were forced, we had no say, we were told we had to be vaccinated and that we'd be totally protected, it would last a year. People remember that, and people don't like being pushed around. So, we're dealing with that.

I think what we now are seeing in some instances is that members of various medical professional communities are stepping forward, and they rightly so are saying we need to do a better job communicating. Not just we in the medical center, but journalists such as yourself—we need to communicate and be very transparent and show that we're listening. Because when you look at it, we take this idea and we think all vaccines are about the same. Well, all viruses are not the same.

With measles, we've gone through this thing, and it's unfortunate, we've seen this tremendous decline in immunization of measles. We know that a measles vaccine, you get vaccinated, you're pretty good for life, and that's very important, because measles is highly contagious. Someone walks in the room with measles, they walk out of the room, if they have it, they've left the virus. It's going to still be contagious for two hours. They don't leave the room when the host leaves the room. So in that instance, we're seeing an impact in an area where there's no need to be an impact there. There are legitimate questions on others.

We see certain viruses such as SARS-CoV-2, HIV, mpox—it's a classic example where we continue to see new strains emerge. So we have to be ever vigilant about are those new strains such that we have to do something different for the existing vaccine, similar to what we've done historically with annual flu vaccines, because they're always a little bit different, different strain and all. We're used to that, but that's not true of other vaccines. You get them once, you're good, pretty much for life. We need to be clear in how we educate and communicate to all particular interested parties, especially the public at large, and do a better job, because I think we lost a lot of ground and saw a tremendous decrease in trust in the whole public health system.

In fact, the United States had the envy of the world when it came to a public health system that we all trusted, we accepted their guidance. Unfortunately, that has been pushed back. We saw unprecedented migration into the United States from regions of the world that did not have well-established and well-developed public health systems and policies or immunization practices, which has contributed to what we're seeing with measles. So many people have come in from areas—they didn't come in to bring in measles or to be exposed to it, but they have come from regions that did not have well-established practices and immunization policies and programs.

Now I don't think that because they have fewer vaccines on a list in Denmark, that means they have a better program than we have. Maybe when we had 17, that was better than what people that only had seven. I mean, I don't know, because I've always felt and been very proud of the way the public health system has operated historically within the US. Do I think there were times in which, and certainly during the whole pandemic, that we saw leadership doing a very poor job of communicating and providing guidance and transparency? It was abysmal, quite frankly. So now the challenge is for all of us—those of us in industry, those of you who are journalists who've got the talents and the capabilities of communicating and explaining things well, people in the medical community and policymakers—all of us have a role to try and improve that, and that's what we should be trying to work together to achieve.

Medical Economics: Primary care physicians see a lot of vaccine hesitancy day to day. They're dealing with the misinformation. Some are confused by the conflicting guidance. Do you have any advice for them on how to work through all of this?

Dodd: I think what many of them do—and I'm fortunate to have an excellent primary care physician, and it's one with whom we have worked, my wife and I, since he hung up a shingle, literally when he started as a practicing physician. So, we've been working with him, have great trust in him. Do not always agree with him. He knows I'm in the industry, so I'm going to be a smart aleck and challenge him back on things. Don't ever ask me if I want to be part of a clinical trial, because I don't want to be a guinea pig. But I need those people to accept it when it's one of our products that are going through.

I think the most important thing is really that talent and capability of listening and communication and those skill sets. I can't think of a more important profession than medicine where you have to be outstanding at being able to listen, to understand, in this case, your patient, to ask a little bit deeper, probing questions, because maybe you pick up on something. When you think about it, there has to be a profession to be more skilled at that than you've ever seen. Again, we're fortunate that we have been working with someone through the last 20-plus years of our life with someone that has that capability. Yet we've all encountered medical professionals, physicians in the past, nurses, PAs, that were very curt and said, this is the way you do it.

I had someone once—I was diagnosed with a particular chronic condition, it was not life-threatening—and the person didn't want to explain it to me, told me that all they wanted to do was put me in this clinical trial that they were running. What I did the next day, because of the profession I'm in, and we happened at that time, that company we were at, we had a product in the clinic for that same condition. I went to the clinical department and said, can you tell me if there is a physician here in the Atlanta area in this therapeutic area that we know of that I might consider wanting to talk with? I've been working with a physician since 1997 once I was introduced to him. I dropped the one, I went to the other one.

So I think that your audience—there's no bigger challenge than a primary care physician, because you have to cover that breadth and be able to guide people to whatever specialists they need to have, and you've got to be such a great communicator. So, I think that is a critical aspect of what they need to be doing, and they should be seeking—and I would say, I know your time is short, but don't hesitate to seek out people in industry for input and otherwise. I had someone recently that said, well, I don't trust my physician, I really don't like the input I get from them. I said, you know, it's up to you, but that would tell me you need to find another physician. Because if you don't feel that the person is working and communicating in your best interest, then you need to find someone else.