Un-leveling the public health playing field


1+1=2. The Earth is round. We went to the moon. Vaccines work.

You can argue about anything. But what’s the value of argument when all it accomplishes is elevating nonsense while simultaneously diminishing basic truths. There’s no value in “listening to both sides” when one side (no matter how well intentioned) is just plain wrong. It’s time to call it like it is. It’s time to un-level the public health playing field.

Such is the quandary over the current battle between the forces of misinformation (mistaken beliefs), disinformation (purposeful lies) and the science of public health. “Mis/Dis” has always been a thorn in the side of agencies like the Food and Drug Administration but exploded during the COVID-19 pandemic for a variety of reasons that are not useful to discuss in detail here. Why not useful? Because repeating a falsehood to debunk it only magnifies dangerous lies.

When it comes to Mis/Dis, the public health community is in an asymmetric warfare situation. In the real world, politics, polemics, tweets, and threads trump advanced educational degrees, impressive academic affiliations, and peer review. Nobels ring no bells with vaccine deniers.

It’s time we recognize that the best way to battle public health Mis/Dis is to focus on a few basic, truthful, urgent, and understandable messages. Here’s one: Get a flu shot.

Why not lead with the importance of getting a COVID-19 booster? Yes, that’s urgent too but, let’s be honest, flying directly into the eye of the storm, the “COVID-Din,” isn’t the best strategy. Flu shots have been around for decades and though not perfect, they have been repeatedly shown to save lives. On the other hand, debating the antivaccine juggernaut that has developed delivers more to them than to us by helping them spread their messages of Mis/Disand suffers from the Law of Diminishing Returns. Want proof? The percentage of parents getting their children the basic vaccine schedule (i.e., the MMR — Measles, Mumps, Rubella vaccine) is on the decline. Basic childhood vaccination rates are lower today than before the pandemic and parents requesting exemptions for their kids are up. Be afraid. Be very afraid of the consequences.

So why focus on seasonal influenza? Because getting a flu shot will save lives — lots of them and particularly among high-risk groups (for example Americans age 65+, those with certain chronic medical conditions, and communities of color). Sound familiar? It should. The public health community (regulators, physicians, pharmacists, nurses, school administrators, etc.) say it every year. Before the pandemic no one called it “fake news” or accused us of implanting microchips in flu shots. Not everyone followed our advice, (nobody ever does) but there weren’t potent political, religious, or social media communities actively committed to “fighting the flu shot.”    

But it’s more important than just protecting ourselves against the flu or about “just” saving 35,000 lives a year from this particular respiratory virus. It’s about reintroducing faith in the public health system and trust in vaccines. By actively promoting the annual flu shot, we’re focusing the message not to those most adamantly opposed to vaccines, but to the great “moveable middle.” In an asymmetric warfare situation, you want to fight where you can win.

As Sun Tsu reminds us, “Opportunities multiply as they are seized.”

We are living on borrowed time. Previous COVID-19 shots aren’t highly effective against the current variants and new, effective booster rates are low. Childhood vaccination rates, a basic pillar of our public health strategy are declining, seasonal influenza kills, and the public health community is (at least presently) out gunned in the battle for public trust. To reverse this trend, we must first acknowledge it, recognize that trust is earned and, finally, realize there are no short cuts or magic bullets.

In the war against misinformation and disinformation, the public health community must fight the battles we can win in order to convince the great American moveable middle to move (slowly at first and then more swiftly and comprehensibly) to do the right thing. America. Roll up your sleeves and get a flu shot.

Peter Pitts, a former FDA Associate Commissioner, is President of the Center for Medicine in the Public Interest and a Visiting Scholar at the New York University School of Medicine, Division of Medical Ethics.

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