Online International Pediatric Association Vaccine Trust Course

As of December 1, 2022, more than 7,500 people from 149 countries had registered for the Online IPA Vaccine Trust Course, with 1,962 course completions, 1,787 participants in progress, and many more waiting to start the course said Thacker.¹ The seven-module course covers (1) infodemiology, (2) the behavioral science behind vaccine acceptance interventions, (3) interpersonal communication, (4) social media engagement, (5) addressing vocal vaccine deniers, (6) interacting with media, and (7) building vaccine value through advocacy and messaging to affect change. All modules are evidence-based and feature findings from leading experts in their fields. The course also covers evidenced-based technology in social media.

Thacker explained that this course was born out of discussions about vaccine hesitancy held in 2015 by Gavi, the Vaccine Alliance (Gavi) (WHO, 2015b). When Thacker completed his term as a Gavi board member, he started to develop the IPA Vaccine Hesitancy Project. Initially, he focused on the expertise of pediatricians, but colleagues advised him to establish an interdisciplinary team. In December 2018, IPA hosted participants from 26 countries at an international Training of Trainers workshop on vaccine hesitancy in Delhi, India. One month later, the World Health Organization (WHO) identified vaccine hesitancy as one of the top 10 threats to global health in 2019 (WHO, 2019). In March 2019, a second Training of Trainers workshop was held in Panama, attracting participants from Latin America and around the world. The COVID-19 pandemic disrupted plans to continue in-person training events while highlighting the role of vaccines and development of the mRNA platform. In 2020, IPA renamed the initiative the Vaccine Trust Project and pivoted toward online training with the launch of the Online IPA Vaccine Trust Course.

Enrollment in the online course is tracked by profession, gender, and age; the majority of participants are pediatricians (Uttekar et al., 2023). Thacker noted that pre- and post-training surveys indicate that upon completing the course, enrollees feel more competent in discussing vaccination with vaccine-hesitant patients and in responding to misinformation on social media. Pre- and post-training tests administered for each module indicate that most participants improve their knowledge base by taking the course, and the training is well-received by many participants.² He emphasized that the pandemic-induced shift from in-person to online training expanded the global reach of the program and that the recorded format also helped to increase the breadth of expertise included in the course. The recordings have been translated to increase accessibility, he added.

Engaging Trusted Sources to Increase COVID-19 Vaccine Uptake

In addition to offering vaccine hesitancy training, IPA has engaged in activities to increase uptake of COVID-19 vaccines, noted Thacker. A COVID Vaccine Solidarity Campaign was launched in advance of vaccine availability. The campaign featured a short video of vaccine experts from around the world sharing, in their native languages, the importance of COVID-19 vaccines and their eagerness to become vaccinated.³ Thacker recounted being the first person to receive the COVID-19 vaccine in Gujarat, India, at a publicized event during which he received a badge from the Chief Minister of Gujarat (ET Healthworld, 2021; The Economic Times, 2020). More than 100 journalists provided media coverage of the event, with many of them following up with Thacker over the next week to inquire about any adverse reactions from the vaccination. He attributed the amount of attention he received to be a reflection of the interest in and power of the vaccines.

The Child Health Foundation, where Thacker serves as a board member, created a social media toolkit on vaccine confidence that included more than 30 experts answering frequently asked questions.⁴ The toolkit was translated into 11 languages spoken in India. Noting that health care providers and religious leaders are trusted community members, Thacker remarked that most families are connected to a health practitioner whom they hold in high regard as a source of important perspective on health matters.

Addressing Public Concerns

Thacker commented that the concerns many people have about the COVID-19 vaccine are often alleviated upon receipt of relevant information. Not everyone with concerns is vaccine-hesitant or anti-vaccine, he added. Common concerns include news of vaccinated people contracting the infection and doubts about vaccine efficacy against new variants. Thacker also highlighted the challenge in accurately communicating the value and goal of the vaccines. Initially, vaccine efficacy against infection was touted. Over time, it became apparent that infection after vaccination is common and that vaccines decrease the likelihood of serious disease, hospitalization, and death. Conveying this shift in understanding to the public required months of communication efforts.

Thacker noted that COVID-19 vaccination efforts in India began when the Delta variant was already spreading. Because the vaccine rollout occurred while large numbers of people were contracting the new variant, a misconception spread that receiving the vaccine could result in developing the disease within 2 weeks. Misinformation changes daily, he said, and successfully addressing it requires understanding the underlying misconceptions and adapting messaging accordingly. Trust was eroded by confusion caused by health experts, he added. For instance, no clear assurance was issued that the vaccines were safe for pregnant and lactating women or for people with comorbidities. Changes in the dosing administration schedule—which shifted from 4 weeks to 8 weeks to 6 months—caused further confusion. Some scientists debated publicly on social media, rather than in private conversation, and the apparent conflicting opinions damaged public trust, he contended.

Elements of Effective Strategies

Thacker highlighted several strategies that proved successful in promoting COVID-19 vaccinations. He found that honest, transparent, two-way communication is effective when professionals listen to the community and address their concerns. Communication strategies can be designed based on principles of behavioral science that recognize the role of perceptions, beliefs, and attitudes. Community mobilizers and trust voices should be equipped to convey uncertainty with total honesty, he added. For instance, medical professionals, scientists, and community leaders are often more trusted than politicians; Thacker believed they can be trained to hone interpersonal communication skills and literacy in social and mainstream media. Investment is needed in communication, digital literacy, and fact checking, said Thacker. He remarked that India made extensive investments in vaccination—even hosting nationwide mock drills to test preparedness in advance of vaccine availability—but investment in communication has paled in comparison.

Gone are the days when the public would take the word of a scientist without seeing data, Thacker maintained; therefore, data should be made available in the public domain. He noted that data were not publicly available in India despite the public's interest and demand, contributing to an explosion of misinformation. He suggested that rapid review of data related to adverse events following immunization could aid efforts to counter misinformation; however, the review process typically takes several months. Concurrently, the media should be aware of the importance of providing correct and complete information and be more selective of the medical professionals whom they choose to interview, said Thacker.

Role of Risk Perception in Vaccination Rates

The relatively high vaccination rate among residents and staff in skilled nursing settings could inform strategies for combating hesitancy and increasing acceptance of vaccinations and therapeutics, said Worz. Early in the COVID-19 pandemic, up to 40 percent of fatalities were individuals in skilled nursing facilities, and vaccinations were effective in decreasing this proportion to approximately 15 percent of overall COVID-19 deaths by late 2022 (Data.CMS.gov, 2023). Worz remarked that it tends to be less difficult to convince an older person with comorbidities who lives in a nursing or assisted living facility that they are vulnerable and need protection than it is to convince someone in the general public—the COVID-19 vaccine acceptance rate for skilled nursing home residents outpaced the 67 percent rate for the general population. He noted that vaccination for many nursing home residents requires consent from their children and that the perceived risk and vulnerability of the older population was substantial enough to lead some people to consent to vaccination for their loved ones, even if they themselves were not getting vaccinated.

The COVID-19 response failed to translate accurate data into communication that addresses a diverse population—from residents of nursing facilities to their caregivers to medical professionals—and to deliver messaging in a timely manner, Worz contended. Moving forward, data can be used to convince people to utilize therapeutics and bivalent vaccines. Publicly available statistics such as death and case rates for the skilled nursing communities compared with those for the general public can be persuasive in highlighting the power of targeted interventions on specific populations. Currently, 93 percent of COVID-19 deaths in the United States are individuals over age 50. People over age 65 account for 75 percent of all U.S. COVID-19 mortality, totaling more than 804,000 deaths. Such statistics can be powerful in illustrating the vulnerability of certain populations and the importance of taking steps to prevent mortality, he stated.

Finally, Worz commented that although the 4 million individuals who spend time each year in skilled nursing facilities constitute a small percentage of the overall population, they comprise a much higher percentage of people requiring hospital care. During the COVID-19 pandemic, flexibilities were extended to different disciplines to authorize a larger scope of practice and improve access to therapeutics and vaccines for prioritized populations. He maintained that these practices should be continued and capitalized on in the future. Work can be done now that could increase the speed with which vaccines and therapeutics become available and accessible, particularly for at-risk individuals, in future pandemics.

Political Identity

Larson stated that political identity in the United States often features powerful loyalty and alliance, a tendency that influenced many people's decision making during the COVID-19 pandemic. For some, no amount of data would convince them to behave in a manner that conflicts with their political identity and loyalty, she noted. In forums and interviews, people often emphasize the importance of the concept of “my people.” In essence, this sentiment is tied to trust; therefore, trusted colleagues, relatives, and community members can leverage the power of trust to influence behavior. She added that the component of trust can also play a role in racial, ethnic, or gender identity. Some of the most powerful levers of increasing vaccine confidence and compliance with healthy behavior recommendations came from within identity communities, particularly in the absence of national leadership, she remarked.

Community Identity

Larson is conducting a large study on people's experiences during the COVID-19 pandemic in Brazil, France, India, Nigeria, Thailand, and the United States. So far, disappointment in a lack of government preparedness has emerged as a pervasive theme. Responses frequently note support from local networks, resources, and communities. Belonging to a community is often viewed as an asset, she said, but scientists can recognize and be sensitive to the fact that this perspective is not ubiquitous; some individuals consider being labeled as part of a community as stigmatizing or limiting. Nonetheless, for many, community identity can be a powerful lever of positive behaviors, she remarked. Noting the work of Reed Tuckson, former Commissioner of Public Health for the District of Columbia, and his participation in the Black Coalition Against COVID, she highlighted community identity efforts within the United States to increase vaccination. For example, the coalition created a “Black Doctors Read COVID Tweets” video series to engender community trust through familiar figures.⁵ The COVID-19 pandemic caused heightened uncertainty, and changes in data and guidance regarding masks and social distancing led many people to cling to the familiar. In this context, community identity was powerful, said Larson. Furthermore, before COVID-19 vaccines became widely available in the United States, they were often administered at temporary sites in tents or stadiums. Attachment to familiarity translated to vaccine hesitancy for some people who felt uncomfortable visiting an unfamiliar vaccination site.

Religious Identity

Religious identity can also influence a person's behavioral choices. Larson pointed to earlier concerns from the Muslim community regarding the pork-derived gelatin in the polio vaccine and in the nasal influenza vaccine. This concern could be relevant to COVID-19, because nasal COVID-19 vaccines are under development. Larson shared that although religious leaders in the Islamic community declared that the processing of gelatin involves sufficient alteration from pork to make it permissible for Muslims, local imams did not necessarily agree with that determination. Therefore, locality can have as much bearing as religion, said Larson. Religious identity also operates within contexts. In countries where a certain religion is in the minority, a person who identifies with that religion may feel marginalized, whereas the dynamic for people in the religious majority is quite different. In these circumstances, religious and political identities can merge, she added.

Professional Identity

Larson explained that professional identity emerged as a significant factor in her global research. During the COVID-19 pandemic, people often turned to their employers and colleagues for a sense of community. She noted that health professionals in particular seemed to develop tighter support networks in the workplace. Results from the 2022 Edelman Trust Barometer indicated that for the first time, trust in business and employers ranked higher than trust in government.⁶ Thus, the workplace can also serve as a powerful lever in decision making. She shared the example of “silent refusers”—that is, health care professionals with unspoken vaccine hesitancy—who did not want to be vaccinated and did not support vaccination requirements or mandates (Heyerdahl et al., 2022).

Age Identity

Age identity has affected behavior during the pandemic, said Larson, noting that compliance with health guidance during the COVID-19 pandemic has been lower for people aged 18–34. Resentment, anger, frustration, and mental health concerns are common among young people. Considering themselves less vulnerable to the virus, some younger adults have felt that they lost 2 years of normalcy because of a crisis that did not affect them. Disruption in education and social life during the pandemic has led to long-term issues for some people and reduced confidence in health measures, she noted. In a global study, Larson and colleagues compared general vaccine confidence—not specific to COVID-19 vaccines—before and after the emergence of COVID-19. They found an increasing age gap in confidence in vaccines; older people have become slightly more confident in vaccines since the pandemic, and adults younger than age 34 have demonstrated a significant decrease in confidence. She stated that along with a sizable increase in mental health issues, this decrease in vaccine confidence represents the wide-ranging nature of the health effects of the COVID-19 pandemic on younger adults.

The Role of Trust and Skepticism in Vaccine Hesitancy

Questions regarding the trustworthiness of health providers and institutions emerged repeatedly during the COVID-19 pandemic, said Lewis. He participated on a behavioral science task force that worked with the U.S. Department of Health and Human Services (HHS) during the rollout of COVID-19 vaccines at the end of 2020 and beginning of 2021 (Barsade et al., 2021). This task force was assembled in response to recognition by HHS and the Centers for Medicare & Medicaid Services that nurses working in long-term care facilities—most of whom were women of color—were initially reluctant to be vaccinated against COVID-19 despite being members of a prioritized group given early access to the vaccines. The task force investigated the potential causes of this reluctance. They discovered that missteps earlier in the pandemic undermined trust in the system that was now asking the nurses to receive vaccines, Lewis reported. Nurses stated that at the beginning of the pandemic, they were asking for help and support, yet they were among the last health professionals to receive personal protective equipment and other types of protection. The sudden shift in prioritizing them for vaccination made them wary, he explained.

Lewis explained that the nurses' reflections aligned with a lesson from attitudes and persuasion literature: if the messages being delivered are dis-fluent or incongruent with the surrounding context and culture, then people are less likely to be persuaded to change their behaviors (Oppenheimer, 2006; Schwarz, 2012; Song and Schwarz, 2008). When resources were kept from nurses and specific subpopulations, the U.S. government sent and reinforced an implicit message that privileged members of society are the first to receive desirable goods and services, he explained. When people experience this systemic de-prioritization, they come to expect that they will not be prioritized, Lewis stated. In addition, this experience of being passed over felt familiar to the nurses and fit the context of a society that prioritizes privileged members, he continued. A sudden change in the status quo generates disfluency and can create skepticism. In the context of vaccine prioritization, some nurses were skeptical about their sudden prioritization. The sentiment of “if the vaccines were really that good, they would be given to rich, white people first” was common among nurses, said Lewis. To shift the status quo and improve equity, interventionists and policymakers must directly and explicitly address people's concerns; otherwise, people are likely to distrust and dismiss change efforts.

Addressing Distrust and Skepticism

Lewis said that the task force tried to directly address the nurses' concerns by acknowledging past wrongs and explaining that COVID-19 vaccine prioritization reflected an effort to avoid repeating mistakes of the past (Barsade et al., 2021). He found that institutional acknowledgments of past mistakes matter—in this case, the nurses became more willing to discuss their vaccine hesitancy. These types of productive conversations start with direct outreach to identify the needs behind their resistance to behavior change. Future pandemic preparedness efforts should extend beyond investments in biology and new technology to include investments in qualitative and community-based research methods that enable exploration and understanding of people's thoughts and needs regarding public health interventions.

Although he is primarily a quantitative and experimental researcher, Lewis acknowledged that qualitative methods have informed his understanding of the processes that underlie health behaviors and health outcomes (Humphreys et al., 2021; Lewis, 2021b). These methods inform understanding of (1) the features of social context that affect how people perceive health and health behaviors, (2) how these perceptions are connected to social identities, in terms of whether participation in certain health behaviors is considered appropriate for people “like them,” and (3) how people perceive and contend with the difficulties they might experience in the health system (Lewis, 2021a; Lewis and Earl, 2018; Lewis and Oyserman, 2016; Lewis et al., 2021). He emphasized the value of understanding people's thoughts about these issues when developing interventions aimed at changing their behavior, which might involve convincing them of the trustworthiness of institutions issuing health guidance.

Communication Gaps in COVID-19 Messaging

Albarracín asked about changes needed within the health system to increase and communicate trustworthiness. Lewis replied that time spent understanding people's concerns and issues that underlie a lack of trust in the health system is valuable. Without this understanding, messaging efforts may not address actual public concerns and therefore decrease their effectiveness. Community-based work—which can include monitoring and surveying—can be instrumental in developing better messaging strategies. Albarracín asked about needed changes in health communication strategy. Larson acknowledged that replicating the speed with which COVID-19 vaccines were developed may not be feasible in the next pandemic, but the public has been exposed to the vaccine development process and has gained more awareness of the time it typically needed to develop a vaccine. As one lesson learned from this pandemic, public messaging could have focused more on the decades-long research on the mRNA platform that formed the foundation of the COVID-19 vaccine development. The COVID-19 pandemic also raised public awareness of various brands of vaccines. People typically refer to other vaccinations in a general sense (e.g., “flu shot” or “MMR vaccine”), whereas now people often differentiate between the Pfizer, Moderna, or AstraZeneca COVID-19 vaccines.

Larson added that more work could have been done in 2020 to prepare the public for the vaccine rollout. Most messaging focused on masking and social distancing; it would have been beneficial to increase the volume of communication intended to prime the vaccine effort. Lewis added that more communication about the process of vaccine development might have been helpful. The “all-hands-on-deck” approach to COVID-19 vaccine development shortened the timeline without compromising standards. However, the speed of vaccine development was often communicated independently of any explanation about why this speed was possible—that is, without the appropriate context. The term “warp speed” was applied to efforts to accelerate COVID-19 vaccine development, but “warp speed” is generally not associated with safety, added Lewis.⁷ He suggested considering people's potential associations with meta messages and providing explanations to help dispel those associations that do not foster trust. Larson commented that early in the pandemic, messaging focused on the risks that COVID-19 poses to older people, a strategy that likely contributed to a tendency among young people to perceive that the pathogen was not their problem. In Asia, the dynamic played out in reverse; a strategy to prioritize the workforce for initial vaccination to keep them healthy and productive resulted in higher levels of vaccine hesitancy among older adults. When triaging is required because of the limited vaccine availability, implications for long-term acceptance by non-prioritized groups should be considered, she added.

Current Dynamics in Vaccine Hesitancy

Noting that the task force on vaccine uptake issued its report in February 2021, David Kim, director of the National Vaccine Program at HHS, asked about the status of vaccine hesitancy and efforts to address it as of December 2022 (Barsade et al., 2021). Lewis replied that the report highlighted the diffusion-of-innovation curve, which describes the theory that when new products are introduced, one subset of people will rush to try it, a large portion of the population will wait to see how the product performs over time before trying it, and a group of resistors will hold out. Messaging efforts initially targeted the population that was eager to be vaccinated, but have since re-focused to target the specific subpopulations requiring persuasion. Earlier in the pandemic, these efforts involved addressing racial disparities in vaccine uptake; later, the focus shifted to political divisions in vaccination trends. Kim commented on the evolving nature of vaccine uptake behavior and noted that bivalent vaccine uptake is a current concern. Lewis remarked that his investigation of bivalent vaccine uptake has revealed that many people who received their primary COVID-19 vaccines series—and even some who received an initial booster—have questioned when “enough is enough.” He stated that understanding this dynamic will be helpful in addressing bivalent vaccine uptake moving forward.

Prominent Types of Vaccination Misconceptions

Noting her work at FactCheck.org, an organization credited with starting the fact-checking movement in the United States, Jamieson spotlighted SciCheck, a FactCheck.org feature that focuses exclusively on misleading scientific claims. SciCheck's COVID-19/Vaccination Project has established a process and taxonomy for analyzing and responding to false claims about COVID-19. To identify prevalent misconceptions about vaccination, Jamieson and colleagues examined claims about COVID-19 that were fact checked by three international and five U.S. fact-checker organizations. From January 2020 to May 2022, 4,153 claims were flagged as misconceptions and categorized. The most significant categories were the origins of SARS-CoV-2; disease transmission; existence and virulence of SARS-CoV-2; diagnosis, testing, and tracing; prevention; treatment; and vaccination.⁸ Jamieson interpreted this list as priority areas that science must address in advance of the next pandemic to establish basic, protective knowledge. In addition, fact checkers could consider these categories in anticipating the core knowledge that should be deployed against deceptive claims.

Effects of Misconceptions on Vaccination Acceptance

Of the 4,153 misconceptions about COVID-19, 1,895 (45.6%) were about vaccines, said Jamieson. Of this amount, 1,060 were about safety. Because one-quarter of COVID-19 misconceptions were about vaccine safety, she selected this subgroup as the focus of analysis of susceptibility to misconception. Jamieson and colleagues then reviewed the misconceptions to determine whether they were consequential. With this information, misconceptions can be targeted to garner the most effect. She and her colleagues identified nine prevalent vaccine claims, some general and some specific to COVID-19 vaccines (Romer et al., 2022) (see Figure 6-1). A national probability sample indicated that uncertainty or active acceptance of misinformation about each claim was sufficient enough to cause hesitancy to vaccinate children. Thus, the misconceptions were found to be consequential. Some of the deceptive claims have been used for decades, such as falsely linking increased vaccinations with autism. Jamieson remarked that efforts to address these misconceptions when they first emerged could have prevented their reemergence with each new vaccine. Other misconceptions that affect parental willingness to vaccinate their children include beliefs that vaccines can cause death, infertility, changes in DNA, and allergic reactions, as well as contain toxins such as antifreeze. Misinformation acceptance was found to be negatively correlated with vaccine acceptance across time; the higher the acceptance of misinformation about vaccines, the lower the probability of adult willingness to vaccinate their children. She added that this finding held true for vaccinated parents, with beliefs in these misconceptions associated with increased hesitancy to have vaccinate their children, despite having received the vaccines themselves.

FIGURE 6-1

Knowledge used to predict hesitance to vaccinate kids. SOURCES: Jamieson presentation, December 8, 2022; Romer et al., 2022.

Preemptively Addressing Misconception-Sustaining Arguments

Once misconceptions are verified as consequential, the evidence and lines of argument sustaining them should be identified, said Jamieson. She contended that since the Vaccine Adverse Event Reporting System (VAERS) was established in 1990, it has been a source of misinformation for virtually every vaccine—particularly regarding the claims between vaccination and autism. Politicians frequently cite VAERS statistics in purporting the dangers of vaccination. For example, in December 2021 Robert F. Kennedy Jr. testified against the Louisiana governor's proposal to add Pfizer's COVID-19 vaccine to the state's childhood vaccination schedule, falsely stating that COVID-19 vaccines were the deadliest vaccines based on “deaths reported to VAERS” (PolitiFact, 2021). Also in 2021, Senator Ron Johnson of Wisconsin cited VAERS as a source of vaccine-related death data, as did Fox News host Tucker Carlson (Dunlop, 2021).

To undercut susceptibility to false claims, Jamieson suggested changing the name of VAERS to reduce the conflation of reported and verified adverse events and to reduce the emphasis on adverse events. Rather than priming an association between vaccination and adverse events, the system could promote an association with safety by changing its name to “Vaccination Safety Monitor,” “Vaccination Safety Watch,” or “Vaccination Safety Sentinel.” Until the system is renamed, efforts should be made to associate “VAERS” with “unverified,” she stated. Adding the “unverified” qualifier to any statement about reports filed in VAERS could address confusion caused by the failure to distinguish between claims and causally established events. Furthermore, the subtitle for VAERS—“a national program for monitoring vaccine safety”—could be used in conjunction with the title each time it is referenced to emphasize that the function of the system is monitoring for safety.

Jamieson also recommended language shifts in general discussions of vaccination. Stating that the benefits of vaccination outweigh the risks can be more effective than saying that vaccination is safe. Jamieson explained that this categorical language can prompt counterarguments. Instead, she suggested using statements that vaccines are safer than contracting the disease. Acknowledging that vaccination carries some risk maintains the validity of the argument when a side effect occurs. An understanding of how national certification processes operate can also strengthen the argument that evidence has established that the benefits of vaccination outweigh the risks.

Addressing Misinformation and Inequalities in Communicating Biomedical Research

Newland asked the speakers to discuss potential next steps in pandemic preparedness. Jamieson replied that patterns of deception and interference should be identified and interdicted. Because VAERS is repeatedly cited as evidence in misleading claims, she said, the name of the system should be changed so that it no longer implies an assertion of causality. Addressing the issue of misinformation is more difficult than changing the name of a monitoring system, Horton maintained. In a marketplace model of ideas, making better information readily available to counter the erroneous information would be effective. However, this model is not currently at play; rather, powerful social networks introduce various degrees of mistrust associated with certain beliefs or the sources of those beliefs, he stated. This practice can lead to rapid polarization, which—when overlaid on the human weakness of conformity bias—creates an ideal setting for propogandists to spread misinformation. Contending with this landscape is a complicated problem, said Horton.

Horton emphasized the importance of addressing deep-seated inequalities in science to improve pandemic preparedness. He remarked that women and early career researchers are particularly prone to online abuse, and they face additional challenges in communicating, conducting research, and accessing resources for their research.

Diversifying Communication Platforms

Newland asked about the ability to leverage non-peer-reviewed avenues to communicate biomedical research—including social media platforms such as Twitter, Facebook, and TikTok—to reach younger audiences. Bertuzzi replied that in theory, social media has the power to democratize information by spreading the ability to communicate beyond a few media outlets and enabling individuals to focus on what is relevant to them and may have been missed by others. However, social media has also provided a platform for the entire world to yell at one another from the perspective of a shattered lens through which very little new information is learned, he contended. Bertuzzi noted an article likening social media to living in the tower of Babel (Haidt, 2022). Jamieson remarked on a strategy to respond to polarizing ideological cues by locating ideologically congruent communicators who are trusted among those holding an opposing view. For instance, when President Donald Trump received the COVID-19 vaccine, it was an opportunity to reach some conservatives.

Horton noted public confusion in the United Kingdom born from disagreement among scientists. Science is not a monolithic point of view; thus, reasonable scientists will have different points of views on recommendations and policies. During the COVID-19 pandemic, scientists debated whether children should be vaccinated, whether schools should close or remain open, and—in the early months of the pandemic—whether masks were effective. Given the lack of certainty in the scientific community, confusion within the public sphere is understandable, he added. Bertuzzi commented that scientists and society need a forum for discussion that extends beyond echo chambers. Scientists often communicate via The New York Times and National Public Radio, but these platforms do not reach the full diversity of society, he stated. Furthermore, scientists are often only called onto television programs during a crisis, whereas economists are featured on a routine basis. The scientific community should strive to speak to the larger society on a regular basis with diversity and inclusion in mind, said Bertuzzi.