6 months into America's COVID-19 pandemic cases are surging. Small businesses are faltering playgrounds are empty and unemployment is at 11%. Our best hope for ending this nightmare is a vaccine and there are more than 165 in development. But when a vaccine becomes available, how many Americans will refuse it? Bill Gates vaccine is magically ready but in order to get the vaccine you also have to receive the biometric tattoo. Will you take it? I don't trust the vaccines I never did and get more forced things into your body that then slowly debilitate you with binary weapons such as a gillian. Vaccines are the greatest health care advance of our time, preventing an estimated 4.5 billion infections since their advent. So what explains the reluctance of so many Americans to vaccinate? It's a combination of bad science, the government's long history of misleading the public, and the collapse of confidence in public health authorities because of their catastrophic failures in response to the COVID-19 pandemic. But if the government responds by attempting to force Americans to take a COVID-19 vaccine, it will only help the conspiracy theorists. Public health officials can begin to undo the damage of the past six months by rejecting authoritarian and paternalistic approaches in favor of careful persuasion and brutal honesty about the limits of their own knowledge. Though most American surveys say they'll probably take the vaccine, there's a real possibility that a sizable block of refusers could allow this novel coronavirus to continue spreading based on what's happened with measles. And vaccine refusal tends to happen in clusters according to researcher Taurus Smith. 2019 was the worst measles year in a generation. When you have some of these groups of individuals where vaccination rates are low, it just takes one person with measles to get in there and spread it through a community. Vaccines skeptics often focus on the claim that childhood vaccines cause autism. I think they need to wake up and stop hurting our kids. The vaccines are dangerous if not given a dangerous to certain people who are more susceptible. Two years old, two and a half years old, a child, a beautiful child went to have the vaccine and came back and a week later got a tremendous fever, got very, very sick, now is autistic. The claim famously was amplified by a British researcher named Andrew Wakefield. I started getting calls from parents who said my child was developing perfectly normally and then they had their MMR vaccine in many cases and then they just disappeared. His 1998 paper linking vaccines and autism was later retracted and the UK General Medical Council found him guilty of multiple ethics violations for lying about his test subjects and failing to disclose a financial link to an anti-vaccine lawsuit. But concern about vaccines is rising among parents, along with objections to the use of mercury preservatives, which both haven't been proven to do harm and haven't been present in childhood vaccines for nearly 20 years. An ecosystem of anti-vaccine information has emerged and according to the American Journal of Public Health, bots and paid Russian trolls participate in online vaccine debates far more than the average social media user. And the trolls don't always join the anti-vaccine side of the debate, but aim to elevate the visibility to create false equivalency and eroding public consensus on vaccination. You have some people that really don't know what to think, so you know we think of them as kind of fence sitters and they're really just trying to figure out you know what is going on, what do I believe, what do I trust? Largely those people in the middle are the ones that I try to reach. But you as public health authorities have sometimes misled the public about vaccines and other public health interventions, which has made the job of convincing skeptics more difficult. The United States government did something that was wrong, deeply, profoundly, morally wrong. The Tuskegee experiment so deep distrust of the government and public health, particularly in black American communities. In 1932 government doctors recruited mostly poor black sharecroppers at the Tuskegee Institute for a study of the impact of syphilis. The participants, the majority of whom had the disease were told they were getting an experimental medicine when in fact they were all given a placebo. Scientists running the study were actually interested in the progression of the illness when left untreated. The experiment continued until well after penicillin became available in 1947 and many participants died. They were lied to by their government. Another incident to damage trust in public health occurred in 1976 when a novel virus called the swine flu broke out at a US Army base and scientists believe that it bore a genetic similarity to the 1918 flu that had killed more than 100 million people worldwide. We offer every American the opportunity to be inoculated against a swine type influenza virus. President Gerald Ford authorized $135 million to develop and deploy a vaccine and the government injected 25% of Americans in a 10-month period. But the global pandemic never came. The disease died out and the rushed version of the vaccine likely resulted in some injuries, though probably not as many as reported by the media at the time. Smith says more humility is called for in public health communication. It's hard but I think we have to emphasize that uncertainty and I think that may have been one thing missing with the masks and I was probably guilty of it myself. You do not have to wear masks because there is no evidence that they protect people who are not sick. Over the weekend the US surgeon general urged people to stop buying masks saying in a tweet they are not effective in preventing general public from catching hashtag coronavirus. Wearing a mask might make people feel a little bit better and it might even block a droplet but it's not providing the perfect protection that people think that it is. After reversing their position on face masks authorities claimed their earlier message was motivated by a desire to preserve protective gear for medical workers without a very acknowledging that they were wrong to say that masks wouldn't slow the spread of the virus. Do you now regret not advising people more forcefully to wear masks earlier? I don't regret that because let me explain to you what happened. At that time there was a paucity of equipment that our healthcare providers needed. Public health authorities also issued contradictory messages on the safety of large gatherings following the Black Lives Matter protests. The WHO failed to properly investigate the original outbreak in China perhaps leaving the world less prepared than it should have been for the emerging pandemic. The Trump administration repeatedly played down the threat of the virus and the CDC botched the early rollout of testing. If there is any hope of winning back public trust in a vaccination program which unlike the 1973 Swine flu vaccine will have been subject to extensive safety testing. Public health authorities should acknowledge their past mistakes. We did not want to divert masks and PPE away from them to be used by the people. If warning against face masks was a so-called noble lie to preserve supplies for healthcare workers they should own up to that rationale and stop condescending to the public. Doctors should acknowledge that vaccines can carry some risk but that it's a risk often worth taking because there are no perfect solutions only trade ops. The lesson of the last six months is that authoritarian mandates and noble lies tend to backfire. Fact-based persuasion which is the basis of good science is our best hope for stopping COVID-19 and restoring the personal freedom that's been eroded by the governmental and societal response to it.