Vaccination and the defence of democracy – Authors' reply
Authors: Richard M Carpiano, Timothy Callahan, Jad A Elharake, Peter Hotez
Journal: The Lancet (2024)

Roger L Albin's Correspondence shows some of the many ways to conceptualise the potential mechanisms underlying the evolution and expansion of anti-vaccine activism in the USA. Two of Albin's points prompted us to elaborate here on ideas we discussed in our Viewpoint.1Carpiano RM Callaghan T DiResta R et al.Confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 era.Lancet. 2023; 401: 967-970Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar First, Albin notes that "Just as anti-vaccine movements are part of a broad front of right-wing activism, successful defence of vaccination requires a broad response." We agree that the movement has begun to merge with some right-wing efforts. Per our Viewpoint, a successful defence requires a whole of society approach,2Ortenzi F Marten R Valentine NB Kwamie A Rasanathan K Whole of government and whole of society approaches: call for further research to improve population health and health equity.BMJ Glob Health. 2022; 7e009972 Crossref PubMed Scopus (20) Google Scholar whereby governments (federal, state, and local) collaborate with civic organisations (eg, foundations and non-profit groups), academia, and the private sector in developing and implementing coordinated approaches to assess the extent of anti-vaccine activism; educate diverse populations about vaccine safety and efficacy; facilitate equitable vaccination access; and strengthen trust in our public health institutions. Although numerous opportunities exist for implementing a whole of society approach, we offer two. The US Centers for Disease Control and Prevention could partner with professional associations (eg, American Association for the Advancement of Science, American Academy of Pediatrics, and American Public Health Association), academia, marketing firms, and local and state public health authorities to assess local variability in vaccine confidence and implement culturally sensitive campaigns to increase vaccine understanding and uptake. Likewise, the US Department of Health and Human Services and private foundations could support community organisations and professional societies in developing counter-messaging initiatives. Second, Albin notes that "Defence of vaccination will only be successful in the context of vigorous defence of democratic institutions and explicit advocacy of using state power in the public interest." Governance that is accountable and responsive to the public's welfare requires well functioning institutions. However, the current political climate3Sharfstein JM Callaghan T Carpiano RM et al.Uncoupling vaccination from politics: a call to action.Lancet. 2021; 398: 1211-1212Summary Full Text Full Text PDF PubMed Scopus (50) Google Scholar presents substantial obstacles to even modest exercise of state power for providing vital public health functions. Such efforts can be easily misunderstood and are often challenged by anti-vaccine activists and their allies as government over-reach, jeopardising the effectiveness and success of such public health activities. Addressing the present challenges to vaccine uptake should involve a form of public health diplomacy that is more akin to exercising so-called soft power via cross-partisan, whole of society efforts rather than an exclusive reliance on the use of traditional tools such as vaccine mandates or ordinances, which are likely to face political backlash regardless of their legality, ethics, or past effectiveness.4Mello MM Opel DJ Benjamin RM et al.Effectiveness of vaccination mandates in improving uptake of COVID-19 vaccines in the USA.Lancet. 2022; 400: 535-538Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar RMC reports funding from Novo Nordisk Foundation, outside of the submitted work, as well as support from non-profit professional associations to attend or travel to their conferences and speak on topics related to this work. PH is an inventor and patent holder on several vaccines against neglected tropical diseases that are in development or clinical trials, and is co-inventor of a COVID-19 recombinant protein vaccine technology owned by Baylor College of Medicine (BCM) that was licensed by BCM non-exclusively and with no patent restrictions to several companies committed to advancing vaccines for low-income and middle-income countries. All other authors declare no competing interests. Confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 eraOver the past two decades, anti-vaccine activism in the USA has evolved from a fringe subculture into an increasingly well organised, networked movement with important repercussions for public health. The COVID-19 pandemic has exacerbated this evolution and magnified the reach of vaccine misinformation. Anti-vaccine activists, who for many years spoke primarily to niche communities hesitant about childhood vaccinations, have used traditional and social media to amplify vaccine-related mistruths about COVID-19 vaccines while also targeting historically marginalised racial and ethnic communities. Full-Text PDF Vaccination and the defence of democracyRichard M Carpiano and colleagues provide a useful summary of anti-vaccine activism in the USA.1 Their policy prescriptions are sensible but are likely to fall short because they fail to confront a fundamental feature of anti-vaccine activism. Anti-vaccine activism is one of numerous right-wing initiatives defending free market fundamentalism.2 Full-Text PDF