Central to our hope of returning to life as normal is the possibility of a vaccine against SARS-CoV-2, the coronavirus that is causing covid-19. Dozens of companies have announced innovative development plans, and the White House has called for relaxed regulations that would expedite testing and approval.

It seems as if everyone would be on board: a simple intervention to prevent future infection, protect those who are most vulnerable and allow us to move freely once again, all without significant side effects. Yet the race for a vaccine and the techniques being used to manufacture it are bound to activate some familiar fears. In particular, those who worry about “unnatural” medical interventions may fear the vaccine more than the pandemic it’s designed to stop. If we don’t learn from past mistakes and funnel resources into education and outreach, the process could backfire, magnifying distrust of vaccines and making widespread immunity harder to achieve.

There are many players in the current vaccine development race, using several different techniques. Among them are biotechnology companies, relatively new to vaccine development, that are using novel technologies that do not employ the traditional approach of culturing and attenuating a live virus. The first vaccine approved for clinical trials in Germany aims to deliver an engineered synthetic gene that will allow the body to recognize an antigen and build an immune response without risk of illness. The hope is that such vaccines could be administered in smaller doses, facilitating quicker delivery to more people even with relatively limited manufacturing capabilities. Meanwhile, at Oxford’s Jenner Institute, researchers have begun human testing of a vaccine made by genetically modifying a common cold virus to produce proteins from the virus that causes covid-19, causing it to trigger an immune response.

The trouble — at least where public perception is concerned — may begin with the vexing terms “synthetic” and “modified.” Consumers draw strong distinctions between natural and artificial. This is most obvious in the food industry, where non-GMO and natural branding command outsize influence. Overcoming the stigma of “artificial” or “synthetic” is also proving to be a problem for so-called “cultured” meat. Yet rejection of high-tech foods is a symptom of a broader preference for the natural and fear of the “unnatural,” which has featured in historical objections to everything from in vitro fertilization to cloning animals.

Troublingly, the natural/unnatural binary is a powerful paradigm for parents who reject some or all vaccines. Such parents tend to emphasize natural living and see man-made inventions as intrinsically inferior and potentially dangerous. The movement led by actress Jenny McCarthy to “Green the Vaccine” focuses specifically on the ingredients in vaccines. As she told a crowd of supporters: “This is not an anti-vaccine rally. This is not an anti-vaccine group. … What we are saying is that the number of vaccines given and the ingredients, like the freaking mercury, the ether, the aluminum, the antifreeze, need to be removed immediately.” (Antifreeze is not used in vaccines.) McCarthy’s is a position that allows one to be theoretically open to vaccines, while opposing the unnatural chemicals that are inevitably in them, as in this characteristic tweet: “The reason why I’m most likely against [a vaccine] is because beside the pathogen, there are 100 or more chemicals and preservatives which outcome [sic] the advantages of vaccines. Almost anything unnatural to your body is bad.”

These are the critiques that have long been leveled at vaccines produced by more traditional means. If new vaccines are seemingly less “natural” and rely on synthetic genetic material or genetic modification, their perceived artificiality is likely to heighten concerns. It could also exacerbate the widespread misconception that vaccine-derived immunity is inferior to “natural” immunity derived from infection and recovery. As one parent put it an interview, comparing immunity resulting from vaccines with “natural” immunity resulting from infection: “A vaccine’s never gonna do better than [what] my body can produce if my body’s healthy enough to produce, so that’s what we went with.”

Misguided as such ideas are, it would be reckless to dismiss parents’ concerns as foolish or ignorant. It would also be reckless to continue to develop a vaccine without significant investment in public outreach. Not everyone who rejects vaccines is a conspiracy theorist: Some are just under the spell of the natural/unnatural binary, which has also captured everyone from fans of LaCroix seltzer to devotees of Gwyneth Paltrow’s wellness brand. Moreover, pharmaceutical companies and tech companies have squandered our trust, failing to be transparent about their product development, testing procedures and safety measures, which has resulted in marketing of ineffective drugs and patient harm. Given all of this, a vaccine produced by untrusted actors using synthetic genetic material and rushed to production runs a very high risk of provoking resistance.

Fortunately, there are established ways to mitigate that risk. Social distancing for polio in years past resembles our response to covid-19. Uncertainty and fear were equally common, and there was also a race for a vaccine. Yet as groups like the National Foundation for Infantile Paralysis — later the March of Dimes and an early example of crowdsourced science — raised funds for a vaccine, they communicated clearly and effectively to the public. So clearly and effectively, in fact, that a 1954 Gallup poll shows that more people knew about the polio vaccine field trials than knew the name of the president.

Today, trust in the medical establishment is notably lower than it was decades ago. Public perception of pharmaceutical companies has been clouded, understandably, by exposes of widespread corruption, profiteering and manipulation of the kind that led to the opioid crisis. That makes it imperative for SARS-CoV-2 vaccine researchers in the United States and abroad, as well as government agencies and health care providers, to emphasize transparency, clarity and reassurance about vaccine science — including the way vaccines work in the body and what steps were abbreviated in what will surely be an expedited review process.

Long lists of side effects in fine print and newspaper articles laden with technical jargon are not enough. An essential part of transparency is ensuring that explanations are easily accessible and widely distributed through active outreach. Supply chains and manufacturing standards, often opaque, must also be made painstakingly clear. This is especially important given the global nature of vaccine development and production, which includes countries with different standards of transparency and regulation.

Overcoming the natural/unnatural binary is a good place to start. Pediatricians are already increasingly working to describe vaccines as a technology that allows the “body’s natural immune response to create protections” and stimulate a “natural reaction.” “Immunize for Good,” a Colorado vaccine advocacy campaign, has adopted similar rhetoric to reassure the public, explaining that “Vaccines cause a natural immune response in the body without causing illness. … Our bodies recognize these weakened invaders and create antibodies to protect us against future infection. In this way, we trick our bodies into thinking we’ve already had the disease.” In other words, they emphasize how the end result is not only safe, but also natural.

Those who frame the vaccine in this way do so because they have listened to people’s concerns, and that’s what we should be doing right now. Vaccine development ought to be conducted with the continual feedback of laypeople, upon whose willingness to vaccinate our general health depends. That means anticipating new concerns and empowering the public by soliciting their input on how to communicate about them.

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