Q&A: NIH Director Francis Collins on the battle to improve vaccine acceptance 

As the coronavirus pandemic begins to come under control in the United States, public health experts are increasingly anxious about the significant number of Americans who express skepticism or hesitancy about getting one of the three FDA-approved vaccines.

Few Americans have greater insight into the history, safety and efficacy of vaccines in general, and the coronavirus vaccines in particular, than Francis Collins, the director of the National Institutes of Health (NIH). The Hill spoke with Collins this week to understand how he and the Biden administration are winning over those who remain skeptical.

The following transcript has been lightly edited for clarity and length.

The Hill: Dr. Collins, thank you so much for taking the time. I know this is an issue that you care about a lot. So I wanted to define the problem here. What are the populations that you see are most likely to be vaccine skeptical right now?

NIH Director Francis Collins: Well, it’s good to think about it as not a homogeneous group, they’re different populations with different reasons for concern. African Americans with a long history of uncertainty about whether the medical care system has really got their best interests at heart — and a history from episodes like Tuskegee where even medical researchers seem to be behaving in unethical ways — have their reasons to be somewhat doubtful about whether something that government is putting forward is necessarily well-suited to them, so they’re asking those kinds of questions, and I totally understand that. 

People of faith, particularly white evangelicals, I think are also concerned about the vaccine on a couple of bases. One is, do they really need to depend on something out of medicine? If they’re believers, is God going to take care of them? And of course, God can work through medicine as well, so I would argue that’s a separation of trust to suggest you can only trust in either God or medicine. I think you could probably trust in both, but that does trip people up. 

There’s the fetal tissue issue, where there are concerns amongst pro-life believers, that there may be something about these vaccines that’s contaminated by the abortion issue. For the Moderna and the Pfizer vaccines which are mRNA based, there is no use of a fetal cell line to prepare the vaccine. The Johnson & Johnson vaccine is grown in a cell line that’s been around since 1985, which was derived from an elective termination in Scandinavia. So, [abortion] I think is on the minds of some believers, although the Catholic Church has made it quite clear that they believe submitting to these vaccinations is entirely ethical, even for people who are rigidly pro-life. 

Then there’s a political perspective. I guess one of the things that’s most surprising is to see the rise in resistance, particularly from Republican men, which recent polls suggest as many as 50 percent may be hesitant. And that situation this is clearly all tangled up with the polarization of virtually everything in the United States, and the sense I suppose that the way in which the vaccines were put together was not something that they feel was fully supported by the political system, and maybe there was some agenda there, and now that their party is no longer in power in the White House, they would have less confidence in the messages they’re hearing from the government about why this is a good thing — even though of course, Donald Trump was himself vaccinated.

In every instance what I’ve learned is if somebody says they’re hesitant, the first thing I want to know is, tell me about that. Tell me what it is that has you troubled. Is it the conspiracy theories you’ve been hearing? And there’s plenty of those out there on social media. Is it your concern about safety issues not having been fully addressed? Is it some other factor that’s in there? And there’s no single, I think, best response until you’ve listened to hear what the basis of the hesitancy is and that person.

The Hill: I hear a lot of health experts say that the listening process is crucial, but that takes time. I wonder if there’s a balance between taking the time to listen and respond, and the race to get shots in arms.

Collins: Yeah, and that’s our current challenge, isn’t it? Because we are approaching the point where we will have a sufficient supply of vaccines for everybody in the United States to have the chance to get immunized by the end of May. And so the hesitancy will begin to become the defining factor and whether we reach herd immunity or not. That doesn’t give us a lot of time. We’re down to a little over two months to try to do the listening and also then the responding. 

I think that means this has to be the moment where we really pull into this conversation all of the trustworthy voices. I think that’s a big part of what we need to do right now really is to empower those voices who are not necessarily old white guys who work for the federal government, like me. But others who have the trust of communities that are likely to be resistant. So that means the doctors out there in the community. It’s interesting when you see that something like 95 percent of doctors are getting vaccinated, that tells you they believe that this is a good thing and the more they can be explicit about that, the more helpful that will be in getting the message across that this really is safe and effective. 

I’ve done a lot of my time in the last few weeks and more today, talking to churches, because there again, I think those are voices that are trusted that don’t have an ax to grind, that are going to bring information to people about what is good for them and that is also consistent with their beliefs. So empowering clergy leaders to have the facts, so that they can share those, is another important step we could be taking. And then elected officials, if they have the trust of their community, they can be helpful as well. 

We just have to get the word in front of people coming from voices that don’t appear to have some conflict. And the government, in many people’s minds and our current fracturing situation, will appear to have a conflict of interest. So will industry. So better to have the voices coming from other sources.

The Hill: What messages themselves have you found to be the most impactful in convincing skeptics, whether among the African American community, among the evangelical community, among the Republican right?

Collins: I think it helps to explain how the vaccines were developed, that this concern about them having been rushed can be answered by pointing out how the speed was achieved, which was by basically getting rid of the downtimes that traditionally occur when a vaccine is being developed and results in it taking years. There was no shortcut taken with any of the rigorous steps, and to evaluate these vaccines. The shortcuts were to get rid of the downtime, the bureaucracy, the red tape, the need to go back and try to raise more funds when you ran out. All of that was planned in advance, realizing that this really was a global pandemic and people were dying. So, to reassure people that the speed of preparation should not be seen as a cause of concern about its safety, that’s certainly one message. 

I think it helps, also, just to help people think through what are they trying to decide between. Between, am I going to get vaccinated? And am I worried about what that might mean as far as any negative effects? Versus, am I going to get COVID-19 and potentially get very sick or even die? And you sort of put those two next to each other. It is harder to make that case compelling for a young person who thinks of themselves as pretty much invincible and if they get sick, it’s not going to be so bad. 

One of the things that we’re learning more is about long COVID, and that even young people with mild illness may not get better after this, which is another reason you really don’t want to put yourself in harm’s way. 

And then one other thing I think we do have to be clear about is the vaccination, while it is a great benefit to the person, it’s also a benefit to the rest of the community. By declining vaccination, you’re not just declining something for yourself, you’re potentially putting other people at risk around you by being that asymptomatic super-spreader that could cause a lot of harms to occur. And you have to think about, am I willing to take on that potential responsibility that I could be really hurting other people? That has to be on the table as people are balancing pros and cons. 

And I must say for people who are resistant on the basis of religious belief, this is one I think that people do look at and go, ‘Oh, wow. You mean, is this a love your neighbor moment?’ Yes it is. And whatever faith you are the golden rule seems to apply, and the golden rule would say, for your neighbor or for your family, for your neighbors down the street who may be vulnerable. This is something you can do for them.

The Hill: You mentioned some of the messengers who have been most effective — church leaders and clergy. Who are the other messengers who are most effective in their community? I was talking to the mayor of Kansas City the other day and he said he wanted to see LeBron James get vaccinated.

Collins: I would love to see as many celebrities as possible roll up their sleeves with cameras on them. How much of an impact that has, if you talk to the focus groups, they will say yeah that’d be nice but I’d rather hear it from my doc.

The Hill: That’s interesting. Tell me about the focus groups, they seem to be saying they want to hear from their doctors.

Collins: They are impressed by very visible people taking the time to document their receipt of the vaccine. But if they’re worried about safety and efficacy, they’d rather hear this from somebody they assume has access to some of the facts that may not be so readily apparent. Therefore their doctor may be able to tell them more convincingly that this is something you’d want to do than LeBron James could.

The Hill: Has your approach to convincing people not to be skeptical evolved at all? Were there messages that you were using that you’re not anymore?

Collins: I think it has. I must say, I initially, I found this [skepticism] sort of hard to understand and probably that response was coming across, that sort of disbelief, which can be translated into, ‘what are you, stupid?’ And that was not helpful. I’ve really evolved to the point of recognizing there are plenty of reasons why thoughtful serious people may be having reservations, but they are addressable. But it isn’t going to help to hit somebody over the head with a whole bunch of instructions until you’ve listened to where they’re coming from. So I really tried to switch into that mode.

The Hill: How closely are you working with the White House and governors in developing their own messages?

Collins: The White House is very invested in getting these messages out there, and I have been part of that team in terms of making sure that any kind of interaction I’m having on this topic is coordinated with what they’re trying to do. There is a lot of efforts now to get public service messages out there. The White House has particularly encouraged me to be a voice to people of faith, because they know that I’m a person of faith and therefore I may be able to resonate a bit with some of those concerns and convince people that I understand the perspectives that they’re bringing to the table.

The Hill: At our current pace of vaccinating people, do you think we’ll achieve enough acceptance to reach some kind of herd immunity in the next few months?

Collins: I don’t know. It’s not a slam dunk, considering what the polls tell you about resistance. So, we only have a couple of months to try to see how that can turn around, so yeah, this is going to be a really critical, couple of months of watching closely to see if some of those trends can be turned around by appropriate messages from trustworthy people.