One of the nation’s most outspoken vaccine experts believes the U.S. is already forgetting a critical lesson reinforced during the covid-19 pandemic: Vaccines save lives.

Dr. Peter Hotez said increased vaccine hesitancy, misinformation and politicization are jeopardizing people’s health.

As dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s Hospital Center for Vaccine Development, Hotez frequently boosted science and combated bad information that circulated during the pandemic. He and his ever-present bow tie became fixtures on cable news shows.

But now, five years after the covid crisis began, scientists such as Hotez see an increasing polarization around vaccines. Hotez believes the research he conducts protects the world from debilitating diseases.

The thanks he gets: death threats, vitriol and social media slander.

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“The problem is that disinformation dominates,” Hotez told TribLive this month. “It’s going to make public health pandemic preparedness very difficult, next to impossible.”

Dr. Donald Burke, retired dean of the University of Pittsburgh’s School of Public Health, agrees.

There had been a moment when it seemed the world was better prepared than ever for the next pandemic, said Burke, who previously led Pitt’s Center for Vaccine Research.

“But what worries me is that we are dismantling all of the international organizations that allow us to respond effectively to global pandemics,” Burke said. “All of these things jeopardize all of the technological advances that we had.”

Not all public health benefits that grew out of the pandemic relied on technology. Covid prompted people to pay more attention to proper hygiene and sanitization. Mental health care lost some of its stigma. The sick stayed home to avoid infecting others.

Major innovations to battle the pandemic, however, relied on science.

Advancements made it possible to crunch massive amounts of data and track trends. Vaccine development improved at record speed. And global players like the World Health Organization allowed experts to share knowledge instantaneously.

What’s more, wastewater testing allowed experts to track the virus in a new way. At-home testing — which became popular during the pandemic — is now ramping up for influenza and could expand to other viruses, too.

“Our technology to address pandemics, in terms of developing rapid diagnostics and vaccines and viral drugs, is at an all-time high,” Hotez said.

Trust in science and vaccination, however, has waned.

Disparity gap

Dr. Don Whiting, Allegheny Health Network’s chief medical officer throughout the pandemic, said vaccine skepticism could reverse the strides modern science has made to nearly wipe out once-prevalent illnesses such as polio, diphtheria, tetanus, measles and mumps. A measles outbreak in Texas and New Mexico has reached nearly 300 cases.

U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr., who has long been criticized for his vaccine skepticism, addressed the measles outbreak with this statement: “All parents should consult with their health care providers to understand their options to get the MMR vaccine. The decision to vaccinate is a personal one.”

Kennedy has recommended Vitamin A to fight measles, raising concerns among some health experts who say it cannot replace vaccination.

Families are increasingly telling doctors they want to forgo standard childhood vaccines for their kids, Whiting said.

“They don’t believe in the science anymore,” he said.

People of color, who were hit particularly hard by the pandemic, also tend to be more skeptical of health care in general, said Dr. Margaret Larkins-Pettigrew, an Allegheny Health Network obstetrician and gynecologist who is Black.

She is also the health system’s chief clinical diversity, equity and inclusion officer.

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Larkins-Pettigrew said some people of color were wary of receiving the covid-19 vaccine because of incidents like the Untreated Syphilis Study at Tuskegee, in which the federal government withheld treatments from Black men with syphilis and did not obtain their consent to be part of the study, which ran from 1932 to 1972.

People of color were more likely to work the kind of frontline jobs that put them in contact with the public at the height of the pandemic — and increased their risk of getting sick.

“There was this large disparity gap in health care, health awareness,” Larkins-Pettigrew said. “We saw the number of people of color — Blacks, African Americans, Hispanics — affected disproportionately.”

According to the National Institutes of Health, covid-19 was 156% more prevalent in Black populations than white. It was 154% higher for Hispanic people than white people.

Larkins-Pettigrew said health networks like hers have teamed up with smaller community organizations to connect minority populations with health care, education and resources.

Low-income people also have a harder time accessing health care, Larkins-Pettigrew said. Those who wanted the covid-19 vaccine weren’t always able to find transportation to clinics.

Allegheny Health Network providers worked to address those problems by taking vaccines to barbershops, restaurants and low-income housing complexes — anywhere more accessible to the most vulnerable populations.

‘Golden window’ is closing

The pandemic spurred collaboration, according to Dr. Carol Fox, chief medical officer at Independence Health System.

“There’s a lot of cooperation in research labs that might not have necessarily worked together,” Fox said. “They’re bringing together the best and the brightest to look at different means of developing vaccines.”

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But Whiting fears some of that focus has started to falter.

President Donald Trump’s recent federal funding and personnel cuts could diminish disease surveillance, experts have warned, as could his executive order pulling the United States from the World Health Organization.

Trump cited the organization’s “mishandling” of the pandemic when he announced the nation’s withdrawal.

“I think there was sort of a golden window during covid when there was a lot of collaboration and focus on planning for the future, and I think that’s mitigated a little now with more financial stress in the world and a little bit of isolationism now that the disaster’s over,” Whiting said.

Lingering trauma

Covid spurred a newfound acceptance of mental health care — an important development considering the World Health Organization reported a 25% jump in global anxiety and depression rates during the pandemic.

At least 1 in 4 adults experienced “high levels of psychological distress,” the Pew Research Center found.

To counter that, public figures spoke out about mental health issues.

Singers Kelly Clarkson and Katy Perry in 2020 chatted about mental health on Clarkson’s talk show. The United Kingdom’s Prince William joined other celebrities in urging people to reach out for mental health help if they were struggling during the height of the pandemic. Socialite Kendall Jenner shared a video with fans acknowledging her own quarantine anxiety.

Amid widespread anxiety and isolation, more people felt comfortable seeking therapy.

It became more commonplace to talk about mental health, find a therapist and take medications to help with anxiety or depression, said Monica Cwynar, a licensed clinical social worker with Thriveworks in Pittsburgh.

But the stigma around mental health remains higher in minority communities, according to Larkins-Pettigrew. People of color are less likely to seek help for mental health issues, she said, though she sees incremental progress.

Mental health treatment also carries more of a stigma among men, according to Cwynar, who said the majority of her patients are professional women between the ages of 20 and 50.

For many, the effects are still felt five years later, Cwynar said.

“The pandemic led to a surge of anxiety and depression, and other mental disorders were amplified,” she said. “I think for some people, it’s definitely going to have long-lasting effects. It’s like people who can’t move on after a war.”

That seems to be particularly true for young people whose social skills were at a critical phase of development during the pandemic, she said. Cwynar said she’s helping people in their 20s who are unsure about how to make friends, and children who are overwhelmed by noisy public spaces because they were so isolated during formative years.

Others slipped into alcoholism or addiction to cope with the pandemic — problems that can be hard to put behind them.

“People didn’t come out of it well,” Cwynar said. “Trauma lingers.”

The good news, though, is that mental health help is more available than ever before, Cwynar said, thanks to virtual options.

“People are doing therapy from their kitchens, from their bedrooms, from their cars,” she said.

‘Big question mark’

Some still grapple with the direct effects of covid-19.

Long covid, which one 2023 medical journal study found afflicts about 7% of American adults, remains something of an enigma. Sufferers await a cure.

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“It’s still a big question mark,” Whiting said.

Black and Hispanic people in the U.S. each made up a quarter of severe long-covid cases, while 1 in 7 was white, according to the National Institutes of Health.

“They entered the pandemic already behind the eight ball,” Larkins-Pettigrew said of minority populations disproportionately impacted by the virus.

Further complicating research and diagnosis is that many long-covid symptoms can be mistaken for other illnesses, Whiting said.

Symptoms include fatigue, brain fog, dizziness, shortness of breath, joint inflammation, micro clotting and irregular heart beat.

Some people may have long covid but be misdiagnosed, Whiting said. Others with mild symptoms may not seek medical care at all.

More recent mutations of covid-19 are less dangerous and virulent, Whiting said. Those changes have led to a decline in new cases of long covid.

Operation Warp Speed

Researchers who raced to find a covid cure during the pandemic’s early days considered a variety of techniques to manufacture a vaccine, said Hotez, the Baylor College professor.

Ultimately, mRNA vaccines, which use messenger RNA to teach cells how to make a protein that triggers an immune response, crossed the finish line first. They emerged in December 2020 and went into widespread use.

Hotez said it made sense to research as many options as possible, noting that scientists used a similar approach to fight Ebola.

The federal government’s Operation Warp Speed — the effort to design, produce and administer covid-19 vaccines at a breakneck pace — didn’t have a strong central communications network, according to Hotez. That left individual companies to send their own messages about vaccines they created.

“Ultimately, it tended to make it seem like these vaccines were miracle technologies that came out of nowhere,” he said.

That made some people skeptical.

In reality, Hotez said, the groundwork that made possible the covid-19 vaccines had been laid long before.

For years, researchers like Hotez had studied how the spike protein targeted by the covid shots could create coronavirus vaccines, with research prompted by a SARS outbreak a decade earlier.

Research showing that mRNA vaccines could spark an immune response was first published in 2005 by researchers at the University of Pennsylvania, who would later win a Nobel Prize for their efforts.

Hotez said the covid-19 vaccines are safe and effective — a message health care experts have been trying to drive home since the vaccines became available.

But that wasn’t the message that spread on social media. Instead, disinformation and grossly exaggerated reports of uncommon side effects dominated the discourse, Hotez said.

People shared stories claiming the vaccines caused “turbo cancer,” Hotez said, and accused people like himself of intentionally unleashing a “plandemic,” an orchestrated outbreak aimed at making people sick and crippling the economy to disrupt the first Trump administration.

Uncertainty ahead

Now, Hotez said, he thinks uptake of any mRNA vaccine — even for illnesses other than covid-19 — would be greatly hindered by the anti-vaccine sentiment that soared during the pandemic.

Those ideas continue to spread like infectious diseases themselves, Hotez said.

“The anti-vaccine sentiment is spilling over into childhood immunizations,” he said, adding that some parents now “erroneously think the vaccines are more dangerous than the diseases they’re designed to prevent.”

That, he said, is what allowed the current measles epidemic in Texas to escalate.

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In general, health officials’ messages about the pandemic sparked controversy and mistrust, said Burke, the former Pitt dean. Many people resisted mask mandates, possibly in part because even experts gave mixed messages about their effectiveness, who should don them and what kind would work.

The public pushed back on lockdowns, especially healthy, young people who were at less risk of serious illness.

And vaccines became more polarizing as they became more political. Exacerbating the debate, Burke said, was the fact that some employers mandated the jabs.

The federal government recently yanked funding for research into vaccine hesitancy. Medical institutions, Hotez believes, don’t have the same social media reach as anti-science influencers.

“We are definitely not in good shape for the next pandemic,” Hotez said. “We have the technical ability to solve a lot of these problems in terms of vaccines, diagnostics — but we’re stuck because of all the anti-science aggression.”

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