Fast Vaccine Science Still Fails Without Public Trust

Kizzmekia Corbett’s term for a crucial public-health audience is “vaccine inquisitive.” She does not use it as a synonym for anti-vaccine or anti-science. She means people who are unconvinced: people with questions, concerns, misinformation or criticisms that need expert answers “without scorn and without judgment.”

The category came into focus for her on a first date in 2018. The man across the table said he planned to vaccinate his future children, except for the flu vaccine, because he believed it contained viruses and made him sick whenever he took it. Corbett was then a research fellow at the National Institutes of Health Vaccine Research Center and had just invented a novel flu vaccine slated for clinical trial. Instead of leaving, she answered.

Yes, she told him, the flu vaccine contains viruses, but they are not alive and “technically cannot make you sick.” Feeling groggy after vaccination can be a sign that the immune system is working. She also asked whether he knew that 200 or more viruses can cause flu-like symptoms or the common cold. He did not.

That exchange became the model for her larger argument. His position was not simple refusal. He had questions and misinformation “buried deep down” that an expert could answer. Corbett says he was not offended; he asked her on a second date. The point is not that every skeptical question is right. It is that skepticism handled without contempt can become the beginning of trust.

Corbett argues that vaccine readiness has to include answering people who are being asked to take vaccines. The scientific capacity to design and test a vaccine quickly is necessary, but it is not sufficient if the people being asked to take the vaccine do not trust the process, the messengers or the answers they receive.

Corbett says vaccinologists had long ignored people who were not going to take vaccines for one reason or another. Scientists were busy publishing data in world-renowned journals, she says, and “kind of talking to ourselves.” That gap became impossible to treat as peripheral during COVID-19.

By the end of 2020, after the vaccine she helped develop had moved with record speed and been determined to be 94 percent effective against disease, the “gut punch” for her was that 20 percent of people were what the World Health Organization would call vaccine hesitant.

She emphasizes that hesitancy was not new. Even before the pandemic, vaccine hesitancy had been deemed one of the top 10 global health threats. Her lesson is not that scientific achievement failed. It is that scientific achievement did not, by itself, solve the public trust problem.

One major public concern, Corbett says, was that COVID-19 vaccines were moving too fast. Her answer is that the vaccine did not come from nowhere. Researchers had already studied coronavirus basic biology. Nobel-recognized work had helped make mRNA feasible for delivering medicines into the body. Her own team had developed a coronavirus spike protein with a small sequence change that made it an “ideal vaccine candidate” in case of a pandemic.

The visual model accompanying her explanation depicts a coronavirus with orange spike proteins on its surface. Those proteins, she says, are responsible for driving immunity. That prior work mattered when a report emerged on December 31, 2019, of a mysterious virus in Wuhan, China, that had sickened 27 people. In January 2020, when the circulating virus was deemed to be a coronavirus, her team joined Moderna and set a goal of entering a phase one clinical trial in 100 days.

Corbett calls that goal “purely scientific,” though she adds that, looking back, “there was probably a little bit of ego attached to it too.” After testing the vaccine in mice and monkeys and determining it was safe and effective enough for human study, mRNA-1273 — later known as Spikevax — entered a phase one clinical trial in 66 days.

That speed became part of both the achievement and the communications burden. Corbett says the accumulated research pushed the coronavirus vaccine out “quicker, safer and more effective.” But she also argues that people still had questions that needed answers. The fact that a concern could be answered scientifically did not mean the concern should be dismissed socially.

Corbett’s critique includes her own public communication. On her first television appearance, she said the vaccine was going to curb transmission. “At that time, it did,” she says. But she now argues she should have added that over time, as the virus mutated, the vaccine might become less effective at curbing transmission.

She says scientists also should have used more “care and tenderness” when talking about the possibility of vaccine injury. Even if vaccine injury did not turn up in clinical trials, she says, the possibility remained. For someone reading headlines about vaccine injury while deciding whether to vaccinate themselves or loved ones, statistics alone did not settle the question.

Her point is not that every objection was correct. It is that some people were weighing real fears under conditions of uncertainty, and Corbett thinks scientists made honest communication mistakes while also spending too much time talking to one another. Failed communication, she worries, lingered.

She links some of that failure to a present rise in vaccine refusal: kindergartners arriving at school without full vaccine regimens, measles rising in many communities, and measles, as she stresses, being vaccine-preventable. The stakes extend beyond the current vaccination schedule. Corbett says there are 23 viral families with the potential to infect humans. Another pandemic, in her formulation, is not a question of whether, but when. That makes public trust part of pandemic preparedness.

At Harvard, Corbett says her lab studies how to turn nanoparticles — “small protein balls” — into vaccines. The molecular animation used to illustrate the work shows a nanoparticle, a viral protein and a linker assembling into a vaccine structure studded with viral proteins. She describes the method as placing viral proteins on nanoparticle surfaces in a “click and bait” way, using small linkers to drive those proteins to immune-system cells needed for ideal pandemic vaccines.

The possible breadth is central to why she treats trust as a preparedness issue. Corbett says scientists can put just about any type of viral protein on the surface, including many at the same time, so they can make vaccines that are “hypothetically good against many viruses in one shot.”

Her future vaccine work makes the trust problem more urgent, not less. “Vaccine technology is going to go on and on and on,” she says. “But I like to believe that vaccine hesitancy does not have to go on and on and on with it.” The shift she wants is for researchers to open their minds to vaccine inquisitiveness the way they open their minds to scientific inquisitiveness.

She describes the meeting of community and science as practical rather than revolutionary. When community and science meet, she says, science advances faster and vaccine refusal can turn into vaccine acceptance. She returns to her first-date story with a personal turn: when the vaccine-inquisitive person met a scientist on a date, it became a marriage.

A black-and-white wedding photograph reinforces that ending, but Corbett’s final point is not that trust eliminates questions. Her husband, she says, still has questions every time they take their children to get vaccines, and she still has to find the answers — not only as a scientist, but as a mother concerned with her children’s safety.