Although he did not specifically throw his old agency under the bus, the former director of the Centers for Disease Control and Prevention (CDC) under the Obama administration described critical aspects of public health messaging that have been conspicuously lacking under current leadership.

“Communication is crucial. At CDC, your principles are be first, be right, be credible,” Tom Frieden, MD, MPH, former director of the CDC, said at the recent IDWeek 2020 infectious disease meeting. “It is so important to epidemic response. Tell people what you know and tell them how you know it. Tell them what you don’t know and what you will do to figure it out. Consistent, sincere, transparent. Give people concrete, practical things to do to protect themselves, their families, and their communities.”

Under an unprecedented level of political pressure, the CDC has issued and recalled recommendations, sent out mixed messages, and seen its pandemic guidelines undermined and ignored by the Trump administration.

“I think we have to recognize that there are some things we can control and some we can’t control,” Frieden said. “We need clear communication. We need to be speaking regularly to the public day in and day out in plain language, transparently, telling them what we know and don’t know.”

In addition to a pandemic, we are living in an “infodemic,” Michael Ryan, MD, MPH, director of the Health Emergencies Programme at the World Health Organization, said at IDWeek.

Part of the reason there is “this information and disinformation is [people] have had to face the pandemic with the sense of being on their own,” he said. “In fact, there is a sense of fatigue and in some cases hopelessness for the future in terms of what can be done to stop this virus.”

Going forward, public health officials need to publicly acknowledge the information gaps and challenges. “We have to get much better at filling those channels with good information,” Ryan said. “We need to work on our side to make it the place where people come to get information. The world has changed, and disinformation is part of that. We need to be aware and track that. We don’t need to be turning this into another combat between us and the bad people who put out the misinformation. A lot of that misinformation is genuinely held belief and therefore can’t be countered by scolding and censoring.”

Social and behavioral sciences can help understand these attitudes and beliefs. “It’s not about who wins the information,” Ryan said. “It’s who wins the trust war, the behavioral war.”

Engage people who have sincere doubts, “and then along with the social media companies, we need to isolate the clear malicious misinformation,” Frieden said.

Vaccine ‘Skeptics and Cynics’

Within this broader disinformation is specific distrust of the vaccines under development for COVID-19. There are essentially two groups historically: vaccine skeptics and antivaccine activists, said Paul Offit, MD, director of the Vaccine Education Center and an infectious disease physician at Children’s Hospital of Philadelphia.

“Vaccine skeptics are people who are reasonably concerned that the speed with which we are developing this vaccine is unprecedented,” Offit said at IDWeek. “We just had this virus in hand really in January and now within roughly a year we are going to have a vaccine. That’s the fastest vaccine that has ever been made.”

In addition, the messaging of doing something potentially dangerous at “warp speed,” along with media descriptions of a “race to a vaccine,” have “made people nervous,” Offit said. “I do think we are going to have to explain these vaccines to people.”

Antivaccine activists have adopted belief systems beyond science and reason, and therefore cannot be reached using them, he added.

“These people aren’t skeptics — I think they are cynics,” he said. “They just believe the pharmaceutical companies control everything and they are not going to believe anything you have to say.”

In a move that threatens uptake of an eventual SARS-CoV-2 vaccine, the nation’s antivaccine movement is framing an immunization refusal strategy based on civil rights arguments that likely will be underscored by conspiracy theories, says David A. Broniatowski, PhD, a professor of engineering and applied science at George Washington University.

Previously, Broniatowski published research on how Russian antivaccine bots and trolls were mobilized during the 2016 general election.1 That paper was followed earlier this year by a study on how vaccine communications have been weaponized through identity politics.2 His latest paper, an analysis of 204 Facebook pages of antivax groups, traces how a large measles outbreak at Disneyland in 2015 led to the emergence of a common antivaccine narrative, “emphasizing civil rights and freedom from elitist government vaccine opposition.”3

“One of the things that is interesting about the COVID discourse online is that it really draws pretty heavily on what we’ve seen before in the antivaccine communities,” Broniatowski says. “A lot of the things we are seeing around COVID — not just about a vaccine but wearing masks — are basically a page out of the antivaxxer playbook.”

Professionally produced films like Vaxxed and more recently, Plandemic, reinforce the conspiratorial attitudes of these groups, he adds.

“QAnon has been in the news a lot recently,” he says. “They have incorporated antivaccine tropes into their mythology — also chemtrails, antifluoride, flat Earth. Just about every conspiracy theory under the sun shows up in some form or another on QAnon. They don’t necessarily care if the conspiracy theories are right or wrong — in many cases, they contradict each other. It allows the theory itself to spread and gives them something to hang their hat on.”

When you are talking about opposing vaccination, you are fundamentally talking about issues of health freedom, especially in the civil liberties world, he explains.

“If you believe the government or somebody who is vaccinating is out to get you — if you believe some conspiracy theory like people are going to profit off of your poor health — you are more likely to refuse to be vaccinated,” he said. “If you just leave it at it’s your choice to vaccinate or not, [most people] think it’s a good idea. You have to tell them it’s their choice and give them why it is a good choice not to vaccinate. It’s framed as freedom of choice, but the implicit assumption is vaccine is not the right choice.”


  1. Broniatowski DA, Jamison AM, Qi S, et al. Weaponized health communication: Twitter bots and Russian trolls amplify the vaccine debate. Am J Public Health 2018;108:1378-1384.
  2. Broniatowski DA, Quinn SC, Dredze M, et al. Vaccine communication as weaponized identity politics. Am J Public Health 2020;110:617-618.
  3. Broniatowski DA, Jamison AM, Johnson NF, et al. Facebook pages, the “Disneyland” measles outbreak, and promotion of vaccine refusal as a civil right, 2009-2019. Am J Public Health 2020;110:S312-S318.