A new New York Times perspective piece on whether we’re underselling the various COVID-19 vaccines had public health Twitter abuzz on Jan. 18, with responses ranging from high fives to intense critique. My reaction was in the latter camp. The points I made in this thread (unrolled here) are essential to consider for all journalists reporting on all vaccines and for this virus in particular. I’ve touched on these issues multiple times in the past, particularly the importance of knowing:

• The research on vaccine hesitancy before writing about it
• Understanding the potential impact of reporting on vaccination intent surveys
• Avoiding false balance in reporting on science topics

The bottom line is this: Reporters should familiarize themselves with the vaccine reporting landscape and research on vaccines and vaccine hesitancy before writing about vaccines. I’ve reported on vaccines for a decade and amassed a lot of knowledge (and sources). I don’t expect reporters new to the beat to come in with that level of background, and there aren’t enough reporters who have that in-depth knowledge and experience to cover the demand for stories about these vaccines right now. So it’s not unexpected that many folks will need to write about vaccines without having done much previous reporting on them.

But that is not an excuse not to do the homework because the stakes are high, as Curtis Brainard wrote nearly eight years ago in CJR. At the very least, reporters should spend extra time talking to more sources than they usually would to understand better the particular vaccine issue they’re reporting. Yes, it takes more time — sometimes a lot more time. That doesn’t change the necessity, deadline or not.

Poor and uninformed reporting on vaccines is dangerous and has genuine public health repercussions. It is not a journalist’s job to promote vaccines, and they should not do so. But they also need to be cautious not to undermine accurate and transparent public health messaging about vaccines or vaccine research either.

The NYT article, by the otherwise excellent and thoughtful reporter David Leonhardt, is a perfect example of why journalists without experience in reporting on vaccines should avoid hot takes about them until they’ve educated themselves. The article’s intentions are good, but its execution is so uninformed and irresponsible as to undermine its mission. It appears to promote the COVID-19 vaccines — but in the discordant context of claiming public health experts are being dishonest with the public, which is a narrative that can fuel anti-vaccine advocacy.

Leonhardt’s main point is that the news media and public health experts aren’t discussing these vaccines enthusiastically enough because they’re overly emphasizing that we still don’t yet know the vaccine’s ability to prevent transmission. To understand the piece’s problems, I recommend reading my Twitter thread in full (unrolled here), but here are the key points:

• The NYT piece opens with a comparison to mask guidance that’s unwise because mask compliance is highly politicized. Leonhardt misrepresents the reasons for early guidance on masks. He frames his argument as public health experts not trusting the public with “the truth” about the vaccine.
• Leonhardt literally writes, “Once again, the experts don’t seem to trust the public to hear the full truth.” Anyone experienced and knowledgeable in writing about vaccines and vaccine hesitancy knows those exact words are the narrative underlying all anti-vaccine activism and are used as a dog whistle for anti-vaccine advocacy. I know Leonhardt isn’t dog-whistling, and his post is well-intended, but his ignorance of the vaccine reporting landscape leads him to make this dangerous mistake.
• Vaccine messaging from public health experts has suffered for years from not being grounded in evidence about what makes for effective health communications. In recent years, that’s improved dramatically. Public health experts now rely on a wealth of vaccine hesitancy and communication research to craft messages. A key part is not to oversimplify information or oversell a vaccine’s strengths. As Australian vaccine researcher Julie Leask tweeted, “Overconfident vaccine risk communication can reduce trust when there is scientific uncertainty. But healthcare providers can cue hesitancy if they’re under-confident in vaccines. It’s a delicate balance, but we’ve found some reasonable approaches.”
• We’ve finally reached a point where public health messaging involves clear communication on the benefits, risks, and limits of a vaccine. That’s genuine progress in public health messaging, as anyone familiar with vaccine hesitancy research knows. Yet, that’s precisely what Leonhardt criticizes because he isn’t familiar enough with the topic. Experts are being careful to say that we don’t know whether a particular vaccine can prevent transmission from infection (where the virus enters the body and begins replicating) because of what they’ve learned from years of research into vaccine hesitancy and communication.
• The piece cites a dangerously wrong quote — disappointingly by an infectious disease physician in NEJM — that suggests no existing vaccines prevent disease without also preventing infection. That’s scientifically false, as vaccine experts and frequent reporters about vaccines know. High-profile research by Nicola Klein, Tod Merkel and others has shown the pertussis vaccine is well known to prevent disease, but not an infection. In addition, the influenza, pneumococcal, rotavirus, inactivated polio and shingles (herpes zoster) vaccines all prevent disease (symptoms from infection) but not necessarily infection itself. All these vaccines reduce transmission via the mechanism of herd immunity, but they don’t necessarily biologically prevent transmission.
• The piece states that 95% effectiveness “understates” a vaccine’s effectiveness, revealing his lack of understanding about the nuances of vaccine effectiveness and efficacy.
• Leonhardt makes an assumption about COVID-19 vaccines that isn’t true: that we don’t have enough people excited about getting it. The reality is the opposite: we have an incredibly high demand from people desperate to get it who so far can’t. As one person tweeted, “This is all so hard to read because it’s like a carrot being dangled that we can’t reach. Please understand. There are millions of seniors who want these vaccines so badly but CAN’T GET THEM FOR MONTHS. We don’t need to hear any more paeans or see any more photos. It’s torture.” That lack of access for very high demand is the big issue we need to focus on right now, as an excellent thread from scientist Becca Harrison emphasizes: “Good communication tells nuanced stories; we’re lacking in the “selling” b/c the rollout is a MESS.” She goes on to say (and I agree) that “We need to be careful we are not spending ALL energy on ‘selling’ this product to people who are (IMO rightly) nervous, and spend more of it on political pressure to actually access the vaccine.”

Melinda Wenner Moyer, another science journalist who has extensively covered vaccines for more than a decade, wrote about the NYT piece that “it’s dangerous to speak beyond the data and tell the public that *we know* that the vaccine does something that it hasn’t yet been shown to do.” Moyer says that “being honest with the public about what we know and don’t know is the best way to earn and keep their trust. Sure, we can speculate, but we need to be clear we’re speculating.” She’s written before about the challenges and perils of balancing communication about vaccine research.

In a beautiful and informative thread that includes an analogy about climbing out of a deep, dark well, virologist Angie Rasmussen, Ph.D. explains why we need to be cautious and hopeful at the same time regarding vaccines — and continue emphasizing behavioral interventions like distancing and mask-wearing.

She acknowledges that we’ve developed vaccines that “exceeded our wildest expectations at protecting us against disease,” but “there’s still a lot we don’t know about the vaccines,” including questions about transmission prevention.

Leonhardt’s purpose — to suggest we might be underselling the vaccine — is a completely valid one worth writing about. But because he lacked a foundation in vaccine reporting, he makes multiple mistakes that harm public health experts’ ability to do what he calls for. Yes, the public needs to understand better that these vaccines have remarkably, impressively high effectiveness. Even if they don’t fully prevent disease, they prevent severe disease, reducing a COVID-19 infection to something closer to a mild flu. But we also have to be sure the public understands the vaccines’ limitations. Not acknowledging those will only undermine the public trust in vaccines that experts have been working so long to gain and retain.

Tara Haelle (@TaraHaelle) is AHCJ's medical studies core topic leader, guiding journalists through the jargon-filled shorthand of science and research and enabling them to translate the evidence into accurate information.