In an article for Journal of Evaluation in Clinical Practice, Dr David Robert Grimes and Professor Trisha Greenhalgh consider the argument that regulatory bodies have a “duty to act against” doctors who “intentionally mislead over the safety and efficacy of vaccination”. While enjoying a “uniquely privileged position of public trust” across much of the world, some doctors have “emerged as perpetrators” of both “inadvertent misinformation” and “deliberate disinformation” about vaccines, with “detrimental implications”. In their article, Dr Grimes and Professor Greenhalgh explore some notable examples of doctors speaking against the mainstream narrative.
Misinformation and the media
The authors reflect that “anti-vaccine rhetoric on social and mainstream media” has had a “substantial impact” on the uptake of COVID-19 vaccines, particularly in “certain demographic groups”, with social media having a key influence on “public perception of vaccine safety”. They recognise that the “abundance” of anti-vaccine materials allows “the weight of reputation” to give “undeserved legitimacy” to a “fiction”.
Trust the professionals
“The highly trusted nature of medical professionals means they are privileged to play a critical role in combatting these fictions and reversing vaccine hesitancy.”
While previous examples of concerted public engagement demonstrate the power of medical professionals, the COVID-19 pandemic “saw the worrying rise” of medical and scientific professionals “who made assertions” about vaccines based on “selective, questionable, or already refuted” evidence. As is often the case, these assertions were delivered in emotive language and repeatedly, to “huge audiences”. The authors therefore suggest that “how medical regulators should respond” is an “open, urgent question”.
“With medico-scientific professionals viewed as highly credible sources, their pronouncements on vaccination (both positive and negative) garner significantly more attention online than those of other individuals, and there is increasing awareness from both the public and medical bodies that false assertions from doctors do disproportionate harm to public understanding.”
A tragic example is offered in the paper: in the 1990s, Thabo Mbeki’s government “embraced AIDS denialism” in South Africa, citing “unorthodox opinions” of the scientist Peter Duesberg. This resulted in “an estimated 343,000 avoidable deaths”. Another example that continues to have consequences relates to vaccination: the “infamous” 1998 paper by Andrew Wakefield that “falsely linked” the MMR vaccine to autism. Although the paper was “exposed as fraudulent and retracted” in 2010, it has a “damaging legacy”. Furthermore, Wakefield was removed from the medical register by the GMC for research fraud, rather than the “long-term damage to public health” he caused through “deliberate spreading of vaccine disinformation”.
“The world is now a very different place. Social media platforms are now a major source of information and connection for millions of people around the world.”
During the “first ‘digital’ pandemic”, social platforms became outlets for “accurate, measured advice” but also presented opportunities to “garner huge audiences”.
Everything in moderation
While the authors emphasise the dangers that can be associated with allowing doctors to express their views widely, they recognise that “curtailing” their speech “risks suppressing clinical and scientific debate”. They present a handful of examples that demonstrate the importance of allowing doctors and scientists to challenge the norm. These include the case of Drs Graning and Dyar from the US, who “sounded the alarm” about a batch of polio vaccine in 1955.
However, the authors invite medical regulators to “draw the line between freedom of speech and protection of the public”. A key concern here is “whether statements appear to have been made in good faith”.
“Medical professionals, like all citizens, are entitled to their own opinion – but not their own facts.”
Authority comes not just from training and qualifications but the “reasonable assumption” that doctors will “accurately reflect what they believe to be the totality of evidence, conveying the spectrum of opinion and scientific uncertainty on contentious matters”.
The role of regulators
The authors suggest that medical regulators will need to adapt to the “challenges of health disinformation and maintaining standards”, particularly as “anti-vaccine views grow even inside the medical profession”. They consider the UK as a “no qualms” example in “dealing assertively” with complaints; in July 2023 a GP and homeopath who had encouraged parents to falsify children’s vaccination records and spread misinformation for over 15 years was “struck off” by the GMC. However, they highlight a “less proactive stance on members who make antivaccine statements in public”.
In the US, the situation is “also somewhat polarised”, with tensions between regulatory bodies who “take this issue very seriously” and the country’s “long tradition of supporting freedom of speech”. Indeed, a California law passed in 2022 that tackled misinformation from doctors was repealed a year later after doctors referred to their First Amendment rights.
“These conflicts highlight that regulation of what doctors say and write is a fine line to tread, particularly in the unregulated world of social media.”
Despite this, the authors demand “some regulatory safeguards” against those who “persistently ignore or distort data to present disingenuous positions to the public”.
What’s to be done?
The authors note that the UK GMC has “on occasion” implied that an argument against investigating high-profile doctors who make anti-vaccine statements is the potential to “amplify” their reach through publicity. However, they dismiss this as an effective argument as “celebrity doctor” already have “vast media reach for their fringe positions”.
“Regulatory action against doctors will not solve the complex problem of rising anti-vaccine sentiment among the lay public. But a rebuke from the regulator, should an investigation deem this appropriate, will send a clear signal to the public.”
The authors conclude that the current era demands regulatory involvement from an ethical and legal perspective. Furthermore, a public stand against the “propagation of misinformation” will support a regulatory body’s own credibility and “bolster public trust”.
Many members of our community publicly and privately engage in information dissemination and management to ensure that the public is presented with facts or an informed interpretation of these facts. However, this is a challenging task, so what can regulatory bodies do to encourage or support this? Do let us know your thoughts on this and the questions raised by the article and don’t forget that there’s still time to enter these discussions at the Congress in Washington this April. You can also subscribe to our newsletters here for more insights.
