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Overcoming vaccine hesitancy: five minutes with . . . Heidi Larson

BMJ 2019; 364 doi: (Published 18 March 2019) Cite this as: BMJ 2019;364:l1259

Rapid Response:

Fear of the disease is not a reason for confidence in the product...

The World Health Organization has nominated "vaccine hesitancy" [1] one of the ten threat to global health in 2019. So perhaps a pertinent question for Heidi Larson [2], director of the Vaccine Confidence Project, is from what body of evidence does she draw her confidence?

As an example Larson wrote last year in the Financial Times:

"In 2009, during the swine flu pandemic of the H1N1 influenza virus, poor public co-operation and low acceptance of the vaccine was a wake-up call. The public might fall for faulty science, but the more worrying trend in 2009 was the lack of civic responsibility and co-operation. Governments should see in this an urgent need for a new social contract."

But there were many disturbing aspects to this episode and it is far from clear that public scepticism regarding the WHO and its decision making were unjustified [3,4, 5,6,7]. As we know vaccine products were rushed to the market in weeks, and GlaxoSmithKline's Pandemrix became rapidly associated with the condition of narcolepsy. In the UK only about six million doses were taken up but the situation could have been much worse if the 132 million rounds originally ordered had be taken up [8].

Perhaps ordinary citizens are entitled to know and discuss shortcomings in the science for influenza vaccines or vaccines against HPV virus [9,10,11].

Suppressing public debate will inevitably undermine trust further.


[2] Joanne Silberner, 'Overcoming vaccine hesitancy: five minutes with . . . Heidi Larson', BMJ 2019; 364 doi: (Published 18 March 2019)

[3] Deborah Cohen & Philip Carter, 'WHO and the pandemic flu “conspiracies”' BMJ 2010; 340 doi: (Published 04 June 2010)

[4] 'Interview with Epidemiologist Tom Jefferson 'A Whole Industry Is Waiting For A Pandemic'', Der Spiegel, 21 July 2009,

[5] Tom Jefferson, The UK turns to Witty, Vallance, and Van Tam for leadership: revolving doors?, 6 December 2017,

[6] Peter Doshi, 'Pandemrix vaccine: why was the public not told of early warning signs?',
BMJ 2018; 362 doi: (Published 20 September 2018)

[7] Fiona Godlee, 'A tale of two vaccines', BMJ 2018; 363 doi: (Published 04 October 2018)

[8] John Stone, 'Re: A tale of two vaccines - how the British people averted disaster?', 13 October 2018,

[9] Jørgensen L, Gøtzsche PC, Jefferson T.'The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias', BMJ Evid Based Med. 2018 Oct;23(5):165-168. doi: 10.1136/bmjebm-2018-111012. Epub 2018 Jul 27

[10] Nigel Hawkes, 'Cochrane director’s expulsion results in four board members resigning', BMJ 2018; 362 doi: (Published 17 September 2018)

[11] Lars Jørgensen, Peter Doshi, Peter Gøtzsche, Tom Jefferson, 'Challenges of independent assessment of potential harms of HPV vaccines', BMJ 2018; 362 doi: (Published 24 September 2018)

Competing interests: No competing interests

21 March 2019
John Stone
UK Editor
London N22