The Infosphere as a SDOH: Leveraging Providers’ Influence to Counter Vaccine Misinformation

The Incidental Economist

The following, which originally appeared on the Drivers of Health blog, is authored by Luke Testa, Program Assistant, The Harvard Global Health Institute.

In 2018, a short video circulated on WhatsApp claiming that the MMR vaccine was designed by Indian Prime Minister Narendra Modi to stop the population growth of Muslims. Subsequently, hundreds of madrassas across western Uttar Pradesh refused to allow health departments to vaccinate their constituents.

In 2020, a three-minute video claiming that the coronavirus vaccination campaign was secretly a plan by Bill Gates to implant trackable microchips in people was one of the most widely shared pieces of misinformation online. Alongside a torrent of online COVID-19 vaccine falsehoods and conspiracy theories, sources of medical mis- and disinformation are fostering distrust in COVID-19 vaccines, undermining immunization efforts, and demonstrating how poor information is a determinant of health.

Medical misinformation, referring to inaccurate or unverified information that can drive misperceptions about medical practices or treatments, has flooded the infosphere (all types of information available online). Examples can vary from overrepresentations of anecdotes claiming that complications occurred following inoculation to misinterpretations of research findings by well-meaning individuals.

Considering the many ways in which medical misinformation can shape health behaviors, researchers at the Oxford Internet Institute recently suggested that the infosphere should be classified as a social determinant of health (SDOH) (designated alongside general socioeconomic, environmental, and cultural conditions). This classification, they argue, properly accounts for the correlation between exposure to poor quality information and poor health outcomes.

The connection between information quality and health has been especially pronounced during the COVID-19 pandemic. A 2021 study found that amongst those who indicated that they would definitely take a COVID-19 vaccine, exposure to misinformation induced a decline in intent of 6.2% in the U.K. and 6.4% in the U.S. Further, misinformation that appeared to be science-based was found to be especially damaging to vaccination intentions. These findings are particularly concerning considering the fact that during the pandemic, the 147 biggest anti-vaccine accounts on social media (which often purport to be science-based) gained 7.8 million followers in the first half of 2020, an increase of 19%.

During an unprecedented health crisis, medical misinformation within the infosphere is leaving both individuals and communities vulnerable to poor health outcomes. Those who are unvaccinated are at a higher risk of infection and increase the likelihood of community transmission. This places undue burden on those who cannot get vaccinated—due to inequities and/or preexisting conditions—and increases opportunities for variants to continue to mutate into more infectious and/or deadly forms of the virus. Poor quality information within the infosphere is undermining immunization efforts and threatens to prolong the ark of the pandemic.

Leveraging Healthcare Provider Influence in the Battle Against Poor Quality Information

Healthcare providers are uniquely suited to respond to this challenge. Throughout the pandemic, majorities of U.S. adults have identified their doctors and nurses as the most trustworthy sources of information about the coronavirus. In fact, 8 in 10 U.S. adults said that they are very or somewhat likely to turn to a doctor, nurse, or other healthcare provider when deciding whether or not to get a COVID-19 vaccine.

This influence is especially pertinent considering the state of vaccine resistance across the globe. In March 2021, a Kaiser Family Foundation poll found that 37% of U.S. respondents indicated some degree of resistance to vaccination. If that percentage of Americans remain unvaccinated, the country will be short of what is needed to achieve herd immunity (likely 70% or more vaccinated). Similar levels of resistance to vaccination remain high in countries across the globe, such as Lebanon, Serbia, Paraguay, and France.

Although medical misinformation is contributing to high rates of refusal, it is important to note that drivers of vaccine resistance are complex and intersectional. Vaccine distrust or refusal may be rooted in exposure to anti-vaccine rhetoric, racial injustice or medical exploitation in healthcare, fears that vaccine development was rushed, and/or other drivers. For this reason, responses must be tailored to unique individual or communal motivations. For example, experts have pressed the critical need for vaccine distrust within Black communities to be approached not as a shortcoming of community members, but as a failure of health systems to prove themselves as trustworthy.

With regard to resistance rooted in anti-COVID-19 vaccine misinformation, healthcare providers are leveraging their unique influence through novel, grassroots approaches to encourage vaccine uptake. In North Dakotaproviders are recording videos and sending out messages to their patients communicating that they have been vaccinated and explaining why it is safe to do the same. On social media, a network of female doctors and scientists across various social media pages, such as Dear Pandemic (82,000 followers) and Your Local Epidemiologist (181,000 followers), are collaborating to answer medical questions, clear up misperceptions about COVID-19 vaccines, and provide communities with accurate information about the virus. Similarly, the #BetweenUsAboutUs online campaign is elevating conversations about vaccines with Black doctors, nurses, and researchers in an effort to increase vaccine confidence in BIPOC communities. This campaign is especially critical considering the fact that BIPOC communities are often the target of anti-vaccine groups in an effort to exploit existing, rational distrust in health systems.

In addition to these timely responses, evidence-based interventions offer promising opportunities for healthcare providers to improve vaccine uptake amongst their patients. For example, there is a growing consensus around the practice of motivational interviewing (MI).

MI is a set of patient-centered communication techniques that aim to enhance a patient’s intrinsic motivation to change health behaviors by tapping into their own arguments for change. The approach is based on empathetic, nonjudgmental patient-provider dialogue. In other words, as opposed to simply telling a patient why they should get vaccinated, a provider will include the patient in a problem-solving process that accounts for their unique motivations and helps them discover their own reasons for getting vaccinated.

When applying MI techniques to a conversation with a patient who is unsure if they should receive a vaccine, providers will use an “evoke-provide-evoke” approach where they will ask patients: 1) what they already know about the vaccine; 2) if the patient would like additional information about the vaccine (if yes, then provide the most up to date information); and 3) how the new information changes how they are thinking or feeling about vaccination. During these conversations, the MI framework encourages providers to ask open-ended questions, practice reflective listening, offer affirmations, elicit pros and cons of change, and summarize conversations, amongst other tools.

Numerous studies show motivational interviewing to be effective in increasing vaccine uptake. For example, one randomized controlled trial found that with parents in maternity wards, vaccine hesitancy fell by 40% after participation in an educational intervention based on MI. Given its demonstrated effectiveness, MI is likely to help reduce vaccine hesitancy during the COVID-19 pandemic.

With infectious disease outbreaks becoming more likely and resistance to various vaccines increasing across the globe, continuing to leverage healthcare providers’ unique influence through grassroots campaigns while honing motivational interviewing skills as a way to combat mis- and disinformation in the infosphere may prove critical to advancing public health now and in the future.

Share this…

Incidents and Criticisms: Vaccine Backlash Part 2

Incidents and Criticisms: Vaccine Backlash Part 2 - YouTube

Part five of our six-part series on vaccinations, supported by the National Institute for Health Care Management Foundation, continues to explore the history of societal backlash against vaccination, with particular attention to vaccine-adjacent incidents and misinformation.

The History of Vaccine Backlash Part 1

The History of Vaccine Backlash Part 1 - YouTube

Part four of our six-part series on vaccinations, supported by the National Institute for Health Care Management Foundation. It turns out, people have been resistant to the idea of vaccines pretty much since vaccines were invented. This video explores the history of anti-vaccine sentiments, vaccine legislation, and societal backlash.

Mona Lisa getting her Covid-19 Vaccine

May be an image of 1 person and strawberry
Mona Lisa getting her Covid-19 Vaccine.

A quarter of the country won’t get the coronavirus vaccine

We’re a year into the coronavirus pandemic, so the math that undergirds its risks should by now be familiar. We all should know, for example, that the ability of the virus to spread depends on it being able to find a host, someone who is not protected against infection. If you have a group of 10 people, one of whom is infected and nine of whom are immune to the virus, it’s not going to be able to spread anywhere.

That calculus is well known, but there is still some uncertainty at play. To achieve herd immunity — the state where the population of immune people is dense enough to stamp out new infections — how many people need to be protected against the virus? And how good is natural immunity, resistance to infection built through exposure to the virus and contracting covid-19, the disease it causes?

The safe way to increase the number of immune people, thereby probably protecting everyone by limiting the ability of the virus to spread, is through vaccination. More vaccinated people means fewer new infections and fewer infections needed to get close to herd immunity. The closer we get to herd immunity, the safer people are who can’t get vaccinated, such as young children (at least for now).

The challenge the world faces is that the rollout of vaccines has been slow, relatively speaking. The coronavirus vaccines were developed at a lightning pace, but many parts of the world are still waiting for supplies sufficient to broadly immunize their populations. In the United States, the challenge is different: About a quarter of adult Americans say they aren’t planning on getting vaccinated against the virus, according to Economist-YouGov polling released last week.

That’s problematic in part because it means we’re less likely to get to herd immunity without millions more Americans becoming infected. Again, it’s not clear how effective natural immunity will be over the long term as new variants of the virus emerge. So we might continue to see tens of thousands of new infections each day, keeping the population at risk broadly by delaying herd immunity and continuing to add to the pandemic’s death toll in this country.

But we also see from the Economist-YouGov poll the same thing we saw in Gallup polling earlier this month: The people who are least interested in being vaccinated are also the people who are least likely to be concerned about the virus and to take other steps aimed at preventing it from spreading.

In the Economist-YouGov poll, nearly three-quarters of those who say they don’t plan on being vaccinated when they’re eligible also say they’re not too or not at all worried about the virus.

That makes some perverse sense: If you don’t see the virus as a risk, you won’t see the need to get vaccinated. Unfortunately, it also means you’re going to be less likely to do things like wear a mask in public.

Or you might be more likely to view as unnecessary precautions such as avoiding close-quarter contact with friends and family or traveling out of state.

About a quarter of adults hold the view that they won’t be vaccinated when eligible. That’s equivalent to about 64 million Americans.

Who are they? As prior polls have shown, they’re disproportionately political conservatives. At the outset of the pandemic, there was concern that vaccine skepticism would heavily be centered in non-White populations. At the moment, though, the rate of skepticism among those who say they voted for Donald Trump in 2020 and among Republicans is substantially higher than skepticism overall.

That shows up in another way in the Economist poll. Respondents were asked whose medical advice they trusted. Among those who say they don’t plan to get the vaccine, half say they trust Trump’s advice a lot or somewhat — far more than the advice of the Centers for Disease Control and Prevention or the country’s top infectious-disease expert Anthony S. Fauci.

If we look only at Republican skeptics, the difference is much larger: Half of Republican skeptics say they have a lot of trust in Trump’s medical advice.

The irony, of course, is that Trump sees the vaccine as his positive legacy on the pandemic. He’s eager to seize credit for vaccine development and has — sporadically — advocated for Americans to get the vaccine. (He got it himself while still president, without advertising that fact.) It’s his supporters, though, who are most hostile to the idea.

Trump bears most of the responsibility for that, too. Over the course of 2020, worried about reelection, he undercut containment efforts and downplayed the danger of the virus. He undermined experts such as Fauci largely out of concern that continuing to limit economic activity would erode his main argument for his reelection. Over and over, he insisted that the virus was going away without the vaccine, that it was not terribly dangerous and that America should just go about its business as usual — and his supporters heard that message.

They’re still listening to it, as the Economist poll shows. One result may be that the United States doesn’t reach herd immunity through vaccinations and, instead, some large chunk of those tens of millions of skeptics end up being exposed to the virus. Some of them will die. Some may risk repeat infections from new variants against which a vaccine offers better protection. Some of those unable to get vaccinated may also become sick from the virus because we haven’t achieved herd immunity, suffering long-term complications from covid-19.

Trump wants his legacy to be the rollout of the vaccine. His legacy will also probably include fostering skepticism about the vaccine that limits its utility in containing the pandemic.

Hospital Volunteers Wanted

May be an image of text that says 'WANTED Volunteers who don '+ believe in COVID19. Activities include transfer of Patients, transfer of the dead, general cleaning on the COVID ward and personal care of COVID patients. OS: It won '+ be a problem that you won + get PPE as you don't believe they are necessary. Signed: Health care Workers'

Cartoon – Open the U.S. Now

A. Christian van Gorder: George Washington meets a viral pandemic | Board  Of Contributors | wacotrib.com

Yogi Berra on the Pandemic

Yogi Berra's wordplay wisdom for writers: "It ain't over till it's over"  and more | Stuff Writers Like

Brazil has become South America’s superspreader event

LIMA, Peru — The doctor watched the patients stream into his intensive care unit with a sense of dread.

For weeks, César Salomé, a physician in Lima’s Hospital Mongrut, had followed the chilling reports. A new coronavirus variant, spawned in the Amazon rainforest, had stormed Brazil and driven its health system to the brink of collapse. Now his patients, too, were arriving far sicker, their lungs saturated with disease, and dying within days. Even the young and healthy didn’t appear protected.

The new variant, he realized, was here.

“We used to have more time,” Salomé said. “Now, we have patients who come in and in a few days they’ve lost the use of their lungs.”

The P.1 variant, which packs a suite of mutations that makes it more transmissible and potentially more dangerous, is no longer just Brazil’s problem. It’s South America’s problem — and the world’s.

In recent weeks, it has been carried across rivers and over borders, evading restrictive measures meant to curb its advance to help fuel a coronavirus surge across the continent. There is mounting anxiety in parts of South America that P.1 could quickly become the dominant variant, transporting Brazil’s humanitarian disaster — patients languishing without care, a skyrocketing death toll — into their countries.

“It’s spreading,” said Julio Castro, a Venezuelan infectious-disease expert. “It’s impossible to stop.”

In Lima, scientists have detected the variant in 40 percent of coronavirus cases. In Uruguay, it’s been found in 30 percent. In Paraguay, officials say half of cases at the border with Brazil are P.1. Other South American countries — Colombia, Argentina, Venezuela, Chile — have discovered it in their territories. Limitations in genomic sequencing have made it difficult to know the variant’s true breadth, but it has been identified in more than two dozen countries, from Japan to the United States.

Hospital systems across South America are being pushed to their limits. Uruguay, one of South America’s wealthiest nations and a success story early in the pandemic, is barreling toward a medical system failure. Health officials say Peru is on the precipice, with only 84 intensive care beds left at the end of March. The intensive care system in Paraguay, roiled by protests last month over medical shortcomings, has run out of hospital beds.

“Paraguay has little chance of stopping the spread of the P.1 variant,” said Elena Candia Florentín, president of the Paraguayan Society of Infectious Diseases.

“With the medical system collapsed, medications and supplies chronically depleted, early detection deficient, contact tracing nonexistent, waiting patients begging for treatment on social media, insufficient vaccinations for health workers, and uncertainty over when general and vulnerable populations will be vaccinated, the outlook in Paraguay is dark,” she said.

How P.1 spread across the region is a distinctly South American story. Nearly every country on the continent shares a land border with Brazil. People converge on border towns, where crossing into another country can be as simple as crossing the street. Limited surveillance and border security have made the region a paradise for smugglers. But they have also made it nearly impossible to control the variant’s spread.

“We share 1,000 kilometers of dry border with Brazil, the biggest factory of variants in the world and the epicenter of the crisis,” said Gonzalo Moratorio, a Uruguayan molecular virologist tracking the variant’s growth. “And now it’s not just one country.”

The Brazilian city of Tabatinga, deep in the Amazon rainforest, where officials suspect the virus crossed into Colombia and Peru, is emblematic of the struggle to contain the variant. The city of 70,000 was swept by P.1 earlier this year. Many in the area have family ties in several countries and are accustomed to crossing borders with ease — canoeing across the Amazon River to Peru or walking into Colombia.

“People ended up bringing the virus from one side to the other,” said Sinesio Tikuna Trovão, an Indigenous leader. “The crossing was free, with both sides living right on top of one another.”

Now that the variant has infiltrated numerous countries, stopping its spread will be difficult. Most South American countries, with the exception of Brazil, adopted stringent containment measures last year. But they have been undone by poverty, apathy, distrust and exhaustion. With national economies battered and poverty rising sharply, public health experts fear more restrictions will be difficult to maintain. In Brazil, despite record death numbers, many states are lifting restrictions. (SOUND FAMILIAR)

That has left inoculation as the only way out. But coronavirus vaccines are South America’s white whale: often discussed, but rarely seen. The continent hasn’t distributed its own vaccine or negotiated a regional agreement with pharmaceutical companies. It’s one of the world’s hardest-hit regions but has administered only 6 percent of the world’s vaccine doses, according to the site Our World in Data. (The outlier is Chile, which is vaccinating residents more quickly than anywhere in the Americas — but still suffering a surge in cases.)

“We should not only blame the policy response,” said Luis Felipe López-Calva, the United Nations Development Program’s regional director for Latin America and the Caribbean. “We have to understand the vaccine market.”

“And there is a failure in the market,” he said.

The vaccine has become so scarce, López-Calva said, that officials are imposing restrictions on information. It’s nearly impossible to know how much governments are paying for doses. Some regional blocs, such as the African Union and the European Union, have negotiated joint contracts. But in South America, it has been every country for itself — diminishing the bargaining power for each one.

“This has been harmful for these countries, and for the whole world to stop the virus,” López-Calva said. “Because it’s never been more clear that no one is protected until everyone is protected.”

Paulo Buss, a prominent Brazilian scientist, said it didn’t have to be like this. He was Brazil’s health representative to the Union of South American Nations, which negotiated several regional deals with pharmaceutical companies before the coronavirus pandemic. But that union came apart amid political differences just before the arrival of the virus.

“It was the worst possible moment,” Buss said. “We’ve lost capacity and our negotiation attempts have been fragmented. Multi-lateralism was weakened.”

Vaccine scarcity has led to line-jumping scandals all over South America, but particularly in Peru. Hundreds of politically connected people, including cabinet ministers and former president Martín Vizcarra, snagged vaccine doses early. Now people are calling for criminal charges.

As officials bicker and the vaccination campaign is delayed, the variant continues to spread. P.1 accounts for 70 percent of cases in some parts of the Lima region, according to officials. Last week, the country logged the highest daily case count since August — more than 11,000. On Saturday, the country recorded 294 deaths, the most in a day since the start of the pandemic.

Peruvians have been stunned by how quickly the surge overwhelmed the health-care system. Public health analysts and government officials had believed Peru was prepared for a second wave. But it wasn’t ready for the variant.

“We did not expect such a strong second wave,” said Percy Mayta-Tristan, director of research at the Scientific University of the South in Lima. “The first wave was so extensive. The presence of the Brazilian variant helps explain why.”

How Vaccine Refusal Could Prolong the Pandemic

Stephanie Nana, an evangelical Christian in Edmond, Okla., refused to get a Covid-19 vaccine because she believed it contained “aborted cell tissue.”

Nathan French, who leads a nondenominational ministry in Tacoma, Wash., said he received a divine message that God was the ultimate healer and deliverer: “The vaccine is not the savior.”

Lauri Armstrong, a Bible-believing nutritionist outside of Dallas, said she did not need the vaccine because God designed the body to heal itself, if given the right nutrients. More than that, she said, “It would be God’s will if I am here or if I am not here.”

The deeply held spiritual convictions or counterfactual arguments may vary. But across white evangelical America, reasons not to get vaccinated have spread as quickly as the virus that public health officials are hoping to overcome through herd immunity.

The opposition is rooted in a mix of religious faith and a longstanding wariness of mainstream science, and it is fueled by broader cultural distrust of institutions and gravitation to online conspiracy theories. The sheer size of the community poses a major problem for the country’s ability to recover from a pandemic that has resulted in the deaths of half a million Americans. And evangelical ideas and instincts have a way of spreading, even internationally.

There are about 41 million white evangelical adults in the U.S. About 45 percent said in late February that they would not get vaccinated against Covid-19, making them among the least likely demographic groups to do so, according to the Pew Research Center.

“If we can’t get a significant number of white evangelicals to come around on this, the pandemic is going to last much longer than it needs to,” said Jamie Aten, founder and executive director of the Humanitarian Disaster Institute at Wheaton College, an evangelical institution in Illinois.

As vaccines become more widely available, and as worrisome virus variants develop, the problem takes on new urgency. Significant numbers of Americans generally are resistant to getting vaccinated, but white evangelicals present unique challenges because of their complex web of moral, medical, and political objections. The challenge is further complicated by longstanding distrust between evangelicals and the scientific community.

“Would I say that all public health agencies have the information that they need to address their questions and concerns? Probably not,” said Dr. Julie Morita, the executive vice president of the Robert Wood Johnson Foundation and a former Chicago public health commissioner.

No clear data is available about vaccine hesitancy among evangelicals of other racial groups. But religious reasoning often spreads beyond white churches.

Many high-profile conservative pastors and institutional leaders have endorsed the vaccines. Franklin Graham told his 9.6 million Facebook followers that Jesus would advocate for vaccination. Pastor Robert Jeffress commended it from an anti-abortion perspective on Fox News. (“We talk about life inside the womb being a gift from God. Well, life outside the womb is a gift from God, too.”) The president of the Southern Baptist Convention, J.D. Greear, tweeted a photo of himself receiving a shot.

But other influential voices in the sprawling, trans-denominational movement, especially those who have gained their stature through media fame, have sown fears. Gene Bailey, the host of a prophecy-focused talk show on the Victory Channel, warned his audience in March that the government and “globalist entities” will “use bayonets and prisons to force a needle into your arm.” In a now-deleted TikTok post from an evangelical influencer’s account that has more than 900,000 followers, she dramatized being killed by authorities for refusing the vaccine.

Dr. Simone Gold, a prominent Covid-19 skeptic who was charged with violent entry and disorderly conduct in the Jan. 6 Capitol siege, told an evangelical congregation in Florida that they were in danger of being “coerced into taking an experimental biological agent.”

The evangelical radio host Eric Metaxas wrote “Don’t get the vaccine” in a tweet on March 28 that has since been deleted. “Pass it on,” he wrote.

Some evangelicals believe that any Covid restrictions — including mask mandates and restrictions on in-person church worship — constitute oppression.

And some have been energized by what they see as a battle between faith and fear, and freedom and persecution.

Fear is the motivating power behind all of this, and fear is the opposite of who God is,” said Teresa Beukers, who travels throughout California in a motor home. “I violently oppose fear.”

Ms. Beukers foresees severe political and social consequences for resisting the vaccine, but she is determined to do so. She quit a job at Trader Joe’s when the company insisted that she wear a mask at work. Her son, she said, was kicked off his community college football team for refusing Covid testing protocols.

“Go ahead and throw us in the lions’ den, go ahead and throw us in the furnace,” she said, referring to two biblical stories in which God’s people miraculously survive persecution after refusing to submit to temporal powers.

Jesus, she added, broke ritual purity laws by interacting with lepers. “We can compare that to people who are unvaccinated,” she said. “If they get pushed out, they’ll need to live in their own colonies.”

One widespread concern among evangelicals is the vaccines’ ties to abortion. In reality, the connection is remote: Some of the vaccines were developed and tested using cells derived from the fetal tissue of elective abortions that took place decades ago.

The vaccines do not include fetal tissue, and no additional abortions are required to manufacture them. Still, the kernel of a connection has metastasized online into false rumors about human remains or fetal DNA being an ingredient in the vaccines.

Some evangelicals see the vaccine as a redemptive outcome for the original aborted fetus.

Some Catholic bishops have expressed concerns about the abortion link, too. But the Vatican has concluded the vaccines are “morally acceptable,” and has emphasized the immediate danger posed by the virus. Just 22 percent of Catholics in America say they will not get the vaccine, less than half the share of white evangelicals who say that.

White evangelicals who do not plan to get vaccinated sometimes say they see no need, because they do not feel at risk. Rates of Covid-19 death have been about twice as high for Black, Hispanic, and Native Americans as for white Americans.

White pastors have largely remained quiet. That’s in part because the wariness among white conservative Christians is not just medical, but also political. If white pastors encourage vaccination directly, said Dr. Aten, “there are people in the pews where you’ve just attacked their political party, and maybe their whole worldview.”

Dr. Morita, of the Robert Wood Johnson Foundation, said the method to reach white evangelicals is similar to building vaccine confidence in other groups: Listen to their concerns and questions, and then provide information that they can understand from people they trust.

But a public education campaign alone may not be enough.

There has been a “sea change” over the past century in how evangelical Christians see science, a change rooted largely in the debates over evolution and the secularization of the academy, said Elaine Ecklund, professor of sociology and director of the Religion and Public Life Program at Rice University.

There are two parts to the problem, she said: The scientific community has not been as friendly toward evangelicals, and the religious community has not encouraged followers to pursue careers in science.

Distrust of scientists has become part of cultural identity, of what it means to be white and evangelical in America, she said.

For slightly different reasons, the distrust is sometimes shared by Asian, Hispanic and Black Christians, who are skeptical that hospitals and medical professionals will be sensitive to their concerns, Dr. Ecklund said.

“We are seeing some of the implications of the inequalities in science,” she said. “This is an enormous warning of the fact that we do not have a more diverse scientific work force, religiously and racially.”

Among evangelicals, Pentecostal and charismatic Christians may be particularly wary of the vaccine, in part because their tradition historically emphasizes divine health and miraculous healing in ways that can rival traditional medicine, said Erica Ramirez, a scholar of Pentecostalism and director of applied research at Auburn Seminary. Charismatic churches also attract significant shares of Black and Hispanic Christians.

Dr. Ramirez compares modern Pentecostalism to Gwyneth Paltrow’s Goop, with the brand’s emphasis on “wellness” and “energy” that infuriates some scientists: “It’s extra-medical,” she said. “It’s not anti-medical, but it decenters medicine.”

The Centers for Disease Control and Prevention and Dr. Anthony Fauci are not going to be able to persuade evangelicals, according to Curtis Chang, a consulting professor at Duke Divinity School who is leading an outreach project to educate evangelicals about the vaccine.

The project includes a series of short, shareable videos for pastors, answering questions like “How can Christians spot fake news on the vaccine?” and “Is the vaccine the Mark of the Beast?” The latter refers to an apocalyptic theory that the AntiChrist will force his sign onto everyone at the end of the world.

These are questions that secular public health entities are not equipped to answer, he said. “The even deeper problem is, the white evangelicals aren’t even on their screen.”

Mr. Chang said he recently spoke with a colleague in Uganda whose hospital had received 5,000 vaccine doses, but had only been able to administer about 400, because of the hesitancy of the heavily evangelical population.

“How American evangelicals think, write, feel about issues quickly replicates throughout the entire world,” he said.

At this critical moment, even pastors struggle to know how to reach their flocks. Joel Rainey, who leads Covenant Church in Shepherdstown, W.Va., said several colleagues were forced out of their churches after promoting health and vaccination guidelines.

Politics has increasingly been shaping faith among white evangelicals, rather than the other way around, he said. Pastors’ influence on their churches is decreasing. “They get their people for one hour, and Sean Hannity gets them for the next 20,” he said.

Mr. Rainey helped his own Southern Baptist congregation get ahead of false information by publicly interviewing medical experts — a retired colonel specializing in infectious disease, a church member who is a Walter Reed logistics management analyst, and a church elder who is a nurse for the Department of Veterans Affairs.

On the worship stage, in front of the praise band’s drum set, he asked them “all of the questions that a follower of Jesus might have,” he said later.

“It is necessary for pastors to instruct their people that we don’t always have to be adversaries with the culture around us,” he said. “We believe Jesus died for those people, so why in the world would we see them as adversaries?”