WASHINGTON — To Joe Biden and his campaign allies, it’s a straightforward distinction: They trust vaccines. They just don’t trust President Trump, who has undercut the expertise of U.S. scientific agencies since Covid-19 first arrived.

But at least for the remainder of Trump’s first term, it can be difficult to pick apart the two, leaving Democrats in a precarious spot: Either they endorse any vaccine’s use regardless of Trump’s track record, in hopes of fostering crucial public buy-in, or they suggest any vaccine approval could be politically motivated — and risk doing further damage to Americans’ trust in immunizations, regardless of when they’re approved.

Many Democrats have strayed toward the second option. Sen. Kamala Harris, Biden’s vice presidential pick, said she wouldn’t trust Trump on a vaccine approval, and Cal Cunningham, the Democratic nominee for Senate in North Carolina, said recently he’d be “hesitant” to take a vaccine authorized before the end of 2020. Republicans hurried to attack both as “anti-vaxxers.”

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The bizarre campaign-trail battle over vaccines highlights the precarious political and public health dynamics surrounding a potential vaccine approval, and the daunting challenge of convincing Americans to receive a Covid-19 immunization once one is proven to be safe and effective. In a country where vaccine hesitancy is already a major barrier to public health efforts, anything but a full-throated endorsement of vaccines is often risky. But the Trump administration’s cavalier attitude toward science and public health communications, Biden allies say, has left them with little choice but to express their misgivings.

“Typically, you have the political leadership and scientific leadership speaking with one voice … and for that reason, there typically has not been reason to question what the administration is recommending,” said Vivek Murthy, the former U.S. surgeon general and a top Biden Covid-19 adviser. But under Trump, he said, “we’ve seen time and time again that there has been a divergence between the scientists and the political leadership, and efforts to even influence, in an inaccurate direction, what the scientific guidance is.”

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In recent weeks, Biden’s campaign has only doubled down on its caution: Only once apolitical government scientists and outside experts endorse a Covid-19 vaccine, they say, will the campaign encourage Americans to follow federal vaccination guidance. A thumbs-up from political appointees alone, Murthy said, wouldn’t be good enough.

“If an emergency use authorization is issued without good data being made available to back up whether it met standards for safety and efficacy, that, to me, would not meet the threshold that we need to say that this vaccine truly is safe for distribution,” he told STAT in an interview.

Large majorities of Americans already believe the Covid-19 vaccine development process is driven more by politics than by science, according to a recent STAT/Harris poll. Only 62% of Americans would seek to be vaccinated by Election Day if an approval comes before then, and only 66% would seek a vaccine if one is available by the end of 2020.

Trump’s helter-skelter rhetoric on vaccine timing likely hasn’t helped. Despite top scientists’ insistence that the Food and Drug Administration’s vaccine process has not been tainted by politics, Trump has repeatedly teased that one will be available by October. The president has even acknowledged he’d like an approval by “a very special date” — an open nod to Election Day on Nov. 3.

It’s those comments, among others, that have given Democrats on the campaign trail like Harris and Cunningham openings to publicly express their doubts.

But Democrats’ cautious messaging is sufficiently targeted at the president that it’s unlikely to harm the broader cause of vaccine acceptance, said Saskia Popescu, a University of Arizona epidemiology professor and biodefense expert.

“I think a healthy dose of skepticism is always important, but then again, I’m a scientist,” she said. “I’ve taken it more as: ‘Hey, you need to ask questions.’ If there’s a push for a vaccine, and there are a lot of experts that are concerned about the rapid pace of that development, ask questions. Something coming out Nov. 1, when the election is on Nov. 3, carries with it some amount of skepticism.”

Republicans are less sympathetic. The Trump campaign’s communications director, Tim Murtaugh, called Harris an “anti-vaxxer” after her comments. The National Republican Senatorial Committee used the same term to describe Cunningham. And last week, the Trump campaign held a press call on the topic of “Biden’s coronavirus vaccine fearmongering.”

“It’s very, very disappointing, obviously, to hear a presidential candidate, Joe Biden, and vice presidential running mate, Kamala Harris, downplaying this and saying they wouldn’t take it,” Rep. Brad Wenstrup (R-Ohio), a member of the GOP Doctors Caucus, a group of Republican physicians in Congress, told reporters on the call. “That is very dangerous for the health of America.”

Other Republicans have rushed to Trump’s defense, citing the remarkable progress of Operation Warp Speed, a vaccine moonshot the administration launched in May. So far, the collaboration between government scientists and drug companies has accelerated three vaccine candidates into Phase 3 testing, making an emergency approval by the end of 2020 an increasingly distinct possibility.

Republicans’ criticism, to date, has ignored key context, including Trump’s own anti-vaccine rhetoric in the past, most notably a 2014 tweet that pushed the long-debunked link between child vaccinations and autism. Republicans have also largely ignored a controversial Facebook video that Michael Caputo, the top communications official at the Department of Health and Human Services, posted before he announced he was taking medical leave last week, in which he urged Americans skeptical of vaccines should “follow their freedom.”

In general, Republican lawmakers are more likely than Democrats to oppose requirements that children attending public schools be vaccinated.

In defending the safety of a Covid-19 vaccine, GOP lawmakers have also cited their faith in the FDA — the agency that Trump himself has suggested, baselessly, may be part of a “deep state” conspiracy to harm his re-election bid. Sen. Thom Tillis, the incumbent trailing Cunningham in polls in North Carolina, argued the FDA would never approve a vaccine unsafe for use by Americans, calling the agency’s authorization a “gold standard” for safety and efficacy.

Even the FDA, however, is embroiled in controversy: Its commissioner, Stephen Hahn, was roundly criticized last month for badly mischaracterizing the effectiveness of blood plasma from recovered Covid-19 patients as a treatment for the disease. It’s missteps like those, Murthy said, that make Biden’s cautious messaging, and his plan to seek outside validation for any vaccine approval,all the more necessary.

“If people don’t know where to go for accurate information, if they don’t know what to look for, I worry that their default position is going to be: This seems murky, it seems complicated, it seems unclear, I’m just going to stay away from it,” he said. “But if you give them a path through which to understand whether a vaccine is actually acceptable, and there’s a greater chance that they will accept it, if those standards are in fact met and if they’re hearing from the right voices.”

  • I think there is a huge difference between what is understood to be expedient and what it is to be rushed. And this difference is evident in the private vs public timeframes for getting things done. I’ve worked in both and from my experience public workers take things alot slower, not from caution, but from complacency. Thank God this President comes from the Private Sector or we would be waiting many more months for the COVID vaccine to come to us.

  • Under Obama who ordered CDC to study guidelines for pain medication for many thousands who are now effected by this action. Trump took this to his lack of empathy for people and now my life is filled with unmerciful pain, if they came for us, they will come for all.

  • “But their doubts could fuel vaccine skepticism.” With respect, the point of the Dem message IS to fuel vaccine skepticism!

  • The real problem here is based upon the past history of Federal agencies and congress in the past few years most American citizens do not trust much if anything in the Federal government in DC ; ask yourself how many people there have committed known crimes and walked away scott free period

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