More lessons from COVID. Vaccine hesitancy, intellectual superiority, and deficits of trust.
Times headline, putting 'the' pandemic clearly behind us: This Emergency Is Over... That's so nice to hear. Thank you. But it continues: Now It's Time to Get Ready for the Next Pandemic.... Why you gotta be like that?
That article was from an American perspective, Kizzmekia Corbett, NIH researcher on the COVID-19 vaccine, a viral immunologist at Harvard. From an African viewpoint, Ellen Johnson Sirleaf, former President of Liberia, and co-chair of the Independent Panel on Pandemic Preparedness and Response, writes Don't put COVID-19 in the rearview mirror. Now we need to prepare for the next pandemic. She reminds us of a big lesson we should have learned for modern disasters:
...nobody is safe until everybody is safe.
-Ellen Johnson Sirleaf
In his strikingly prescient book, Psychology of Pandemics (published 2019), Steven Taylor, an academic psychologist (UBC) described how important it would be (and now has been and is still) to consider the human aspect in the face of an infectious outbreak (1). The fundamental principles of pandemic planning are widely accepted: public messaging, vaccines and antivirals, hygiene practices, and social distancing. The role of psychology in every one of these aspects determines how well the planning is relayed, understood, accepted, and executed.
“...health communication lies at the heart of epidemic control”
Vaccination hesitancy is more about trust than knowledge or morality.
We have ignored this truth because we have bought into several unjustified explanations of why people don’t get vaccinated. Of course these are themes. Everyone is unique (just like everyone else), and these common themes are not likely to capture anyone’s attitudes and actions perfectly, just as they are not conceivably going to capture everyone’s particular situation. With those caveats, the reasons commonly offered, accepted, and perpetuated (2) for why people don’t get vaccinated (against coronavirus, influenza, or any other virus) are that they are:
3. Rejecting of expertise
Goldenberg describes the common explanation that vaccine hesitancy is part and parcel with a war on science (2). Since science has proven their efficacy, not accepting vaccines for ourselves and our children, can only be understood by a deficit of knowledge. This includes being deceived by the malicious or infamous like Andrew Wakefield or Robert F. Kennedy Jr.
If they aren’t un- or ill-informed, as this narrative goes, they must be ensnared by their biases. They are irrational. Here, the fascinating and extensive research on cognitive biases serves to keep the spotlight off the learned and beneficent scientific and medical establishment and instead focuses on the “patient as the problem.” Good thing, too, because we accept that these biases are too ingrained, so there’s nothing we can do. Our work is done. (Sarcasm intended).
A third form of this supposed war-on-science theme is that people are too arrogant to accept vaccines. They reject vaccination from the position of knowing more than the experts. This may serve to paint the ‘non-vaxxer’ in a negative light and keep our virtuous minds untarnished.
There will certainly be a small number of people that do fall into the categories described above. There are probably people with little or an inaccurate understanding of science and physiology that would be best served by information. Given the overabundance of information on this topic and perhaps any in this current age of information (3), this probably applies to some extent to many people.
Maybe there are people so caught up in biases, so far down one path of interpretation, that their ego will not allow them to see how things really are. Education and information may help. But the only way to really overcome bias is to be able to look openly and humbly enough to question one’s own perception. You don’t get to this point but out of a need for safety, acceptance, and understanding. (1 - see especially Epistemological, existential, and social roots of conspiracy theories). Overcoming biases cannot occur except within a trusting environment.
There are people who utterly reject authority. They know better. And, well, it may not be so simple as saying that they don’t. Authority is an elusive concept. “Traditional notions of expertise have difficulty accounting for the increasing complexity of knowledge production...” (4). And usually the question is not one of generalized expertise but of local knowledge. You might be an expert on infections in kids, but you are not an expert on my kid, for example. Questions in a personal context may not be well-addressed by generalized answers.
If the “non-vaxxer’s” do fall into one of the above groups, the following solutions still apply. But the more accurate representation of why people don’t accept vaccination revolves around trust than it does around ignorance, irrationality, or arrogance.
We have ignored these principles as a medical profession when we throw all our efforts into information and education. Not that the facts aren’t important. In fact, early and abundant information is a key to the unconsciously-absorbed misinformation that becomes so difficult once entrenched (inculcation). But more information is not the answer for many ‘dissenters’. Nor is to see patients (by this I mean ‘persons’, that’s the funny thing about being an emergency physician, every person is a potential patient) as either ignorant or reprehensible. And though the possibility distinctly exists to be both ignorant and morally reprehensible, so, too does the possibility of being neither. And it is this last position, neither ignorant nor morally bad, that is most justified.
Decision-makers ignore this when transparency is not the first and foremost priority in pandemic planning and response. Policy-makers ignore the truth of vaccine hesitancy when they implement mandates and manifestos without attending to building or repairing trust. We ignore this when we buy into narratives dividing ‘us’ from ‘them’ with the resultant sense of moral or intellectual superiority.
...our research is only as strong as our communication.
We receive an overabundance of information. Information and evidence, the accompanying opinion of scientists, and the resultant decisions of politicians and administrators. So why does it not get any less confusing or contentious? We have to remember that science provides answers, lots of them, and they don’t all agree. Science isn’t all objective; it is as value-laden as any other human activity. The relative value of the answers is not the domain of the researcher. That’s what philosophers do. Philosophy is not good at data, it may not be immediately practical, but it is the job of the philosopher to offer insight.
“...philosophy does not have the task of providing tools or instruments to be used in concrete life. This is the task of technology, but this does not mean that philosophy has no other task in front of even concrete situations... philosophy aims to give a sense to reality. From this it can then derive duties, concrete indications and guidelines for practice in the situations that lie ahead” (5).
Or to put it simply “philosophy can help inform what we ought to do, given what we know” (6). A few lines from Sweeney Todd are illustrative. This is Ben the Meateater’s thoughtful description of what may get us through hard times.
“...so I had to put up with my fate, and put the best face I could upon the matter.’
“Yes, that’s what learned folks call —what’s its name—fill—fill—something.’
‘Philosophy, I suppose you mean, Ben’
“Ah, that’s it—you must put up with what you can’t help, it means, I take it. It’s a fine name for saying you must grin and bear it.”
We could all use a little philosophy.
1. Psychology of Pandemics (published 2019) Steven Taylor
2. Goldenberg, M. J. (2016). Public misunderstanding of science? Reframing the problem of vaccine hesitancy. Perspectives on Science, 24(5), 552-581.
3. James, J. J. (2021). COVID-19: A Retrospective by the Numbers. Disaster Medicine and Public Health Preparedness, 15(6), e1-e4.
4. de Melo-Martín, I., & Intemann, K. (2018). The fight against doubt: How to bridge the gap between scientists and the public. Oxford University Press.
5. Velázquez, G. L. (2020). The role of philosophy in the pandemic era. Bioethics Update, 6(2), 92-100.
6. Wilkinson in The philosophy of COVID-19: is it even possible to do the ‘right thing’? Oxford news blog. 25 Aug 2020. Science cannot tell us what values we should put weight on. These are ethical decisions – not scientific ones...What is more, science is messy and complicated and very often says different things and science will evolve over time.’
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