Virtue Signaling in the Medical Arena: An Impediment to COVID-19 Vaccination

Virtue signaling is disingenuous behavior; sometimes it is doing the right thing for the wrong reason. Virtue signaling’s chilling and polarizing effects are far broader than a few politically correct topics demonstrate. When people take a position vocally in public for the purpose of expressing their moral rightness, moral superiority, or virtue, they close the door on valuable arguments.

Virtue Signaling or Genuine Support?

Examples of virtue signaling include vocal support for a cause on social media, protest signs that suggest one cares more than others about morally charged issue, and essentially humblebrags about certain righteous topics. For example, loudly supporting things on social media like the Women’s March of January 2017 or race protests in the wake of George Floyd’s death, without attending, donating, or sincerely supporting the cause may be virtue signaling. It also may be genuine support. In the context of nonprofits, virtue signaling often takes the form of words without donations. Yet the same actions are considered building awareness and not necessarily devoid of value to the cause or the organizations supporting it. Rather than doubt everyone’s sincerity, and question people’s motives, this post focuses on virtue signaling in the bioethics arena and its chilling effects.

When some people take an extreme view, or a strong view but their support for it harnesses virtue, then all other arguments have the uphill battle of proving the virtue of their side. In some contexts, the virtue is controversial, not universal. To pick which virtue you represent and then stay with it is tribalism. Barack Obama has commented that maybe some people are too “woke” and they “call people out” for not supporting certain practices, policies, or movements, or for failing to express things in a politically correct way. They incorporate virtue signaling and use shaming. The people on both sides of a political spectrum use similar shaming, with many people claiming virtue in their patriotism or enthusiasm for constitutional liberties, and others (the more typically accused) claiming virtue in the realm of diversity and inclusion. In the pandemic, virtue signaling politicized vaccination, undermining its reach.

What About Two Legitimate Sides?

Virtue signaling in bioethics stops important conversations. There are many examples of the medical community using virtue to quiet legitimate questions and criticisms. The arguments seem childish: If you criticize widespread use of antidepressants and anxiety medications, then you must wish people to remain depressed and anxious or be indifferent to death by suicide. If you criticize the overreach of child protective services resulting in lost custody, you must not care about child abuse. If you do not want your child to use opioids during a surgical recovery, you must not care about her pain. If you criticize a recycling program, you must not care about the earth. The challenge in each of these areas is more difficult because they are unnecessarily framed as challenges to the “virtue” of caring about individual or societal well-being.

So how would we reconcile this analogy to those statements? If you criticize vaccination for COVID-19, you must want to kill people or risk your own life. You must not care about individuals, neighbors, and community. There has been significant virtue signaling in the COVID-19 precautions. How does the vaccination analogy differ from the other “you must wish X” attacks? Does it differ? The risk of COVID-19 would increase, especially when someone forgoes vaccination as well as masks or distancing. But people wore masks when they would not have been exposed as either an extra precaution or virtue signaling. COVID-19 public health policy is about managing risk. A failure to recognize or appreciate the other side’s virtue created an adversarial relationship, undermining proper risk assessment, a factual and predictive endeavor that involves models, assumptions, and estimates. The data on transmissibility should inform public policy. Virtue signaling interrupts the flow of information.

The debate over mandatory COVID-19 vaccination pits the virtue of protecting oneself and all of those with whom one comes into contact (community protection as a virtue) against those to whom freedom is a virtue and an essential aspect of patriotism. Some of those who were quick to get the vaccine and who distinguish themselves from the regularly un-masked, have been virtue signaling all along. Social media pictures of people proudly displaying stickers saying they were vaccinated were thought to bolster vaccination rates but also evidence virtue signaling. Why would adults post themselves wearing silly stickers other than for the sake of likes? Virtue signaling generally enrages the other side, fosters the appearance of two teams of Americans. One sure sign of virtue signaling (or laziness) is remaining masked in open outdoor areas without people nearby. The debate between public health and personal choice, and to me, between public and private morality, is undermined when virtue is used to suggest everyone who is not vaccinated lacks virtue.

Virtue Signaling or Risk Management

Along the lines of Jonathan Haidt’s, The Righteous Mind, a sophisticated argument that allows for competing virtues or even different ways of ranking well-recognized virtues would clarify which public health approaches would be best received. Then, that information must complement public health policy, helping outline which approaches would be most effective against the virus. If we were authoritarian, we might eliminate risk through strict measures like tracking everyone’s every move, shutting all businesses and public spaces, or strictly quarantining the entire country, but that is obvious overkill. Managing risk ethically requires using the least restrictive means to control the pandemic. The failure to control the pandemic through vaccination and masking indicates a need to move toward more restrictive means like mandatory vaccination and mandatory masking. If vaccination is not mandatory, it would be beneficial to have those who refuse to get the vaccine test often and implement a test-and-quarantine-if-positive system. Mandates should not be seen as representative of or contrary to virtue.

One of the biggest problems with attaching virtue to vaccination is that it is counteracted by other “virtue” arguments. The Arkansas governor jumped on the virtue bandwagon when he passed a law that banned state and local mask mandates. Now the state, with its 37 percent vaccination rate, has fewer tools and would need to go through a legislative process to change the law. If schools start without masks, the spread will continue. A greater cost would be closing schools altogether if masks cannot be required in them.

Had the governor not associated freedom with virtue and not been combating virtue rather than just public health tools, the predicament could have been avoided. Governors are in the distinct position to reasonably assess pros and cons, yet governors like Asa Hutchinson in Arkansas and Ron DeSantis in Florida take the bait of those virtue signaling and engage in signaling the virtue of freedom. With hospitals filling and deaths increasing, DeSantis is sticking to virtue, and the virtue of protecting “jobs and small businesses.” Once virtue is involved, it is more difficult to compromise. Any compromise looks like a compromise of a fundamental principle rather than what it is: simple policy changes that reflect the science and are reasonable like encouraging or requiring vaccination and/or masks.

In the struggle for herd immunity, we would do well to replace “virtue” with reasonable rules that place scientifically warranted limits on those who are vaccine-eligible but remain unvaccinated. If ever there were a time to mandate a vaccine, it is now. While extreme views of liberty are an impediment, virtue signaling has proven that even the smallest compromise is made more difficult when it is a compromise of virtue.

Frameworks for Countering Virtue-Based Arguments

Appealing to public morality while recognizing private morality, and accepting commonality—we all appreciate freedom although some of the bioethics literature is sounding as though one side does not—we all tend to care for family and friends and we wish to reduce risk for ourselves and others—would bring two sides together. From early on, I encouraged recognizing that there is a difference in degree of the enthusiasm for liberty, and a difference in the methodology one uses to help one’s community, rather than an all-or-nothing acceptance of either freedom or public health, never both. The vast majority believes in a social compact. The compact differs but there is an underlying shared virtue in both freedom and there are many ways to demonstrate caring for community.

Finding common virtues and narrowing the controversy would promote productive conversations. Leaving virtue out of public health and medical data would be best—I am not a believer in doctors as ethicists, and the scientist may not be the best person to deliver advice on virtue. A presentation of facts, of what is known and what is not yet known, and of policies to minimize risk, is the proper role of public health. As physicians and public health experts have dabbled in social sciences information on human behavior, their scientific approach and agenda undermine their goals.

Community leaders, especially in Arkansas and Florida, must emphasize common virtues like protecting family and community and sacrificing small freedoms to enjoy more freedom later. The medical and bioethics community must speak to vaccination in a less politically charged way. Rather than encouraging pride in vaccination, public health officials and bioethicists could just let vaccination go unrewarded. Then encouraging vaccination might come off as appropriate medical advice rather than charged commentary on virtue.