COVID-19 vaccine hesitancy requires a trust-based solution. A response to societal problems should be steeped in social solutions. Science does the most good if it coexists with public trust. A focus on misunderstanding science as a primary reason for refusal to get a COVID-19 vaccine distracts from failing to believe scientists and the other reasons for hesitancy. This post is a follow-up to one examining religious refusals. Arguably, no science is necessary to absorb the number of deaths, the nature of the emergency, and even to assess the role of the vaccine in decreasing severe cases.
Highlighting the Danger of COVID-19 Vaccine Hesitancy
Vaccine hesitancy can reflect reasonableness and rationality, protective parenting, and precautionary behaviors. It is worth assuming the logic that supports some hesitancy as a start to repair some of the distrust. One misconception is that all hesitancy is bad. Bernice L. Hausman recognizes hesitancy as an appropriate check on scientists and government and in her book, Anti-Vax, voices and backs up with evidence many of the rational reasons for which people question vaccines or require additional information. She asserts in an age of “helicopter parenting” discomfort with the many vaccines expected or required at very young ages is predictable and often comes from well-educated adults. Addressing them with an understanding stance and asking for a small sacrifice for the public good makes sense in the hesitant population. The best argument may acknowledge that some vaccinations are less justifiable and the ethical arguments in favor of those are weaker, but the COVID-19 vaccine speaks to an ethical imperative to save your neighbors and yourself.
Some Hesitancy is Consistent with Science as Usual
Waiting for data aligns with science—so those waiting for more data should be recognized as having views completely consistent with science as usual, yet inconsistent with the unusual speed of the pandemic and the degree of risk of remaining unvaccinated. The same scientific community that assures people pharmaceutical safety is worth the long wait must reconcile the crucial difference: the pandemic is an emergency. Common sense makes it clear—but science is devised purposely to hold clinical trials and observe and record results over time. The discrepancy in methodology, the need to rush, must be framed explicitly with a focus on the risks of the disease compared to the risks of the vaccines. Depicting those who wish for more clinical trials as “misunderstanding science” is not exactly correct, although they likely misunderstand the gravity of the disease or are unconvinced by the available safety data.
Understanding Science is an Unnecessarily Tall Order
If misunderstanding science were the root cause, then simple science lessons would win everyone over. Importantly, some people dislike vaccines for reasons that operate outside of science. Never before have we associated an understanding of the science with medical care to the degree we do now. It seems to me when I was permitted to sign off on my child’s stem cell transplant with a certain degree of understanding, I met others signing off who grasped much less of the science. We were all able to “consent”. It is refusal, as usual, that is at issue. Rather than expecting people to understand new mRNA vaccines and the science behind them, trust is the missing feature: I trusted the doctors at the time of the stem cell transplant.
While misinformation and a failure to understand or appreciate vaccine science continue to plague the discussion of hesitancy, that line of reasoning implies a scientific education solution to what is essentially a social failing. Social problems call for social solutions. Why do so many people either fail to understand or succumb to misinformation?
Distrust Due to Health Care and Partisanship
One study recognizes that where hospitals failed to meet the public’s needs in the pandemic, vaccination hesitancy is higher. Where healthcare delivery is worse, public trust is generally and predictably worse. But at a higher level, where health is made unachievable or impediments to health exist and flow from government policy, public trust is rightfully eroded as well. People feel left behind. Yet also, in the US, areas with less access to high quality or specialized care also may have more people who vote Republican, a trait correlated with a failure to get the COVID-19 vaccine. “Partisanship is the strongest predictor of COVID-19 response.” Political affiliation is correlated with COVID-19 vaccine refusal and government mandates like masks and social distancing. There are many causes of distrust.
Distrust Due to Psychology and Media
Republicans who watch Fox News were less likely to become vaccinated than other Republicans. Media is influential in voting patterns. Polarization and a group mentality are societal problems that this time happen to concern science, leading to wrongly identifying COVID-19 vaccine hesitancy as primarily a lapse in the ability to understand science. The assumption that scientific literacy is the primary issue implies that people would individually leave their herd if they received scientific data from outside the group. They sometimes do—so the assumption that misunderstanding is partly to blame is partly correct —but there has been too much public health messaging that is correct to assume that better scientific messaging would win them over. Rather, they do not trust the other sources and do not want to deviate from their social group or media loyalty. Rather than relegate the problem to a failure to understand science, the failure I would identify is a failure of public health to appreciate how much people distrust institutions and the reasons for the distrust.
The desire to misunderstand the science may exist– motivated reasoning, attitudes deeply rooted in social mechanisms, and a desire for validation lead people away from objectively approaching facts.
The social controversy operates on the plane of individual rights, community ethics, and corporate power in society. At one level, a patient (rationally or irrationally) may distrust big pharma or their own doctor to a certain degree. Similarly, a consumer of information might distrust the media, or certain media outlets. Separately still, people may wish to exercise rights that go beyond those accepted as reasonable in civilized society historically, also regardless of science. Trust in institutions must become a shared goal to be achieved both by persuading the public to engage and learn and by institutions maintaining or developing trustworthiness. Both the supply of and demand for truthful information should grow.
STEM education is great, and likely would contribute to people understanding science, but it will not solve a problem of distrust or polarization. A good social sciences paper might address important topics: Why is a COVID-19 vaccination mandate not a sign of authoritarianism, but instead a codification of a presumed or desirable moral social compact? What are the distinguishing traits and the proper emergency powers of government, and how can we protect against the abuse of those powers? How was the erosion of the credibility of institutions that provide primary scientific research during the Trump presidency a sign that democracy is vulnerable to ignoring science and to extreme views of individual rights? How do a distrust of media, economic and social discontent, and appeals to those who are feeling left out to join fringe groups with extreme viewpoints impact society?
If a failure to understand the science is viewed as a public trust issue, then shoring up the institutions that provide trustworthy research should be an important goal. I would assert a journey from FDA commissioner to venture capital firm that financed Moderna is bad for public trust. The delivery of second-hand spin on talk shows and social media snippets reflects the financial agenda of media giants and confirms that the media influences the public and furthers the misinformation. The ability to distinguish valid trustworthy research and to discern which organizations consistently provide verifiable valid research stems from understanding institutions, democracy, processes, history, and political and social sciences as well as some natural science. Science is most impactful when more people in the general population know which organizations to trust and how to find reliable evidence. A movement away from two myths (that all vaccines are equally good and that no vaccines are any good) is giving way to an opportunity to understand the relationship between hesitancy and trust and between rights and rules.