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Vaccination hesitation in the COVID-19 era

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With the steady increase in supplies of COVID-19 vaccines, reluctance and refusal to get vaccinated is becoming an issue for high vaccination coverage in many parts of the world. In his book Reluctance to vaccination: public trust, expertise and the war on science, philosopher Maya Goldenberg provides an overview of vaccine reluctance, its genesis, rationale, and potential solutions using a multidisciplinary approach to base the arguments.

Goldenberg presents how vaccine reluctance in the West is steeped in the social, cultural and historical context. For example, structural racism and neglect, as well as the historical legacy of the medical establishment that has discriminated against and exploited black Americans can breed distrust of vaccines and health interventions offered by the American health care system. Debates over value versus evidence-based medicine are the outer layer of a deep rift between scientists and the public – a crisis of confidence that shapes reluctance to immunize. The perceived superiority of science and expertise over public opinion, increasing technological intrusion and multiculturalism are some of the larger contextual factors that explain the divide between science and the public.

In Part I, Goldenberg discusses a “war on science”. It avoids attributing public misunderstanding as the cause of vaccine hesitancy and calls for further analysis of the reasons, including historical evidence. One historical account discussed is that of Andrew Wakefield’s famous work Lancet publication about a spurious association between the measles, mumps and rubella vaccine and autism, which has eroded an entire generation’s confidence in vaccines. Goldenberg offers a compelling case to explain that the strong hesitation over vaccines is due to scientists ‘insufficient investment in scientific translation, which may well be motivated by the scientists’ hypothesis that the evidence generated is understandable. and achievable for the public. Nonetheless, Goldenberg cautions against the haughty notion of correcting public misunderstanding to address the issue of vaccine reluctance.

Goldenberg also illustrates the limitation of educational interventions in the mitigation of vaccine hesitation. Many antivaxxers tend to avoid new information that can challenge their beliefs. The motivation is not to deny the truth, but to reconcile the truth when it is too threatening to our identity and the values ​​we hold dear. Goldenberg then explains how values ​​and evidence-based decision making should be aligned. Facts, when pleasantly mixed with values-based reasoning, can motivate vaccination and was a central tenet of an “I Immunize” campaign in Western Australia where vaccine promotion messages were mixed with cultural values. residents who valued environmentally friendly lifestyles such as home birthing and alternative medicine. Instead of ignoring these values-based decision-making, the campaign succeeded in aligning the vaccine’s promotional message with their values ​​and improving vaccine uptake.

Goldenberg further explores the inconsistent relationship between experts and the public by responding to the notion of the death of expertise. “I contend that the public doesn’t think they know better. On the contrary, they don’t buy what the experts sell, ”she says, stressing the need for meaningful public engagement rather than easy-to-trust appeals to science. The flourishing of conspiracy theories against science hints at the expanding sites of knowledge generation. An ongoing problem is how science cannot be worthless when it maintains epistemic standards that no scientist can operate outside of their cultural framework, and there is no objective frame of reference from from which anyone can operate. Science and the production of evidence should not be limited to experts alone, but involve its stakeholders. Public concerns about vaccines can be motivated by values ​​and reflect cultural anxieties that require answers through scientific and political translations.

Then Goldenberg presents the “war on science” as “a crisis of confidence”. His analysis highlights how trusting others involves a negotiation of vulnerability and trust, and involves the precariousness of trust. For example, a person may trust their doctor but not the health care system because of a historical injustice. Nonetheless, trust involves a leap of faith into the unknown, which has been an established mechanism where the public places their faith in the face of incomplete knowledge and anxiety over uncertainties. Decision making is also influenced by peers, professionals and scientific institutions. Yet the decision-making process or the confidence to take the vaccine is not entirely rational; in fact, is a combination of cognitive, affective and conative processes.

In the latter part of the book, Goldenberg offers some suggestions on how to deal with declining confidence in vaccines. Blame, shame and punish for their beliefs, or lack of confidence in science alienates and widens the gap. Trust is necessary between experts and audiences and can only be built through an open and honest relationship based on mutual respect. She concludes by highlighting areas that require special attention to build confidence in vaccines, including encounters between health care providers and patients, public health messages, vaccine mandates, diversity, inclusion and representation in health sectors and the influence of industry on health care.

Reluctance to vaccination: public trust, expertise and the war on science Maya Goldenberg University of Pittsburgh Press, 2021 pp 264, £ 34.67 ISBN-13: 978-0822946557