Volume 3, Issue 4: Vaccines and humanized medicine

  

Vaccines and humanized medicine

 

Maya J. Goldenberg, Vaccine Hesitancy: Public Trust, Expertise, and the War on Science. Pittsburgh: University of Pittsburgh Press, 2021, pp. xii + 251. Hardcover ISBN 978-0-8229-4655-7. $45.00

 

 

When Maya Goldenberg, philosopher at the University of Guelph, has started to write her book on Vaccine Hesitancy, she did not have a clue that by the time of publication, it will be so actual. Many consider vaccines as the most effective preventing tool of the coronavirus pandemic, and though many countries are producing nice numbers, vaccines are still surrounded by uncertainty, misbeliefs, and mistrust. Goldenberg’s book will not change the world, of course, but her remarkable views and sop

histicated approach will emerge from the literature.

            In 1998, Andrew Wakefield published a study in the world’s oldest journal, The Lancet medical journal; he claimed that evidence was allegedly found about the relation between certain vaccines (such as the combined measles-mumps-smallpox vaccine, MMR for short) and autism in children. The paper immediately brought Wakefield to the forefront of media attention, despite the fact that it was proven erroneous quickly: the data in the article were false and / or misleading, and they were unethical to the subjects of the investigation. There were serious legal problems with the person of Wakefield the effects of which are still being felt to this day. While Wakefield’s medical license was revoked along with the study a few years ago, the popularity of his figure has turned him into a cult figure. While his fame grew large, the number of vaccinations accepted and administered declined.

            In recent decades, a number of developed Western countries have been hit by a disease that had previously been pushed back by vaccinations. Due to negative opinions, many did not give the right vaccines to their children. Thus, long-not-seen epidemics (and many otherwise avoidable deaths) were caused by whooping cough in England and Sweden in the 1970s; the Netherlands, England and Ireland were hit by measles around 2000, the US in 2005, and Wales in 2013. Developing countries have not been spared by epidemics due to un-administered vaccines either: Samoa was hit by measles in 2019, and Nigeria has been at risk of polio, measles and larynx since 2001. Unfortunately, the list could be continued for hours.

            One of the central strands of Goldenberg’s book is that it confronts the received views of the scientific world, more narrowly, by the medical community—not, of course, about the effectiveness of vaccines, but rather about the reasons for vaccine refusals. Exactly speaking, Goldenberg is not talking about vaccine-denials: their numbers, although growing, are extremely low; they represent only a few percent of society. Those who hesitate to inject the vaccine provide the real challenge for the health system: the number of insecure people, or vaccine hesitants, in certain countries can reach 25% (p. 4). “Vaccine hesitancy” can be defined as having doubts about the effectiveness and timeliness of vaccinations, as a result of which (usually) children are often not vaccinated in the end. We are not speaking here, of course, about those alleged people who are hunting for their vaccinated fellows around the doctor’s offices. Quite simply, many parents have doubts, worries, and fears—and because of this they are postponing and then “forgot” to give the vaccine.

            According to established medical and socio-political ideas, these hesitants (and ultimately the more extreme anti-vacciners), often led by Wakefield, waged a war against science (“war on science” became a key term in the mainstream popular science literature since Chris Mooney’s 2005 bestseller of the same title). They ravaged the popularity and power of science; in the end, the general authority of science was undermined. Three things are usually highlighted in this regard.

            On the one hand, it is believed that one of the reasons for the war on science is the ignorance of the people. People don’t want to be “vaccinated” because they have misleading and false beliefs about vaccines—they don’t really know how science and vaccines work; if they would know, they would surely be vaccinated. The task, then, is simply to “enlighten”, to “teach” them, that is, knowledge dissemination. Goldenberg explains in detail how pointless this kind of attitude is on the part of the scientists. For if people’s ignorance were the real cause of hesitation, the camp of those who accepted vaccinations should have grown as a result of the relentless amount of lectures and popular volumes aimed at the general public over the past decade. However, the situation has apparently not improved. Comprehensible and popular scientific information is available to a very wide range of people. Often very useful and exciting books are made for children as well, but vaccine hesitancy is not diminishing.

            Based on the results of several empirical studies, Goldenberg concludes that for many, this is not so much a scientific issue but a personal one. ‘Okay, I understand how vaccines work, I saw a very colorful video compiled by a well-known medical research team, and okay, in general, vaccines work without more serious complications, but will it happen to my child?’ Everyone considers their own child to be special, unique, and parents better known them than anyone else. ‘My baby used to be sick, weak, etc., what if she was the 0.1% who could have more serious side effects?’ Parents are, quite understandably, concerned and not so much interested in what the consensus of science is about a vaccine, what peer-reviewed study has been published in a (politically and economically never entirely independent). Until doctors, communication professionals, nurses, healthcare providers and science communicators can respond adequately to these concerns (beyond the usual ‘don’ worry there, everything will be fine’), the number of vaccine hesitants will not decrease.

            According to many, the reasons for hesitation are not personal fear, anxiety, parental love, possibly bad memories and rumors learned and brought from home, but simply that people are stubborn, biased, short-sighted and are not willing to deal with the truth (this is the second point of the received view). When people who hesitate were let know that vaccinations were safe in a too harsh, aggressive, authoritative, and assertive tone, the results were—surprise, surprise—not that they became pro-vaccine, but rather confirmed in their insecurity. There was a backfiring effect (p. 45), ‘there is no smoke, without a fire’, many said. The evidence presented to them was selectively treated by those who were previously uncertain, but this is by no means unique to them—we are all affected to some extent by the so-called confirmation bias, according to which people prefer data and opinions that confirm their own previously (though often unconsciously held) position. This is not because “we do not want to know the truth—many of us do—but because the truth is sometimes too threatening to our send-identities and the values we cherish” (p. 46). Even if we think that everyone should accept the objective and independent facts presented to us—which have been established by the supposed sole, crystal-clear, centuries-old methods of science—people simply do not work that way. (We’ve known since Thomas Kuhn that scientists don’t work that way, which of course isn’t surprising, because after all, they’re human too.) To put it a little metaphorically: from the bag of arguments, counter-arguments, and information, everyone is welcomed to cherry-pick.

            That is why, Goldenberg argues, it is not the people who need to be further beaten with the knobkerrie of science; what’s more, since even after the loud roar of scientists who view citizens as fools, people still don’t want to “convert,” the problem presumably shall not be localized only in their stubbornness and blindness. According to Goldenberg, strategies should be developed that can make vaccinations more attractive without disrupting one’s identity and values. The task is not easy, but there are good examples (pp. 59-65). All this may help to understand why, moving to the contemporary scene, as one may add, the amok run of many scientists—based on historically and philosophically unfounded and idealistic science-images—would rather backfire again. It is enough to think of the rather simplistic “I’ve already inoculated myself ” type of poster campaign. “Well you’ve already vaccinated yourself, I haven’t; they have chipped you, not me.”

            Finally, the author discusses the role of experts as the third point of the conventional view. There is an almost incomprehensible literature on how the role of scientific experts in society has eroded in recent years (what’s more, decades). Some speak of the ‘death of expertise’, the cause of which, again, is to be found only in the war against science fueled by human ignorance and blindness. Goldenberg also acknowledges that the role of experts has been significantly reduced in resolving social debates, moreover, she claims that this is a dangerous process. However, she also warns that this skeptical attitude is not unreasonable: the socially worn-out function of the “expert” is questioned (p. 73) after doctors, scientists, and science communication managers, not to mention politicians, exaggerated it rather one-dimensionally.        

            Many have the image that a bona fide scientist collects the facts, kneads them into a theory, and passes it to politicians who make laws, rules, and regulations accordingly. Even during the coronavirus epidemic, many people exhibit and suggested this attitude (politicians anyway, because if things go backwards, they can be pointed at scientists.) However, this is a very distorted picture. Neither science nor the phenomena described by scientist exist on their own, independently of space and time. Although the epidemic caused by the virus is primarily a virological (and epidemiological) phenomenon, the people infected with the virus and the contexts of the infection are rather complex issues. It is no surprise that many voiced their concerns when leading virologists were unable to get beyond the walls of the lab: although they were right on scientific matters, they were simply not able to reach out to masses or were people got angry and disillusioned when the complex scientists tried to push the aggregation of the world into a small box, defined under microscopes with statistical significances. Experts were experts and remained so, of course, within their fields—but their social perception has stagnated at best, deteriorated at worse.

            Goldenberg lists a number of case studies in which people question the role of experts based on their everyday experiences. To give another current example, it is enough to think here of the increasingly obvious difficulties surrounding childbirth. Numerous historical and medical studies have been published on how male physicians and gynecologists have ignored the requests, characteristics, and natural phenomena of childbirth and women’s values therein. There are a number of traditions and practices from professors to residents in classrooms and maternity rooms that are introduced and upheld for the convenience and legal security of doctors as opposed to the comfort, safety and values of mothers (medicalization of childbirth is an incredibly complex phenomenon, I just noted one dimension from a birds eye view). All this is even more striking in the case of hospital treatment (or rather lack thereof) of minorities. In such a situation, Goldenberg says, when a person is regularly humiliated, disregarded, or simply looked down upon as a human being, we should not be surprised by the skeptical reaction and the accompanying hesitancy.

            The fact that both those who are vaccinated and those who are insecure find (or even look for) their own experts shows very well that it is somewhat misplaced to talk about the “death of expertise”. There has been a fundamental change in the mentality of science-skepticism: while a few decades earlier people tried to stand in the way of widespread acceptance of the climate crisis, or the harmful effects of smoking, by questioning the scientific consensus (as this is described by Erik M. Conway and Naomi Oreskes in Merchants of Doubt), in the meantime a kind of alternative scientific, expert consensus is being proclaimed today. Many virus-skeptics who call themselves “viral realists” refer to the empirical research of German, American, and other experts and leading scientists. People want experts; and if “regular” or mainstream experts are unable to address their concerns and fears, people’s attention will be directed elsewhere in a matter of moments. Considering the consequences, this is a rather unfortunate situation, but this is not entirely unreasonable, although in the long run, turning away from reliable expertise will not help anyone. Is it understandable in light of the above that they do this? Fully.

            But if it is not a “war on science”, what is causing the decline of science, experts, and the number of vaccines taken? According to Goldenberg, we are dealing with a crisis of confidence. People have lost confidence in scientists, scientific institutions, scientific theories. “Even if patients trust their physicians, they may not trust the medical system that their healthcare provider represents” (p. 115). Goldenberg lists and analyzes a number of reasons and historical events that contributed to the loss of trust. It is enough to highlight just one here.

            An important recurring theme in the popular medical literature is the “Big Pharma,” a ruthless, immoral, God-ignorant, exploitative, and unethical mentality of pharmaceutical companies. Everyone has heard that once a certain drug is authorized, only the pharmaceutical companies will gain the most, mostly to the detriment of the people. A lot of these stories are often exaggerations, often fictions. We de not have to suspect a big pharmaceutical company with a bad intention behind every medical doctor. But just as the tobacco lobby has been able to keep evidence of the harmful effects of smoking afloat for decades for profit, so many pharmaceutical companies are actually producing products that don’t necessarily make a significant contribution to people’s well-being. (Suffice it to think here, for example, of nutrition companies that distributed formula samples in the 1960s in third world countries where breastfeeding was an important and well-used method for the benefit of everyone, and where hygiene conditions were insufficient to use infant formulas safely; consequently many infants have lost their lives due to infections and malnutrition after breastfeeding was left behind for the formula-samples, delivered often by saleswomen instead of real doctors.) According to Goldenberg, people’s skepticism, fear, and distrust of science are well founded in several ways. It is especially so, if we take into account the fact that scientists and communication professionals were rarely able to address publics’ actual concerns. “Public trust in science demands socially responsible science that is transparent about the interests it serves and aware of its own histories of power and privilege” (p. 125).

            After several in-depth critical remarks, in the last chapters of the volume, the author comes up with positive suggestions: how could confidence in science be restored? Unfortunately, these chapters are undeveloped, to say the least, but Goldenberg’s goal was basically to localize and outline the problem, not to provide detailed solutions. There are many positive comments about transparency, a reflexive way to address science’s place in society, about respecting the diversity of people’s needs, values, and personal integrity. No matter how objective and truth-seeking science may be, as long as its products, consequences, and results affect people, it simply cannot ignore what people believe about their own world and concerns. And this sphere is extremely complex and intricate. The volume can also be read as revitalizing a long-forgotten concept, namely the humanization of science—the fact that scientists cannot turn a blind eye to the presence of human values. These values, interests, wishes, dreams, and everyday struggles laden with delicate nuances are mostly studied by social scientists. Medicine must be humanized, not medicalized. If we can do this, the desire to vaccinate may also increase at a faster rate.

Adam Tamas Tuboly

Institute of Philosophy, Research Centre for the Humanities, ELRN

Supported by the MTA Lendulet Morals and Science Research group and by the MTA Premium Postdoctoral Scholarship.