Opinion: As the consequences of vaccine hesitancy ripple through the pandemic, trust in experts and institutions must be rebuilt

Jonathan Berman is a physiologist and an assistant professor in the Department of Basic Sciences at NYITCOM-Arkansas and the author of Anti-Vaxxers: How to Challenge a Misinformed Movement.

One cannot help but look at the current state of anti-vaccine rhetoric and action, and wonder: “How did we get here?” Prior to the COVID-19 pandemic, many viewed the anti-vaccine movement as sufficiently marginalized and fringe enough as to be effectively irrelevant. After all, as of 2017, the childhood National Immunization Coverage Survey found that children in Canada were near to vaccination goals for Hib, measles, mumps, rubella, polio, tetanus, pertussis and diphtheria. When I set out to write about the anti-vaccine movement in that same year, the most common question I was asked is, “Why? Who cares? They haven’t convinced anyone.” One academic, rather than schedule an interview, linked me to an article he had written about how overstated he believed fears about the anti-vaccine movement to be.

Taking a historical perspective, the anti-vaccine movement is alarming, even in times of relative quiescence. At times, anti-vaccine proponents have become violent, organized large marches and threatened vaccine supplies. Modern anti-public-health protests are history repeating. A myth attributes near total responsibility for the existence of the modern anti-vaccine movement to a single disgraced former physician involved in research misconduct, who started a vaccine scare. These events played a role in exacerbating parental fears, and linking vaccines to autism in the popular consciousness – but these were reinventions of old fears, not the discovery of new ones.

The language used by campaigners against smallpox vaccination mirrors the language used against SARS-CoV-2 vaccination almost perfectly, because it is driven by the same fears. Humans have not changed, and our anxieties are universal across time. Amid these fears of taking foreign materials into our bodies, or ceding control of our health to government entities, eras of distrust in institutions and expertise and partisan polarization are especially exacerbating.

Certainly partisan polarization of the anti-vaccine movement has increased since the start of the COVID-19 pandemic. Prior to the pandemic, vaccine hesitancy was fairly evenly distributed between those with more conservative and liberal views. Now, vaccine hesitancy and vaccination rates fall along distinctly political lines during a time of mistrust in experts and institutions. Over the past decade, right-wing populist movements have seen growth in Western democracies, with groups such as the National Rally in France, the Lega Nord in Italy and UKIP in the U.K. all gaining seats in parliaments, and similar forces pushing U.S. and Brazilian politics to the extreme right. Right-wing populism requires an enemy in “the establishment” and intellectuals. Populist movements define politics as a struggle between such social elites and so-called “ordinary people.” Scientists, physicians, public-health experts and social agencies may not view themselves as elite, but populist movements often do.

Simultaneously, systematic attacks have been made on universities and academics with claims of “cancel culture,” bias against conservatives, and attempts to make the teaching of concepts such as critical race theory a wedge issue (often even at schools and in programs that do not teach CRT). All of these attacks serve the same anti-intellectual goal of casting universities as places of indoctrination and experts as radicals who are pushing an agenda. Although certain academic specialties such as gender studies have often been the subject of these attacks, they represent only a small fraction of degrees, as fewer than 10 per cent of students major in humanities.

These attacks are not new. Complaints about cancel culture are simply a rebranding of attacks on “political correctness” from the 1980s. Historian Richard Hofstadter identified these trends back in the 1960s, arguing they arose from a kind of class resentment. Although anti-intellectualism can be an effective political strategy, it fails as a means of dealing with real-world problems.

Anti-intellectual political impulses did not subside when the pandemic began to spread. The former U.S. president spent much of his time as steward of a government overseeing a pandemic response by playing down its extent, and casting news of its severity and persistence as personal attacks designed to make him look bad. Lockdowns and quarantines – measures meant to slow the spread of the pandemic while a vaccine could be developed – faced heavy opposition as well, as the economic costs were deemed too great. Even early in the spread of the pandemic, prominent media voices were calling COVID-19 a hoax.

When widespread distribution of vaccines began earlier this year, it was already difficult to reference the issue of vaccination without framing it in terms of culture wars. The vaccine-hesitant were framed as rural ignoramuses, too uneducated to do what was right for their own (and others’) good. Vaccine advocates were framed as out-of-touch elites at best, and nefarious liars inventing a false pandemic to create economic ruin at worst.

At the same time, anti-vaccine groups saw an opportunity to reach a greater audience. Funded and led by a handful of misinformation superspreaders, they were quick to adapt to whichever political identity was most convenient. Anti-vaccine groups attended BLM rallies during the worldwide protests last summer, hoping to convince people that vaccination is a form of medical racism. They also worked with conservative anti-mask groups to craft messaging that would reach a wider audience. Major media figures repeated anti-vaccine talking points, seeing it as a cultural wedge issue.

We are now seeing the consequences of these events. In the United States, case counts have risen close to their peak of last summer as states with low vaccination coverage have been hit hardest. In Arkansas, the state where I currently work, only 3 per cent of ICU beds are available as of this writing. Canadian case counts have started to rise as well, threatening the cancellation of events and the renewal of public-health interventions once intended as stopgaps before vaccines became available. In the short term, immediate pandemic needs must be addressed – but it’s clear that in the long term, trust in experts and institutions must be rebuilt.

The first step is recognition that there is in fact a trust relationship between experts and the public. Merely possessing an advanced degree, having a lengthy CV, or occupying a position of influence does not automatically bequeath trust. We would like to think that a track record of success would be enough to gain trust; but in reality, driven by emotions, trust is harder to win – and easy to lose. Merely providing correct information is not enough to convince. It is not enough to simply be right – we must also be connected to the communities that we serve.

Experts must ask two questions: “Do I trust those I ask to trust me?” and “How have I earned the public’s trust?” We cannot assume that we deserve something that we refuse to reciprocate. Trust in the process of science is perennially strong. However, few seek out scientific sources, and few scientists bother to speak directly with their communities.

Unearned trust is fragile, and not premised on mutual respect. In 2017, I co-chaired the March for Science, an international protest calling for governments to consider scientific evidence when setting policy, and simultaneously asking scientists and their professional societies to engage with political decision-making. The COVID-19 pandemic illustrates that these goals are yet to be accomplished. The consequences of both goals remaining incomplete are weighty: How many have died because governments around the world have failed to follow the science of this pandemic and expert recommendations? How many have we lost because of the eroded edifice of trust? As a medical scientist, I wonder daily if I could have done more. Could I have made specific demands, raised my voice louder in protest, or crafted a clearer message?

To lament and mourn the deaths from COVID is also to seek solutions to prevent a repeat in the future, rather than casting blame. Too many responses to the rise of Delta variant cases have been mean-spirited – no one deserves death, even those whose poor decisions played a role in their own illness. Much of the commentary seems designed to provoke a backfire effect – making entrenched views more intractable, and minds harder to change. The death of an anti-vaxxer is not “karma” or “justice” – only a preventable tragedy. Seeking to end this pandemic should be a humanist goal, driven by compassion.

Scientists rarely acknowledge that they hold power. The democratization of knowledge through digital resources has not democratized that power. To participate in a scientific dialogue, formal education is still expected. Academic degrees and institutional affiliations still carry weight. That same democratization of knowledge supplants one kind of trust with another – instead of experts, many turn to media personalities, social media, meme pages and troll farms. These “sources” – as or more biased than the trusted sources they replace – offer quick access to the feeling of power and restore a sense of equality: “Make up your own mind. Do your own research.” The naive view that lack of access to information was the cause of science denial has proved false. Complicated information benefits from expert interpretation, and that interpretation needs to overlap with trust networks.

The worst thing we could do is bury our heads in the sand and hope that the anti-vaccine movement and other manifestations of science denial go away and that we can simply return to a paternalistic era of unexamined institutionalism. Mr. Hofstadter identified the “mystique of the practical” as a draw of anti-intellectual populist movements. The epistemology of knowledge, hard won through empirical testing, experimentation and analysis, is as practical as anyone could want. The fruits of scientific labour, and the methods of scientific inquiry, are the birthright of every human being.

Trust between institutions, experts and the public built on mutual respect, compassion and a sense of shared mission is a project that may take decades for the scientific community to accomplish. It must compete with political and financial interests that benefit from misinformation. It comes up against our own instincts to circle the wagons and protect ourselves. It demands of us that we not only change other’s minds, but our own minds – but remains, especially today, an essential project.

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