Hello and welcome to FAB Gab. This is the podcast for the International Journal of feminist approaches to bioethics brought to you by fab Network. My name is Kathryn MacKay. And today I'm joined by Maya Goldenberg from University of Guelph to discuss the book panel based on Professor Goldenberg's book, 'vaccine hesitancy, public trust expertise and the war on science'. Hi, Maya. Hi, how are you?
I'm good. Thanks for having me.
Thank you so much for joining me today. So the book panel was published in sort of four parts in a recent journal issue. I wonder if to kind of kick us off. You might give us a kind of overview of what of what your book is actually about. Sure thing.
So this book was when I was writing it, there wasn't any philosophical work on vaccine hesitancy so vaccine hesitancy is the attitude of ambivalence or uncertainty around vaccination. And there was there's a lot of psychology research, a lot of various other social science research and public health research into this topic, but as of yet there hadn't been a philosophical account. So I wanted to work on that. And in the book, I reframed vaccine hesitancy away from the common thinking about the issue, that it is a problem of ignorance or irrationality, or that people have some kind of anti science sentiment that drives vaccine hesitancy. I did acknowledge that it often looks like that when people ignore medical advice, or they repeat things that they've read on the internet. But there's lots of evidence that science illiteracy is not the cause. Some of the evidence is that plenty of has there's plenty of hesitancy among educated people. And it's also well documented that educational campaigns were were, let's say vaccine facts are separated from vaccine myths. They don't do much to change vaccine attitudes. And you would think if there was an educational or knowledge deficit, that's exactly what would happen. People would say, Oh, well, now that I know. So I mean, that. That was interesting to me when I when I started reading into this, because the fact that these campaigns don't work very well, this should tell us that there's some something wrong with the initial assessment. But instead, I found that this, this, this knowledge deficit model is surprisingly resilient. In fact, it is usually the audience and namely the vaccine hesitant public that are blamed for health communications failing to have a serious impact. So I wanted to think about what else could it be if not some kind of science problem, or science illiteracy problem. And I drew from my background in social epistemology, feminist philosophy and philosophy of medicine and science to propose an alternative framing of what I call the war on science. And I said that what we had here was actually a crisis of trust. And I paid attention to the reasons that people give for not trusting, authoritative advice and the kinds of things that came out were very informed by my feminist philosophy background, things like past and present harms associated with industry funding of biomedical research. Medical racism and injustice actually looms large as rational reasons for mistrusting medical advice, not to say that vaccine refuses are right. But I will say that the work of fostering and maintaining public trust has not been sufficiently attended to by healthcare institutions. So vaccine hesitancy as a whole, it's a symptom of this neglect.
Yeah. And so your, your book, you started writing your book, I think you say in your commentary in 2015, the focus was clearly not on COVID-19.
That's right. It was on the big topic at the time that elicited a lot of energy and concern by public health people by politicians was childhood vaccinations. And we're coming back to that now after a few years hiatus, but it was this sort of puzzling problem where at least in industrialized nations, we had a we had a strong and well communicated science consensus on vaccines. There was consistent messaging and and relatively good access, yet vaccine hesitancy persisted and a lot of people were spending energy trying to figure out why that was, and I joined in that I when I started this research, I wanted to figure out what evidence was is going to convince them. And it turned out, I figured out pretty quickly that I was actually the wrong question to ask it. First of all, it seemed that it must be some missing data point or evidence that's missing, I now think I no longer think that is true. And it also created this polarizing position where there's us who accept vaccines and them who don't. And a little bit of looking into some of the psychology research and grounding that in epistemology of trust, made me realize that we're not actually that different instead, people are very motivated to respond to health care advice from people that they trust. And if you live in a in a social circle, where most people don't vaccinate, chances are you are going to reasonably take the steps to not vaccinating your children. Well, if you live in a world where vaccines are the norm, vaccinating is the norm, then you chances are in most cases, you will follow along in that way.
Yeah, I would love to come back to that. But first, I guess let's talk about the book panel a little bit. Okay. So the the two people that were writing kind of very, very friendly sort of critiques to you were Miriam Solomon, and Inmaculada De Melo-Martin. And I guess I wanted to ask, first of all, what was the sort of motivation behind putting the panel together? What was the motivation for this discussion?
We were invited to do this book panel at the central APA meeting. And we were happy to do it. For me. It was also my first in person conference in in years. But when I received their their commentaries, yes, they were very, very approving of the general findings of the book. But they were reflecting on whether the analysis still held during this during this time, which was, you know, right. Still, COVID-19 was still going strong. A lot of public health measures were still in place, like masking and testing before you went, went on a plane. And they both in different ways, were asking that question. Does it still hold now. And I think their frustration was, loomed large, both of them are, are living in America, where they both had this feeling that vaccination had become so polarized, in fact, every health recommendation around COVID had become so polarized that it was hard to see how some kind of analysis around building trust was going to do much. In the end. Miriam Solomon was more wary of that. She said, I just don't know if it's enough, it seems like we're steeped in misinformation and polarization. And it just may not do the work. As much as I like how it sounds, it may not do the work. Inma De Melo-Martin was was more seemed to be more accepting of it, that there was that there was still good, good grounding for thinking that that all was not lost, and that we could still work with this in these highly intensely polarized situations.
Yeah, yeah. So I wanted to ask you about some of their some of the critiques, I guess, that were lobbed at you. As you just said, I think Miriam, Solomon, she sort of says in her commentary, like, I completely agree with this. However, while I think that my approach is necessary, I'm not sure that it's sufficient. So yes, we need to engage with these people in a more respectful way. And yes, building trust is absolutely important. But this sounds like a very slow a kind of one on one process, something that takes a long time to develop. And so it's not sufficient. It's not enough for what we need now. Or maybe what we would need in a future kind of pandemic scenario. How did you respond to that?
My response was something like it, like I can see that trust takes a while to build, but it's also very easy to lose it. All the theorists centrist, say something like that slow to build quick to lose. And I pointed out the many steps along the way where different decisions around policy and communications during COVID could have resulted in a much different scenario. So we can actually go back and look at some of the policy decisions that were made and communications that were made as a playbook in how not to do it. It's funny how COVID will be remembered as you know that this time when governments were very likely to say We were following the science and they were convening expert panels. I mean, despite all the, you sometimes read the statements, that expertise is dead, but instead, we had expert opinions everywhere during COVID. And they read expertise very narrowly, if there had been more discussion not just with infectious disease experts, but communication specialists, people coming from critical social sciences and humanities about how you engage with with a diversity of people, things could have gone along a lot better. Instead, there was things like excess bluster in saying these vaccines are going to end this pandemic, there was no evidence for that, there was a feeling that there was too much allowance for the manufacturers of these vaccines to set the price establish their own networks of distribution. And of course, they didn't have a global plan, either. So any worry that was already tied to vaccine hesitancy, where the pharmaceutical and biotechnology companies have too much power over it, that was only amplified, and had they consulted, let's say, experts in vaccine hesitancy, there could have been steps along the way to mitigate that kind of concern, because it could have been anticipated and instead it was treated like we'd never, we'd never heard of vaccine hesitancy before. In fact, I can point to early communications around vaccination and the especially the rollout, which, you know, in high income countries, came a year into the pandemic, it's like, they've never heard of vaccine hesitancy before. And they expected everyone to be lining up for this vaccine. I actually, I can think that I did a lot of media during, during the height of the pandemic, where I remember the first one I had was just maybe a month into the maybe it was a month into the pandemic I got, I was interviewed by a Canadian journalist who said, so, once these vaccines are available, everyone's gonna want it right. And why would you think that and it to him, it was so obvious, because at this point, we were all we were literally locked down. And the need was so great. But he he couldn't even imagine that there would be people that were resistant to it. And I said, historically, of course, I couldn't see the future. But I said, based on history, we have no reason to think that everyone is going to want this vaccine, as appealing as it sounds to you, it will not sound appealing to everyone. And sure enough, it was not appealing to everyone.
And this kind of I mean, this connects into in Inma De Melo-Martin's commentary on your piece as well, because she kind of thought, I think one of the takeaways from her commentary is this is fundamentally about values. At some level, and you agree with this, you say this in your book. But her her view is that well, maybe there are just some that are perhaps more problematic than others, like maybe they're just some some values that we need to not take too seriously. Maybe there are some people who put trust where trust is not deserved, like in people who make crazy claims about totally untested, fake treatments, you know, I don't even want to say treatments, claims about things that will help with something like COVID-19 that have no basis in evidence whatsoever, whereas at least this vaccine is based in some evidence. So there seems to be like there's an epistemological gap here. But there's also a values based gap here, where I think part of your response would be, we can try to tackle the epistemological part, but we can't do that without the values. And it's sort of like, it becomes a question of whose values do we take seriously? And how do we kind of employ them? And like, how do we negotiate that?
That's right. And so I agreed with her claim that it is certainly about values. I mean, all scientific issues are laden with values all the way through. And it's also the case that there are some values that we will not take seriously. The same way we don't take all opinions seriously. It's a you have a right to have an opinion. But it doesn't mean that I need to take it very seriously. That's, that's, you know, kind of standard thinking about argumentation. So I got I was both authors. were pushing me a little bit to say why weren't you more? Why didn't you come down on the on the wrong values and say, there are some values that are unacceptable the same way that there are some ideas that have no merit either, and I had to allow that I had done more descriptive work. on what vaccine hesitates, as we're saying, based on the empirical research that's out there, that's actually a ton of it. And I thought that was valuable to at least understand your audience when you're trying to communicate with them doesn't mean you're going to agree with them. And it doesn't mean that you're just going to allow wrongful claims to persist. But the tendency in science communications, is to try to fix the wrong claims. So that's I mentioned, vaccine facts versus vaccine myths. If I, if I look at the kind of vaccine communications that happen, you know, 99 out of 100 times, it's always about myth busting, countering misinformation. So the assumption is always that there's something wrong that needs to be righted, when sometimes listening to what people have to say is helpful, too. It doesn't mean you need to allow what they say to hold. But trying to always be right is not a great way to get along with people. And I think deep down, we know that it's not a great way, if you've tried to have friendships and personal relationships with people be right is not going to make you well liked. And there are some times where you do need to step back, you may not agree with what they say, but try to figure out where are they coming from? Where would they get these ideas? Why is it that something that sounds wild to you, you know, some conspiracy theory doesn't sound wild to them? What situation put them there that? The the extreme view sounds more believable than something more? Something more, you know, common, like? Well, the scientists say this, and it probably works. And they're right most of the time.
I wanted to ask you about freedom. So one of the interesting things that you point out in your response to Solomon and Jamila, Martin, is that it sounds like there was a really big shift in public discourse around vaccines between 2015 When you started writing the book, and 2022 When you were writing this kind of commentary or even 2021, when you were kind of having the APA discussions, where it seems like the topic of conversation really changed so that it became a matter of kind of parental choice and parental freedom about vaccines. Whereas if that had not been the framing of the values before, I'm not sure at what point that changed if it was COVID-19, or if it was actually something around COVID-19. But I just wanted to ask you more about that. Because I think that that's really, it seems like that's still kind of where we are, is this idea that it's kind of like science versus freedom or something like that now. So that's right. Yeah. Like what is what do you think about this?
It was actually a challenge about doing this philosophical work that I was working on a live debate that kept changing. And there's, I think we're trained as philosophers to do to do that sort of step back a little bit, assess the situation, and then cover it with some kind of overarching framework or broad principles or something like that. I was never able to do that, because it kept changing so much. So when I started researching in 2015, there was certainly vaccine hesitancy that was a concern for public health. But it was not politically polarized in the same way. For one politicians on left and right. We're generally in agreement with vaccination. So Republicans and Democrats were in favor of vaccination in the US, for example, that's certainly not the way it is now. And even in terms of vaccine refusal and vaccine hesitancy you found arguments on the left and the right. So it was not like it is now which is right now, vaccine refusal is largely has largely been adopted by the right. And interestingly, there used to be a lefty kind of lifestyle argument against vaccination, like kind of the like natural living. West Coast Californian yoga moms have this kind of view about nature and not needing vaccines that has been quieted. You don't hear it from the left anymore. I think they still exist. They're just quieter about it. So that it became more obvious in during COVID When there was many politicians that were sort of using the populist right populist rhetoric to and bringing vaccination into a vaccination refusal into that political fold. But it was happening before so there were some events where politicians who pre Usually would have said things like I'm in favor of vaccination, the discourse kind of shifted in favor of parental rights. And there's been some analysis of the media and the discourses around vaccine refusal. And it kind of came from the protesters. It seemed the story is that vaccine refusers were trying to get leverage with their politicians. And they weren't getting very far when they were trying to convince the politicians that vaccines aren't safe vaccines cause autism and something like that. So they shifted the language towards parental choice and say, shouldn't it be this was against the vaccine mandates, which are, you know, quite common around pediatric vaccines, shouldn't it be a parent's choice whether to vaccinate or not, and it was hard for any Republican or right a right leaning politician to disagree with that, I'd say even on the left, it should be hard to disagree with that, too. But somehow the left remained in favor of mandatory vaccination. So the language shifted towards rights. And with that, then they could kind of slip in the the questionable science about this vaccines not being safe. And and within a very short period, you started hearing politicians repeating this kind of questionable scientific findings about vaccination colleagues causing neurological damage and autism and things like that. And of course, it it reached its peak with in the US with, then President Trump actually being outwardly anti vaccine and claiming that kids get autism from from childhood vaccines.
Yeah, so interesting. And another thing that you kind of touched on in your, in your response, and your commentary is how the main kind of response to this from the left or from leftist politicians left leaning politicians is to say, well, we're waiting on the science, or we're listening to the science or we have to listen to the science or something like that. And so on the one hand, you have people saying, I actually would say that there's a kind of inflation of the value of personal choice going on, on one side of the debate. On the other side, you have a kind of abdication or refusal to acknowledge that there's no such thing as sort of just like neutrally listening to science in quotation marks. of science here.
Yeah, the left is adopting or has adopted during COVID as scientistic. Language of we don't need to talk about values. It's science, after all. And, you know, anyone who studies science studies, listens to that and says, Oh, no, don't do that. Again, that never works. It's not a way to bring people in, it is assuming a lot about science, that just isn't true. Science does not direct our policies in any straightforward way. It hopefully informs it, but does not direct it. Science is laden with values. And the best science is critical of those values, not just of the scientific evidence. And if you want to alienate people from public policy, you say, Don't worry, folks, we're listening, we're following the science because there are plenty of people who have had past and even present experience with let's say, healthcare, or other, or know that, you know, history of science and say, Yeah, but science doesn't always work in the interest of, let's say, marginalized communities. So, you know, it's not irrational to be weary of claims that science is going to save us.
Absolutely. So you've kind of commented that there was a big challenge to you in writing the book, or even kind of like post post book with the fact that the debate has been shifting and moving so quickly. Were there other challenges that you faced, either in the book kind of after after book?
Yeah, the live debate was was was probably my biggest challenge, as I mentioned, and I should say, I was finishing up the book in March 20. Right as COVID was declared a pandemic. And I had that moment I said, Oh, my God, do I need to add another chapter or book? And I took a few weeks to think about it and eventually realized that my chapter on COVID-19 And I was already anticipating there's going to be vaccines, there's going to be vaccine hesitancy. My prediction was that the concerns that I that I raised and the themes of public trust and and relationships of the of the public to experts was going to loom large. And I decided instead of trying to say something about that, that hasn't happened yet. I said, Let's just flag that as something that we're going to need to watch. So, you know, I think I mentioned COVID-19 In my sort of preface to the reader was on the last page of the let's keep watching. Luckily, I kept it general. And I'd say the prediction was true that public trust became kind of the, you know, common language public trust in science. Why don't the public's trust science was was so common concerns about expertise were big themes all through COVID. And, I mean, I think the groundwork was already there. But if they ended up being major themes for thinking through COVID, the COVID situation that we're still in?
Well, then I think that it's, I think that it's good in a way and also really interesting that the book is focused on childhood vaccination, because childhood vaccination seems like it's, it was one of the very, very many ongoing issues that just fell off the table during the pandemic, and we just sort of forgot about it. And we forgot about a whole lot of stuff. And I think that's understandable. But at the same time, that was a kind of issue that pre existed. So you were saying, you know, vaccine hesitancy was around before we had the COVID-19 vaccines. And actually, even if the pandemic is over, now, we have to grapple with a kind of new world of vaccine hesitancy because I think it's possible that COVID-19 has actually made it worse, maybe for childhood vaccination.
So it's already been documented in the medical literature. A lot of a lot of children missed their vaccinations, you know, the wellness visits didn't happen. And now physicians want to catch people up. And a lot of parents are saying, Why would I do that? It might be just because well, my kids fine for now. So you've already got an older child. So you didn't just so one thing that's known about how do you get people vaccinated, if you normalize it, the best way to get people to vaccinate is is not to argue with them or to make them think too hard, is just when that's the norm, people just follow what everyone else is, for a while it wasn't the norm. In addition to that, there was all the politics around COVID vaccination. So now we're coming back to parents and say, Hey, want to catch up your kids on vaccination? And many of them are saying no. So that backs that concern about vaccination is back. It's funny to have a book, that's two years, that's, you know, just just over a year old, and it already sort of works as a bit of a historical case. But historical cases, of course, are very illuminating, they can remind us that the situation we're in right now doesn't have to be that way. So that was one thing I said to the authors and at the APA panel was, was as wild as it seems. Now, we've had different scenarios, and we will have different scenarios. Again, we just have to think about what are the conditions that creates better scenarios, better relationships between the public and healthcare institutions?
Yeah, absolutely. So I guess my final question for you feels like it's a little bit of an unfair one, because I'm kind of going to be asking you to like summarize your entire book in a sentence. But I am really curious to know. And I'm sure that the listeners are two, sort of how do we walk back this sort of terribly polarized situation we're in now, what is your sort of recommendation for healing this massive sort of divide between Pro and anti vaccine folks?
I think we're going to first need a period of calm and I just don't know when we're going to get it. Everything is so heightened now. You know, just to right now, one thing that happened during COVID Was that the the many government leaders got were impatient with the usual techniques of persuasion, trying to get people to vaccinate, and they brought in vaccine mandates very quickly. And because of that, all the debates were around freedom. And you know, whether whether mandates make it better or worse. And this is so different than how it was before. If you look at my book, I spent like three pages on vaccine mandates. That's it, because mandates were already the norm. And many of them worked very well, where I live in Ontario, we've had childhood vaccine mandates. So school entry mandates for children to go to daycare and school since the early 1980s. And there's been high uptake and not a lot of fight against it. And we can look at why that was I have suspicions why that was. One is it was introduced during a period of calm, not in the middle of a pandemic where everything had been. Everything had been heightened. There had been some measles outbreaks in the early 1980s. It was actually introduced by a Conservative government in In Ontario, which people are chosen from, they're surprised when I say that. But it was seen as a way to protect individual rights to protect children from getting infected by other children in their classes. And because vaccination wasn't, you know, a tipping point for, you know, larger social unrest and mistress, it came in fairly, I don't know if easily is the right word, but it didn't create all kinds of issues around it. And another thing that was probably crucial, at least in Ontario, was they allowed for exemptions, you could have religious exemptions. So your child could still go to school with that. And the idea was always as long as the exemption rate stays low, and most kids are vaccinated, it works out well, something happened during COVID, that there was very little tolerance for exemptions. In fact, I was surprised how strict the exemptions were, in Ontario, the same province, where we allow exemptions for children, suddenly, there was very little tolerance for that. Hardly anyone got a COVID exemption, even people who had had past reactions and health conditions there was, I think, every there was a huge, you know, human rights courts were looking through them and all of them were failing. And that is not a good public health strategy. It's kind of known that you have to have a little bit of a release valve, I've heard that described where the anger needs to be able to be released somehow. Otherwise, people get mad, they organize and it gets bad. And we've seen some examples of that where various states or other jurisdictions got very strict on exemptions, because they felt that there was too many of them. And then the people get organized people who otherwise would have mainly maybe grumbled about it, and other done other things. They got organized, and many of them were ready when COVID first hit, they said, We know there'll be COVID vaccines, and our people will be ready when that happens. So this is a kind of secondary effects that you need to be thinking about when you introduce this kind of legislation. So this is all to say that I'm I'm not making an argument against vaccine mandates. It's actually an argument that if you distill vaccination and all the feelings and attitudes around it to mandate or don't mandate, you actually miss a lot of the relevant values that are at play there. Instead, it becomes a Don't you agree that we should have freedom? Yeah. Well, you know, then we can't talk to each other. And that's something that we now need to deal with. So. So now that COVID mandates have a vaccine mandates have been pulled back, it might be a time that we can have sort of calm or thought where where people feel less backed up against the wall about what kind of society we want to live in. And where do vaccines fit into overall health strategies? It certainly can't be our only health strategy, which it did feel like that in some moments during COVID, that it was vaccinate or you're on your own. And that was not a great way to think about public health.
Well, thank you so much for speaking with me. That's been so interesting Maya.
thanks. It's been great to talk to you.
And thank you for listening to this episode of FAB Gab. You can find Maya's book in all great bookstores, you can find the papers that we've discussed linked in, this episode's notes along with the transcript of our discussion. FAB Gab is hosted and produced by me, Kathryn MacKay. You can find our other episodes on Spotify, radio public, anchor or wherever you get your podcasts quality. Thanks again for listening. Bye