National Post (National Edition)
One year later
In a year of the plague, a crisis of trust when Canada needs it most
It is hard to trust politicians at the best of times, and these are not those. The pandemic has offered countless reasons to mistrust Canadian leaders. It is not just that cabinet ministers were hiding out on tropical beaches or posting misleading pre-recorded videos of themselves pretending to read in front of a wintry home fire.
It goes deeper than that, from lockdown rules that seemed to go easy on big businesses and hard on small ones, to the theoretically principled but practically dubious slogan that we are all in this together.
Polling bears this out. In responding to the pandemic, nearly a quarter of Canadians trust neither their provincial government, which is directly responsible for health care, nor the federal government, which has mostly run the economic response, according to research in January by Leger and the Association for Canadian Studies.
This is one data point in a constellation of skepticism about governance, constitutional freedoms and evidence-based policy in a pandemic. As one philosopher who tracks vaccine hesitancy argues in a new book, Canada is in a crisis of trust just when it matters most.
The first year of pandemic has changed Canada's social and cultural patterns, from the way Canadians think and feel to the way they work, shop, learn, unwind, socialize, and seek health care or emergency help.
A year's hindsight shows that an indiscriminate virus found vulnerable Canadian populations, especially the institutionalized elderly. More than 700,000 infections spared some people entirely while crippling others, and killing 18,000. A generation of schoolchildren submitted to a strange educational experiment. Christmas was all but cancelled, to say nothing of birthday parties. People lost jobs to the actual restrictions and the broader behavioural effects of provincial and regional lockdowns, even curfews, which themselves were cobbled together on the fly and inconstantly enforced. Many Canadians struggled in their various ways to cope, to hope, and to trust that one day this would be over.
As vaccines started to roll out recently, Ontario offered a case study in trust, with a new set of lockdown restrictions that relied on the good judgment of citizens not to do what they are trusted not to do, which is to stay home for all but essential things. By offering more examples than definitions, the government was not really ordering, more like trusting everyone to decide the rule for themselves, and to act accordingly.
“Is leaving home absolutely essential?” said Ontario Premier Doug Ford. “If the answer isn't an immediate and emphatic `yes' then please stay home.”
Results were predictably mixed. Pandemic survival has become a game of trust, but the rules are not clear. In Ontario, they are barely written down. Trust is not what it was a few months ago.
Last April, as the pandemic took off in Canada, social science tracking polls showed trust in government was elevated above its normal baseline. A sense of solidarity followed this disaster, as it often does, as politicians rose to the occasion and public health officers became popular celebrities.
Trust has cratered since then. Today, as Canada embarks on a massive national vaccination strategy as the last hope for saving thousands of lives in a second wave, there is a crisis of public trust in the people behind that effort, according to Maya Goldenberg, University of Guelph philosophy professor and author of the newly published Vaccine Hesitancy: Public Trust, Expertise, and the War on Science.
“It is a difficult challenge to know when trust is well placed,” she said in an interview. Canadians hold their leadership to very high expectations, so each transgression, such as violating a ban on unnecessary foreign travel, is more than just typical hypocrisy. It hits harder.
“People aren't just annoyed by that,” Goldenberg said. “They are absolutely demoralized by it.”
The effect is that public trust in government has fallen just when it is needed the most. In Ontario, for example, which recently went into a stricter lockdown after an earlier one over the holidays proved ineffective, confidence in political leadership “is pretty much lost at this point, and that's the government's fault,” Goldenberg said.
She is not the first philosopher to investigate the nature of trust, to inquire into how people make a rational assessment of credibility, and the various kinds of implicit biases that can affect a person's judgment whether to trust an authority. But she has the unusual added perspective of an urgent new real life experiment in trust at a societal level, the massive rollout of vaccination for all Canadians.
Vaccines are a “signal of how much trust people have in the system,” Goldenberg said. This is broader than a mere scientific or medical questions about safety or efficacy. Trust in vaccines means trusting the institutional structure that creates, regulates and distributes them.
It is not an ideal experiment, and it has a feeling of hurried desperation. For some, this is reason to try to get the vaccine sooner in a panicked rush. For others, the hurry is all the more reason to be skeptical of its safety and efficacy. The Leger poll for the Association for Canadian Studies also showed widespread public uncertainty about whether vaccination means only that a person will not suffer COVID symptoms, or that they also will not transmit the virus to others asymptomatically.
“We're coming to this vaccine because we've got nothing left to try,” Goldenberg said, citing Ontario's “watered down lockdowns” and failure to fully pursue the “test, trace and isolate” strategy that has worked in other jurisdictions.
A key idea in her new book is that trust has not been properly thought through as it relates to vaccination strategies, such that promoters of vaccines are heading into this major new public health mission with misguided ideas about why people might be hesitant to be jabbed.
These thought leaders, who include public health experts in academia and infectious disease experts with previous pandemic experience such as with SARS and H1N1, tend to take the view that vaccine hesitancy is down to ignorance, misunderstanding, cognitive biases, the influence of emotions and social perceptions, and the cultural trends of anti-expertise and science denialism.
In other words, it is the public who is the problem. They are the other side in the war on science.
Goldenberg thinks this is all wrong. People have plenty of reasons to mistrust “the system,” broadly defined, to fear that it could all fall apart in disaster. Politicians have warned of exactly this. The vulnerability of the public health system is a major lesson of the pandemic, but it is not news to everybody. Many Canadians have long experience in having their mistrust of “the system” justified, especially in marginalized communities already poorly served by health care.
“Vaccine hesitancy, however, is still curiously framed as a war on science,” Goldenberg writes.
As a result, she argues outreach efforts should be rethought so as not to “re-entrench the idea of a war.”
“To counter falling public trust in scientific institutions, public health agencies and experts must move their ideas and communications beyond false ideals of scientism and work to address vaccine hesitancy by responding to discrimination within their institutions, reforming their susceptibility to industry influence, and appealing to shared values and priorities with public stakeholders,” Goldenberg writes.
One piece of evidence
WE WANT TO AVOID BEING PATIENTS. WE WANT TO EXERCISE OUR AUTONOMY TO HELP EVERYONE GET THROUGH THIS VIRAL WAR THAT WE'RE IN AND THAT WE'RE NOT WINNING RIGHT NOW. — DR. JUDY ILLES, PROFESSOR OF NEUROLOGY AT THE UNIVERSITY OF BRITISH COLUMBIA
VACCINE HESITANCY, HOWEVER, IS STILL CURIOUSLY FRAMED AS A WAR ON SCIENCE.
she offers for her view is how the organized antivaccine movement overstates the uncertainty of legitimate science. In other words, they do not present new authorities, rather they simply try to undermine the existing ones.
This strategy puts the lie to the familiar worry that expertise is dead, Goldenberg argues. On the contrary, she said, people skeptical of vaccines do seek out expert opinions — because their trust in the system is so low, they have different ideas about what counts as an expert.
That is how followings develop around “maverick” characters who claim to speak truth from the position of both a system insider and an outsider, most famously the disgraced former scientist and vaccine research fraudster Andrew Wakefield.
The dominant response to these movements has involved shaming and mockery of supposedly stupid people, Goldenberg said. Social media thrills to the take downs of anti-science provocateurs by a new class of skeptic-slayer expert. In the pandemic, anti-vaccine, anti-mask and anti-lockdown movements have interacted and melded, promoted by characters who deliberately break laws, get arrested, and strike a pose.
This stereotyping of vaccine hesitators as either anti-mask weirdos or clueless dopes poses a new sort of risk when public trust needs to be built in a hurry for Moderna or Pfizer, and for the regulatory system by which Canada has approved their products.
There is a “crisis of trust,” Goldenberg said. “Enacting change is difficult, but the status quo is a plague.”