Lack of trust, not of science, be­hind vac­cine re­sis­tance

Toronto Star - - OPINION - MAYA J. GOLDENBERG

With flu sea­son upon us and the open­ing of flu vac­cine clin­ics, we can ex­pect ad­ver­tise­ments, re­minders and en­cour­age­ment to get our­selves and our chil­dren vac­ci­nated. We can also ex­pect to hear ar­gu­ments and ex­pla­na­tions from friends, col­leagues and fam­ily mem­bers about why they do not get im­mu­nized against in­fluenza.

While the ef­fi­cacy of the flu vac­cine varies from year to year, im­mu­niza­tion is our best means for di­min­ish­ing the av­er­age 12,200 flu-re­lated hos­pi­tal­iza­tions and 3,500 deaths from flu across Canada an­nu­ally re­ported by Sta­tis­tics Canada. The in­fluenza vac­cine is widely rec­og­nized by health pro­fes­sion­als to be a safe and ef­fec­tive way of pro­tect­ing our­selves and our com­mu­ni­ties.

So why the re­luc­tance to ac­cept the sci­en­tific con­sen­sus on vac­cines?

We can ask this ques­tion about not only in­fluenza vac­cine but also child­hood vac­cines and vac­cines for older adults, such as shin­gles.

While the rea­sons for vac­cine hes­i­tancy are many, Cana­dian me­dia turned the spot­light last week on the pre­cip­i­tous spread of anti-vac­cine myths via on­line fo­rums as a driver of vac­cine re­fusal.

But be­fore we blame the sources of mis­in­for­ma­tion, we might ask why peo­ple visit these vac­cine-skep­ti­cal web­sites at all. We are all pre­sum­ably aware of the var­ied qual­ity of in­ter­net in­for­ma­tion, and the sci­en­tific con­sen­sus is un­com­pro­mis­ing in its mes­sag­ing of safety and ef­fi­cacy. Shouldn’t this be enough? Many com­men­ta­tors lament “anti-science” sen­ti­ments and “science de­nial­ism;” they won­der why the ques­tion­ing pub­lic doesn’t “be­lieve” in science.

But the terms “be­liev­ers” and “de­niers” don’t cap­ture the dis­pute ac­cu­rately. Science, when it’s done well, is our most ac­cu­rate means of un­der­stand­ing the nat­u­ral world. There is no need for “be­lief.”

Vac­cine skep­tics do not re­ject science per se, but rather chal­lenge the trust­wor­thi­ness of sci­en­tific gover­nance — how re­search is pri­or­i­tized and funded, how tri­als are de­signed and ev­i­dence col­lected and an­a­lyzed, which stud­ies get pub­lished, and how sci­en­tific ev­i­dence is used to in­form pol­icy de­ci­sions. The crit­ics charge sci­en­tific in­sti­tu­tions with bias — say, hav­ing fi­nan­cial in­ter­ests that work against the pub­lic in­ter­est.

Crit­i­cisms of the slanted pri­or­i­ties of sci­en­tific in­sti­tu­tions are far greater than the small num­bers of vac­cine re­fusers. Sur­veys of pub­lic at­ti­tudes re­veal a low trust in med­i­cal and gov­ern­ment in­sti­tu­tions. Pol­icy wonks wring their hands over the death of ex­per­tise, as sci­en­tists — and more im­por­tantly, the sci­en­tific con­sen­sus — ap­pear to have lost their se­cure foot­ing as an au­thor­i­ta­tive source of re­li­able knowl­edge.

The science con­sen­sus is the col­lec­tive judg­ment of the com­mu­nity of sci­en­tists in a par­tic­u­lar field of study. Con­sen­sus state­ments cap­ture the state of gen­eral knowl­edge within a field, of­ten to in­form prac­tice and pol­icy or to ed­u­cate the pub­lic about im­por­tant mat­ters.

Con­sen­sus state­ments earn their le­git­i­macy through rig­or­ous de­bate and scru­tiny by ex­pert com­mu­ni­ties of sci­en­tists. The meth­ods in­clude the ne­go­ti­a­tion of con­flict­ing views in aca­demic con­fer­ence set­tings and in ex­pert jour­nals, peer re­view and the repli­ca­tion of find­ings.

Yet the mech­a­nisms used to en­sure the trust­wor­thi­ness of that in­for­ma­tion are in­ter­nal to the sci­en­tific com­mu­nity and are there­fore largely shielded from pub­lic view. The pub­lic is ex­pected, even im­plored, to trust the source.

Most mem­bers of the pub­lic are will­ing to do this. De­spite be­ing largely un­able to judge the con­tents of the con­sen­sus state­ment and how the con­sen­sus was reached, non­ex­perts choose to trust the con­sen­sus as sci­en­tif­i­cally ac­cu­rate, and to trust that the in­for­ma­tion has been con­veyed hon­estly.

When mem­bers of the pub­lic chal­lenge the con­sen­sus view, they do not re­ject science but, rather, chal­lenge the in­tegrity of the state­ment. They do not trust the source, and thereby ques­tion the con­tent of the con­sen­sus state­ment.

We trust those whom we per­ceive to have our best in­ter­est at heart. If we do not find that in our fam­ily physi­cian, who might dis­miss vac­cine con­cerns and shut down de­bate, we turn to fam­ily, friends and on­line com­mu­ni­ties of like-minded peo­ple. Pub­lic trust is gained by mean­ing­ful en­gage­ment and re­spon­sive­ness to con­cerns. Com­mu­ni­ca­tions must be di­rected at the ac­tual con­cerns of par­ents rather than dis­mis­sive com­men­tary, such as “ad­verse events fol­low­ing im­mu­niza­tion are ex­tremely rare.” Par­ents, after all, want to know if their child will be one of those rare cases.

The com­mon re­frain that Big Pharma is cor­rupt­ing vac­cine re­search (and health re­search in gen­eral) should be a flag for our health-care in­sti­tu­tions to se­ri­ously reg­u­late and cur­tail those ques­tion­able re­la­tion­ships be­tween the health-care pro­fes­sion and for-profit in­dus­try.

Pub­lic in­sti­tu­tions must not only be trust­wor­thy, but the pub­lic needs to rec­og­nize them as such. Oth­er­wise, pub­lic health can­not ful­fil its man­date to safe­guard pub­lic health and well-be­ing.

Vac­cine hes­i­tancy is a symp­tom of poor pub­lic trust in sci­en­tific in­sti­tu­tions. Earn­ing and main­tain­ing the pub­lic trust is cru­cial for ful­fill­ing pub­lic health man­dates.

Vac­cine skep­tics don’t re­ject science, but chal­lenge the trust­wor­thi­ness of sci­en­tific gover­nance

CHUCK STOODY/THE CANA­DIAN PRESS FILE PHOTO

The in­fluenza vac­cine is widely rec­og­nized by health pro­fes­sion­als to be a safe way of pro­tect­ing our­selves and com­mu­ni­ties.

Maya J. Goldenberg is a pro­fes­sor in the de­part­ment of phi­los­o­phy at the Univer­sity of Guelph. Her re­search ad­dresses the fun­da­men­tal epis­temic ques­tion “How do we know what to be­lieve?” in health care.

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