The natural impulse of public health professionals to blame their critics for the public’s increased mistrust isn’t just mistaken. It is self-defeating. It keeps public health people from assessing what they said and did during the pandemic that aroused that mistrust, apologizing for these misstatements and misbehaviors, and figuring out how to do better going forward.
I haven’t read Peter Hotez’s new book, but its title – The Deadly Rise of Anti-science: A Scientist’s Warning – signals a topic Hotez has written and spoken about extensively. So I feel I can respond to his thinking, though obviously not to the book itself.
Hotez is certainly right that many people have died because they were unduly mistrustful of COVID vaccines. But I think he is far from right in blaming the antivax movement (or the “anti-science movement”) for this tragedy.
Like most public health professionals, he gets the causality backwards. No doubt some people started mistrusting public health officials because they listened to antivax outliers and extremists. But far more people started listening to antivax outliers and extremists because they mistrusted public health officials.
This is especially but not exclusively true of people whose politics leaned rightward.
What did public health officials (and expert commentators in mainstream media) do to earn this mistrust? I could list literally dozens of factors, but here are a few:
- Excoriating anti-lockdown demonstrations as superspreader events while giving the George Floyd demonstrations against police violence a free pass.
- Proposing that young people of color were a higher-priority target for scarce vaccine doses than elderly white people.
- Shutting down churches during lockdowns as inessential while keeping liquor stores open.
- Delaying the vaccine rollout until after Election Day so Trump couldn’t take an October victory lap.
- Deferring to teachers’ unions in decision-making about whether/when to reopen schools.
Above all, prioritizing health over all other values (e.g. education and economics), but especially over freedom, which public health officials widely denigrated as a value not even worth considering. See this article, for example. Its title tells the tale: “COVID-19 Mitigation: Individual Freedom Should Not Impede Public Health.”
All this is aside from less politicized examples of public health’s COVID dishonesty and authoritarianism, about which I have written extensively.
Two groups lagged most in COVID vaccine uptake in the early months: urban blacks and conservative whites. Public health agencies worked hard to reach out to urban blacks, struggling with considerable success to ameliorate their mistrust. They did very little to ameliorate the mistrust of conservative whites. Mostly they blamed conservative whites for their mistrust. Hotez is still blaming them for their mistrust.
As a result of the way COVID policies were developed and implemented, a lot of people, especially on the right, came to see public health agencies and experts as authoritarian, dishonest, and contemptuous. They were and are understandably outraged at the way they feel they have been treated.
And one of the basic principles of risk communication is that outrage exacerbates hazard perception. If you’re outraged at the people who keep urging you to roll up your sleeve, you are far likelier to suspect that the vaccine might be more dangerous than they’re admitting. It doesn’t help when they keep telling you what an idiot they think you are for listening to people who respect your hesitancy instead of mocking or excoriating it.
There’s an intriguing parallel here. Hotez has been very badly mistreated by antivaxxers for years; starting way before COVID, he has been the target of endless harassment, even death threats. He is understandably outraged. And so he sees antivaxxers as far more dangerous than they actually are … just as millions of right-leaning Americans, understandably outraged at Hotez and his colleagues, see COVID vaccines as far more dangerous than they actually are.
Another parallel: Hotez has generalized his animus at antivaxxers into what I’m tempted to call a conspiracy theory about a global anti-science movement that threatens life as we know it … just as some people (though fewer than I think Hotez surmises) have generalized their COVID vaccine skepticism into increased hesitancy about other vaccines as well. And, yes, a few have even fallen prey to anti-science conspiracy theories.
Hotez is absolutely right that many people have died because they feared and mistrusted COVID vaccines. He understandably blames antivaxxers. I can certainly understand why he has trouble seeing how public health agencies and experts pushed them into the arms of those antivaxxers.
But it’s basic medicine that you’re unlikely to treat a condition successfully if you have misdiagnosed it. To build or rebuild trust, public health agencies need to understand what they said and did that undermined trust. Then they need to own it and apologize for it and find ways to do better. Blaming antivaxxers won’t help.
Copyright © 2023 by Peter M. Sandman
