WEBVTT - Should Vaccination Be A Choice? 0:00:15.396 --> 0:00:23.796 Pushkin from Pushkin Industries. This is Deep Background, the show 0:00:23.836 --> 0:00:27.116 where we explore the stories behind the stories in the news. 0:00:27.556 --> 0:00:31.636 I'm Noah Feldman. We've been talking a lot in the 0:00:31.716 --> 0:00:35.996 last year about the possibilities of herd immunity or community immunity, 0:00:36.436 --> 0:00:39.876 but it's now overwhelmingly clear that the US population is 0:00:39.956 --> 0:00:42.596 not going to hit in the foreseeable future a rate 0:00:42.676 --> 0:00:46.236 that would satisfy the herd immunity standard. And the main 0:00:46.396 --> 0:00:49.476 reason for that is not distribution of vaccines, but what 0:00:49.676 --> 0:00:55.116 is called, slightly as a euphemism, vaccine hesitancy. Some studies 0:00:55.116 --> 0:00:57.716 have shown that as many as one in five Americans 0:00:57.716 --> 0:01:00.916 say they wouldn't want to take a coronavirus vaccine, and 0:01:00.996 --> 0:01:04.036 there are some indications from other studies that those numbers 0:01:04.116 --> 0:01:09.796 are in fact rising rather than decline. Public health officials 0:01:09.956 --> 0:01:12.996 and governments and indeed all of us therefore need to 0:01:13.036 --> 0:01:17.316 think about ways to understand and increase public acceptance of 0:01:17.356 --> 0:01:20.236 the vaccine, provided they believe, as I do, that the 0:01:20.316 --> 0:01:23.396 vaccine is an important tool in helping us get beyond 0:01:23.476 --> 0:01:27.436 this pandemic. Today's guest is one of the world's leading 0:01:27.436 --> 0:01:31.596 researchers on precisely the question of why people hesitate to 0:01:31.596 --> 0:01:34.596 take vaccines, why they don't want to take vaccines, and 0:01:34.836 --> 0:01:38.116 what might be done about it. Doctor Haddie Larson is 0:01:38.116 --> 0:01:42.716 an anthropologist. She's the founding director of the Vaccine Confidence Project, 0:01:43.116 --> 0:01:46.476 an interdisciplinary research group at the London School of Hygiene 0:01:46.476 --> 0:01:51.276 and Tropical Medicine. She also headed the Global Immunization Communication 0:01:51.356 --> 0:01:55.916 Program at UNISEF, and she's the author of a new book, Stuck, 0:01:56.196 --> 0:02:00.436 How Vaccine Rumors Start and Why they Don't go Away. 0:02:00.596 --> 0:02:03.716 Doctor Larson will help us understand what are the contributing 0:02:03.756 --> 0:02:07.796 factors that undermine vaccine confidence and what we might think 0:02:07.836 --> 0:02:11.236 about doing differently if we want to improve the situation 0:02:11.636 --> 0:02:19.436 going forward. Heidi, thank you so much for being I 0:02:19.516 --> 0:02:21.756 want to begin by asking you a sort of top 0:02:21.756 --> 0:02:25.036 of the line question, which is in your very deep 0:02:25.156 --> 0:02:30.116 cross cultural comparisons of vaccine hesitancy. Do you think that 0:02:30.196 --> 0:02:35.396 there are universal or roughly universal causes for vaccine hesitancy 0:02:35.876 --> 0:02:38.876 or do you think that each culture has its own 0:02:39.036 --> 0:02:43.156 reasons making it difficult to speak in very broad general 0:02:43.236 --> 0:02:48.196 terms comparing places. I would say that the common things 0:02:48.316 --> 0:02:54.276 are issues of liberty and choice, and freedom of choice, 0:02:54.996 --> 0:03:01.196 the anti government control sentiments, versus liberty. The second one 0:03:01.316 --> 0:03:05.476 would be nature. Is it natural or it feels like 0:03:05.516 --> 0:03:10.436 it's against God's plan? But that tension between you know, 0:03:10.636 --> 0:03:15.316 natural versus technical or chemical is another tension. And I 0:03:15.356 --> 0:03:20.756 think the third one, as a universal is just safety, safety, safety, safety. 0:03:21.196 --> 0:03:24.876 And I think the other kind of critical dimension is 0:03:25.516 --> 0:03:31.276 trust and underlying trust in government and authorities. In quote experts, 0:03:32.276 --> 0:03:34.596 I know you've emphasized trust very much. You said to 0:03:34.596 --> 0:03:37.356 the New York Times, we have a trust problem, not 0:03:37.476 --> 0:03:40.916 a misinformation problem, which is a provocative claim. Could you 0:03:40.956 --> 0:03:44.236 say more about why you think trust is at the 0:03:44.236 --> 0:03:49.316 heart of the concerns. I honestly believe that we don't 0:03:49.316 --> 0:03:53.756 have a misinformation problem as much as a relationship problem. 0:03:53.756 --> 0:03:58.476 And I say that because if we had a stronger 0:03:58.956 --> 0:04:05.156 trust relationship between public and science, public and authorities, people 0:04:05.196 --> 0:04:09.356 cope with some risk if they trust you, there willing 0:04:09.396 --> 0:04:11.876 to put up with a little risk. If they don't, 0:04:12.636 --> 0:04:17.596 they're questioning, they're concerned. They start from a position of distrust. 0:04:18.556 --> 0:04:22.956 So if we can build that underlying relationship and make 0:04:22.996 --> 0:04:27.396 it more trusting, we'll have a bit more resilience an 0:04:27.436 --> 0:04:31.956 acceptance of scientific advice. But that's what I mean by 0:04:31.996 --> 0:04:36.916 the underlying resilience and willingness to take that little risk. 0:04:38.436 --> 0:04:41.236 May I ask a follow on question there, because it 0:04:41.276 --> 0:04:43.716 looks to me like there's some tension between the trust 0:04:43.756 --> 0:04:49.996 analysis and you are three big drivers of vaccine misinformation. 0:04:50.156 --> 0:04:54.996 So for libertarians, some distrust and authority is kind of 0:04:55.076 --> 0:04:58.796 constitutive of their worldview that we need to be fundamentally 0:04:58.876 --> 0:05:03.036 skeptical of aggregations of power and authority. And then with 0:05:03.076 --> 0:05:05.836 respect to people who think that it's in God's hands, 0:05:06.076 --> 0:05:11.516 those folks too have a principled reason to be distrustful 0:05:12.036 --> 0:05:16.836 of human interventions. And so I'm really wondering if the 0:05:16.836 --> 0:05:21.116 trust problem is overcomable at all, or maybe even shouldn't 0:05:21.116 --> 0:05:23.676 be overcome from the standpoint of those two kinds of 0:05:24.236 --> 0:05:29.356 hesitancy objections, the analysis, the sophisticate analysis that you're offering, 0:05:29.956 --> 0:05:34.996 may suggest almost a kind of impossibility of overcoming some 0:05:35.076 --> 0:05:38.356 of these things because of a contradiction that exists between 0:05:38.396 --> 0:05:42.276 the value of trust and then these principal objections to trust. 0:05:42.796 --> 0:05:45.716 I do believe that there are going to be certain 0:05:45.796 --> 0:05:50.276 kinds of hesitancy and actually deep refusers that we won't 0:05:50.316 --> 0:05:52.636 be able to overcome. I think we need to accept that, 0:05:53.396 --> 0:05:58.436 But what we should as a health and medical community 0:05:59.076 --> 0:06:03.876 strive to get as many people on board as it were, 0:06:04.396 --> 0:06:07.156 for the sake of the public sealth. And there will 0:06:07.196 --> 0:06:10.876 also be people. There are also people who can't take 0:06:10.996 --> 0:06:17.756 vaccines because of underlying medical conditions. So, for instance, with COVID, 0:06:18.196 --> 0:06:21.876 we don't need one hundred percent of people vaccinated to 0:06:21.996 --> 0:06:27.436 get community immunity, as they say, but we do want 0:06:27.436 --> 0:06:29.716 to get as many as we can. I'm not saying 0:06:29.756 --> 0:06:35.476 give up, but we will have these deep challenges. Why 0:06:35.636 --> 0:06:38.876 can't we actually nevertheless do better? I mean, go back 0:06:38.916 --> 0:06:44.916 to smallpox, one of the great successes of immunizations in 0:06:45.356 --> 0:06:50.356 global history, right, effective eradication over a long period of 0:06:50.356 --> 0:06:53.316 time with a lot of coordination, but not so very 0:06:53.356 --> 0:06:56.436 long ago, right, I mean that process ended in the seventies, 0:06:56.476 --> 0:07:00.796 if I'm not mistaken. So why was it possible to 0:07:00.836 --> 0:07:04.636 do that? But it's not quote unquote possible to do 0:07:04.676 --> 0:07:07.636 this now. I mean, what were the tools and techniques 0:07:07.676 --> 0:07:11.396 that were used to bring us to smallpox eradication? And 0:07:11.436 --> 0:07:16.876 why do we seem so stuck in so many places today? 0:07:17.276 --> 0:07:22.036 We're much more democratic. This is a really important point 0:07:22.076 --> 0:07:25.396 you're thinking, and I thought about it a lot when 0:07:25.436 --> 0:07:29.196 I was going with the polio workers door to door 0:07:29.236 --> 0:07:33.876 in northern Nigeria, in India in some of the most 0:07:33.996 --> 0:07:38.956 resistant communities, and thinking, you know, these are some of 0:07:38.996 --> 0:07:42.796 the same communities, particularly in India, which went through the 0:07:42.836 --> 0:07:47.636 same thing around smallpox. But for the smallpox eradication, there 0:07:47.716 --> 0:07:53.076 was some police force and pretty coercive measures that would 0:07:53.116 --> 0:07:57.756 absolutely not be acceptable today, and certainly in the context 0:07:57.756 --> 0:08:01.636 of the polio eradication initiative, we could not do in 0:08:01.716 --> 0:08:03.796 some of the states I was in what was done 0:08:05.196 --> 0:08:08.356 in the previous campaigns. I'm not saying it was all 0:08:08.436 --> 0:08:13.636 that way, but there were certain types of coercion that 0:08:13.796 --> 0:08:17.956 isn't just not tolerated today. I'm going to ask a 0:08:17.996 --> 0:08:20.236 subversive question, and I want to preface it by saying, 0:08:20.276 --> 0:08:21.916 you know, my day job is that I'm a constitutional 0:08:21.956 --> 0:08:25.276 law professor. I spend all of my time thinking about, 0:08:25.356 --> 0:08:28.516 you know, how you could make liberal democracy work alongside 0:08:28.516 --> 0:08:31.316 the need for government authority. So I take this with 0:08:31.476 --> 0:08:35.156 you with that background, Maybe we're just doing it wrong. 0:08:35.676 --> 0:08:37.876 You know, maybe the idea that there should be a 0:08:37.916 --> 0:08:43.636 democratic right to refuse vaccination is not only a mistake 0:08:43.756 --> 0:08:47.556 from a practical standpoint, but is generating the kind of 0:08:47.716 --> 0:08:51.316 hesitancy that you're talking about to a greater degree than 0:08:51.316 --> 0:08:54.076 it would otherwise exist, in the sense that if you 0:08:54.156 --> 0:08:56.796 ask people do you want the vaccine or not, you're 0:08:56.836 --> 0:09:00.516 putting them almost in an existential situation of having to 0:09:00.556 --> 0:09:06.556 weigh many, many, many different factors ideological personal belief, chance, risk, knowledge, ignorance. 0:09:06.876 --> 0:09:09.676 Maybe that's just asking too much bunch of people. And 0:09:09.716 --> 0:09:13.356 maybe if we simply required it universally, there would be 0:09:13.436 --> 0:09:16.196 there would still be some objections, but maybe people just 0:09:16.196 --> 0:09:18.956 wouldn't spend as much time dreaming them up and just 0:09:18.956 --> 0:09:21.676 to finish the thought about why this isn't maybe so crazy. 0:09:22.116 --> 0:09:24.436 You know, when the US Supreme Court was asked to 0:09:24.476 --> 0:09:28.956 consider this issue in the early twentieth century, it answered unequivocally, Look, 0:09:29.076 --> 0:09:31.516 you have lots of liberal rights against the state, but 0:09:31.596 --> 0:09:33.876 you don't have a right to say, note of vaccines 0:09:33.916 --> 0:09:38.076 because vaccination is necessary to help everybody, and so you 0:09:38.156 --> 0:09:40.596 just don't have that as a fundamental constitutional right. And 0:09:40.636 --> 0:09:42.316 you know what, if it went to the Supreme Court today, 0:09:42.516 --> 0:09:46.476 they might well reach the same conclusion. So it's not 0:09:46.756 --> 0:09:51.876 necessary that we say that forced immunization is undemocratic. We 0:09:51.916 --> 0:09:55.636 could just say forced immunization is consistent with our values 0:09:55.636 --> 0:10:01.876 because it's necessary to save lives. I absolutely agree with you. 0:10:02.596 --> 0:10:06.236 I mean, we do have required immunization to go to school, 0:10:06.796 --> 0:10:09.876 but it's about settings. In my work in the UN, 0:10:09.956 --> 0:10:13.356 I worked a lot on rights issues, and particularly the 0:10:13.356 --> 0:10:16.316 Convention on the Rights of the Child, and we often 0:10:16.356 --> 0:10:20.756 talked about this fine line where rights become responsibilities. You 0:10:20.836 --> 0:10:23.436 have your individual right until you get to a point 0:10:23.436 --> 0:10:28.076 where it harms others, and vaccines sit on that cusp. 0:10:28.916 --> 0:10:32.676 I agree with you that we do need to rethink 0:10:33.276 --> 0:10:37.156 our whole approach. I think we really need a whole 0:10:37.156 --> 0:10:40.676 different approach because also we have a lot more vaccines, 0:10:40.756 --> 0:10:45.756 and I know that, for instance, in France they added 0:10:46.236 --> 0:10:50.596 a number of additional vaccines required for school in the 0:10:50.676 --> 0:10:55.036 context of some very serious measles outbreaks in twenty eighteen. 0:10:55.076 --> 0:10:57.996 I think there were eighty thousand across Europe, and there 0:10:58.116 --> 0:11:02.316 was outrage in the streets against it, but ultimately a 0:11:02.396 --> 0:11:06.356 number of the healthcare professionals told colleagues at the Ministry 0:11:06.396 --> 0:11:10.516 of Health, thank you. It takes the onus off of 0:11:10.556 --> 0:11:14.476 me as a healthcare provider to have to persuade someone 0:11:14.516 --> 0:11:16.956 to take I feel like the government is behind me. 0:11:17.276 --> 0:11:20.956 I'm supporting that, I'm helping implement that, but the onus 0:11:21.116 --> 0:11:24.996 is not on me to make that persuasive argument. Well, 0:11:25.196 --> 0:11:28.556 can you say more about the approach that you would advocate, 0:11:28.636 --> 0:11:33.796 because we don't train physicians or scientists very much in 0:11:34.076 --> 0:11:38.316 convincing people to take up the pro social, pro health 0:11:38.396 --> 0:11:41.596 interventions that they invent, right, I mean, scientists are supposed 0:11:41.636 --> 0:11:44.636 to invent things that make the world better, and physicians 0:11:44.676 --> 0:11:47.836 are supposed to give treatments that make the world better. 0:11:47.956 --> 0:11:50.516 But we don't think that their job is to do persuading. 0:11:50.876 --> 0:11:53.916 So what is the approach that you think would be 0:11:53.916 --> 0:11:57.756 better for the next time around. Well, I think actually 0:11:57.796 --> 0:12:01.956 in the current environment, a lot of the medical community, 0:12:02.116 --> 0:12:05.276 particularly the more senior medical community, is not used to 0:12:05.316 --> 0:12:09.676 being challenged, is not used to having their authority challenged. 0:12:10.076 --> 0:12:13.516 And I think we've come to a different point where 0:12:13.596 --> 0:12:16.156 we have publics that are very different than they were, 0:12:16.756 --> 0:12:21.516 certainly twenty years ago, much more questioning the world of 0:12:21.556 --> 0:12:26.236 information at their fingertips, not hesitant to be challenging the 0:12:26.276 --> 0:12:30.316 authority of their doctors. And what I've seen happen is 0:12:30.396 --> 0:12:34.116 some doctors actually shut down because they don't want to 0:12:34.116 --> 0:12:36.836 go there. They don't want to have that argument. So 0:12:36.956 --> 0:12:40.876 I think what needs to be trained is less of 0:12:40.916 --> 0:12:44.116 the promotional side and more of the how to have 0:12:44.156 --> 0:12:47.196 a difficult conversation. But can I just ask, do you 0:12:47.196 --> 0:12:48.956 think that would work? I mean, in light of the 0:12:49.516 --> 0:12:52.916 subtle social pressures that you're describing, I don't think. I mean, 0:12:52.956 --> 0:12:55.516 I'm just thinking of physicians. I know many of them 0:12:55.516 --> 0:12:58.596 are most impressive people you know that I come into 0:12:58.636 --> 0:13:02.356 contact with, and they have many, many amazing skills. But 0:13:02.396 --> 0:13:04.916 I'm not sure that even with you know, a sophisticated 0:13:04.956 --> 0:13:08.996 training seminar, they would be able to convince people who 0:13:08.996 --> 0:13:13.196 are truly vaccine hesitant, partly because I'm just not sure 0:13:13.196 --> 0:13:15.716 what arguments are are gonna work. I mean, you know, 0:13:15.716 --> 0:13:17.916 you could say, well, gee, you trust me the rest 0:13:17.916 --> 0:13:19.916 of the time, why don't you trust me this time? 0:13:20.676 --> 0:13:24.276 And that's the honest answer, right That's the true answer, 0:13:24.356 --> 0:13:27.756 Like I can't demonstrate to you the truth of the 0:13:27.796 --> 0:13:30.196 scientific evidence right now, you have to trust me because 0:13:30.236 --> 0:13:31.796 you trust me the rest of the time. Like that's 0:13:31.796 --> 0:13:35.516 the actual epistemological answer. But I don't think people be 0:13:35.636 --> 0:13:37.636 very inclined to believe them when they said that, given 0:13:37.676 --> 0:13:43.396 what you're describing, Yeah, you know, it's interesting. I agree 0:13:43.436 --> 0:13:45.356 with you. And I know a number of doctors who 0:13:45.396 --> 0:13:48.876 have told me that, you know, they've tried all kinds 0:13:48.916 --> 0:13:52.396 of angles in some situations, and it's just not going 0:13:52.396 --> 0:13:55.996 to change some people's minds. And they've kind of gotten 0:13:55.996 --> 0:13:59.396 to a point where they say, I try in many 0:13:59.436 --> 0:14:03.036 different angles. I talk about vaccinating my own children, I 0:14:03.116 --> 0:14:06.996 talk about vaccinating myself. They still don't. So there are 0:14:07.036 --> 0:14:10.356 going to be some people that are difficult to change. 0:14:10.916 --> 0:14:13.996 But at the end of the day, we still in 0:14:14.036 --> 0:14:18.676 all of our globally, in surveys and in any kind 0:14:18.716 --> 0:14:23.276 of trust barometers or whatever, we still see that more 0:14:23.316 --> 0:14:27.676 than ever, doctors and healthcare providers have more trust than 0:14:27.716 --> 0:14:32.036 just about any other institution going. So there is a 0:14:32.076 --> 0:14:35.196 trust there. But I think right now they need more 0:14:35.236 --> 0:14:39.316 than the doctor. They need somebody else in their social 0:14:39.356 --> 0:14:44.156 spheres to change their mind. Now. I don't pretend to 0:14:44.196 --> 0:14:47.956 have any easy answers, but all I would say is, 0:14:48.116 --> 0:14:51.516 don't give up. If you're a doctor, keep trying. One 0:14:51.596 --> 0:14:55.956 of the puzzles that strikes me so rich and interesting 0:14:55.996 --> 0:15:01.636 around vaccine hesitancy is that unlike almost any other situation 0:15:01.756 --> 0:15:04.156 that we're required to make a decision about our healthcare, 0:15:04.796 --> 0:15:08.756 which are usually individualized. That is to say, my decision 0:15:08.756 --> 0:15:11.716 only affect me. In the case of vaccines, there is 0:15:11.716 --> 0:15:15.956 a free rider dynamic, right If enough other people are 0:15:16.036 --> 0:15:20.876 vaccinated and I'm not vaccinated, I'm still reducing my odds 0:15:20.916 --> 0:15:25.156 of getting sick because the prevalence of the disease will 0:15:25.196 --> 0:15:29.516 decline by whatever percentage of people are are vaccinated. And 0:15:29.796 --> 0:15:32.476 that makes me wonder, are there any examples that you've 0:15:32.476 --> 0:15:35.236 come across in your work of situations where lots of 0:15:35.276 --> 0:15:38.556 people decline a vaccine and then the disease is bad 0:15:38.676 --> 0:15:41.996 enough that it spreads, it continues to do harm in 0:15:41.996 --> 0:15:44.476 the community where the people live, and then you get 0:15:44.516 --> 0:15:48.156 some kind of systematic shift where people say, WHOA, I 0:15:48.196 --> 0:15:49.836 thought I was going to get away with this, but 0:15:49.916 --> 0:15:52.436 now I can't get away with it, and so I'm 0:15:52.476 --> 0:15:54.596 shifting my views and now I'm going to go out 0:15:54.636 --> 0:15:57.516 there and get a vaccine. Or does the kind of 0:15:57.556 --> 0:16:01.236 free rider effect is it so powerful that once people 0:16:01.236 --> 0:16:05.276 have said no, they're probably never going to say yes. Yeah. 0:16:05.356 --> 0:16:08.036 I think at the end of the day, the free riders, 0:16:08.076 --> 0:16:11.356 if they think that there's enough going on. They might 0:16:12.916 --> 0:16:16.276 be opportunistic. But if they see that it's a pretty 0:16:16.316 --> 0:16:20.436 serious pandemic or whatever, or in the case of measles, 0:16:20.916 --> 0:16:26.756 pretty serious wave coming back, they could be more open 0:16:26.796 --> 0:16:29.436 to getting vaccinated. That could be enough to change their 0:16:29.476 --> 0:16:35.116 mind if we want to leverage that situation. People don't 0:16:35.596 --> 0:16:39.836 in general, how many people know what percentage of their 0:16:39.916 --> 0:16:44.356 community is actually getting vaccinated to even know if they 0:16:44.396 --> 0:16:48.196 can relax. One strategy would be to let people know, 0:16:48.916 --> 0:16:51.396 like how many people in your community are vaccinate. I 0:16:51.436 --> 0:16:53.556 don't know if that's a good strategy in a sense, 0:16:53.596 --> 0:16:58.956 because it might if the community's going going well, it 0:16:59.076 --> 0:17:01.356 might make more people say, oh, I don't have to 0:17:01.356 --> 0:17:05.476 get vaccinated. Do you think, Heidi, that it's too late 0:17:05.596 --> 0:17:10.956 this time around to make sibstential inroads in let's say, 0:17:11.276 --> 0:17:13.996 the United States and Western Europe against people who are 0:17:14.236 --> 0:17:16.716 vaccine hesitant. I mean, I understand that this is a 0:17:16.756 --> 0:17:18.356 fight that's going to be a global fight, and there 0:17:18.356 --> 0:17:21.116 may be places in the world where vaccines still haven't 0:17:21.116 --> 0:17:23.276 spread that much at all and where the fight really 0:17:23.316 --> 0:17:26.196 needs to be concentrated. Or do you think there's still 0:17:26.236 --> 0:17:32.916 time to make a meaningful difference in this particular round. So, 0:17:32.996 --> 0:17:35.196 you know, an optimistic view which didn't turn out to 0:17:35.236 --> 0:17:38.116 be true, was that we would vaccinate enough people fast 0:17:38.196 --> 0:17:42.156 enough that community immunity or her immunity could be reached 0:17:42.396 --> 0:17:44.836 and we would not have to worry about the variants 0:17:44.836 --> 0:17:48.596 that are will inevitably now spread and some of which 0:17:48.636 --> 0:17:53.676 may eventually evolve to be vaccine resistant. That ship seems 0:17:53.716 --> 0:17:59.356 to have sailed, at least in the West. Yeah, I 0:17:59.396 --> 0:18:01.756 think we still need to get as many people as 0:18:01.796 --> 0:18:06.676 possible vaccinated. I don't think it's too late, and I 0:18:06.716 --> 0:18:10.236 don't think we should give up, because out of principle, 0:18:11.836 --> 0:18:16.036 it's really important to get people on board. I'd like 0:18:16.116 --> 0:18:18.796 to say it's never too late. It's a very dynamic 0:18:18.876 --> 0:18:23.396 changing environment. I think I remember saying, I think it 0:18:23.436 --> 0:18:26.916 was in late January we're going to hit a wall 0:18:27.356 --> 0:18:30.436 in late March April, I said. So it was a 0:18:30.476 --> 0:18:33.236 bit later than that because at the beginning of the 0:18:33.316 --> 0:18:36.196 year we are in the thick of a serious second wave. 0:18:36.716 --> 0:18:40.196 We had recent news of these vaccines being highly effective, 0:18:41.236 --> 0:18:45.076 more effective than most vaccines, and there was a limited supply, 0:18:45.716 --> 0:18:49.236 so all of those things would drive people. So we 0:18:49.276 --> 0:18:52.636 had the willing the eager upfront, wanting to get whatever 0:18:52.756 --> 0:18:56.756 limited supply, seeing that you know, this is bad, still bad. 0:18:57.476 --> 0:19:02.156 But as we get more supply, as the willing have 0:19:02.276 --> 0:19:06.356 been more vaccinated, and as the pandemic appears to be waning, 0:19:07.196 --> 0:19:11.116 you know, we're starting to hit it more difficult population. 0:19:11.196 --> 0:19:14.276 So I think we have to change some strategies. And 0:19:14.356 --> 0:19:17.156 I also don't think we should give up, because it's 0:19:17.196 --> 0:19:21.716 not just about COVID vaccine. Everything we do around COVID 0:19:22.116 --> 0:19:26.556 and building confidence around the vaccines it could be foundational 0:19:26.676 --> 0:19:41.116 moving forward for other vaccines. We'll be right back. How 0:19:41.156 --> 0:19:43.716 do you. I am fascinated by the role that fear 0:19:43.836 --> 0:19:48.436 has played on all sides of the COVID pandemic, addits 0:19:49.116 --> 0:19:51.836 and the various treatments that we've been looking at for it. 0:19:51.956 --> 0:19:56.836 So it sometimes seems to me that at first, many, 0:19:56.876 --> 0:20:00.596 many people were afraid of getting COVID, and those folks 0:20:00.636 --> 0:20:04.516 eventually masked up and engaged in social distancing, and others said, well, look, 0:20:04.556 --> 0:20:07.636 it's not the end of the world. Statistically, you probably 0:20:07.676 --> 0:20:10.196 won't die from it and not get it, and so 0:20:10.556 --> 0:20:13.596 don't be so fear based. And then with the rise 0:20:13.596 --> 0:20:16.556 of the vaccines, we've seen a shift, and now there 0:20:16.556 --> 0:20:21.636 are lots of people saying, well, I am afraid of 0:20:21.636 --> 0:20:24.956 the vaccine more than I am afraid of the possibility 0:20:24.956 --> 0:20:27.556 of getting COVID. Now, obviously there's a lot of overlap 0:20:27.596 --> 0:20:29.436 between those people and people who said they weren't afraid 0:20:29.476 --> 0:20:32.236 of COVID in the first place. But before they were 0:20:32.236 --> 0:20:34.956 saying we're not afraid of COVID, and now they're saying, 0:20:34.996 --> 0:20:37.516 we are afraid of a vaccine. Meanwhile, the people who 0:20:37.556 --> 0:20:40.036 before we're afraid of COVID are now saying that they're 0:20:40.076 --> 0:20:41.796 not afraid of a vaccine. I don't realize there's not 0:20:41.796 --> 0:20:43.836 a perfect match, but that does seem to be the case. 0:20:44.556 --> 0:20:48.676 I mean, I'm genuinely curious. I don't really understand how 0:20:48.676 --> 0:20:52.396 the economy of fear is working for each group, except 0:20:52.436 --> 0:20:56.636 to say that each group is afraid of something different. Yeah, 0:20:56.676 --> 0:21:00.396 and I think it's a risk perception thing too. I mean, 0:21:00.916 --> 0:21:04.916 there was more fear about the virus back a few 0:21:04.956 --> 0:21:08.956 months ago, because there was more virus, the mortality rates 0:21:09.196 --> 0:21:14.716 or higher. It was more fearful. And now as we 0:21:14.756 --> 0:21:19.316 see that waning a bit, what seemed like a smaller risk, 0:21:19.916 --> 0:21:23.516 the relative risk has changed in the Meanwhile, too, people 0:21:23.556 --> 0:21:27.596 didn't have before the information about the rare risk of 0:21:27.676 --> 0:21:32.756 these the blood clots, for instance, So there's new information 0:21:32.876 --> 0:21:36.236 in that mix that we didn't have before. We see 0:21:36.236 --> 0:21:39.996 this even with childhood vaccines. We've got a lot of 0:21:40.076 --> 0:21:44.436 mothers now who are skeptical about childhood vaccines. They're just 0:21:44.596 --> 0:21:49.236 doing a very basic risk calculation. They don't see the 0:21:49.316 --> 0:21:54.156 threat of all these childhood diseases, but ironically, does the 0:21:54.236 --> 0:21:59.356 vaccines work. Yeah, But to them and their child, it's 0:21:59.396 --> 0:22:01.796 like the thing that has the risk is the vaccine. 0:22:02.996 --> 0:22:07.076 And there's also this kind of way that risk plays 0:22:07.116 --> 0:22:11.356 with our minds in a way, if a mother gives 0:22:11.356 --> 0:22:15.036 a child the vaccine or gets a child vaccinated and 0:22:15.116 --> 0:22:21.156 there's a problem, she feels far more regret and responsibility 0:22:21.316 --> 0:22:26.076 than if a child naturally gets measles, because it's nature. 0:22:26.756 --> 0:22:31.836 So it's another factor that weighs in there. Yeah, that 0:22:31.876 --> 0:22:34.116 actually leads me to a question that I imagine you've 0:22:34.116 --> 0:22:37.236 spent a lot of time thinking about. It. Seems like 0:22:37.356 --> 0:22:41.116 vaccine hesitancy has some components that are grounded in quote 0:22:41.156 --> 0:22:46.516 unquote reason, mathematical reason risk assessment that an economist would 0:22:46.596 --> 0:22:50.196 say is rational to undertake and then some of it 0:22:50.236 --> 0:22:54.516 consists in beliefs and values, which who's to say exactly 0:22:54.516 --> 0:22:58.756 which you're right and wrong? And then some inheres in 0:22:59.756 --> 0:23:05.756 true irrationality, paranoia, fantasies, false claims about the world that 0:23:05.796 --> 0:23:09.556 are demonstrably false, not just false opinion, but false claims 0:23:09.556 --> 0:23:12.916 of fact. And I guess what I'm wondering is, I mean, 0:23:12.996 --> 0:23:15.676 having spent so much of your career thinking about these questions, 0:23:15.996 --> 0:23:18.636 do you ever think about, like, roughly what percentage is 0:23:18.636 --> 0:23:21.956 contributing to each You know, how much of vaccine hesitancy 0:23:22.036 --> 0:23:27.436 is coming from rational calculations, even if they're unconscious rational calculations. 0:23:27.916 --> 0:23:30.636 How much of it is coming from beliefs and values 0:23:30.676 --> 0:23:33.156 which aren't really subject to being shown true or false 0:23:33.476 --> 0:23:35.956 in the same way that facts are. And how much 0:23:35.956 --> 0:23:38.956 of it is coming from just false beliefs about the 0:23:38.956 --> 0:23:42.196 world that we might be willing to labels as irrational. 0:23:44.516 --> 0:23:48.036 I have thought about that. It really depends on the person. 0:23:48.396 --> 0:23:51.756 But I think that in the broader group of hesitant 0:23:52.396 --> 0:23:56.236 people around vaccines, I mean, I think we don't give 0:23:56.316 --> 0:24:01.876 enough credit sometimes to parents, to others who are kind 0:24:01.916 --> 0:24:07.036 of weighing things they're not just you know, emotional crazy 0:24:07.116 --> 0:24:12.076 beliefs there are, and and my point of haut anti vaccine, 0:24:12.676 --> 0:24:16.516 I don't mind the word. The thing I don't like 0:24:16.956 --> 0:24:20.316 is that it's used so loosely for anyone who doesn't 0:24:20.356 --> 0:24:24.036 want a vaccine. It's often used to a lot of 0:24:24.076 --> 0:24:27.916 hesitant parents who aren't at all anti vaccine. They have 0:24:28.036 --> 0:24:31.676 some you know, they're asking some questions and then they oh, 0:24:31.756 --> 0:24:35.916 she's just an anti VAXX, and then she becomes it 0:24:36.236 --> 0:24:40.276 more anti vacs because of that judgment. Although it is 0:24:40.396 --> 0:24:44.036 vaccine hesitancy then also though in a sense over inclusive, 0:24:44.076 --> 0:24:46.396 because for some of the people, sure they're hesitating, and 0:24:46.516 --> 0:24:49.676 the implication of hesitancy is it hints, oh, you can 0:24:49.716 --> 0:24:52.556 be convinced. But it seems a bit like a euphemism 0:24:52.556 --> 0:24:55.276 to me to describe people who are saying, oh, hell no, 0:24:55.516 --> 0:24:57.596 I'm not going anywhere near this vaccine. And there are 0:24:57.596 --> 0:24:59.476 a lot of people who are saying that they're not 0:24:59.556 --> 0:25:02.996 hesitant at all, they're just a clear no. I agree. 0:25:03.276 --> 0:25:06.836 Hesitancy was not a word I chose. This was a 0:25:06.836 --> 0:25:11.556 word that was decided by the World Health Organization, and 0:25:11.836 --> 0:25:16.316 I was part of the advisory group to kind of 0:25:16.396 --> 0:25:20.676 characterize the scope and scale of it, but we weren't 0:25:20.716 --> 0:25:24.116 able to name it. We were given that framing of it. 0:25:24.676 --> 0:25:28.796 And I've written some things about the ambiguity of that term. 0:25:28.836 --> 0:25:31.596 So I fully fully agree with you. What would you 0:25:31.676 --> 0:25:34.556 choose if you could choose any term? Well, well, I've 0:25:34.556 --> 0:25:37.596 picked the framing of confidence because also I was thinking 0:25:37.596 --> 0:25:40.796 of the consumer confidence index, and we have a vaccine 0:25:40.836 --> 0:25:43.956 confidence index. You can be zero percent confident and you 0:25:43.956 --> 0:25:47.596 can be one hundred percent confident. But I don't think 0:25:47.596 --> 0:25:51.436 there's any magic, one one word. Just to try to 0:25:51.476 --> 0:25:56.996 close with something slightly optimistic, what is your case study that, 0:25:57.076 --> 0:26:00.116 in your mind is the most optimistic or positive case 0:26:00.756 --> 0:26:04.996 in which a population which had hesitancy gradually shifted to 0:26:05.076 --> 0:26:08.876 being less hesitant. If there are I hope some examples 0:26:08.876 --> 0:26:11.196 of that out there that you've encountered in your research. 0:26:11.676 --> 0:26:14.436 There's a few of them. I mean the most recent one, 0:26:14.556 --> 0:26:17.196 for instance, on the COVID work. One of the more 0:26:18.116 --> 0:26:23.396 successful engagement strategies was through barbers and hairdressers in Maryland. 0:26:24.436 --> 0:26:26.796 I know in some of my work in India and 0:26:27.716 --> 0:26:33.756