Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show
Speaker 1: where we explore the stories behind the stories in the news.
Speaker 1: I'm Noah Feldman. We've been talking a lot in the
Speaker 1: last year about the possibilities of herd immunity or community immunity,
Speaker 1: but it's now overwhelmingly clear that the US population is
Speaker 1: not going to hit in the foreseeable future a rate
Speaker 1: that would satisfy the herd immunity standard. And the main
Speaker 1: reason for that is not distribution of vaccines, but what
Speaker 1: is called, slightly as a euphemism, vaccine hesitancy. Some studies
Speaker 1: have shown that as many as one in five Americans
Speaker 1: say they wouldn't want to take a coronavirus vaccine, and
Speaker 1: there are some indications from other studies that those numbers
Speaker 1: are in fact rising rather than decline. Public health officials
Speaker 1: and governments and indeed all of us therefore need to
Speaker 1: think about ways to understand and increase public acceptance of
Speaker 1: the vaccine, provided they believe, as I do, that the
Speaker 1: vaccine is an important tool in helping us get beyond
Speaker 1: this pandemic. Today's guest is one of the world's leading
Speaker 1: researchers on precisely the question of why people hesitate to
Speaker 1: take vaccines, why they don't want to take vaccines, and
Speaker 1: what might be done about it. Doctor Haddie Larson is
Speaker 1: an anthropologist. She's the founding director of the Vaccine Confidence Project,
Speaker 1: an interdisciplinary research group at the London School of Hygiene
Speaker 1: and Tropical Medicine. She also headed the Global Immunization Communication
Speaker 1: Program at UNISEF, and she's the author of a new book, Stuck,
Speaker 1: How Vaccine Rumors Start and Why they Don't go Away.
Speaker 1: Doctor Larson will help us understand what are the contributing
Speaker 1: factors that undermine vaccine confidence and what we might think
Speaker 1: about doing differently if we want to improve the situation
Speaker 1: going forward. Heidi, thank you so much for being I
Speaker 1: want to begin by asking you a sort of top
Speaker 1: of the line question, which is in your very deep
Speaker 1: cross cultural comparisons of vaccine hesitancy. Do you think that
Speaker 1: there are universal or roughly universal causes for vaccine hesitancy
Speaker 1: or do you think that each culture has its own
Speaker 1: reasons making it difficult to speak in very broad general
Speaker 1: terms comparing places. I would say that the common things
Speaker 1: are issues of liberty and choice, and freedom of choice,
Speaker 1: the anti government control sentiments, versus liberty. The second one
Speaker 1: would be nature. Is it natural or it feels like
Speaker 1: it's against God's plan? But that tension between you know,
Speaker 1: natural versus technical or chemical is another tension. And I
Speaker 1: think the third one, as a universal is just safety, safety, safety, safety.
Speaker 1: And I think the other kind of critical dimension is
Speaker 1: trust and underlying trust in government and authorities. In quote experts,
Speaker 1: I know you've emphasized trust very much. You said to
Speaker 1: the New York Times, we have a trust problem, not
Speaker 1: a misinformation problem, which is a provocative claim. Could you
Speaker 1: say more about why you think trust is at the
Speaker 1: heart of the concerns. I honestly believe that we don't
Speaker 1: have a misinformation problem as much as a relationship problem.
Speaker 1: And I say that because if we had a stronger
Speaker 1: trust relationship between public and science, public and authorities, people
Speaker 1: cope with some risk if they trust you, there willing
Speaker 1: to put up with a little risk. If they don't,
Speaker 1: they're questioning, they're concerned. They start from a position of distrust.
Speaker 1: So if we can build that underlying relationship and make
Speaker 1: it more trusting, we'll have a bit more resilience an
Speaker 1: acceptance of scientific advice. But that's what I mean by
Speaker 1: the underlying resilience and willingness to take that little risk.
Speaker 1: May I ask a follow on question there, because it
Speaker 1: looks to me like there's some tension between the trust
Speaker 1: analysis and you are three big drivers of vaccine misinformation.
Speaker 1: So for libertarians, some distrust and authority is kind of
Speaker 1: constitutive of their worldview that we need to be fundamentally
Speaker 1: skeptical of aggregations of power and authority. And then with
Speaker 1: respect to people who think that it's in God's hands,
Speaker 1: those folks too have a principled reason to be distrustful
Speaker 1: of human interventions. And so I'm really wondering if the
Speaker 1: trust problem is overcomable at all, or maybe even shouldn't
Speaker 1: be overcome from the standpoint of those two kinds of
Speaker 1: hesitancy objections, the analysis, the sophisticate analysis that you're offering,
Speaker 1: may suggest almost a kind of impossibility of overcoming some
Speaker 1: of these things because of a contradiction that exists between
Speaker 1: the value of trust and then these principal objections to trust.
Speaker 1: I do believe that there are going to be certain
Speaker 1: kinds of hesitancy and actually deep refusers that we won't
Speaker 1: be able to overcome. I think we need to accept that,
Speaker 1: But what we should as a health and medical community
Speaker 1: strive to get as many people on board as it were,
Speaker 1: for the sake of the public sealth. And there will
Speaker 1: also be people. There are also people who can't take
Speaker 1: vaccines because of underlying medical conditions. So, for instance, with COVID,
Speaker 1: we don't need one hundred percent of people vaccinated to
Speaker 1: get community immunity, as they say, but we do want
Speaker 1: to get as many as we can. I'm not saying
Speaker 1: give up, but we will have these deep challenges. Why
Speaker 1: can't we actually nevertheless do better? I mean, go back
Speaker 1: to smallpox, one of the great successes of immunizations in
Speaker 1: global history, right, effective eradication over a long period of
Speaker 1: time with a lot of coordination, but not so very
Speaker 1: long ago, right, I mean that process ended in the seventies,
Speaker 1: if I'm not mistaken. So why was it possible to
Speaker 1: do that? But it's not quote unquote possible to do
Speaker 1: this now. I mean, what were the tools and techniques
Speaker 1: that were used to bring us to smallpox eradication? And
Speaker 1: why do we seem so stuck in so many places today?
Speaker 1: We're much more democratic. This is a really important point
Speaker 1: you're thinking, and I thought about it a lot when
Speaker 1: I was going with the polio workers door to door
Speaker 1: in northern Nigeria, in India in some of the most
Speaker 1: resistant communities, and thinking, you know, these are some of
Speaker 1: the same communities, particularly in India, which went through the
Speaker 1: same thing around smallpox. But for the smallpox eradication, there
Speaker 1: was some police force and pretty coercive measures that would
Speaker 1: absolutely not be acceptable today, and certainly in the context
Speaker 1: of the polio eradication initiative, we could not do in
Speaker 1: some of the states I was in what was done
Speaker 1: in the previous campaigns. I'm not saying it was all
Speaker 1: that way, but there were certain types of coercion that
Speaker 1: isn't just not tolerated today. I'm going to ask a
Speaker 1: subversive question, and I want to preface it by saying,
Speaker 1: you know, my day job is that I'm a constitutional
Speaker 1: law professor. I spend all of my time thinking about,
Speaker 1: you know, how you could make liberal democracy work alongside
Speaker 1: the need for government authority. So I take this with
Speaker 1: you with that background, Maybe we're just doing it wrong.
Speaker 1: You know, maybe the idea that there should be a
Speaker 1: democratic right to refuse vaccination is not only a mistake
Speaker 1: from a practical standpoint, but is generating the kind of
Speaker 1: hesitancy that you're talking about to a greater degree than
Speaker 1: it would otherwise exist, in the sense that if you
Speaker 1: ask people do you want the vaccine or not, you're
Speaker 1: putting them almost in an existential situation of having to
Speaker 1: weigh many, many, many different factors ideological personal belief, chance, risk, knowledge, ignorance.
Speaker 1: Maybe that's just asking too much bunch of people. And
Speaker 1: maybe if we simply required it universally, there would be
Speaker 1: there would still be some objections, but maybe people just
Speaker 1: wouldn't spend as much time dreaming them up and just
Speaker 1: to finish the thought about why this isn't maybe so crazy.
Speaker 1: You know, when the US Supreme Court was asked to
Speaker 1: consider this issue in the early twentieth century, it answered unequivocally, Look,
Speaker 1: you have lots of liberal rights against the state, but
Speaker 1: you don't have a right to say, note of vaccines
Speaker 1: because vaccination is necessary to help everybody, and so you
Speaker 1: just don't have that as a fundamental constitutional right. And
Speaker 1: you know what, if it went to the Supreme Court today,
Speaker 1: they might well reach the same conclusion. So it's not
Speaker 1: necessary that we say that forced immunization is undemocratic. We
Speaker 1: could just say forced immunization is consistent with our values
Speaker 1: because it's necessary to save lives. I absolutely agree with you.
Speaker 1: I mean, we do have required immunization to go to school,
Speaker 1: but it's about settings. In my work in the UN,
Speaker 1: I worked a lot on rights issues, and particularly the
Speaker 1: Convention on the Rights of the Child, and we often
Speaker 1: talked about this fine line where rights become responsibilities. You
Speaker 1: have your individual right until you get to a point
Speaker 1: where it harms others, and vaccines sit on that cusp.
Speaker 1: I agree with you that we do need to rethink
Speaker 1: our whole approach. I think we really need a whole
Speaker 1: different approach because also we have a lot more vaccines,
Speaker 1: and I know that, for instance, in France they added
Speaker 1: a number of additional vaccines required for school in the
Speaker 1: context of some very serious measles outbreaks in twenty eighteen.
Speaker 1: I think there were eighty thousand across Europe, and there
Speaker 1: was outrage in the streets against it, but ultimately a
Speaker 1: number of the healthcare professionals told colleagues at the Ministry
Speaker 1: of Health, thank you. It takes the onus off of
Speaker 1: me as a healthcare provider to have to persuade someone
Speaker 1: to take I feel like the government is behind me.
Speaker 1: I'm supporting that, I'm helping implement that, but the onus
Speaker 1: is not on me to make that persuasive argument. Well,
Speaker 1: can you say more about the approach that you would advocate,
Speaker 1: because we don't train physicians or scientists very much in
Speaker 1: convincing people to take up the pro social, pro health
Speaker 1: interventions that they invent, right, I mean, scientists are supposed
Speaker 1: to invent things that make the world better, and physicians
Speaker 1: are supposed to give treatments that make the world better.
Speaker 1: But we don't think that their job is to do persuading.
Speaker 1: So what is the approach that you think would be
Speaker 1: better for the next time around. Well, I think actually
Speaker 1: in the current environment, a lot of the medical community,
Speaker 1: particularly the more senior medical community, is not used to
Speaker 1: being challenged, is not used to having their authority challenged.
Speaker 1: And I think we've come to a different point where
Speaker 1: we have publics that are very different than they were,
Speaker 1: certainly twenty years ago, much more questioning the world of
Speaker 1: information at their fingertips, not hesitant to be challenging the
Speaker 1: authority of their doctors. And what I've seen happen is
Speaker 1: some doctors actually shut down because they don't want to
Speaker 1: go there. They don't want to have that argument. So
Speaker 1: I think what needs to be trained is less of
Speaker 1: the promotional side and more of the how to have
Speaker 1: a difficult conversation. But can I just ask, do you
Speaker 1: think that would work? I mean, in light of the
Speaker 1: subtle social pressures that you're describing, I don't think. I mean,
Speaker 1: I'm just thinking of physicians. I know many of them
Speaker 1: are most impressive people you know that I come into
Speaker 1: contact with, and they have many, many amazing skills. But
Speaker 1: I'm not sure that even with you know, a sophisticated
Speaker 1: training seminar, they would be able to convince people who
Speaker 1: are truly vaccine hesitant, partly because I'm just not sure
Speaker 1: what arguments are are gonna work. I mean, you know,
Speaker 1: you could say, well, gee, you trust me the rest
Speaker 1: of the time, why don't you trust me this time?
Speaker 1: And that's the honest answer, right That's the true answer,
Speaker 1: Like I can't demonstrate to you the truth of the
Speaker 1: scientific evidence right now, you have to trust me because
Speaker 1: you trust me the rest of the time. Like that's
Speaker 1: the actual epistemological answer. But I don't think people be
Speaker 1: very inclined to believe them when they said that, given
Speaker 1: what you're describing, Yeah, you know, it's interesting. I agree
Speaker 1: with you. And I know a number of doctors who
Speaker 1: have told me that, you know, they've tried all kinds
Speaker 1: of angles in some situations, and it's just not going
Speaker 1: to change some people's minds. And they've kind of gotten
Speaker 1: to a point where they say, I try in many
Speaker 1: different angles. I talk about vaccinating my own children, I
Speaker 1: talk about vaccinating myself. They still don't. So there are
Speaker 1: going to be some people that are difficult to change.
Speaker 1: But at the end of the day, we still in
Speaker 1: all of our globally, in surveys and in any kind
Speaker 1: of trust barometers or whatever, we still see that more
Speaker 1: than ever, doctors and healthcare providers have more trust than
Speaker 1: just about any other institution going. So there is a
Speaker 1: trust there. But I think right now they need more
Speaker 1: than the doctor. They need somebody else in their social
Speaker 1: spheres to change their mind. Now. I don't pretend to
Speaker 1: have any easy answers, but all I would say is,
Speaker 1: don't give up. If you're a doctor, keep trying. One
Speaker 1: of the puzzles that strikes me so rich and interesting
Speaker 1: around vaccine hesitancy is that unlike almost any other situation
Speaker 1: that we're required to make a decision about our healthcare,
Speaker 1: which are usually individualized. That is to say, my decision
Speaker 1: only affect me. In the case of vaccines, there is
Speaker 1: a free rider dynamic, right If enough other people are
Speaker 1: vaccinated and I'm not vaccinated, I'm still reducing my odds
Speaker 1: of getting sick because the prevalence of the disease will
Speaker 1: decline by whatever percentage of people are are vaccinated. And
Speaker 1: that makes me wonder, are there any examples that you've
Speaker 1: come across in your work of situations where lots of
Speaker 1: people decline a vaccine and then the disease is bad
Speaker 1: enough that it spreads, it continues to do harm in
Speaker 1: the community where the people live, and then you get
Speaker 1: some kind of systematic shift where people say, WHOA, I
Speaker 1: thought I was going to get away with this, but
Speaker 1: now I can't get away with it, and so I'm
Speaker 1: shifting my views and now I'm going to go out
Speaker 1: there and get a vaccine. Or does the kind of
Speaker 1: free rider effect is it so powerful that once people
Speaker 1: have said no, they're probably never going to say yes. Yeah.
Speaker 1: I think at the end of the day, the free riders,
Speaker 1: if they think that there's enough going on. They might
Speaker 1: be opportunistic. But if they see that it's a pretty
Speaker 1: serious pandemic or whatever, or in the case of measles,
Speaker 1: pretty serious wave coming back, they could be more open
Speaker 1: to getting vaccinated. That could be enough to change their
Speaker 1: mind if we want to leverage that situation. People don't
Speaker 1: in general, how many people know what percentage of their
Speaker 1: community is actually getting vaccinated to even know if they
Speaker 1: can relax. One strategy would be to let people know,
Speaker 1: like how many people in your community are vaccinate. I
Speaker 1: don't know if that's a good strategy in a sense,
Speaker 1: because it might if the community's going going well, it
Speaker 1: might make more people say, oh, I don't have to
Speaker 1: get vaccinated. Do you think, Heidi, that it's too late
Speaker 1: this time around to make sibstential inroads in let's say,
Speaker 1: the United States and Western Europe against people who are
Speaker 1: vaccine hesitant. I mean, I understand that this is a
Speaker 1: fight that's going to be a global fight, and there
Speaker 1: may be places in the world where vaccines still haven't
Speaker 1: spread that much at all and where the fight really
Speaker 1: needs to be concentrated. Or do you think there's still
Speaker 1: time to make a meaningful difference in this particular round. So,
Speaker 1: you know, an optimistic view which didn't turn out to
Speaker 1: be true, was that we would vaccinate enough people fast
Speaker 1: enough that community immunity or her immunity could be reached
Speaker 1: and we would not have to worry about the variants
Speaker 1: that are will inevitably now spread and some of which
Speaker 1: may eventually evolve to be vaccine resistant. That ship seems
Speaker 1: to have sailed, at least in the West. Yeah, I
Speaker 1: think we still need to get as many people as
Speaker 1: possible vaccinated. I don't think it's too late, and I
Speaker 1: don't think we should give up, because out of principle,
Speaker 1: it's really important to get people on board. I'd like
Speaker 1: to say it's never too late. It's a very dynamic
Speaker 1: changing environment. I think I remember saying, I think it
Speaker 1: was in late January we're going to hit a wall
Speaker 1: in late March April, I said. So it was a
Speaker 1: bit later than that because at the beginning of the
Speaker 1: year we are in the thick of a serious second wave.
Speaker 1: We had recent news of these vaccines being highly effective,
Speaker 1: more effective than most vaccines, and there was a limited supply,
Speaker 1: so all of those things would drive people. So we
Speaker 1: had the willing the eager upfront, wanting to get whatever
Speaker 1: limited supply, seeing that you know, this is bad, still bad.
Speaker 1: But as we get more supply, as the willing have
Speaker 1: been more vaccinated, and as the pandemic appears to be waning,
Speaker 1: you know, we're starting to hit it more difficult population.
Speaker 1: So I think we have to change some strategies. And
Speaker 1: I also don't think we should give up, because it's
Speaker 1: not just about COVID vaccine. Everything we do around COVID
Speaker 1: and building confidence around the vaccines it could be foundational
Speaker 1: moving forward for other vaccines. We'll be right back. How
Speaker 1: do you. I am fascinated by the role that fear
Speaker 1: has played on all sides of the COVID pandemic, addits
Speaker 1: and the various treatments that we've been looking at for it.
Speaker 1: So it sometimes seems to me that at first, many,
Speaker 1: many people were afraid of getting COVID, and those folks
Speaker 1: eventually masked up and engaged in social distancing, and others said, well, look,
Speaker 1: it's not the end of the world. Statistically, you probably
Speaker 1: won't die from it and not get it, and so
Speaker 1: don't be so fear based. And then with the rise
Speaker 1: of the vaccines, we've seen a shift, and now there
Speaker 1: are lots of people saying, well, I am afraid of
Speaker 1: the vaccine more than I am afraid of the possibility
Speaker 1: of getting COVID. Now, obviously there's a lot of overlap
Speaker 1: between those people and people who said they weren't afraid
Speaker 1: of COVID in the first place. But before they were
Speaker 1: saying we're not afraid of COVID, and now they're saying,
Speaker 1: we are afraid of a vaccine. Meanwhile, the people who
Speaker 1: before we're afraid of COVID are now saying that they're
Speaker 1: not afraid of a vaccine. I don't realize there's not
Speaker 1: a perfect match, but that does seem to be the case.
Speaker 1: I mean, I'm genuinely curious. I don't really understand how
Speaker 1: the economy of fear is working for each group, except
Speaker 1: to say that each group is afraid of something different. Yeah,
Speaker 1: and I think it's a risk perception thing too. I mean,
Speaker 1: there was more fear about the virus back a few
Speaker 1: months ago, because there was more virus, the mortality rates
Speaker 1: or higher. It was more fearful. And now as we
Speaker 1: see that waning a bit, what seemed like a smaller risk,
Speaker 1: the relative risk has changed in the Meanwhile, too, people
Speaker 1: didn't have before the information about the rare risk of
Speaker 1: these the blood clots, for instance, So there's new information
Speaker 1: in that mix that we didn't have before. We see
Speaker 1: this even with childhood vaccines. We've got a lot of
Speaker 1: mothers now who are skeptical about childhood vaccines. They're just
Speaker 1: doing a very basic risk calculation. They don't see the
Speaker 1: threat of all these childhood diseases, but ironically, does the
Speaker 1: vaccines work. Yeah, But to them and their child, it's
Speaker 1: like the thing that has the risk is the vaccine.
Speaker 1: And there's also this kind of way that risk plays
Speaker 1: with our minds in a way, if a mother gives
Speaker 1: a child the vaccine or gets a child vaccinated and
Speaker 1: there's a problem, she feels far more regret and responsibility
Speaker 1: than if a child naturally gets measles, because it's nature.
Speaker 1: So it's another factor that weighs in there. Yeah, that
Speaker 1: actually leads me to a question that I imagine you've
Speaker 1: spent a lot of time thinking about. It. Seems like
Speaker 1: vaccine hesitancy has some components that are grounded in quote
Speaker 1: unquote reason, mathematical reason risk assessment that an economist would
Speaker 1: say is rational to undertake and then some of it
Speaker 1: consists in beliefs and values, which who's to say exactly
Speaker 1: which you're right and wrong? And then some inheres in
Speaker 1: true irrationality, paranoia, fantasies, false claims about the world that
Speaker 1: are demonstrably false, not just false opinion, but false claims
Speaker 1: of fact. And I guess what I'm wondering is, I mean,
Speaker 1: having spent so much of your career thinking about these questions,
Speaker 1: do you ever think about, like, roughly what percentage is
Speaker 1: contributing to each You know, how much of vaccine hesitancy
Speaker 1: is coming from rational calculations, even if they're unconscious rational calculations.
Speaker 1: How much of it is coming from beliefs and values
Speaker 1: which aren't really subject to being shown true or false
Speaker 1: in the same way that facts are. And how much
Speaker 1: of it is coming from just false beliefs about the
Speaker 1: world that we might be willing to labels as irrational.
Speaker 1: I have thought about that. It really depends on the person.
Speaker 1: But I think that in the broader group of hesitant
Speaker 1: people around vaccines, I mean, I think we don't give
Speaker 1: enough credit sometimes to parents, to others who are kind
Speaker 1: of weighing things they're not just you know, emotional crazy
Speaker 1: beliefs there are, and and my point of haut anti vaccine,
Speaker 1: I don't mind the word. The thing I don't like
Speaker 1: is that it's used so loosely for anyone who doesn't
Speaker 1: want a vaccine. It's often used to a lot of
Speaker 1: hesitant parents who aren't at all anti vaccine. They have
Speaker 1: some you know, they're asking some questions and then they oh,
Speaker 1: she's just an anti VAXX, and then she becomes it
Speaker 1: more anti vacs because of that judgment. Although it is
Speaker 1: vaccine hesitancy then also though in a sense over inclusive,
Speaker 1: because for some of the people, sure they're hesitating, and
Speaker 1: the implication of hesitancy is it hints, oh, you can
Speaker 1: be convinced. But it seems a bit like a euphemism
Speaker 1: to me to describe people who are saying, oh, hell no,
Speaker 1: I'm not going anywhere near this vaccine. And there are
Speaker 1: a lot of people who are saying that they're not
Speaker 1: hesitant at all, they're just a clear no. I agree.
Speaker 1: Hesitancy was not a word I chose. This was a
Speaker 1: word that was decided by the World Health Organization, and
Speaker 1: I was part of the advisory group to kind of
Speaker 1: characterize the scope and scale of it, but we weren't
Speaker 1: able to name it. We were given that framing of it.
Speaker 1: And I've written some things about the ambiguity of that term.
Speaker 1: So I fully fully agree with you. What would you
Speaker 1: choose if you could choose any term? Well, well, I've
Speaker 1: picked the framing of confidence because also I was thinking
Speaker 1: of the consumer confidence index, and we have a vaccine
Speaker 1: confidence index. You can be zero percent confident and you
Speaker 1: can be one hundred percent confident. But I don't think
Speaker 1: there's any magic, one one word. Just to try to
Speaker 1: close with something slightly optimistic, what is your case study that,
Speaker 1: in your mind is the most optimistic or positive case
Speaker 1: in which a population which had hesitancy gradually shifted to
Speaker 1: being less hesitant. If there are I hope some examples
Speaker 1: of that out there that you've encountered in your research.
Speaker 1: There's a few of them. I mean the most recent one,
Speaker 1: for instance, on the COVID work. One of the more
Speaker 1: successful engagement strategies was through barbers and hairdressers in Maryland.
Speaker 1: I know in some of my work in India and
Speaker 1: in Africa, when you started to address other things in
Speaker 1: the community that people cared about, they were more accepting
Speaker 1: of the vaccine because they felt like, actually, you're not
Speaker 1: just here to give me my job and keep moving. Oh,
Speaker 1: maybe you do care about what I think or my
Speaker 1: well being. And I think moving forward on COVID, we
Speaker 1: do need to somehow embed it in COVID recovery more broadly,
Speaker 1: addressing mental health things, addressing other things. So I think
Speaker 1: we need to step back from the needle, as it were,
Speaker 1: and really think about context and never assume what's in
Speaker 1: the minds of people. They may be telling you they
Speaker 1: think it's a safety issue, but there may be something else.
Speaker 1: I think we need to hear out people because in India,
Speaker 1: I remember one example that I always think about is
Speaker 1: there was everyone was saying, oh, it's a rumor that's
Speaker 1: going to sterilize us. They're never going to let go
Speaker 1: of this rumor. Well, spending some time when some of
Speaker 1: these villages talking to people and not just a one
Speaker 1: time survey, but going back and saying, well, what else
Speaker 1: is bugging you? You know? And it turned out that
Speaker 1: this community didn't want men coming from Delhi to their village.
Speaker 1: One they didn't want men vaccinating their children, and two
Speaker 1: they wanted people who were from the community. So if
Speaker 1: something happened they could find them. Well, these are pretty
Speaker 1: reasonable things. Once that changed, somehow, the rumor thing disappeared.
Speaker 1: So I think trying to understand if is there something
Speaker 1: else going on here that you know, is more tangible
Speaker 1: that maybe maybe it's more straightforward than you think, and
Speaker 1: maybe it's not, maybe it's more complicated. But well, my Barbara,
Speaker 1: who's been cutting in my hair since I was nine,
Speaker 1: it is definitely the wisest person that I know. So
Speaker 1: I like the idea of relying on relying on Barbara's
Speaker 1: I mean in the Indian case, of course, in many
Speaker 1: villages in India people were forcibly sterilized, sometimes against their will,
Speaker 1: sometimes without their knowledge, as recently as the nineteen seventies,
Speaker 1: so you could sort of understand. That seems to me
Speaker 1: to fall into the category of very reasonable people to
Speaker 1: be afraid of that they had a real world experience.
Speaker 1: What should I be asking you that I'm not asking you, Heidi, Well,
Speaker 1: I can tell you what I'm most worried about is
Speaker 1: where we're going with social media. I think we need
Speaker 1: to find some way to allow for opinion, find a
Speaker 1: different way to handle the way we're dealing with it,
Speaker 1: particularly around vaccines. I see us going in a direction
Speaker 1: of shutting a lot of things down that might backfire.
Speaker 1: It is something that keeps me up at night because
Speaker 1: I see some extreme behavior on both sides. This is
Speaker 1: something I also spend a huge amount of my time
Speaker 1: working on and listeners of the show. Not that I've
Speaker 1: advised Facebook on their free expression policy, so I care
Speaker 1: a lot about this. I thought I heard you hinting
Speaker 1: that maybe the social media companies are going too far
Speaker 1: in taking down content that they label as anti vaccination misinformation.
Speaker 1: And that surprised me to hear you say that, because
Speaker 1: so many people from the medical establishment are out there
Speaker 1: pressuring the social media companies to do still more to
Speaker 1: take down what is described as COVID misinformation, including anti
Speaker 1: vaccine misinformation. So I did I hear you're right? Yeah,
Speaker 1: and governments are too. Did I hear you're right there
Speaker 1: that you think it would be actually a mistake for
Speaker 1: the social media companies to go too far in shutting
Speaker 1: down skeptical discourse. I think it's a risk, and I
Speaker 1: think that it's not just the health authorities who are
Speaker 1: putting that pressure. It's government. I mean, it's coming from
Speaker 1: the top. But my Vaccine Confidence Project group here after
Speaker 1: spending eleven years and continuing to be listening and understand
Speaker 1: the dynamics of what's going on out there. You can't
Speaker 1: just flip a switch. You cannot delete doubt. And some
Speaker 1: of the key strategies right now that are being used
Speaker 1: by those who want to disrupt are quicker and more
Speaker 1: clever and nimble than the more promotional positive ones. And
Speaker 1: we're just either driving at underground or it's going into
Speaker 1: its embedding and a lot of other networks, and we
Speaker 1: need I think we need a different strategy. I mean,
Speaker 1: I think I fully and absolutely agree with taking down
Speaker 1: things that are overtly harmful, and I do think and
Speaker 1: fully agree that we need to work on mitigating the
Speaker 1: amplification of risk that I think is one of the
Speaker 1: real issues how it spreads. My red flag is that
Speaker 1: we need a lot more work to understand the dynamics
Speaker 1: of this space. And I worried that in trying to
Speaker 1: clean it up, we're pushing it underground, We're pushing it
Speaker 1: in spaces that we're going to be less able to
Speaker 1: engage with it, less able to address it, and not
Speaker 1: able to get cues on where we need to build
Speaker 1: more resilience, and I think it should be also a
Speaker 1: challenge to the public health and scientific community that are
Speaker 1: we not strong enough to stand up to And you
Speaker 1: can't just take something down with giving a better story,
Speaker 1: because they're going to find it somewhere else. It's kind
Speaker 1: of an almost existential task in sorting this out. And
Speaker 1: I think it's not just about vaccines. It's in other areas,
Speaker 1: but vaccines, I think, because of the public health implications,
Speaker 1: is a serious one. And I'd love to talk to
Speaker 1: you more about this if you're working on it, because yeah,
Speaker 1: it's really important, very gladly. I mean, you've really described
Speaker 1: one of the classic free speech arguments, which is that
Speaker 1: if speech is suppressed too much, it tends to go
Speaker 1: underground and then it can do greater harm. I mean,
Speaker 1: one of the early arguments for free speech, being the
Speaker 1: twentieth century, when Western government started adopting it more actively,
Speaker 1: was just the one you're making that we need actually
Speaker 1: the full range of arguments to be made in public
Speaker 1: in order to achieve some kind of consensus in order
Speaker 1: for people to have trust in underlying institutions. And now
Speaker 1: there's of course a lot of skepticism of that view.
Speaker 1: In the light of the rise of social media, and
Speaker 1: that view is very much under attack, so I think
Speaker 1: your voice is extremely important on this subject. I want
Speaker 1: to thank you for your fascinating work and for taking
Speaker 1: time out of your incredibly busy crusade, as it were,
Speaker 1: to understand hesitancy better to speak with us. Thank you
Speaker 1: so much, doctor Larson. Thanks very nice to meet you.
Speaker 1: I found my conversation with doctor Heidi Larson genuinely eye
Speaker 1: opening and more than a little bit disturbing. Not because
Speaker 1: of for research, which seems to me thoughtful and brilliant. No,
Speaker 1: what scared me the most was the realization that what
Speaker 1: we call vaccine hesitancy is almost certainly a necessary feature
Speaker 1: of our contemporary liberal democratic approach to vaccines. When I
Speaker 1: asked Heidi, why is it that in the past we
Speaker 1: were able to get lots of people to take the
Speaker 1: vaccine and were not, she answered unequivocally that the difference
Speaker 1: was democracy. Now she was very positive about democracy, but
Speaker 1: I have to say that her comment really made me
Speaker 1: think that we don't have to, as a constitutional democracy,
Speaker 1: necessarily take the view that people can choose whether or
Speaker 1: not to get vaccines. We could, in principle say that
Speaker 1: it is a legal obligation, and under current Supreme Court precedent,
Speaker 1: the government would be empowered if Congress passed a law
Speaker 1: to say that everybody must get this vaccine. I don't
Speaker 1: think that's practically going to happen in the world in
Speaker 1: which we currently live, but it did occur to me
Speaker 1: that that might actually be desirable, because in a world
Speaker 1: where ultimately people are given the choice of having vaccines,
Speaker 1: then the points that Heidi brought up, namely libertarianism of
Speaker 1: the left and the right, people who think that it's
Speaker 1: against nature, against God's plan to have vaccines, people who
Speaker 1: worry about the vaccine's safety, and overall, people who have
Speaker 1: less trust in the capacities of government or medical authority
Speaker 1: to do well by them are inevitably, I think, going
Speaker 1: to substantially undercut the possibility of broadly adopted vaccinations. In
Speaker 1: other words, by choosing to define liberal democratic rights in
Speaker 1: the way that we have, we've invited the possibility of
Speaker 1: much greater harm. That's a cost benefit analysis that I
Speaker 1: don't think I fully thought through in the right way
Speaker 1: before this conversation with Heidi. Finally, and significantly, Heidi made
Speaker 1: a very counterintuitive point which I think is very well
Speaker 1: worth listening too carefully, and that is that we need
Speaker 1: to think about whether we might be going too far
Speaker 1: in some contexts, including in the context of social media
Speaker 1: at shutting down discourse that undermines vaccine confidence. Her concern
Speaker 1: is that if we go too far, we will drive
Speaker 1: vaccine confidence questions underground, and that that will make it harder,
Speaker 1: not easier, for medical authorities and the government to convince
Speaker 1: people to take that scenes Throughout the conversation, our theme
Speaker 1: of power here on Deep Background was absolutely essential. The
Speaker 1: power of government to make people take vaccines, the power
Speaker 1: of people's beliefs to lead them to places of uncertainty
Speaker 1: or questioning, and perhaps most significantly, the power of the
Speaker 1: medical establishment, limited by its capacity to be trusted. These
Speaker 1: questions all could not be more pressing at the moment,
Speaker 1: and I'm grateful to doctor Larson for joining us to
Speaker 1: explain them so intelligently. Until the next time I speak
Speaker 1: to you, be careful, be safe, and please be well.
Speaker 1: Deep Background is brought to you by Pushkin Industries. Our
Speaker 1: producer is Mola Board, our engineer is Ben Talliday, and
Speaker 1: our showrunner is Sophie Crane. Mckibbon. Editorial support from noam osband.
Speaker 1: Theme music by Luis Gara at Pushkin, thanks to Mia Lobell,
Speaker 1: Julia Barton, Lydia Jeancott, Heather Faine, Carlie Migliori, Maggie Taylor,
Speaker 1: Eric Sandler, and Jacob Weissberg. You can find me on
Speaker 1: Twitter at Noah R. Feldman. I also write a column
Speaker 1: for Bloomberg Opinion, which you can find at bloomberg dot
Speaker 1: com slash Feldman. To discover Bloomberg's original slate of podcasts,
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