Trust and the COVID-19 vaccine

In the last three weeks, the U. S. Food and Drug Administration has approved two vaccines for use against COVID-19.  Both the Pfizer-BioNTech and Moderna vaccines were developed in less than a year, a stunning technical achievement that relied on cutting-edge science and engineering.  Now the big question is, how many people will be willing to take it? 

The only vaccine rollout of comparable importance in my lifetime was the advent of polio vaccines in the late 1950s.  I was not old enough to be reading the newspaper regularly when I ate the sugar cube the Sabin vaccine came on, being about eight years of age, but I understood by the way my parents acted that it was a big deal. 

Polio was a terrifying disease for two reasons:  it tended to strike children and teenagers, and it usually crippled rather than killed you, putting many of its victims in clumsy braces, wheelchairs, or a medieval-looking contraption called an iron lung.  So it's not surprising that polio vaccines received near-universal acceptance in the far-off days when your doctor's word was tantamount to the word of God and the only people who objected to vaccines were Christian Scientists and other minority groups.

Things are different now in a lot of ways.  Public trust in expertise of all kinds has seen a decline in recent years.  There is now a substantial anti-vaccine movement motivated by a variety of factors, but sharing a common belief that the harm vaccines do may well outweigh the good, and assurances to the contrary by scientists or the medical profession should not be trusted. 

Surveys asking people whether they will be willing to take a COVID-19 vaccine turn up substantial numbers of people who don't want it, although recent trends have been in the more-willing direction.  For example, a Kaiser Foundation survey conducted between November 30 to December 8 and reported in U. S. News says that 41% of Americans say they will definitely get it and 30% will "probably" get it.  The number of people who say they definitely won't get a vaccination is 15%, and 12% say probably not. 

The poll broke down respondents by rural versus urban, Republican versus Democrat, and African-American versus everything else.  Those in rural areas, Republicans, and African-Americans are less willing than other groups to get vaccinated for COVID-19.  Why is this?

One factor cited for the reluctance of African-Americans to receive the vaccine is the bad track record of medical experimentation on Black Americans exemplified by the infamous Tuskegee syphilis study conducted between 1932 and 1972, which followed the course of the untreated disease in African-American men by lying to them that they were receiving free medical treatment, when in fact they were not being helped at all, just observed as the disease progressed to its fatal conclusion.  This study is a poster child for unethical experimentation on human subjects, and it's not surprising that after betraying trust in this manner, the U. S. Public Health Service and the Centers for Disease Control find that Blacks are less than enthusiastic than other ethnic groups about government-supported vaccine programs. 

But that doesn't explain why 27% of the U. S. population still doesn't want a COVID-19 vaccination. 

Part of the reason may simply be that younger people don't think catching COVID-19 will hurt them that much, whereas the vaccine makers are admitting up front that the second of the two necessary injections makes many people mildly ill for a day or two.  Absent a job requirement to receive the vaccine (and I'm not aware of any organisations which have yet implemented such a requirement), that is a judgment call that is up to the individual. 

The novel factor in this whole situation is the way that a vaccine that can keep you from contracting a widespread potentially fatal disease has become a political football, with Republicans showing more reluctance to take it than Democrats.  The simplistic answer to this question, namely that followers of Donald Trump are a bunch of ignorant morons who he can lead around by their noses, won't do.  At least before the November election, Trump was boasting about how fast Operation Warp Speed was going to produce and distribute the vaccine.  So why aren't Republicans all on board with it? 

A better answer may be that trust in governmental institutions in general, rather than in individual politicians, has undergone severe erosion in the last decade or two, and perhaps more so among Republicans than among Democrats.  The Gallup poll organisation publishes annual samplings of how ethical various professions and members of institutions are perceived to be.  The poll asks, "Please tell me how you would rate the honesty and ethical standards of people in these different fields -- very high, high, average, low, or very low?"  Their findings are instructive.

Members of Congress, for example, don't do very well in these polls.  In the latest poll conducted earlier this month, Congresspeople rated only 1% very high, 7% high, 29% average, 39% low, and 24% very low.  Contrast this to the public perception of, say, engineers (in 2019):  17% very high, 49% high, 31% average, 2% low, and 1% very low (1% had no opinion).  This is better than engineers were doing in the 1970s, for example, when only 10% of respondents rated them very high. 

Now engineers don't have to run for public office by raising millions of dollars of campaign funds, and if they did, their public perception might be different.  Interestingly, of all the major professions, nurses come out even better than engineers:  41% of the public in December 2020 thought nurses' ethics and honesty were very high and 48% thought they were high.  So maybe public-service ads featuring nurses encouraging you to get a COVID-19 vaccine would be more effective than government pronouncements.

As you probably know, the vaccines will not begin to affect the overall spread and persistence of COVID-19 until a substantial fraction of the public receives effective vaccines.  Estimates of the substantial fraction vary, but it's somewhere around half.  And one thing that is still unknown is whether the vaccines only prevent people from suffering adverse symptoms of COVID-19 (it's pretty clear that they do that), or whether they prevent people from spreading it as well.  There simply hasn't been enough time to determine their effectiveness at reducing infectiousness.

Well, my sister (a nurse, whom I trust) received the first of her pair of COVID-19 vaccine injections last week, and assuming it's eventually available to people in my category (engineer, college teacher, over 65), I plan to get it too.  But I can understand that people may have reasons to refuse, and so far, this is a free enough country where you can do that.

Karl D. Stephan is a professor of electrical engineering at Texas State University in San Marcos, Texas. This article has been republished, with permission, from his blog, Engineering Ethics, which is a MercatorNet partner site. His ebook Ethical and Otherwise: Engineering In the Headlines is available in Kindle format and also in the iTunes store.


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