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 Nov. 30 and Dec. 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 organizations 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 organization 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.

 

Sources:  The U. S. News report on the
Kaiser poll about willingness to take a COVID-19 vaccine appeared at https://www.usnews.com/news/health-news/articles/2020-12-15/americans-willingness-to-get-coronavirus-vaccine-increases-poll-finds.  The Gallup organization has posted historical
and up-to-date responses to its honesty-and-ethics polls at https://news.gallup.com/poll/1654/honesty-ethics-professions.aspx.  I also consulted the Wikipedia article on “Tuskegee
Syphilis Study.”



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