Vaccine hesitancy: It’s not about knowledge

Someone once said, “It ain’t what you don’t know that gets you into trouble; it’s what you know for sure that just ain’t so.” Some of us know for sure that the mRNA vaccine will give you COVID-19, or contains aborted fetal tissue or “hell man, this virus thing is a hoax.” Their beliefs act as a powerful repellant to medical evidence and physician advice. Anti-vaxxers are few in number but their fears have spread faster than the virus itself. Vaccine hesitancy has slowed the progress of herd immunity to a level that healthcare officials have begun to think about an acceptable number of COVID-19 deaths in a post-pandemic world, a question raised recently in Nature, a leading British science journal.

In law school, we learned not to accept opinions at face value. Lawyers know to analyze the facts upon which opinions are based. And we like to brag that we can sniff out assumptions that replace non-existent or manufactured facts– sometimes called disinformation. Yet, experienced lawyers understand that even true facts and logic often fail to change an individual’s opinions and beliefs. Why do reasonably intelligent people reject facts and logic? Why do people in our country refuse to be vaccinated despite the dramatic drop in COVID-19 deaths directly corresponding to the rise in vaccinations of our elderly and most vulnerable? Part of the answer is culturally based, meaning religious, political, and provincial beliefs that reject change.

Recent articles in the New York Times have plumbed the depths of vaccine hesitancy and discovered that it’s not knowledge but a “deeply, held set of beliefs …at the heart of resistance.” (Sabrina Tavernise). Another recent article in the New York Times quoted Mary Politi, a behavioral psychologist and expert in health communication and shared decision-making. She concludes that a better approach to overcoming resistance would be engaging “a trusted figure to address the root cause of hesitancy, fear, and mistrust.”

Jan Hoffman, who writes about behavior health for the New York Times, traveled to Greenville, Tennessee, to interview rural Tennesseans about vaccine hesitancy. I graduated from the University of Tennessee, Knoxville, in the 70s. By car, Greenville is 70 miles from Knoxville. The distance from Greenville to the political science department at the University of Tennessee and the fact-based analysis taught there? Halfway to Mars. I emailed Jan and asked if lack of education was the reason many of the Greenvillians refused to take the vaccine. “Education is a vexing question,” she told me. “It has to do with the sources of information people consult.” It’s rural America no doubt, but she emphasized Greenville has highly rated public schools. Jan interviewed two college-educated people, a nurse practitioner and a retired engineer. Both refused to get the vaccine. If one opts for social media and YouTube instead of their family doctor for information on the risk and benefits of the vaccine, education it seems, depends on a personal conviction on where to find the wellspring of truth. Essentially, behavioral psychologists tell us that more science, more facts, and more medical expertise have failed to stop the recent decline in individual willingness to take the COVID-19 vaccine in the United States.

More exasperating are people who receive medical advice from medical specialists, even their family doctor, yet come away unconvinced or reject medical advice. Why does this happen? I believe the explanation can be found in the Fall 2020, Scientific American Collector’s Edition on “Truth vs. Lies.”In the short introduction to this issue dedicated to the Science of Misinformation and Deception, the senior editor writes, “For starters, human perception is inherently subjective.” According to contributor Anil K. Seth, an expert on cognitive science and the biological basis of consciousness, “reality is constructed by the brain, and no two brains are exactly alike.”Professor Seth then quotes a novelist, Anaïs Nin, “We do not see things as they are, we see them as we are.”

Doctors deal with patients refusing to follow their advice on a daily basis. Lisa Rosenbaum is the National Correspondent for the New England Journal of Medicine and a cardiologist at Brigham and Women’s Hospital. In one of her articles, she wrote about patients that insist on preferences for non-evidence-based therapies and her inability to respond persuasively. The phenomenon at work here is referred to as biased assimilation. Dr. Rosenbaum summed up this corner of cognitive deficiency this way: “When doubt is wrapped up in one’s cultural identity or powerful emotions, facts often not only fail to persuade, but may further entrench skepticism.” Intelligent individuals filter what they hear and “latch” onto the facts that confirm their beliefs.

How impenetrable are strongly held beliefs about COVID-19 and vaccines? Dr. Rosenbaum tells of a South Dakota nurse’s description of patients who were critically ill with COVID-19 but continued to insist the virus was a hoax until the moment they were intubated. “If you can be denying the existence of a disease while you’re dying from it,” she says, “what hope is there for science to persuade people unaffected by that disease to take it seriously enough to get vaccinated?”

In the same Fall issue of Scientific American, two professors of Logic and Philosophy of Science at the University of California, Irvine, penned an article entitled “Why We Trust Lies.” They aimed to study the anti-vaxxer’s playbook. How people’s beliefs are formed by their choice of evidence and shared with others. They used what they called “Network Science”–mathematical models to track human interaction and the spread of ideas. They focused on the Facebook page “Stop Mandatory Vaccination” and its more than 140,000 followers. Their research found that social networks and social influence result in communities that end up at consensus. They concluded that groupthink determines whether vaccinating is safe or that it is dangerous.

What got my attention in this article was their suggestion on overcoming mistrust of science and misinformation. “The best approach is to find individuals who share enough in common with the members of the relevant communities to establish trust.” They compared the east coast to the west coast. In Brooklyn, a Rabbi might be the most effective emissary for the vaccine. Interestingly, they recommended Gwyneth Paltrow for southern California. The common thread running through vaccine hesitancy is the mental process involved in how the human brain makes decisions about who to trust.

So, I’m thinking Lebron James could shoot a COVID-19 vaccine commercial encouraging teens to get the vaccine. What if Kim Kardashian used her social media platforms to implore her fans to get vaccinated? If I believe what I found on the internet, she has 221 million followers on Instagram and nearly 70 million on Twitter.

Does anyone have Beyonce’s cell number?