Vaccination debates: the corona connection

The coronavirus pandemic has intriguing connections with longstanding debates about vaccination.

Background

Vaccination proponents say it’s one of the most important public health measures of the past century, with its benefits in reducing infectious disease vastly outweighing any small risks. Critics say the benefits are overrated and that adverse effects are greater than normally acknowledged.

This was the state of play before the emergence of the new coronavirus, officially known as SARS-CoV-2. How does the coronavirus disease, Covid-19, affect the longstanding claims and counterclaims in the vaccination debate?

 

Quandaries for vaccination proponents

Covid-19 undermines one of the usual arguments for vaccination, namely that unless most people receive routine vaccinations, there is a possibility of a pandemic like the Spanish flu of 1918–1920 linked to the deaths of tens of millions of people. A moment’s reflection, though, should be enough to realise that vaccinating against polio and measles provides little or no protection against a new virus.

Vaccination proponents have tacitly admitted that, when a vaccine is not available, other measures may be necessary, notably contact tracing, quarantine and physical distancing along with hand-washing and other hygienic measures to reduce the risk of transmission. These are relevant for many vaccine-preventable diseases such as measles and whooping cough but are seldom emphasised, perhaps because they might detract from the importance, efficacy and efficiency of vaccination as the first line of defence.

Covid-19 has brought another possibility onto the agenda: the immunity to an infectious disease acquired by having it. This sort of acquired immunity was common before the advent of vaccines.

The entire population, referred to as the herd, is protected if enough people are immune. When, before the measles vaccine, most children had measles, this provided protection for those whose immune systems were impaired. If most people in a community have had Covid-19 then, assuming having had the disease confers immunity, the pandemic will end. However, this is likely to involve much illness and many deaths before herd immunity is attained.

            Critics of vaccines have argued that there are advantages to acquiring immunity by having a disease. Before Covid-19, this argument received very little public attention.

In the vaccination debate, proponents emphasise the importance of herd immunity. This is taken to be vaccine-induced herd immunity. That is, when most people are vaccinated and most gain immunity as a result, the disease agent dies out for lack of individuals to infect.

Some commentators (including scientists) have suggested that widespread immunity acquired from having Covid-19 is an endpoint worth considering. A possible option is to allow or even encourage young and healthy people to be infected while protecting older vulnerable individuals. Few governments have adopted this option, perhaps because it clashes with the vaccination paradigm.

In summary, Covid-19 has undercut the common assumption that vaccines are the only way of dealing with infectious diseases. Claims about unvaccinated children being a health threat, and their parents being irresponsible, have been superseded by worries about contagion from coronavirus-infected individuals.

Quandaries for vaccine critics

For critics of vaccination, Covid-19 raises a possibility that might not be welcome: that an effective vaccine, if developed, might be just what is needed to bring the pandemic under control or to limit its damage. Although all vaccines pose risks, if Covid-19 is as deadly as commonly believed, even a vaccine with significant adverse effects could have more benefits than harms. This is the same sort of assessment used with other vaccine-preventable diseases.

There has been much commentary about how long it will take to test a vaccine and roll it out for the world’s population. There is no guarantee that an effective vaccine can be developed. Just as importantly, vaccines pose risks, especially when introduced for emergency purposes. Mention has been made of the vaccine for the 1976 swine flu, a vaccine that caused more harm than the flu.

Vaccine critics are already warning about the potential dangers of a coronavirus vaccine, especially one that has not received sufficient testing. Some critics see a coronavirus vaccine as a stalking horse for the introduction of mandatory vaccination, including for other vaccines. The social control measures introduced for dealing with Covid-19 might be a precursor for a different control measure: enforced vaccination despite the risks.

Absent viewpoints

The public debate over vaccination is polarised: there are two sides with sharply divergent positions on benefits, risks, ethics and decision-making. This polarisation of the public debate occurs despite both sides having the same ultimate goal: protecting the health of the population, especially children. One of the effects of polarisation is to sideline other perspectives.

Proponents and critics of vaccination agree that immunity to disease is important but differ about the sorts of immunity they emphasise. Proponents focus on the benefits of vaccine-induced immunity whereas critics point to the benefits of natural  immunity.

The immune system can also be boosted through various means, including exercise, diet, vitamin D, sleep and mindfulness. (For references, see my book Vaccination Panic in Australia, pages 352-355.) One of the contradictory features of the response to Covid-19 is that control measures, especially quarantine, distancing and closure of businesses, may have negative effects on an individual’s immune system.

When gyms and pools are closed and exercise classes banned, people get less exercise. In principle, people can exercise by themselves at home, and indeed are encouraged to, but for many individuals the control measures will reduce their level of physical activity. Exercise has many health benefits aside from immune system improvement.

            How control measures are affecting diet is hard to determine. Closure of fast-food outlets might improve some people’s diets. On the other hand, staying at home and worrying can lead to less healthy eating.

            The body manufactures vitamin D when the skin is exposed to sunlight. Staying inside reduces vitamin D production.

Ample sleep benefits people’s immune systems and general health. Staying home more of the time may be enabling people to get more sleep, though worries and physical inactivity can impair sleep quantity and quality.

Mindfulness refers to a state of mind that is calm and focused; meditation is one way to be mindful. Worrying about Covid-19, and obsessively seeking information about risks, is contrary to mindfulness. So are losing one’s job and worrying about finances.

Research shows that personal relationships are crucially important to happiness. Distancing measures have disrupted many relationships, especially physical contact, and thus have adversely impacted wellbeing. There are also other adverse impacts, including increases in domestic violence.

            It is difficult to quantify the impacts of control measures on exercise, diet, vitamin D, sleep, mindfulness and relationships and hence difficult to take them into account in policy-making. Probably the impacts are more negative than positive.

One thing is certain: the vaccination debate will continue. Covid-19 may be causing some shifts in public discussions about immunity and vaccination but is incapable of ending the overall controversy.

Brian Martin
bmartin@uow.edu.au

Thanks to Tonya Agostini, Kevin Dew, Meryl Dorey, John Potterat, Jennifer Reich, Samantha Vanderslott and Jody Watts for valuable feedback on drafts. None of them necessarily agrees with any of the views in this post.

Virus debates

The arrival in 2019 of a novel coronavirus and its potentially deadly disease Covid-19 has led to an outpouring of commentary. The impacts on daily life have been enormous, hence it is natural for people to try to understand the significance of these events from their own perspectives.

For several decades, I’ve been studying public scientific controversies, such as the ones about nuclear power, pesticides and fluoridation. There are some regular, often predictable, features of longstanding controversies. Usually there are two sides, with one side supported by most scientific experts and one side backed by groups with wealth and power. For example, in the pesticide debate, most scientists support the pesticide approach to dealing with pests, and this approach is backed by the companies that manufacture the pesticides. This is the most common configuration: scientific experts align with powerful groups. Two exceptions are the debates over smoking and climate change. In each one, most experts are on one side while the most powerful corporate groups with a stake in the issue are on the other side.


It’s debatable: do masks work?

            From the point of view of controversy studies, what is most interesting about Covid-19 is the proliferation of contentious issues in a wide range of domains. Here I can do no more than list a few of these, without commenting on how they might pan out. Because the issues are changing so rapidly, I’m not giving links to sources; it’s easy to find them with a few keywords.

* Seriousness. Commentators differ about how serious Covid-19 is and will be. If most people eventually are infected and the mortality rate is one percent, the ultimate worldwide death toll will be huge. On the other hand, some suggest that the number of infections has been underestimated, so the mortality rate is much lower than one percent, perhaps not much different than for seasonal flu. Judgements about the seriousness of Covid-19 influence views about a number of the other disputed issues, including control measures and civil liberties.

* Control measures. Some experts and citizens have called for stronger isolation measures, or for them to be rolled out sooner. Others raise concerns about the adverse effects of the measures, especially in hurting the economy.

* Civil liberties. Some governments have introduced new measures to track individuals, for example to see whether infected individuals are maintaining their isolation. Concern has been raised about the curtailing of civil liberties, and that the surveillance powers might be used for other purposes or to continue after Covid-19 dangers have waned.

            * Economic equality. Measures against Covid-19 have caused immense economic disruption, including severe hardship in some sectors, for example the tourism industry and spectator sports. Many people have lost their jobs, and businesses have gone bankrupt. This has led to calls for introduction of a universal basic income (UBI), namely a subsistence payment to every member of the population. With a UBI, most other welfare measures could be eliminated. Some governments have introduced measures to protect some hard-hit individuals or sectors of the economy, but so far have not moved to introduce a UBI.

            * Equity. The benefits of control measures are primarily to those who would be seriously ill or die from Covid-19. Those most vulnerable are mainly older people with pre-existing health conditions, whereas the costs of control measures fall on a broad swathe of the population. Simplistically, this is a case of the young making sacrifices for the benefit of the old and infirm. Some might contrast this with intergenerational equity in the climate debate, in which climate sceptics, who tend to be older and richer, do not want to make sacrifices for future generations.

* Treatment. The standard medical methods for treating Covid-19 include drugs, oxygen and, if necessary, ventilators and other life-support technology. Various alternatives have been touted. There have been reports that Chinese doctors have been using intravenous vitamin C in large doses. This is considered “alternative” and shunned or condemned by mainstream figures. Similarly controversial is the use of homeopathic remedies in India.

            * Environmental factors. The standard medical approach is to treat each patient as needed, to promote vaccination (when vaccines are available) and, especially in the case of the coronavirus, to institute physical-distancing measures to slow the spread of the virus. In alternative health circles, there has been attention to the role of environmental factors in making individuals more susceptible to infection. Two factors have received the most attention: 5G and air pollution.

* Vaccination. Having a vaccine is widely assumed to be a way to end the pandemic. There are disagreements about how soon a vaccine can be ready and about whether it is even possible. Critics raise concerns about the hazards of vaccines, especially ones prepared in urgency and insufficiently tested.

* Trust. Governments and health authorities say it’s important that their rules and recommendations be followed. In other words, they say “Trust us.” Some commentators deplore those who question the authorities and warn people against misinformation. Trust in authorities has been declining for decades, and in the US there is a very low level of trust in governments and pharmaceutical companies. Many individuals examine a range of information and make their own judgements. The issue of trust might be considered a meta-level disagreement or divergence, as it underlies many of the other areas of dispute.

The value of public discussion

Some commentators say that government and health authorities need to speak in one voice, because disagreement undermines the effectiveness of measures implemented. On the other hand, there are benefits from disagreement and debate. In a situation of uncertainty, it can be valuable to hear a range of viewpoints, even ones that might seem ridiculous on the surface. Many members of the public have time on their hands, are stuck at home, and have an intense interest in an issue that has disrupted their lives and sometimes their livelihoods, not to mention risks to health. They are bound to explore information on the web, and to use their own judgement about what to believe. In this context, it is valuable for contentious issues to be openly discussed and for views to be presented and challenged with evidence and logic.

            In many controversies, partisans tout evidence supporting their own position and attack weak points in the opponent’s position. This can rally supporters but is not convincing to opponents. A more rigorous approach is to spell out the strong points in the opponent’s position, ideally to the opponent’s satisfaction, and address them systematically. For example, it is easy to dismiss concerns that 5G is part of a plot to harm people but more rigorous to address arguments that 5G might have some impact, maybe small, on people’s immune systems. (I use this example because I haven’t examined any of the claims about 5G!)

Some people will be receptive to sensible comments. There should be no fear of dissent and debate, as long as participants engage with each other openly and respectfully.

Brian Martin
bmartin@uow.edu.au

The value of asking

It’s worthwhile learning effective ways of asking for help, and to do more asking.

Asking has a bad reputation. There’s an old saying, “It is better to give than receive.” Research shows that helping others is a reliable way to increase your happiness, but the research says little about receiving help.

In some areas, asking has become associated with marketing. Advertisers in essence ask people to become customers. Politicians ask citizens to vote for them. Large charities use professional marketers to refine their pitches. In these arenas, people need to develop resistance to those seeking their money or support, and this resistance can rub off to become negative attitudes about asking.

In an illuminating book titled Give and Take, Adam Grant describes three types of people — givers, matchers and takers — in the context of US business. Givers help others without any expectation of receiving anything in return; matchers operate on a reciprocity basis; and takers accept help but don’t give anything in return. Most people are matchers.

The normal assumption is that givers won’t get ahead. Grant argues that they can, and offers many examples of highly successful givers in business. But not all givers get ahead, because they can be taken advantage of. Grant says givers can do very well when they also look out after their own needs. He calls these “otherish givers.”

“Selfless giving, in the absence of self-preservation instincts, easily becomes overwhelming. Being otherish means being willing to give more than you receive, but still keeping your own interests in sight, using them as a guide for choosing when, where, how, and to whom you give.” (p. 158)

Grant presents ideas via detailed stories of individuals who have a giver style. He uses the stories to make points, supplemented by descriptions of relevant research, of which there is quite a lot. Give and Take is a highly readable book, independently of the important messages conveyed.

Adam Grant

Asking

If you care about others, then you don’t want to be a taker. But there’s still a place for asking for help, according to Wayne Baker, author of All You Have to Do Is Ask, just published. Baker has worked closely with Grant, and like Grant focuses on US businesses.

Asking others for help can make a tremendous difference to your career and your life. You might save lots of time and money by getting a tip on how to improve, a contact to a lucrative venture, or information that can save a life.

One of the techniques used by both Grant and Baker is called a reciprocity ring. Bring together a group of maybe 20 people and invite each of them in turn to make a request about something, work-related or personal, on which they need help. The more diverse the group the better, because unexpected ideas and personal connections are more likely.


Posterboard for a reciprocity ring

When takers join reciprocity rings, the public nature of the process moderates their taker tendencies. Because they want to look good to the group, they can offer valuable assistance to others. This suggests that giving, matching and taking depend not just on personal characteristics but also on the circumstances.

Baker says some ways of asking are better than others. He recommends an approach with the acronym SMART: specific, meaningful, action-oriented, realistic and time-bound. He also gives advice on when and where to ask. He recommends accepting rejections gracefully, giving thanks for acceptances, and letting the other person know what happened in the aftermath.


Wayne Baker

I decided to examine this approach in light of a type of scholarly asking.

Checking citations

In writing an academic paper, authors usually cite various other publications. Some of these citations are important. Asking can be used to make them more accurate.

Scott Armstrong, a professor at the Wharton School at the University of Pennsylvania, was co-author of a 1977 paper about correcting for nonresponse bias in survey research, and hundreds of other authors cited this paper. Years later, Armstrong collaborated with Malcolm Wright to examine some of these citations. They found that of 50 papers that cited Armstrong’s 1977 paper, only one reported its findings correctly.


J Scott Armstrong

Wright and Armstrong recommend that researchers contact authors whose work they cite, asking them whether the citation is correct. This is most important when your results and methods rely heavily on another’s work or where you discuss it extensively.

After reading Wright and Armstrong’s paper (and writing a commentary on it), I adopted their approach myself. When I’ve discussed an author’s work, usually I send a draft of what I’ve written to the author, asking whether I’ve cited it correctly. Sometimes this isn’t possible: the author is dead or otherwise uncontactable. But in many cases it’s possible. Here’s a typical but fictional email (adapted from an actual one) written to the author of The Definitive Investigator.

Thank you for your valuable study The Definitive Investigator. I’ve been working on a book titled Official Channels. In chapter 15, I’ve discussed and quoted from your book in a short section on investigating. Could you have a look (bottom of page 230 of the pdf or page 12 of chapter 15, or search for your name) and let me know if anything needs fixing? Comments most welcome on any other part of the chapter and book.

This was written before I read Baker’s book on asking. So let’s see how well I’ve followed his SMART approach.

  • Specific. My request is quite specific: it refers to a “short section,” with details of how to find it and what I’m asking.
  • Meaningful. I’m asking the author to check what I’ve written about their work. For most authors, this is very meaningful. In fact, it’s hard to resist looking at what someone else says about your work. I’ve known academics who, when looking at a new book in their field, turn first to the bibliography to see whether their own publications are cited.
  • Action-oriented. I’ve asked the author to check what I’ve written.
  • Realistic. My request is fairly small. It doesn’t take much time to check my text and write a short email in response. In my experience, most authors respond promptly and helpfully.
  • Time-bound. I didn’t satisfy this criterion: I should have given a time frame for replying. In practice, nearly all authors who respond do so within a day or two.

I find it rewarding to make small specific requests about citations. In most cases, authors say that what I’ve said about their work is fine, which is reassuring. In a few cases, they offer corrections, which are valuable in improving the accuracy of what I’ve written. As well, a few engage with the material and send me extensive comments, often including additional references. This is highly stimulating.


Malcolm Wright

I’ve told quite a few colleagues and correspondents about the benefits of seeking feedback about citations, but nearly all seem reluctant to use this method. This brings me back to Baker’s book. In it, he offers eight reasons why people don’t like making requests, and counters each one.  He writes,

“Asking for what we need doesn’t come easily for most of us. Asking is a behavior that must be learned. It requires three steps: determining your goals and needs, translating needs into well-formulated requests, and figuring out whom (and how) to ask.” (p. 85)

In relation to checking citations, Baker’s comments are spot on: scholars are reluctant to ask and need to learn how to do it. The three steps aren’t so hard in this case: improving the accuracy of writing is the goal, requests follow the SMART formula, and cited authors are the people contacted.

In other areas, determining your goals and needs may not be so easy. If you are feeling vaguely unhappy about the way things are going, what exactly is your goal? What do you ask? Who do you ask: a family member, a friend, a counsellor, a stranger? Here’s where Baker’s advice is again valuable. Asking requires skill, and as you obtain more experience you should get better at it. And you can learn from Baker’s book. Remember the title: All you have to do is ask.

Brian Martin
bmartin@uow.edu.au