The vaccine scolds

Dr. Richard Menger of the University of South Alabama:

I practice medicine in an emerging Covid-19 hot spot in a state with one of the lowest vaccination rates. Last year I saw Covid at its worst when I deployed to New York to take care of patients in an overflow intensive-care unit. I am vaccinated. I wouldn’t say I “believe in science,” because science doesn’t work that way, but I trust the scientific process. Yet when it comes to trust and persuasion, the medical profession isn’t always winning the Covid-19 battle, and it’s worth understanding why.

The current attempts at persuading people to get the vaccine follow the typical trinity of persuasion put forth by Aristotle —logos, pathos and ethos. Social media and government platforms focus on data (logos), such as the stark disparities in serious illness between the vaccinated and the not. Then it turns into emotional pleas (pathos), with personal stories of lost patients or loved ones. Advocates talk about a moral duty of getting a vaccine (ethos).

But when the desired response doesn’t materialize—when a substantial portion of the country still refuses a shot—the calls devolve into histrionic and condescending pleas. Many people respond by digging in their heels. Plenty of research shows that once people make a decision and attach a strong moral identity to it, they ignore contrary data.

The medical community needs to confront the ugly reality of distrust, especially in my state. The Tuskegee Syphilis Study is a living memory. Between 1932 and 1972, government researchers actively withheld treatment for syphilis while promising free medical care, meals and burial insurance. Some reluctance in blindly trusting a new vaccine is understandable.

It is also cause for pause that the government appears willing to coerce Americans to take a vaccine that doesn’t have full approval from the Food and Drug Administration. President Biden has considered a $100 payment for vaccination. Such fiscal rewards will likely have the biggest sway on the vulnerable populations. But the government can use sticks as well as carrots. Is it morally acceptable to tax the unvaccinated $100? How would you feel if the government applied this tactic to something you strongly disagreed with?

The best way to change minds is to talk to people and treat them with respect and dignity. I understand a lot of my healthcare colleagues are frustrated and tired, but a sensationalist, sanctimonious narrative driven by social media doesn’t help anyone. This is part of our job: persuading people to take medicine they don’t want to take.

Healthcare professionals have a challenging obligation to work to understand where people are coming from, build a relationship, address their fears to help them understand, gently correct information that is wrong, admit when medicine was wrong and medical authorities misled people, motivate them based on their needs, and develop networks of support in the community.

Using this approach and more, Jacqueline Brooks, superintendent of the Macon County, Ala., School District, helped lead the charge that resulted in universal vaccination among the district’s custodians, bus drivers, and lunchroom workers. Macon County includes the city of Tuskegee.

Ms. Brooks engaged in personal conversations, reduced barriers to appointments, formed a partnership with a local medical center, made sure people were comfortable with the decision, and praised them for making a “sacrifice” and “taking on risk” for the community. Most important, when an initial cohort was in a “wait-and-see” mode, she acknowledged the risk, didn’t pressure them, and offered reassurance and data as more people they knew became vaccinated. The results speak for themselves.


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