The vaccine-hesitant could use some friendly shame
THE experience of the global COVID-19 pandemic raises a troubling question about the state of human society: Why would so many otherwise intelligent people refuse vaccines that can save their lives and help protect their friends and loved ones?
The answer lies to a large extent in shame, and in the ways government officials, scientists and community leaders should and shouldn’t deploy it.
No doubt, the products of science have brought great benefits to humankind. But in their pursuit of new achievements, its practitioners haven’t always comported themselves in ways that inspire universal trust. To better understand what I mean, consider the history of smallpox, which in the 18th Century was a pandemic much more deadly than COVID-19.
A British doctor named Edward Jenner had a theory as to why the disease didn’t seem to affect one sector of society: milkmaids. Perhaps, he thought, an itchy affliction the milkmaids contracted from cattle — cowpox — also conferred protection. So on a spring day in 1796, Jenner harvested pus from the hands and forearms of a local milkmaid named Sarah Nelmes, and used it to inoculate James Phipps, the eight-year-old son of his gardener.
Jenner then gave the boy what would be a deadly dose of smallpox. The boy survived. Just to make sure, Jenner went on to infect Phipps 20 more times. The boy’s defenses held, and the first vaccine was born. (The name derives from vacca, the Latin word for cow.)
Jenner’s vaccine is one of science’s triumphs, establishing the pathway for further breakthroughs against polio, diphtheria, whooping cough, measles, and many other scourges. Yet its development also sheds light on how some lives are valued more than others. In Jenner’s view, many lives saved were worth far more than one life risked, especially that of a lowborn boy. On the social scale of 18th century Britain, Jenner occupied a master’s caste. He had servants, including his landless gardener and the gardener’s son. This gave him the authority, in the name of science, to put the child’s life at risk. It was in the interest of society, as enunciated by a person in a position of power and knowledge, that permitted Jenner to steamroll the rights of an individual, especially a poor one.
It would be outlandish, of course, to compare the helpless James Phipps to someone in modern-day Los Angeles or Brooklyn who resists vaccination against smallpox or COVID-19. Phipps received lethal doses of a deadly disease with no guarantee that Jenner’s hunch would pay off, while today’s vaccines undergo intensive rounds of testing, for both safety and effectiveness, before gaining approval from the Food and Drug Administration.
Still, the drama around vaccines boils down as always to the reasoning of the scientific elite, who invoke the greater good and often shame the recalcitrant for not knowing better. Proponents can assert that the various arguments against vaccines, including a debunked and retracted 1998 paper linking them to childhood autism, are larded with fake science and conspiracy theories. This is true. They can also cite statistics showing the danger from vaccines is minuscule, and the perils of the unvaccinated contracting these diseases are far greater.
Still, a good number of people distrust vaccines. This turned into a divisive issue during the 2010s as communities, from the posh Los Angeles suburb of Santa Monica to the Hasidic neighborhoods of Brooklyn, rebelled against mandatory childhood vaccines. When measles broke out in their schools, politicians, health officials, and news anchors were quick to shame them. This growing skepticism was deeply concerning as COVID-19 spread around the world. The virus was bound to thrive and mutate within unvaccinated populations.
If we look at the crisis as a matter of the community’s health and survival, the COVID vaccine seemed like an ideal opportunity to deploy healthy shame. Getting vaccinated kept people from dying. Refusing was a form of freeloading, leaving the work of building herd immunity to others. Those who didn’t take the trouble to get vaccinated, it could be argued, were lazy, selfish, and ignorant.
But in this case, societal shaming turns out to be counterproductive. Pressure coming from authority figures can send people running in the opposite direction. Many African Americans, for example, are quite reasonably skeptical of vaccines, knowing all too well about the horrors visited upon their community. The infamous Tuskegee experiment, launched in 1932, conducted human trials on Black males, leaving hundreds untreated for syphilis even though they were diagnosed. In 1950, an African American woman named Henrietta Lacks went to the hospital with an advanced case of cervical cancer. Without her knowledge or consent, doctors harvested her cancer cells, which reproduced at an exceptional rate. Lacks died, but her cells went on to become a standard line for oncology research to this day. They were even used in the hunt for COVID-19 vaccines. Add the systemic medical racism experienced daily by people of color, and wariness makes perfect sense.
Hasidic Jews in New York also distrust authorities, nearly all of them outsiders to their community. Shame campaigns from on high only confirm the common suspicion among the Hasidim that the political and economic elite hold them in contempt. In the spring of 2020, during the early days of the pandemic, New York City officials, including Mayor Bill de Blasio, shamed the Hasidic communities in Brooklyn for holding a large and mask-free wedding. The city imposed the strictest lockdown on the zip codes of ultra-Orthodox communities. This shaming fueled powerful resistance. In multiple protests, angry Hasidic men burned their masks.
Part of the problem comes from science itself. Thanks to its rigor, it represents humanity’s best bet for figuring things out, whether it’s evidence for global warming or effective therapies for shingles. But politicians, universities, the media and scientists themselves have botched the communication of science. They have enshrined it as an unassailable marvel of progress, and arrogantly dismissed doubters and contrarians as ignorant or portrayed them as credulous followers of idiotic conspiracy theories.
This is shaming, and people pick up on it. For many, science now represents only the values of the elite, who also benefit from turbocharged tech, pharma, and finance stocks. From the perspective of the aggrieved lower orders, the elite not only lay claim to the lion’s share of wealth but also see themselves as arbiters of truth. Not all vaccine skeptics are ignorant, by any stretch of the imagination. An alarming number of health workers, for example, resisted taking the COVID vaccine in 2021, even after tending for months to victims suffering in their emergency wards. For example, a group of 117 employees sued Houston Methodist Hospital in May 2021 for mandating staff-wide vaccines. The plaintiffs argued that the vaccines were an experimental therapy. This was hardly a knee-jerk rejection of science. According to Kristen Choi, a registered nurse and an assistant professor at the UCLA School of Nursing, some of her colleagues objected to the frantic pace of the vaccine development, suspecting that corners were cut. Others had witnessed what they viewed as shoddy experiments within their own institutions. That fed their skepticism.
“Nurses are not declining because they don’t understand research,” Choi tweeted. “They’re often declining because they do understand research.”
For many, including the nurses Choi knows, the vaccine push must come from people they trust, not distant authorities. Whether it’s African Americans in Detroit, Hasidic Jews in New York, or pandemic deniers at a California hot yoga studio, doubters are far more likely to heed those who can attest to their love and support for them — their families, friends, neighbors, congregations.
In an evangelical church in Orlando, Florida, in early 2021, a reverend named Gabriel Salguero urged his largely Spanish-speaking congregation to get vaccinated. “In getting yourself vaccinated, you are helping your neighbor,” he preached. “God wants you to be whole so you can care for your community. So think of vaccines as part of God’s plan.” Katie Jackson, pastor at Bethany United Church of Christ in Ephrata, Pennsylvania, told her worshippers that God had given them “the technology to protect ourselves.” We should make use of it, she said, “not only because of our best interest, but in the interest of others.”
That may not sound like shame. But in framing vaccinations as a responsibility to the community, and to God, these ministers were delivering a mild dose of it. The implication, after all, was that those who refused to get vaccinated were turning their back on their fellow congregants and saying no to God’s plan.
Even in this age of shame networks and punching down, healthy shame can still work its magic. But it can affect only minds that are open. Friends and allies know where those openings are, and how to get the message across most effectively. Far better than Bill Gates or Dr. Anthony Fauci, they can deliver the kind of gentle shame that signals love. That alone can give us a powerful push in the right direction.
(Adapted from The Shame Machine: Who Profits in the New Age of Humiliation, published this month by Crown, an imprint of Random House, a division of Penguin Random House LLC. Copyright 2022 by Cathy O’Neil.)
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