In the last week of May, the CDC reported 2,574 patients hospitalized with COVID-19 across the United States, a record low in the span of almost a year [1]. With almost two-thirds of Americans vaccinated, and the ongoing full-scale reopening of all U.S. states this summer, the public has reason to be optimistic that the risks from the novel coronavirus have been largely curbed by the combined efforts of immunization, use of face masks, social distancing, and quarantine requirements.
Nevertheless, despite mounting scientific and anecdotal evidence highlighting the safety and efficacy of the COVID-19 vaccines available in the U.S., a large portion of American adults remain unconvinced that they should be vaccinated. Indeed, vaccination rates have steeply declined in the U.S. since mid-April [2], dooming the White House’s goal of an adult vaccination rate of 70% by early July. To make matters worse, this decline is likely to continue, given that the people most enthusiastic to receive a vaccine have likely already done so due to its wide availability. In response, Dr. Anthony Fauci remarked recently, “You’re left with a group that you may need … trusted messengers who go out there and explain to them why it’s critical for themselves, for their family” [3].
In casual conversation, especially among peers working in science, I have often found that many people are quick to dismiss those that remain unvaccinated as ideologically “anti-vaccine” or “anti-science”, giving up before trying to convince them otherwise. However, as a resident physician, my personal interactions with patients and the general public have led me to believe that only a small fraction of the unvaccinated truly fit these descriptors, with the majority being otherwise reasonable citizens who either mistakenly unvaccinated Americans can be reasoned with, provided the appropriate combination of message and messenger. What is the right message? How can we educate the public on matters of science, medicine, and public health when the target audience may not be especially receptive to authority figures interfering with their health?
The most frequent and direct approach to implore vaccination, often used by local and federal governments, consists of a person in a position of authority – a doctor, the head of the CDC, a political leader, etc. – stating that one approach (i.e., getting vaccinated) is superior to another (remaining vulnerable to severe infection). While this approach has the advantage of being simple and common-sense, and has undoubtedly worked in the past (for instance, the polio vaccine rollout), at this time it may do more harm than good for those that are already distrustful of government and authority figures. Moreover, from the perspective of scientists, this approach limits our ability to lead the discussion with evidence and our analysis of the data, and is unlikely to convince those that have already decided for political reasons not to be vaccinated (e.g., if someone does not support or distrusts President Biden, hearing him tout the efficacy of vaccination may demotivate that person). We need public health communication to promote critical thinking and curiosity in the general population – acting as their advocates and allies – without any trace of condescension in the process.
For scientists, a better effort to convince those left unvaccinated is perhaps a bottom-up approach – to act as this “trusted messenger” for unvaccinated individuals in our families or social circles, and to not simply regurgitate established facts, but to lay down a general scientific foundation to help enable evidence-based decision-making. Scientific advances already permeate almost every aspect of daily life (e.g., using the internet on your smartphone), and will likely only grow more consequential in the future. Given this reality, it is incontrovertibly beneficial for every 21st-century citizen to acquire the skillset to discern professional science from internet conspiracies. Although having such an extensive conversation with someone is daunting, the bar should not be set too high so as to require a flawless exposition of the scientific method: when discussing these topics with non-scientific friends and family, one needs only to encourage them to first seek out a justification for a given statement or claim. Whatever the proposition, it cannot be true just by the fact that it was said by someone or that it appears on a person’s favorite news or social media website.
When teaching how to evaluate sources attempting to justify a claim, the ideal strategy may be to describe, in broad strokes, how scientific knowledge is generated. This would include a discussion of common experimental methodologies and the reason for their usage, perhaps including the caveat that no method is flawless and that, at the end of the day, experiments test specific hypotheses, the confirmation or rejection of which is very unlikely to reveal a “universal truth”. Unfortunately, the philosophical bedrock underlying these conversations is almost never touched upon in communication with the public. In everyday science news, for example, preliminary or incomplete results are often presented as indisputable facts without further explanation, often prompting people to think scientists are either hypocrites or incompetent when following studies that reject or amend the original claim. For our purposes as trusted messengers of science, a crucial point to convey is that, in most if not all cases, our knowledge is not black and white, and the truth claims of a given statement depend greatly on the conditions of each of the experiments performed.
Popularizing science is easier than ever. But what is the right message?
In my conversations with others, I find it useful to order and explain different types of biological experiments as a sort of “hierarchy of evidence” with respect to human health. For example, to discover a new therapy for human disease, the hierarchy might look like this:
Cell culture experiments
Proof-of-concept studies in animals
More extensive animal studies, such as genetic models or xenografts models derived from diseased human tissue
Pilot studies in healthy volunteers
Large-scale randomized controlled trials (RCTs)
Meta analyses of multiple RCTs
We have all come across popular articles claiming that we are approaching a miracle cure for a disease, only to be disappointed when the underlying paper only describes in vitro experiments. This kind of hyperbole in science journalism, where enticing but preliminary results are over-interpreted to generate a catchy headline, only helps to fuel public distrust in what we do. Therefore, in our conversations with friends and family, we should attempt to strip away these often-unnecessary embellishments and provide them with a chance, with our guidance, to interpret the raw data for themselves, especially using the primary literature whenever available. For example, if someone were to ask me about whether a certain type of new diet could help treat diabetes as reported in the news, I would ask to see the news article referenced, find the underlying paper, and tell them exactly what experiments were performed. If, for instance, the diet was given to two dozen genetically engineered diabetic mice, and it was helpful to more than three quarters of them, I could then ask the person whether or not the experimental set-up and results constitute good enough evidence for someone with diabetes to try it out. If we are sitting at a computer together, I might also show how to find a paper on PubMed, and how to quickly go over the information in a paper’s abstract. Although it may be too much to expect the general public to adequately interpret the average scientific publication, my goal is simply for them to think: “what kind of study was done to arrive at this conclusion?” when faced with an unfamiliar scientific claim.
Anecdotally, I have been pleasantly surprised by this strategy. By telling family, friends and patients exactly what was done in a study and interpreting that information in the context of a wider problem, each person is left to determine what level of evidence they are willing to accept to make a change in their lives. Importantly, one should remember that in some contexts this can be a very personal decision, as the costs and benefits of each intervention may not be comparable from person to person. For example, it does not take much evidence to convince someone to eat more of their favorite fruit, but successfully convincing a patient with heart disease to follow a strict diet might require far more powerful examples of the potential benefits.
In the end, I believe that the resistance seen in certain populations towards COVID-19 vaccination – and scientific studies in general – is reflective of a broader problem, namely the inability of most Americans to interpret any amount of experimental evidence for themselves. In the post-COVID world, my hope is that scientists begin to collectively advocate for changes in the educational system, particularly in promoting critical thinking at the expense of simply memorizing “facts”. In any given current high school curriculum, science is frequently presented as a sort of religious dogma; the material is often very well established – usually discovered/proven decades, if not centuries, ago – and taught as immutable truth. To make matters worse, the experiments and data used to discover these findings are frequently if not totally omitted in these lectures. Moving forward, the emphasis should shift to instilling in students an understanding of how the scientific method can be applied to generate specific data, and how to interpret that data, rather than memorizing notable conclusions.
Ultimately, as ambassadors of science, we must take it upon ourselves to disseminate our work more broadly and in the process empower people to think about what goes on in labs and clinical trials for themselves with the same evidence-based rigor. Whether inside or outside the classroom, we should promote in our friends, family members, and acquaintances the ability to determine what amount of evidence is sufficient for convincing them about one side or the other for a given topic, and independently seek out this evidence using available resources. This is a future that I hope we can build together.
Edited by Allen Zinkle
