How health workers can close the gap between science and anti-vaxxers

By Dr Remy Daroowala

It is important to restore trust among the public and to do so we cannot afford to turn our backs on anti-vaxxers. It will be difficult. The trauma of these past two years on those in healthcare is unparalleled. Huge personal sacrifices have been made, lives lost, and so it is unsurprising that hospitalised anti-vaxxers face compassion fatigue from embattled and embittered staff. We are human after all.

In the recent past, alternative facts and conspiracies were largely limited to political matters, but as coronavirus spiralled out of control and government responses faltered worldwide, healthcare was pulled into the swamp. This wasn’t the tired old political football match of health service funding and provision; this was the very nature of our intentions being brought into question. The nightly applause and pot banging seem but a distant memory.

SEEKING ANSWERS

As the pandemic has worn on, the public appetite for measures to control it has waned. In response to a mistrust of government, a number of people are seeking their own answers and their own reality and find no shortage of public figures, sports stars and even prominent doctors publicly stating their anti-vaccination stance.

While the relationship between science and society was complex prior to the pandemic, the past 18 months has seen this complexity ramp up. Medical research and science have been inextricably linked with government processes. The utilitarian mission of healthcare has been turned on its head as we have been lumped with a corrupt political elite supposedly using the pandemic to control the masses.

Simultaneously, the scientific process has been laid bare. While it was never hidden, it stayed mostly out of sight, but the public interest element of the pandemic has led to the process being broadcast worldwide. As a community, we have scrambled to understand the pandemic and evidence has changed rapidly and constantly.

The rights of the individual have now become a public health concern. In an unpredictable world escaping the clutches of control, people defend the only thing they can grasp on to, their bodies. We have even seen religious zealots co-opt pro-choice language and slogans, so identified with an intellectual position that impressive mental gymnastics are required. Rather than accept new evidence, people tend to seek what reinforces their existing worldview. We must recognise that our facts and figures may be of little use against such cognitive dissonance.

Those opposed to vaccines in South Africa are thankfully a minority, but a sizeable and vocal one. It is tempting to regard them as paranoid tin-foil-hat wearers and look the other way, but other important factors are at play. The demographics of those opposed to the vaccine in South Africa reveal some interesting figures.

In a recent report, 27 percent of white South Africans reported that they would definitely not get the vaccine, double that of any other individual race group. Along political lines, 61 percent of ANC supporters reported they would get the vaccine, while only eight percent would not. In contrast, 20 percent of DA and 24 percent of EFF supporters reported they would not get the vaccine. Certainly, among the white population, this could indicate a perceived disenfranchisement as well as a loss of trust in the government and its instruments, the healthcare service included. Post-truth largely succeeds in its acceptance of previously “ignored” people and their ideas.

NEW WAYS

We must think of new ways to get our message across.

First, we must restore trust and to do so, we cannot afford to turn our backs on anti-vaxxers. It will be difficult. On a personal level, the trauma of these past two years on those in the healthcare service is unparalleled. Huge personal sacrifices have been made, lives have been lost and so it is only natural that emotions and bias accompany this.

It is unsurprising that hospitalised anti-vaxxers face compassion fatigue from embattled and embittered staff. We are human after all. We must allow and acknowledge these feelings and find space in our institutions, both physical and emotional for their safe and unbridled expression.

Then, we must reach out. Our principles and professionalism will invite us to see these people as victims of another disease that stands in its own class, the infodemic. We must focus on this new illness in front of us, and not the behaviour that led to it, else we risk subverting our sacred purpose. Compassion and empathy will prevail. A superior, mocking attitude will only increase the gap between us all.

We must also adapt our messaging. The way that we communicate with all our patients will have been forever changed by Covid-19. It’s imperative that in our eagerness to end the pandemic we are mindful to communicate the vaccine in a way that “preserves the possibility that it can be disproven in the future”. Any perceived rigidity of thinking will prevent us from reaching those who feel that we are not offering alternative options, even if those alternative options are merely to refuse vaccination.

Next, it will be important for us to place some distance between ourselves and the government and our next greatest opportunity to do this is to vocally stand firm against mandatory vaccinations for the general population. While it is desirable to maximise coverage, any actions to this end will further erode trust and we will be responsible for setting a dangerous precedent. Let’s leave private entities like businesses and airlines to decide whether access is contingent on having received a vaccine. We cannot risk losing what remains of our apolitical nature.

COMMON GROUND

Finally, we must not shoulder anti-vaxxers with disproportionate blame for the poor uptake and let the government off the hook in the process. From procurement processes onwards, huge mistakes were made. A faltering registration system based on SMSes that never arrived, and confusion over vaccination sites and walk-ins. The initiative was lost early, and the execution has been lacking in urgency, is inconsistent, confusing, and oftentimes non-existent.

The era of post-truth is here to stay. Hyper-individualism has rendered shared truths and an objective reality a thing of the past. While both sides of this debate perceive the other to have been brainwashed, it is important that we find common ground on which to stand and work together.

* Dr Remy Daroowala is a medical doctor from the UK. He worked in rural hospitals in the Eastern Cape and KwaZulu-Natal before moving to Cape Town to work in Infectious Disease Research at the University of Cape Town. He founded www.mindful-medic.com, an online community to improve wellbeing and destigmatise mental health issues among healthcare workers.