We live in a strange and interesting time. Last week, the SABC did nothing to justify its incessant calls for TV licence payment when it gave a drama teacher from Plumstead 10 minutes of near-uninterrupted airtime to spew every debunked conspiracy theory under the sun into the microphone of a hapless reporter.
She was standing outside Groote Schuur Hospital, where I worked during the first Covid-19 wave. I felt my whole body tense up with fury. My compassion and understanding abandoned me and my mind was filled with unpleasant mental images. I started writing this piece as an exercise to try and find that compassion again.
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.
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.
The recent FDA and Sahpra approvals will do little to change minds that are already made up. As one accidentally self-aware critic of vaccines noted, “If you think the vaccine-hesitant are going to feel reassured by the FDA’s approval you have no idea how much research they have done.”
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.
Science by its very nature is open, debatable, and falsifiable but to a sceptical public, this nature appears as uncertainty echoing that of a government making up its response as it goes along.
This uncertainty has posed an unprecedented test for clinical research as noted by Adalberto Fernandes: “The risks of the pandemic increase the uncertainty of science and its communication. In turn, the uncertainty of science and its communication aggravate the risks of the pandemic.”
As a result, the perceived credibility of science has been challenged.
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% 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% of ANC supporters reported they would get the vaccine, while only 8% would not. In contrast, 20% of DA and 24% 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.
While those people are in the most part responsible for the information they consume and ultimately their health, we provide a service that makes them our responsibility too.
So, what does this mean for us as healthcare workers and how do we move forward in this new world?
As we communicate scientific information, we do so in an effort to decrease risk and uncertainty. In doing so, we generate other risks such as misunderstanding, producing competing and confusing information and worst of all, we may be seen to further objectionable political ends.
It is up to us as a profession, as those in a position of authority, to better relate to our public. The Einsteinian definition of insanity is doing the same thing repeatedly and expecting a different result. So, while we continue to quote the reputable studies and statistics to them, backed by real experts, it is not enough. It is important to realise that you cannot change someone’s mind by force. “He that complies against his will, is of his own opinion still.”
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.
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. DM
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"A successful coup ain't a treason." ~ Toba Beta
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