By Hayley Galitzer, MD
In less than a year, the medical community has gone from encountering a novel virus to developing 73 potential vaccines [1] one of which is now FDA authorized and two of which are under emergency use authorization. It is an astounding accomplishment. And yet, the current challenge is convincing a public increasingly skeptical of vaccines to get vaccinated. As someone who grew up as an “anti-vaxxer,” I did not receive my first vaccine until the age of 22. Now, as I recently completed medical school, I can confidently say vaccines are safe and that minds can be changed. By sharing my story, I hope to do my part to equip the medical community with a tool just as vital as the vaccine: the understanding needed to combat vaccine skepticism.
My father graduated from medical school and began his career in Emergency Medicine. However, as the son of two Holocaust survivors, mistrust of fascist authoritarianism turned into a misplaced mistrust of the medical establishment’s authority. My mother grew up in Texas in a time when women did not find themselves welcomed in medicine. Though her dream was to be a physician, she instead pursued Clinical Psychology. Grounded in their desires to heal, they found a home in the world of complementary and alternative medicine. Of course, they had plenty of reasons for their mistrust of vaccines or Western medicine. My parents are smart and can defend their beliefs as well as anyone. However, the benefit of being their daughter is that I know that their early emotional experiences informed how they view the world.
Upon entering medical school, not only did I need an education, but I also needed a re-education of what my parents had taught me. In their morality play, doctors and “Big Pharma” play the role of bogeymen who care only about money and status. I learned that it is often quite the opposite. The doctors and nurses I worked with were passionately committed to helping others, sometimes at the expense of their own needs. Every day forced me to not only confront what my community taught me, but to think about how and why we form our beliefs. Fortunately, I was lucky to benefit from incredible mentors both within medical school and in the latest neuroscience and psychological literature. Figures like Kahneman, Haidt, Damasio, and Nisbett became companions in my own research, or rather, me-search. Furthermore, while they were personally helpful to me, I believe the tools they offer are vital to physicians’ work everywhere as the vaccines have become available.
The first lesson I learned is not to argue patients out of their beliefs. Doctors are dedicated to ensuring therapies are evidence-based. Naturally, it can be frustrating to deal with an endless stream of misinformation. In practice, people are not very good at understanding complex fields like medicine. Anti-vaccination advocates have succeeded because they better grasp people’s fears and anxieties. They know how to exploit mistrust and expand it. The misinformation is the symptom. The disease is the fear and anxiety that breeds mistrust. We need to deal with the root of the issue.
Thankfully, it is much easier for doctors and patients to connect on values than to connect to data. That is because whenever doctors and patients come together, they already share a primal desire: human health. When patients come in expressing fears about vaccines, they are not making claims about epidemiology. They are trying to put their fears for their loved ones’ safety into words. The vast majority of doctors have devoted their lives to medicine and took the Hippocratic Oath because they care about people’s health and would never want to harm. By affirming and celebrating how much the patient wants to protect their family and agreeing with it, physicians can become allies in that quest. That is why the second most important is to start with affirming shared values. This builds trust and creates the bandwidth to discover with patients why getting vaccinated is one of the safest, most effective ways to live their values. In not asking patients to respond to the medical science evidence immediately, doctors choose to respond to the evidence of how we all think.
In The Happiness Hypothesis, Haidt sums up the research on how humans form beliefs by comparing the mind to a rider on top of an elephant [2]. The elephant is the emotional, reactive part. It is large, lumbering, and it goes wherever it pleases. The reflective, reasoning part of our mind sits atop that elephant like a rider. It is weak and can nudge the elephant, but only with patience and persistence. This is precisely what doctors and nurses did for me. They did not argue with what my parents had taught me. Mostly, I kept that secret. By demonstrating their compassion day in day out, they nudged the elephant in my brain in a different direction. My rider came along for the ride. Doctors do not necessarily need to get better at communicating epidemiology. They just have to show how much they care.
Given how quickly and politicized the vaccine development and roll out have been, concerns about the safety of the Covid-19 vaccine have more validity than the misplaced concerns of the MMR vaccine. The medical establishment will need to not only use our riders to examine the evidence of how safe and effective these vaccines are, but we will also need to use our elephants to connect with patients on the shared values that build trust. When people feel emotionally safe and connected, we drop our defensiveness and become open to change.
Having had my mind changed, I have begun applying these insights with my own family. Instead of attacking their beliefs, I have begun affirming their underlying values, which we share. The other day I had an open conversation with my brother who like my parents has also been an anti-vaccination advocate, about Dr. Paul Offit’s work and the very low rates of vaccine side effects [3]. I am also pleased to say that surprisingly after all these years, my mother is now enrolled in an MD program to pursue her original dream. I look forward to our future conversations on vaccine hesitancy.
Dr. Hayley Galitzer is a former student of NYU Grossman School of Medicine and a 1st year resident at Stanford University School of Medicine
Image courtesy of Wikimedia Commons, Source: https://www.flickr.com/photos/prefeituracampinas/51232761419/
Author: Prefeitura Campinas
References
- World Health Organization. Draft landscape and tracker of COVID-19 candidate vaccines. Accessed February 24, 2021. https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines
- Haidt J. The Happiness Hypothesis: Finding Modern Truth in Ancient Wisdom. Basic Books; 2006.
- Offit PA, Moser CA. Vaccines and Your Child: Separating Fact from Fiction. Columbia University Press; 2011. https://www.universitypressscholarship.com/view/10.7312/columbia/9780231153072.001.0001/upso-9780231153072