What COVID vaccine uptake has taught us about making impact with science.
Throughout COVID we have had the chance for an ongoing, unplanned, uncontrolled experiment about how science is used and makes impact in communities and with decision-makers.
While it is an experiment that none of us wanted to be a part of, as a nerdy scientist and a practitioner of science impact I can’t help looking for patterns and drawing (likely untestable!) conclusions from this massive uncontrolled (and unexpected) experiment.
I’m sure there are a small legion of social and other scientists submitting grant applications currently to do some real (and evidence-based) research into what has come from this unplanned experiment. As they do some of the real science, I will offer three (completely untested) reflections on the process of science being used in the COVD response.
All three relate to recent public conversations about vaccine uptake.
As we know, vaccine uptake is essential to getting us all into a safer COVID-normal world. We now have a broad discussion of this seemingly new phenomenon (at least at the large scale) of ‘vaccine hesitancy’.
Vaccine hesitancy is different to anti-science anti-vaxxers and seems more like a scepticism – a kind of “I’ll just wait until you prove to me why this one is safe”. As a scientist I note that this is pretty much what we do – we want the evidence before we move onto the next step.
So, in this context, my three reflections about what is happening with science in public discourse I’ve called:
1. The Sausage-making effect
2. Relative risk is crazy hard stuff
3. Things will always go wrong.
Each of these describe activities that are core to how we do science and the fact they are all on very naked display globally is only a healthy thing as long as we scientists own them and tell stories to explain why this is normal. Keep Calm and see science being done live!
1. The Sausage making effect is all about the fact that I love sausages, but don’t want to see them being made…
Urgh! It doesn’t matter whether they are meat filled or meat-free doesn’t, if you get to see sausages being made you can’t unsee that. And you look at your next bratwurst differently.
This is exactly what is happening with the vaccine rollout. The vaccines are produced under strict evidence-based processes, they are tested and rolled out and as more people use them new information emerges confirming some ideas and debunking others – and all of this is normal, adaptive science. It takes time normally. As we learn more over time, we change what we thought.
Science is about proving things that we currently think are true are actually wrong.
[I don’t want to offend my science historian and philosopher of friends so I will note here that what I’m about to say is a very simple discussion of a very nuanced and challenged perspective. As Einstein once reportedly said (albeit likely in German) … if you want to know how to do science, don’t ask a scientist, watch them (he said him) do it. Many scientists think they do one thing but actually do something quite different. If you want to know about this side note, check out how the work of Michel Foucault has impact theories of knowledge and analyses of how science gets done. But back to Karl Popper, and ‘empirical falsification’… or as we know it constantly trying to prove things that we believe to be true, are in fact wrong…]
Anyway – what we do is debate, argue, disagree, and try to break and disprove things over and over again. That is how we get science done. Now, when that happens in a lab behind closed doors between consenting adults that is one thing. When it happens every day in public about one of THE most important issues currently facing humanity (i.e., what vaccine is best for me?), this is very messy.
In general, we humans don’t like uncertainty (see below); we don’t like instability. So, the whole idea of seeing and hearing about some of these vaccines working for some, not working for others, having new and previously unknown side-effects is a challenge to all our comfort.
Personally, I want to know that the one I get has been tested lots and so every time I hear of a new side-effect (and its risk), I rejoice. I have more data to make an informed choice. But I’m a scientist and that is how we work. Remember, I look for proof that what I knew yesterday to be true is what I now know to be wrong.
What can scientists do about the sausage-making effect?
Talk about it. Talk about your comfort with this being how we do science, that new data and information will always change a view. That we need this to continue to know we are making the right calls. Help decision-makers understand this, and not be scared by, or exploit it. For more on decision-making and COVID, see my blog from last year. In short, we need to enable our decision-makers with the words to be brave and own the process of science. And understand that better decisions have evidence behind them.
2. We humans don’t get risk!
The whole notion of relative risk is seriously hard for scientists, let alone non-scientists.
This is best evidenced by the fear people have for sharks, but not mozzies (which are 125 000 x more likely to kill you globally, hippos (83 x more likely to kill you), or dogs (5800 x more likely to kill you). If you were in Australia in the period 2001 to 2017 you were 6.4 times more likely to be killed by a horse, 3 times more likely to be killed by a cow (see this paper for more about killer cows), even 1.3 times more likely to die at the hands (or feet) of a kangaroo than a shark! Let’s not even start comparing the stats for death from accidents in the family car. And one last amazing one… if you live in the USA, you are AS LIKELY to die from badly wired Christmas tree lighting as a shark.
We don’t see people running screaming from cows, cars or Christmas trees! But we do see people running from the water if someone yells ‘shark’.
Again, there is lots of science and psychology behind this and I’m simplifying it, but we are just really bad at assessing risk. Risk is maybe up of two things: the consequence (i.e., what happens to you) AND the likelihood (i.e., the chance of it happening).
As humans we seem to focus on the consequence bit and get surprised or confused when we are exposed to the likelihood bit.
A great example is the global discussion about the vaccine types using adenoviruses like the Oxford/AstraZeneca or Johnson & Johnson varieties. People are rightly concerned about a particular type of blood clotting. It is a real side-effect. However, if people get COVID they are 10 times or greater more likely to get this clotting (and die) than from the vaccine. Relative to other activities, people are very safe taking this vaccine – thanks to the BBC for this graphic:
Some have tried to show in simple terms what the relative risks of clotting are from different activities like smoking or taking the birth control pill.
While this compares “clotting” be careful as the clotting is not the same type. This image has swirling around social media and while it shows verifiable stats about clotting, not all clots are the same. Read this review from health professionals in California about this image. See we scientists will always pursue complete context and informed decisions based on robust evidence – even if it is for science infographics.
The point is that we humans are not good at assess the risk of most of the things we do!
We either don’t think about relative risk, we don’t care about it, we have been habitualised to the activity or maybe we don’t know about the chances of the harm we face. This is completely normal but it sets us up for poor judgement calls when there is conflicting commentary and information. This is especially true when the messy business of science is happening in front of us, live.
3. Finally, things will always go wrong.
One thing that all scientists know if that if something can go wrong when you are doing science, it will go wrong. While scientific journals are full of stories of final experiments and results, what they don’t often have is the journey of failure to get there. They don’t describe all the things that went wrong in the first, second or tenth test is as vivid detail as they do the final experiment.
Don’t get me wrong, no one is hiding anything. They have controlled for the failures, changed designs, changed approaches, and made sure the sources of error have been tested
and covered. They have built all of that into their experiment. What they don’t talk about is that it took 10 months of finding out the new things that can go wrong and building them into the final published results.
We all know science is about getting things wrong – we try to prove things wrong all the time. To control for this we plan. We plan everything out. We test something here, something there. We look for things to break, or not work, or go wrong.
So when the first attempt fails we try a different dose, or size, or shape, or color, or whatever… and try again. The best planning willl lead to find out more things that need planning for next time.
When it comes to vaccine rollouts on a global scale, this is an uncomfortable truth. I’m not talking about better designed logistics programs – people have been carrying something from point A to B for 1000s of year – we should be able to do that well (better?).
I’m talking about science being done in public and not working as hoped. As with the sausage-making this is what we want to happen so we improve the science. As scientists it is our job to bring communities and decision-makers along on that journey with us.
Science is a messy business…
When the messy business of science is happening in front of us, live, it is a chance to build understanding about how science works, about why we do science this way, about what we know, and what we don’t know. Unplanned mass social experiments are a boon for we scientists, science impact professionals and even science communicators.
Our job is to inspire trust in non-scientist everywhere – from members of the public to the most senior decision-makers. And as we do this we might inspire a child to pick up science and she might one day cure cancer, or he might find a new renewable energy source, or she might get more people access to clean water.
Sure, science might be a messy business but it is damn fun and when we find ourselves doing it in public, it is super important we tell the story of how and why we do it this way!
What reflections do you have about how science has made impact in this COVID world?