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Heidi Larson: I remember hearing some of the first calls to industry to stop the noise, and my first instinct was what are we shooting the messenger, here? I mean, let's look at where the roots of dissent are coming from. It's human emotion. People are angry. People are upset. People have issues, and they're channeling it through these things. So, you're going to blame the platforms?
Taylor Owen: Hi, I'm Taylor Owen, and this is Big Tech.
[CLIP]
Becky Quick: Welcome back to Squawk Box, everybody. We have some breaking news from Pfizer. Meg Tirrell joins us, right now. Meg, good morning.
Meg Tirrell: Good morning, Becky. This is the news that we've been waiting to hear.
SOURCE: CNBC Television YouTube Channel https://youtu.be/mMrJSllDoPc
“Pfizer, BioNTech announce Covid-19 vaccine candidate is 90% effective”
November 9, 2020
Taylor Owen: After nearly a year of waiting, the vaccine, or vaccines, to be precise, have finally arrived.
[CLIP]
David Muir: Tonight, news on a second vaccine. Moderna announcing its vaccine is nearly 95% effective.
SOURCE: ABC News YouTube Channel https://youtu.be/qYfEvNEBBIs
“Moderna announces COVID-19 vaccine breakthrough | WNT”
November 16, 2020
Taylor Owen: Developing a vaccine like this in less than a year might be the scientific achievement of the century. But now, we face an equally epic policy challenge, which is how do we actually convince enough people to take it? Some surveys have found that, in Canada, the UK, and the US, fewer than 60% of people say they'll take the COVID vaccine. But Anthony Fauci says that number needs to be between 75% and 85% in order to achieve herd immunity. If we want to put an end to this thing, that gap is going to be a big problem. Particularly, since our information ecosystem is so fragmented, and full of misinformation. Last week, I was driving with my seven-year-old, and we went through an anti-vax protest. Middle-aged guy had a sign that said, "My body, my choice." Another woman warned that Bill Gates was going to inject us with microchips. My response to this scene, a year ago, would have been one of anger and disbelief. How can these people believe this stuff, when it's so obviously, objectively false, and dangerous? But, Heidi Larson thinks that's exactly the wrong reaction to be having. Heidi is a celebrated anthropologist, and the author of a new book called Stuck: How Vaccine Rumours Start — and Why They Don't Go Away. She may be the world's leading authority on vaccine hesitancy. Heidi argues that vaccine rumours, even the most ridiculous and dangerous ones, almost always stem from legitimate concerns. Vaccines are complicated, and Heidi says they require trust in some big institutions: the government, the scientific community, and the pharmaceutical industry. If trust in even one of these is breached, you're going to have a real problem convincing people to get vaccinated. And right now, trust in all three is precarious. Trump has degraded trust in government agencies, the opioid crisis has eroded trust in Big Pharma, and science is under attack. And, here's the thing, with this particular situation: there is real ambiguity, here. There are dozens of vaccines, each with different risks and potential effectiveness, all developed at breakneck speed, and some using new technologies. There is no one answer to who should take what, and when. It's rare that you read something, or hear something, that legitimately changes your thinking, but that's exactly what happened when I read Stuck, and when I spoke to Heidi. And I hope our conversation changes your thinking, too. Our ability to navigate our way out of this pandemic depends on it. As always, if you enjoy this episode, please subscribe. Here's Heidi Larson.
Taylor Owen: Heidi Larson, welcome to Big Tech. I can't even imagine how crazy things are for you, right now, so we really appreciate you being here.
Heidi Larson: It's a pleasure to be here.
Taylor Owen: I actually wanted to start with the very first words of your book, which really, really struck me as sort of saying something about the place you're coming at this debate from. I was wondering if I could ask you to read the first two sentences of the book, in the acknowledgements.
Heidi Larson: Certainly. "My views have not always been welcome, as they question some of the modus operandi of the public health community, and give voice to some of the uncomfortable concerns and questions, expressed by the public, that I feel we, as a scientific and public health community, need to hear."
Taylor Owen: So, you say your views haven't been welcomed. What element of them hasn't been welcomed, and what's the orthodoxy that you're pushing against?
Heidi Larson: Well, the one that I hear, still, less than I did in the beginning, was a sentiment that, if you talk about these issues, it makes them worse. In my view, it's all about how you talk about these issues, and concerns, and questions. If you approach them as more of a listening in an empathetic way, and trying to understand them, I think that's very different than just putting on the screen somebody's big, negative concern, and amplifying it. It's very different than the kind of approach I'm promoting.
Taylor Owen: Yeah, and I definitely want to dive into that, a little bit, in a moment, but I was wondering if you could, first, start with some of your core principles that seem to flow through the book. And one is just the idea of a rumour.
Heidi Larson: Yeah.
Taylor Owen: You often don't hear the misinformation debate, and disinformation debate, cast in that way, as rumours. But, you say that rumours have a story to tell, which really struck me. So, first, I guess, what is a rumour?
Heidi Larson: Well, a rumour, by definition, is an unverified piece of information. I often say, in some of my lectures on this, that rumours have a bad reputation. You tend to write them off as being wrong, or misinformation, but, actually, it's just... It's the early signal of something, and it can become true, it can become verified, and it can wither and die, or it can stick, even though it's not correct. And, as I talk about in the book, I mean, in the basement of the World Health Organization, there are rumour archives. And rumours were an incredibly important source of information during the smallpox eradication initiative. So, they can be really important signals, but even in outbreak detection, I mean, around Ebola, you wanted to hear community rumours, because it could take you to a new outbreak. The problem is that the amount of false rumours, negative rumours, is kind of flooding the landscape. So, it's making the whole rumour issue a bit more volatile.
Taylor Owen: I mean, is rumour, then, still a useful category, or is it just too broad? So, if it encompasses everything from full-on disinformation and conspiracy theories, promoted to cause political upheaval, through to a family, just trying to figure out how to deal with a vaccine, and when we're looking to try to... how to push back and stop some of these problems, is rumour a useful frame? Or do we need to go deeper into the sub-categories of parody, and political division, and financially motivated, and... Right? Like all the different sub-classes?
Heidi Larson: I think rumours are a really useful framing, because, I mean, the framework that I've developed with my team, that we use, is looking at the triggers. What triggers a rumour? What amplifies it? What's the fertile ground, and what are the potential impacts? What are the risks? Because we've seen that you can have two vaccine rumours, for instance, in two different settings, exactly the same rumour, and they play out totally differently. And it all has to do with the fertile ground around it. And some of the factors that we look at is, was there a previous concern, or issue with a vaccine? Was there something else that broke trust between the public and the government? Because these help us understand, as we give advice to governments, or local leaders, how much they should worry about a particular rumour.
Taylor Owen: So, from that perspective, what does it tell you, when the Bill Gates rumor about COVID being an attempt to plant microchips in people's heads, I mean... What does that signal about our information ecosystem?
Heidi Larson: Well, to me, I take it as a... It's much more about people's anxiety about being counted. People's anxiety about being tracked, about being watched, about being monitored. And, frankly, in a way, less about Bill Gates. It could be governments. But I think it does reflect issues around motive, anxiety about being controlled. Publics are, particularly marginalized ones, but also ones that are more libertarian, are more... It matters more to us to have freedom and choice, and we'll compromise our health for that.
Taylor Owen: Which points to the other core theme, here, which seems to be trust, and trust in all sorts of actors, and why societies might evolve in how they view different communities, and different actors with power over their lives. You write about different institutions that have different levels of trust, at the moment: the scientific community who develops the vaccines, the business that creates them, the public health authorities that distribute them, and the governments that ultimately sanction and oversee them, and govern them, and hold them accountable. Can you just run through that typology, almost, and why we are increasingly distrusting all four of those, which is pretty remarkable. It's almost a perfect storm for this problem, isn't it?
Heidi Larson: Yeah. It's because of those different domains, and characteristics about how we get a vaccine that, I think, has made it so vulnerable to the situation it's in. Because, a lot of people say, why a vaccine? Why not soap? Or, why not something else, you know? What is it with vaccines? And I've really spent, well, years trying to understand what is it about vaccines, aside from the fact that it's a needle going into a healthy baby, or a healthy person, that just viscerally gives you a reaction, sometimes. But what else... What is it? And it, really, after all the listening that I've done in communities, or through social media, or whatever... These are the kind of anxieties and concerns people have. "Big Business is trying to make money off of us." "The government is trying to count us, or control us." "The scientists," you know... Scientists, actually, in that collection of people, still have a bit more trust than, certainly, government or Big Business. Media is another group that, interestingly, these days, we see less trust in social media. I think that people were less discriminating about social media in the honeymoon days, when we were just kind of thrilled by the novelty of it.
Taylor Owen: Incidentally, we do a lot of work on the Canadian media environment, and trust in it, here, and... Trust in traditional media still is incredibly high, in Canada, which... It'll be interesting to see how that... And in government institutions. So, I mean, it's going to be very interesting, I think, to watch different countries, as they roll out the vaccine, how those different trust levels in those groups play out with adoption rates. I mean, I imagine that's something that's central in your mind, right now.
Heidi Larson: Yeah. Yeah, I mean, to me, it's the ultimate litmus test at multiple trust levels. Because, as I say in the book, I don't think we have a misinformation problem, as much as we have a relationship problem. And that the misinformation, in a sense, is kind of a symptomatic of not trusting, in any of those domains.
Taylor Owen: That trust that Heidi is talking about? It's a fickle thing. So, it's not hard to see how big, catastrophic events, like the 2008 financial crisis, or the opioid epidemic, may have impacted the way the public views government, or Big Pharma. And, sometimes, that breach of trust is directly related to vaccines.
[CLIP]
Jeff Glor: A report out, this morning, describes a CIA operation right out of a spy novel. The New York Times says...
SOURCE: CBS YouTube Channel https://youtu.be/kDp2v59zmIE
“CIA tried trickery to get bin Laden DNA: reports”
July 12, 2011
Taylor Owen: At one point, in her book, Heidi talks about how the CIA used a fake vaccination campaign to try and find Osama bin Laden, in Pakistan.
[CLIP]
Jeff Glor: The idea was to secure a DNA sample from bin Laden, or a family member.
SOURCE: CBS YouTube Channel https://youtu.be/kDp2v59zmIE
“CIA tried trickery to get bin Laden DNA: reports”
July 12, 2011
Taylor Owen: When the ruse was finally discovered, it gave credence to a wide range of conspiracy theories that the West was using vaccination as a military tool. In the next year, there were numerous murders of vaccine workers. Heidi has countless examples like this in Stuck, going all the way back to the 1800s. The distrust in this space is not new, but there is something that seems different, this time around.
Taylor Owen: So, something that really jumped out, to me, was this connection, this visceral connection, between this distrust and political populism, right now.
Heidi Larson: Oh, it's huge.
Taylor Owen: How on Earth did... Was that always the case? It doesn't seem to me, in your other examples, that was really the underlying spark, but it seems to be, now. So, how did these populists decide that this was going to be their cause?
Heidi Larson: Well, I think the populists saw how polarized this topic had become. And the thing that triggers a lot of the tension is, often, around mandates, about requirements. Which, the original... The very first anti-vaccine league, in the world, was in the UK, in the 1800s. And that was totally sparked by the government putting a mandate, a requirement, on the smallpox vaccine. And the smallpox vaccine... There were people who said, "This is against God's plan," the way it intervenes. So, these tensions go way back. And I think the populists, often, are the ones who side with the people who don't want the government controlling. So, it's been, really, around these issues, where there have been, you know, "Let the people be heard." And a lot of the anti-vaccine narrative is listening to the ones who feel unheard.
Taylor Owen: Hmm. Have you been surprised by the political saliency of these arguments? I mean, knowing they've been around, it doesn't seem like they've actually allowed people to rise to power, in the past. But, now, you're seeing that, right? Where this is embedded in the narrative of, now, governing parties.
Heidi Larson: Well, I think it also reflects the hyper-polarized moment in political history we're in. It's found a fertile ground. I mean, it's a perfect fertile ground factor, and it's fallen right into that.
Taylor Owen: Yeah. I mean, it's remarkable, and kind of terrifying to see, to be honest, but so representative of the moment we're in, in all sorts of ways, I guess. Not just about this issue.
Heidi Larson: Yeah. Unfortunately, with health implications.
Taylor Owen: Right.
Heidi Larson: Yeah. It's not just about principles.
Taylor Owen: Yeah. Yeah, and that's, certainly, the case with the trust of the scientific community, too. And I wonder if... I mean, reading your description of how science communication, and how we talk about science, has changed, struck me, as well. When you said that "the personal stories and emotional testimonies have become the new landscape of evidence, with highly emotional videos trumping dry, scientific press." And, does that just go against, fundamentally, the scientific process, which is this highly evidentiary process, and form of knowledge production, that is being challenged by this new epistemology, almost?
Heidi Larson: Well, in a way, it gets back to the roots of evidence. I mean, evidence, historically, was testimony. Was seeing it. And, in a way, we're going back there. I think we've gone into such specialization that we've gotten farther, and farther, away from the person. I mean, the old family doctor knew families, knew the community, had a relationship there. Had time for a conversation, outside of just giving you whatever drugs or vaccines you need. And we've become so process-oriented, and so number-counting. And, also, we have so many more, aside from a growing population, so many more health interventions. A lot more of that. That's the other part. There's a lot more vaccines. So, I think it's perfectly legitimate for people to have questions. But I do think that... You know, in the beginning, science was the great liberator from religious dogma. It allowed freedom of thinking. But now, I think, a lot of publics are seeing science as, kind of, the new dogma. I mean, listen to the evening news. Well, at least, here. It's like, "The science says..." And it's charts, and arrows, and graphs, and... What about people? What about the people, and the feelings, and the emotions, and the anxieties, and the...? So, I think, we've got to come back to centre, in a way, and, I think, listening, and being open to those conversations... We need to get back there, because the direction we're going is not helpful.
Taylor Owen: Yeah, that binary is dangerous, right? When we have-
Heidi Larson: Yeah. Yeah, and we have so many binaries going on, right now. It's-
Taylor Owen: That's for sure. That's for sure.
Heidi Larson: Got to kill the binaries. Yeah.
Taylor Owen: That takes us nicely, I think, to the platform aspect of this conversation. And, part of it is, we can, now, see this conversation that's happening, because it's happening in public, in a way it wasn't, before. Your project, your work, monitors these conversations on social platforms. But, I mean, I have to say, I was a bit struck, in your book, by where you land on the role of platforms. That, correct me if I'm wrong, but you seem to be making the case that these are fundamental human traits, and understandable behaviours that have happened throughout history. But, I'm wondering if there is anything different about this environment, right now. So, when you look at the structure of social media platforms, and the way information flows on them, and what content is amplified, what kind of behaviour is incentivized, do you see those structures as changing the nature of the problem? Or is it just a continuation of the same thing we've always experienced around these kinds of topics?
Heidi Larson: No. I think the platforms have dramatically altered the nature of that. I mean, I do say that, and I do believe, that Facebook could shut down their whole business tomorrow, and these sentiments would not go away. They'd find other platforms. They'd find other ways. I mean, I remember hearing some of the first calls to industry to stop the noise, and it's their responsibility, and it's their fault. And, I remember, my first instinct was what are we shooting the messenger, here? I mean, let's look at where the roots of dissent are coming from. It's human emotion. People are angry. People are upset. People have issues, and they're channeling it through these things. So, you're going to blame the platforms? On the other hand, I realize, if it was only the messenger, delivering a message that somebody else had written to somebody else, like the mailman, that's one thing. But this is different. It's like the mailman getting one thing in his bag, but he goes off and he photocopies it a million times. And then, everybody gets the same one. So, there is, absolutely, a dangerous amplification risk in these platforms. And, that's why... And I spend a lot of time in conversations, and advising, with these platforms, and doing collaborative research with them on this, how to reign it in. Because, the idea of just going, and them, kind of, deleting just the misinformation, when the worst stuff is not even explicitly misinformation. It's seeding doubt, it's seeding dissent, it's making people question. And you can't take that down. You cannot delete doubt. Legally, ethically, or other.
Taylor Owen: So, what do you make of their, Facebook, banning anti-vax content? Do you think that will make any difference?
Heidi Larson: Well, that particular announcement was about ads. So, I mean, I think, to the extent that there is something that's explicitly discouraging something that can save people's lives, I applaud them for making a harder... Because, they've been spending a lot of time trying to know how far they can go, without having others attack them for being an authoritarian censor. But, I think, in addition to that, at the back end, there's a lot of other murky space that has serious potential harm, but not upfront, explicit harm, that, at a minimum, you need to reign in how it's amplified and replicated.
Taylor Owen: Yeah. I think this speaks so well to the broader platform governance debate, for lack of a better term, that... And, I often find, that whole conversation about how government should regulate platforms gets distracted by the individual, bad thing, right?
Heidi Larson: Yep.
Taylor Owen: The individual bad actor. The clearly egregious post that goes viral. The toxic piece of content. When, really, what we're talking, here, is about incentives, and structure, and design of the system itself. Of the technology, and about the economic model that underlies it. And so, that, in my world, sort of brings me to the need for governments to change those incentives, because those incentives probably aren't going to be changed by the private sector, alone. Do you get to a similar place? Do you think that some of these, if it is things like amplification of grey content, or recommending people into anti-vax groups that otherwise wouldn't be interested in it, and these kind of structural problems, do you think there's a role for government to actually change those incentives?
Heidi Larson: Well, it all depends what country you're in. I mean, the US is quite anti-government-control, kind of, sometimes, at a fault, when it comes to a pandemic. And then, you have other places. I mean, I've been living in Europe. It's a very different relationship with government. Much more of a sense of expectation from government. A sense of entitlement that government would, of course, take care of this. And, I mean, the UK is a bit, somewhere, on an island between the two. Physically, and-
Taylor Owen: In many, many ways.
Heidi Larson: ... in many ways. But, yeah. It's challenging, and it's... You need to find a line, in there. But I do think that I would get off that focus on misinformation, because I think that's not going to deal with this problem.
Taylor Owen: Just, last point on this. In your work with the companies, do you see them making some of those more structural changes to address this problem? How do you judge their response?
Heidi Larson: Oh, absolutely. I mean, yeah. They're definitely looking at the back end of this amplification. But, a lot of it has had to be on more of a case-to-case basis, with some parameters, because this is a kind of a new area. I mean, they've been dealing with it, a lot, with other hate, and violent extremism, and others. So, this topic-
Taylor Owen: Like anti-Semitic speech, right, has been the one they've used as their model for this.
Heidi Larson: Yeah. Yeah. I mean, there are, unfortunately, relevance across these things, so they have been looking at that, but it's not as straightforward as a lot of the officials... It's not like you flick a switch, and it's going to change that way.
Taylor Owen: I mean, that gets us to the final thing I want to talk about, which is how we're going to respond, from a policy perspective, to this need for people to take a vaccine in enough numbers to make it work, in the next year, or two. This is the dominant policy challenge of our era, right?
Heidi Larson: Yep.
Taylor Owen: We have a potential solution to this global catastrophic event, and we don't know-
Heidi Larson: Or three.
Taylor Owen: Or three, or five...
Heidi Larson: Yes.
Taylor Owen: Which is part of the problem, right? Because they're all going to have different complexities to them.
Heidi Larson: Yeah, yeah. Exactly. Exactly. Yeah.
Taylor Owen: So, you have this potential solution, but in Canada, now, only 60% of people are saying they'll take the vaccine.
Heidi Larson: Yeah.
Taylor Owen: Right? And it's lower in other places. And, obviously, there's lots of reasons for that, but that goes directly to your point that this is a really complicated, social, political problem. And, I guess, some of the solutions are very long-term. They're not how do we flick a switch, like you say, and solve this problem. So, how should the policy community address this? Because they need to flick a switch, right? They can't spend 10 years changing cultural attitudes towards institutions, or trust in their governments, or... Right? So, how do you reconcile that tension, there? Or can they? Or is that where they should be focusing their attention, right now?
Heidi Larson: Well, I think, we couldn't have a more incredible opportunity to change that dynamic than we have with COVID. If we get this right, with the COVID vaccine, in terms of using it as an opportunity to build trust with people, to be concerned, not just about them getting a jab in their arm, as they call it here, but to actually, in the context of saying, "How are you doing?" You know, "This has been a tough time." "What are some of your other health needs?" You know, "We think the vaccine," I mean, "We've got a great vaccine. This is an opportunity for you." I think we have to position it as an opportunity for people, not a requirement. And, actually, I think we need to do... really get people to understand the gravity of COVID. I mean, as an illness, we are just in kindergarten, when it comes to understanding how serious, complex, and long-term this illness is. I mean, we are just on the edge.
Taylor Owen: That seems to be so important, because, as you point out, there's this risk paradox people face with vaccines, right?
Heidi Larson: Yeah.
Taylor Owen: That, because they've been successful in the past, we don't see the downside risk of measles. Right? So we have nothing to compare our risk against. But here, we kind of do, right? We're all, in theory, seeing the risk of having COVID. So, is part of it communicating that? Or are we still in denial about that?
Heidi Larson: Yeah, absolutely. I think we need to... That needs to be part of the explanation. This is not the flu. This is not something that you get sick for a couple weeks, or even three weeks, and then you're done. This, even for mild cases, we're seeing longer term heart conditions. We're seeing a whole... Multi-organ issues. We haven't gotten the whole picture, at all, yet.
Taylor Owen: But I wonder, if it is such a big problem, and the evidence shows that this is the solution, do you think we should be talking about mandating it? Or will that just have so much negative spillover that it's not worth doing? I mean, we've mandated vaccines for less harmful things, in the past. Right?
Heidi Larson: Well, I think, you don't move into a mandate, unless you're ready to deliver. I mean, unless you really have systems in place, enough vaccines. I think, the most that you can do is, maybe, require it in certain settings. We don't have a situation where we have enough vaccine for enough people to mandate it in any kind of large-scale way. So, I think, it would have to be very setting-specific, but, ideally, we don't have to. Usually, mandates are kind of a route of last option, when people aren't taking it. I'd go much more with the narrative of, "This is an opportunity."
Taylor Owen: Yeah. And so, with that in mind, and knowing everything you do about the level, and nature, of people's skepticism, and reluctance, how confident are you that enough people will actually take it, for this to work in a large-scale way?
Heidi Larson: I want to be hopeful. I want to have some optimism. And I think that, right now, if we're on it, we've got time. If we sit back, and don't pay attention to what's really going on, we're missing a huge opportunity. So, I think we can, but we need to make a serious investment of time, and of engagement, now, before we have whatever vaccine we have. And we need to talk a lot more about the platforms that these new vaccines are being made on, the different types, the different dosage, because people don't know. They are hearing there's a fast race to quickly get one vaccine that's going to save the planet. I mean, that's, kind of, the headline narrative. Nobody is talking about why it's faster, and the fact that it is faster because we have new technologies, new platforms, new ways of working. This is not a short-cutted, old process. These are brand new processes. And I can promise you, from our work, that the publics are not just going to be asking about that vaccine. They're going to want to know what's in it, how was it made, which country it was produced in. They're asking deep questions, and we need to be ready for that.
Taylor Owen: Right, and have good answers to it, too. Right? I mean-
Heidi Larson: Yeah. Yeah.
Taylor Owen: We need to actually talk this through in an intelligent way.
Heidi Larson: Yeah.
Taylor Owen: Which governments, and the media, aren't always good at doing. Right?
Heidi Larson: No.
Taylor Owen: Last question, I guess. You talk a lot about the historical analogies, here. Are there any precedents for this kind of communication, and ways of intelligently speaking to populations about these kinds of complex scientific processes?
Heidi Larson: Well, I mean, I think we've introduced a lot of new vaccines, over the years, and the ones where we waited till it was ready to start talking about, have taken the longest time to get uptake. The ones that we've, kind of, tried to get people on board earlier, we've done a little bit better with. But, there's no precedent for what we have now. Not in the last century. Well, actually, ever, because in the last pandemic of this scale, we didn't have the opportunities that we have, now, to reign it in with new vaccines.
Taylor Owen: Thanks to science.
Heidi Larson: Thanks to science.
Taylor Owen: All right. Well, on that somewhat hopeful note...
Heidi Larson: Yes.
Taylor Owen: Thank you, so, so much, for this conversation. And, really, good luck with all your work. It's awe-inspiring.
Heidi Larson: Thanks. Appreciate it.
Taylor Owen: That was my conversation with Heidi Larson. Big Tech is presented by the Centre for International Governance Innovation, and produced by Antica Productions. Please consider subscribing on Apple Podcasts, Spotify, or wherever you get your podcasts. We release new episodes on Thursdays, every other week.
