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Out of Order: Sausage-making
October 2020
by Randall C Willis  |  Email the author
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I admit that I am addicted to a delicacy found throughout downtown Toronto: the sausages grilled daily on hot dog carts.
 
Affectionately known as street meat or smog dogs, these amazing comestibles tantalize the taste buds with a heavenly combination of fat and spices. Whenever someone visits Toronto, I insist that I take them for a smog dog run as we sample the varied cuisine across the city.
 
That said, there is one simple rule on which I insist: Never look directly into the sausage.
 
Nothing good will come of anyone knowing what they are ingesting. Revel, I say, in the sensory pleasures of ignorance.
 
Although this intro could be easily linked to the Special Report on Metabolic Disorders found elsewhere in this issue, it instead connects to the challenges of practicing science and medicine in front of a live audience as organizations of all stripes struggle to develop a vaccine against SARS-CoV-2.
 
In late August, I was delighted to learn that the continent of Africa had been declared free of naturally occurring strains of polio, a virus that once paralyzed 75,000 children each year.
 
Despite needing to immunize more than 95 percent of the population to achieve eradication, international, African and local agencies somehow managed to achieve that incredible goal through campaigns as much community relations as clinical.
 
Closer to home, we all watch as organizations work to become the first to launch a vaccine (or more likely, several) for COVID-19 onto the market. Already, countries like Canada, the United States and the United Kingdom have placed orders for millions of doses of vaccines that haven’t yet completed testing.
 
And yet, at the same time that clinical organizations and health departments discuss who should receive the first doses off the line, the general public is starting to express a louder and louder ambivalence at the potential of immunization.
 
As reported elsewhere, a small group of U.K. citizens were asked in March if they would be willing to take a COVID-19 vaccine, and 80 percent reported they would. As May came to an end, that number had dropped to 67 percent.
 
Also in May, a poll of U.S. citizens suggested that only 42 percent would be willing to take the vaccine, whereas 27 percent confirmed they wouldn’t. The remainder were unsure.
 
If this were just down to the anti-vaccine movement, the trend would be disturbing enough, but it feels like we are losing ground with those communities that once accepted immunization.
 
Organizations like the Vaccine Confidence Project put onus on the growing prevalence and penetration of vaccine misinformation campaigns. This no doubt plays a significant role in public hesitation.
 
But I wonder if another factor isn’t also at play.
 
For possibly the first time in human history, the general public is seeing science performed live, in real-time, across all media platforms.
 
And as anyone who has worked in science knows, this is not the sausage into which you want to look unless you understand the bigger game.
 
Science is about evaluation, discussion and re-evaluation. Science is knowing you never have a complete answer and challenging any answer that arises.
 
Even though we are humans and this process can lead to personality clashes as often as scientific disputes, we generally agree to the ground rules and the ultimate goals.
 
To the general public, however, this uncertainty rankles at a minimum and terrifies in its extreme.
 
“If you so-called specialists can’t agree, why would I ever inject this stuff into my body?”
 
And this uncertainty is manna for those looking to thwart immunization efforts.
 
When we then add in political pressure, the situation only gets worse. Witness the 35 percent debacle surrounding convalescent plasma that centered on the concept of relative vs. absolute risk.
 
I have every confidence that the fundamental science is sound—we can argue the nuances and details—but the public-facing messaging has been fumbled (and possibly corrupted) time and again.
 
Africa did not eradicate endemic polio because the science was good. It eradicated it because the messaging helped clinicians and advocates overcome inherent fears and distrust. It related to patients on their terms, not the scientists’.
 
The COVID vaccine situation will be a similar challenge only amplified by several magnitudes.
 
Educating the public in terms meaningful to them is important, but for much of the developed world, this is less about ignorance than it is about risk aversion. In uncertain times, people seek certainty and the percentage of people willing to be early adopters shrinks dramatically.
 
Looking into the sausage that is science hasn’t helped, but it is our reality and we are going to have to adjust.

Randall C Willis can be reached at willis@ddn-news.com

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