Expertise, disagreement, and trust in vaccine science and policy. The importance of transparency in a world of experts
Article Sidebar
Main Article Content
Abstract
We discuss the relationship between expertise, expert authority, and trust in the case of vaccine research and policy, with a particular focus on COVID-19 vaccines. We argue that expert authority is not merely an epistemic notion, but entails being trusted by the relevant public and is valuable if it is accompanied by expert trustworthiness. Trustworthiness requires, among other things, being transparent, acknowledging uncertainty and expert disagreement (e.g., around vaccines’ effectiveness and safety), being willing to revise views in response to new evidence, and being clear about the values that underpin expert recommendations. We explore how failure to acknowledge expert disagreement and uncertainty can undermine trust in vaccination and public health experts, using expert recommendations around COVID-19 vaccines as a case study.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
By submitting his/her work to the Editorial Board, the author accepts, upon having his/her text recommended for publication, that Diametros applies the Attribution 4.0 International (CC BY 4.0) license to the works we publish. Under this license, authors agree to make articles legally available for reuse, without permission or fees. Anyone may read, download, copy, print, distribute or reuse these articles without asking prior permission from the publisher or the author, as long as the author and original source are properly cited. The author holds the copyright without any other restrictions. Full information about CC-BY: https://creativecommons.org/licenses/by/4.0/legalcode.
References
AAP (American Academy of Pediatrics) (2023), “Children and COVID-19 Vaccination Trends,” URL = https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/ [Accessed 12.01.2023].
ACE (American College of Epidemiology) (2000), “Ethics Guidelines,” URL = https://www.acepidemiology.org/ethics-guidelines [Accessed 12.01.2023].
Abrevaya J., Mulligan K. (2011), “Effectiveness of State-Level Vaccination Mandates: Evidence from the Varicella Vaccine,” Journal of Health Economics 30 (5): 966–976.
DOI: https://doi.org/10.1016/j.jhealeco.2011.06.003
Angner E. (2006), “Economists as Experts: Overconfidence in Theory and Practice,” Journal of Economic Methodology 13 (1): 1–24.
DOI: https://doi.org/10.1080/13501780600566271
Bardosh K., de Figueiredo A., Gur-Arie R., Jamrozik E., Doidge J., Lemmens T., Keshavjee S., Graham J.E., Baral S. (2022), “The Unintended Consequences of COVID-19 Vaccine Policy: Why Mandates, Passports and Restrictions May Cause More Harm Than Good,” BMJ Global Health 7 (5): e008684.
DOI: https://doi.org/10.1136/bmjgh-2022-008684
Balch B. (2022), “How Distrust of Childhood Vaccines Could Lead to More Breakouts of Preventable Diseases,” URL = https://www.aamc.org/news-insights/how-distrust-childhood-vaccines-could-lead-more-breakouts-preventable-diseases [Accessed 12.01.2023].
Bennett M. (2020), “Should I do as I’m told? Trust, Experts, and COVID-19,” Kennedy Institute of Ethics Journal 30 (3): 243–263.
DOI: https://doi.org/10.1353/ken.2020.0014
Bernstein J., Holroyd T.A., Atwell J.E., Ali J., Limaye R.J. (2019), “Rockland County’s Proposed Ban Against Unvaccinated Minors: Balancing Disease Control, Trust, and Liberty,” Vaccine 37 (30): 3933–3935.
DOI: https://doi.org/10.1016/j.vaccine.2019.05.093
Bramer C.A., Kimmins L.M., Swanson R., Kuo J., Vranesich P., Jacques-Carroll L.A., Shen A.K. (2020), “Decline in Child Vaccination Coverage During the COVID-19 Pandemic – Michigan Care Improvement Registry, May 2016–May 2020,” American Journal of Transplantation 20 (7): 1930–1931.
DOI: https://doi.org/10.1111/ajt.16112
CDC (Centers of Diasease Control and Prevention) (2021a), “CDC Reccomends Pediatric COVID-19 Vaccine for Children 5 to 11 Years,” URL = https://www.cdc.gov/media/releases/2021/s1102-PediatricCOVID-19Vaccine.html [Accessed 16.07.2023].
CDC (Centers of Diasease Control and Prevention) (2021b), “CDC Director Statement on Pfizer’s Use of COVID-19 Vaccine in Adolescents Age 12 and Older,” URL = https://www.cdc.gov/media/releases/2021/s0512-advisory-committee-signing.html [Accessed 16.07.2023].
CDC (Centers of Diasease Control and Prevention) (2023), “Child and Adolescent Immunization Schedule by Age,” https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html [Accessed 16.07.2023].
Collins H., Evans R. (2007), Rethinking Expertise, University of Chicago Press, Chicago.
DOI: https://doi.org/10.7208/chicago/9780226113623.001.0001
Collins, H. (2014), Are We All Scientific Experts Now?, Polity Press, Cambridge.
de Melo-Martín I., Intemann K. (2013), “Scientific Dissent and Public Policy,” EMBO Reports 14: 231–235.
DOI: https://doi.org/10.1038/embor.2013.8
Fisher L., Roberts L., Turner C. (2021), “Get Your Children Vaccinated Against Covid, Parents are Told,” URL = https://www.telegraph.co.uk/news/2021/09/13/chief-medical-officers-approve-vaccines-teenagers/ [Accessed 9.01.2023].
Fried C. (1974), Medical Experimentation: Personal Integrity and Social Policy, North Holland Publishing, Amsterdam.
Funk C., Kennedy B. (2020), “Public Confidence in Scientists has Remained Stable for Decades,” URL = https://www.pewresearch.org/fact-tank/2020/08/27/public-confidence-in-scientists-has-remained-stable-for-decades/ [Accessed 9.01.2023].
Giubilini A. (2021), “The Double Ethical Mistake of Vaccinating Children against COVID-19,” URL = https://blog.practicalethics.ox.ac.uk/2021/09/the-double-ethical-mistake-of-vaccinating-children-against-covid-19/ [Accessed 9.01.2023].
Giubilini A., Gupta S., Heneghan C. (2021), “A Focused Protection Vaccination Strategy: Why We Should not Target Children with COVID-19 Vaccination Policies,” Journal of Medical Ethics 47 (8): 565–566.
DOI: https://doi.org/10.1136/medethics-2021-107700
Goldman A.I. (2001), “Experts: Which Ones Should You Trust?,” Philosophy and Phenomenological Research 63 (1): 85–110.
DOI: https://doi.org/10.1111/j.1933-1592.2001.tb00093.x
Goldman A.I. (2018), “Expertise,” Topoi 37 (1): 3–10.
DOI: https://doi.org/10.1007/s11245-016-9410-3
Government of Canada (2023), “Covid-19 Vaccination in Canada,” URL = https://health-infobase.canada.ca/covid-19/vaccination-coverage/ [Accessed 12.01.2023].
Gur-Arie R., Jamrozik E., Kingori P. (2021), “No Jab, No Job? Ethical Issues in Mandatory COVID-19 Vaccination of Healthcare Personnel,” BMJ Global Health 6 (2): e004877.
DOI: https://doi.org/10.1136/bmjgh-2020-004877
Haines A., Donald A. (1998), “Making Better Use of Research Funding,” British Medical Journal 317 (7150): 72–75.
DOI: https://doi.org/10.1136/bmj.317.7150.72
Hardwig J. (1985), “Epistemic Dependence,” The Journal of Philosophy 82 (7): 335–349.
DOI: https://doi.org/10.2307/2026523
He K., Mack W.J., Neely M., Lewis L., Anand V. (2022), “Parental Perspectives on Immunizations: Impact of the COVID-19 Pandemic on Childhood Vaccine Hesitancy,” Journal of Community Health 47 (1): 39–52.
DOI: https://doi.org/10.1007/s10900-021-01017-9
Holton W. (2021), “The Danger of Well-Intentioned Deceptions from Public Health Officials,” The Washington Post, URL = https://www.washingtonpost.com/outlook/2021/09/19/danger-well-intentioned-deceptions-public-health-officials/ [Accessed 12.01.2023].
IEA (International Epidemiological Association) (2007), Good Epidemiological Practice, URL = https://www.yumpu.com/en/document/read/19409945/iea-guidelines-for-proper-conduct-of-epidemiological-research-hrsa [Accessed 12.01.2023].
Iacobucci G. (2021), “Covid-19: JCVI Opts not to Recommend Universal Vaccination of 12–15 Year Olds,” British Medical Journal 374: n2180.
DOI: https://doi.org/10.1136/bmj.n2180
Jamrozik E., Heriot G., Bull S., Parker M., Disease O.J.H.G.I. (2021), “Vaccine-Enhanced Disease: Case Studies and Ethical Implications for Research and Public Health,” Wellcome Open Research 6: 154.
DOI: https://doi.org/10.12688/wellcomeopenres.16849.1
JCVI (Joint Committee on Vaccination and Immunisation) (2021), “JCVI Issues Updated Advice on COVID-19 Vaccination of Children Aged 12 to 15,” URL = https://www.gov.uk/government/news/jcvi-issues-updated-advice-on-covid-19-vaccination-of-children-aged-12-to-15 [Accessed 9.01.2023].
Johnson R.H., Blair J.A. (1983), Logical Self-Defense, McGraw Hill, New York.
Jones K. (1996), “Trust as an Affective Attitude,” Ethics 107 (1): 4–25.
DOI: https://doi.org/10.1086/233694
Kennedy B., Tyson A., Funk C. (2022), “Americans’ Trust in Scientists, Other Groups Declines,” URL = https://www.pewresearch.org/science/2022/02/15/americans-trust-in-scientists-other-groups-declines/ [Accessed 9.01.2023].
Kitcher Ph. (1995), The Advancement of Science: Science Without Legend, Objectivity Without Illusions, Oxford University Press, Oxford.
DOI: https://doi.org/10.1093/0195096533.001.0001
Kitcher Ph. (2001), Science, Truth, and Democracy, Oxford University Press, Oxford.
DOI: https://doi.org/10.1093/0195145836.001.0001
Kitcher Ph. (2011), Science in a Democratic Society, Prometheus Books, New York.
Kloc M., Ghobrial R.M., Kuchar E., Lewicki S., Kubiak J.Z. (2020), “Development of Child Immunity in the Context of COVID-19 Pandemic,” Clinical Immunology 217: 108510.
DOI: https://doi.org/10.1016/j.clim.2020.108510
Kracalik I., Oster M.E., Broder K.R., Cortese M.M., Glover M., Shields K., Creech C.B., Romanson B., Novosad Sh., Walter E.B. et al. (2022), “Outcomes at Least 90 Days Since Onset of Myocarditis After Mrna COVID-19 Vaccination in Adolescents and Young Adults in The USA: A Follow-Up Surveillance Study,” The Lancet Child & Adolescent Health 6 (11): 788–779.
DOI: https://doi.org/10.1016/S2352-4642(22)00244-9
Krause P.R., Fleming T.R., Peto R., Longini I.M., Figueroa J.P., Sterne J.A.C., Cravioto A., Rees H., Higgins J.P.T., Boutron I. et al. (2021), “Considerations in Boosting COVID-19 Vaccine Immune Responses,” The Lancet 398 (10308): 1377–1380.
DOI: https://doi.org/10.1016/S0140-6736(21)02046-8
Kuran T. (1997), Private Truths, Public Lies, Harvard University Press, Cambridge, Mass.
DOI: https://doi.org/10.2307/j.ctvt1sgqt
Larson H.J., Clarke R.M., Jarrett C., Eckersberger E., Levine Z., Schulz W.S., Paterson P. (2018), “Measuring Trust in Vaccination: A Systematic Review,” Human Vaccines & Immunotherapeutics 14 (7): 1599–1609.
DOI: https://doi.org/10.1080/21645515.2018.1459252
Larson H.J., Hartigan-Go K., de Figueiredo A. (2019), “Vaccine Confidence Plummets in the Philippines Following Dengue Vaccine Scare: Why it Matters to Pandemic Preparedness,” Human Vaccines & Immunotherapeutics 15 (3): 625–627.
DOI: https://doi.org/10.1080/21645515.2018.1522468
Larson H.J., Gakidou E., Murray Ch.J. (2022), “The Vaccine-Hesitant Moment,” New England Journal of Medicine 387 (1): 58–65.
DOI: https://doi.org/10.1056/NEJMra2106441
Liebermann O., Kaufman A. (2021), “Pentagon Outlines Punishments for Civilian Employees if They Fail to Get Vaccinated,” URL = https://www.cnn.com/2021/10/19/politics/pentagon-civilian-vaccine-mandate-punishments/index.html [Accessed 4.05.2023].
London A.J. (2020), “Equipoise: Integrating Social Value and Equal Respect in Research with Humans,” [in:] The Oxford Handbook of Research Ethics, A.S. Iltis, D. MacKay (eds.), Oxford University Press, New York: 1–24.
DOI: https://doi.org/10.1093/oxfordhb/9780190947750.013.13
London A.J. (2021), “Self-Defeating Codes of Medical Ethics and How to Fix Them: Failures in COVID-19 Response and Beyond,” The American Journal of Bioethics 21 (1): 4–13.
DOI: https://doi.org/10.1080/15265161.2020.1845854
Lovelace B., Tirrell M. (2022), “Two Senior FDA Vaccine Regulators are Stepping Down,” URL = https://www.cnbc.com/2021/08/31/two-senior-fda-vaccine-regulators-are-stepping-down.html [Accessed 9.01.2023].
McKee C., Bohannon K. (2016), “Exploring the Reasons Behind Parental Refusal of Vaccines,” The Journal of Pediatric Pharmacology and Therapeutics 21 (2): 104–109.
DOI: https://doi.org/10.5863/1551-6776-21.2.104
McLeod C. (2021), “Trust,” [in:] The Stanford Encyclopedia of Philosophy, E.N. Zalta (ed.), URL = https://plato.stanford.edu/archives/fall2021/entries/trust/ [Accessed 12.01.2023].
Mizrahi M. (2013), “Why Arguments from Expert Opinion are Weak Arguments,” Informal Logic 33 (1): 57–79.
DOI: https://doi.org/10.22329/il.v33i1.3656
Moore A. (2017), Critical Elitism: Deliberation, Democracy, and the Problem of Expertise, Cambridge University Press, Cambridge.
DOI: https://doi.org/10.1017/9781108159906
Nature (Editors) (2018), “Laws are not the Only Way to Boost Immunization,” Nature 553: 249–250.
DOI: https://doi.org/10.1038/d41586-018-00660-y
Nolen S. (2022), “Sharp Drop in Childhood Vaccination Threatens Millions of Lives,” The New York Times, URL = https://www.nytimes.com/2022/07/14/health/childhood-vaccination-rates-decline.html [Accessed 12.01.2023].
ONS (Office for National Statistics) (2023), “Coronoavirus (COVID-19) Latest Insights: Vaccines,” URL = https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/
conditionsanddiseases/articles/coronaviruscovid19latestinsights/vaccines
#:~:text=Children%20aged%205%20to%2011,were%20recommended%20for%20other%20groups [Accessed 12.01.2023].
O’Neill O. (2020), “Trust and Accountability in a Digital Age,” Philosophy 95 (1): 3–17.
DOI: https://doi.org/10.1017/S0031819119000457
Ollove M. (2022), “Most States are Wary of Mandating COVID Shots for Kids,” URL = https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2022/01/07/most-states-are-wary-of-mandating-covid-shots-for-kids [Accessed 12.01.2023].
Opel D.J., Diekema D.S., Ross L.F. (2021), “Should we Mandate a COVID-19 Vaccine for Children?,” JAMA Pediatrics 175 (2): 125–126.
DOI: https://doi.org/10.1001/jamapediatrics.2020.3019
Prasad V. (2023), “COVID-19 Vaccines: History of the Pandemic’s Great Scientific Success & Flawed Policy Implementation,” Monash Bioethics Review (Forthcoming).
Razai M.S., Oakeshott P., Esmail A., Wiysonge C.S., Viswanath K., Mills M.C. (2021), “COVID-19 Vaccine Hesitancy: The Five Cs to Tackle Behavioural and Sociodemographic Factors,” Journal of the Royal Society of Medicine 114 (6): 295–298.
DOI: https://doi.org/10.1177/01410768211018951
Reveilhac M. (2022), “The Deployment of Social Media by Political Authorities and Health Experts to Enhance Public Information During the COVID-19 Pandemic,” SSM-Population Health 19: 101165.
DOI: https://doi.org/10.1016/j.ssmph.2022.101165
Rid A., Lipsitch M., Miller F.G. (2021), “The Ethics of Continuing Placebo in SARS-CoV-2 Vaccine Trials,” Journal of the American Medical Association 325 (3): 219–220.
DOI: https://doi.org/10.1001/jama.2020.25053
Saver R.S. (2012), “Is it Really all about the Money? Reconsidering Non-Financial Interests in Medical Research,” Journal of Law, Medicine & Ethics 40 (3): 467–481.
DOI: https://doi.org/10.1111/j.1748-720X.2012.00679.x
Smith R. (2021), “Time to Assume That Health Research is Fraudulent until Proven Otherwise?,” BMJ Opinion, URL = https://blogs.bmj.com/bmj/2021/07/05/time-to-assume-that-health-research-is-fraudulent-until-proved-otherwise/ [Accessed 9.01.2023].
Turner S. (2001), “What is the Problem with Experts?,” Social Studies of Science 31 (1): 123–149.
DOI: https://doi.org/10.1177/030631201031001007
Van Norman G.A. (2020), “’Warp Speed’ Operations in the COVID-19 Pandemic: Moving Too Quickly?,” Basic to Translational Science 5 (7): 730–734.
DOI: https://doi.org/10.1016/j.jacbts.2020.06.001
Vogel G., Couzin-Frankel J. (2021), “Israel Reports Link Between Rare Cases of Heart Inflammation and COVID-19 Vaccination in Young Men,” URL = https://www.science.org/content/article/israel-reports-link-between-rare-cases-heart-inflammation-and-covid-19-vaccination#:~:text=In%20a%20report%20submitted%20today,which%20is%20typical%20for%20myocarditis [Accessed 16.07.2023].
DOI: https://doi.org/10.1126/science.abj7796
Watson J.C. (2021), Expertise. A Philosophical Introduction, Bloomsbury, London.
DOI: https://doi.org/10.5040/9781350083875
Wiersma M., Kerridge I., Lipworth W. (2018), “Dangers of Neglecting Non-Financial Conflicts of Interest in Health and Medicine,” Journal of Medical Ethics 44 (5): 319–322.
DOI: https://doi.org/10.1136/medethics-2017-104530