Public Health Policy and Options Erasure

Vaccines and Narrowed Fields of Discourse

Whenever many months ago when the nonsensical technology for covid joined the scene I realized both how little I knew — and how little most of us knew — about public health policy in the pandemic/epidemic realm. Hell, I didn’t know the difference between those words. This, despite SARS in Toronto.

It was not a big surprise to watch a whole lot of the technology community go down the inevitability path regarding covid tech. It was another version of the common song of our democratic deficiency — an inability to hold onto two (or more) truths at once and to keep them both in the arc of discussion. In this case, those who were either for or against covid tech generally didn’t elbow in and use the space to talk about all the other policy measures that should go first before any covid tech was brought into existence, from financial supports to testing regimes. It was another example of generic tech solutionism, though this one felt higher stakes.

And now, well now… I made a comment the other day to someone I hadn’t talked to in a long time. I said it was unfortunate that we’re in this realm of highly divisive discourse, the vaccine discourse. The vaccine discourse in the media back and forth has taken on the sport tones of partisan politics. And inevitability. The mocking, the identity making of cursing “those idiots”, as though that position is a whole identity, etc. It’s the tenor and tone of a closed loop and circuit, not one that seems to have much interest in solving the problem. But maybe that’s because too few of us have had the kind of experience that helps us understand some of it well. Maybe. I had one.

Years ago I had a two-hour plus discussion with a parent that didn’t get their kids vaccinated. This was pre-covid. And after at least two hours of discussion I realized they were as sure that they were doing the right thing for their children as those that got their kids vaccinated. It wasn’t a lightly held or unexamined position. It was full of reading and personal anecdotes. It wasn’t hardcore conspiracy. And it wasn’t moveable. At all. I wasn’t trying to budge it, but I will not forget how every path I went down to talk it through surfaced new reasons, and all of them held a germ of truth or at least enough to feed doubt or fear. Enough that I could kind of see where they were arriving at their position from. I know there are experts in this arena — both in the disinfo and the ways to get people out of it. I’m not one of those. The part of the exchange that I want to convey was the certainty of care. The certainty that they were protecting their children. Certainty as certain as those that get their kids vaccinated are certain they are doing the right and best thing.

In the vaccine discussion, there hasn’t been a great job done of separating those who are anti-vaccine from those who aren’t getting vaccinated for a host of other structural and access reasons. But bigger and more troubling than this piece of it, from my little slice of looking, is the erasure of all the other policy options. Thoughtful policy would have created more allowance for this known issue of those that wouldn’t want to get vaccinated, to minimize the impacts. In the same way that stores plan a certain percentage of loss to breakage or theft. Not sure if that example is helpful or right here, but it’s planning for a thing that no one wants but a thing that will happen. It’s pragmatic, and it uses the state for expansive planning rather than hammer down hard singular tactics.

There were, from day one, many approaches to put into place to help us with covid that wouldn’t have led to so much of the current response and discourse resting so intensely on vaccines. This feels important because we don’t know what’s next, and relying on vaccines is high-stakes. It’s not a space many of us work in on a daily basis. We need to build capacity for the spaces we do work in and exist in on a daily basis. And part of this is working on what we should do, pragmatically, in response to those that don’t want to or can’t get vaccinated. Or those that aren’t well protected by vaccines. Constructively. It happens on the ground, within community, but it also needs to happen more explicitly to leverage our public resources in policy. It’s a project. I imagine someone reading this and I already know I’m messing it up because it’s framed as I’m right and they’re wrong, mostly. And I’m trying to figure out how we get at this to get through it. I’d like to make this something we take on together in a supportive way. I’d like to think this is possible and part of the beauty of using public resources in new ways.

The result of our lack of education in wrap-around public health policy amounts to policy option erasure. I’m still having people tell me — in August 2021 — that they’re wiping things down well. We aren’t aware enough of the optimal ways to have been handling this — not in a binary way, but in a bouquet way, in a pluralistic way. I cannot believe where we are in terms of public awareness of how aerosol transmission works. I cannot believe how many people don’t know what long covid is. We aren’t getting our head around the kinds of shifts and policies we could and should be part of supporting at every one of our institutions and organizations and gatherings and in individual conversations.

It’s a helpful moment in science history to do better in future. And instead of applying what we’ve learned, we’re erasing it or minimizing it. This is additional levels of unethical to those that have lost lives, lost family, and will suffer well into the future. First through lack of protection, now secondly through lack of learning. There are lots of concurrent approaches to deal with everything from structural lack of access to vaccines to all the non-vaccine measures that we have to know about and talk about often as a public and a society, in order to organize for their prioritization and investment in the future. Like ventilation. Why aren’t political leaders taking this crisis as a moment to teach? It’s screaming for them. They want to talk STEM education all day but when a real life practical critical moment for supporting it arrives, what then?

For all of those that say they love democracy and want to be in a democracy, there has to be more work done to broaden and widen the frames of every policy discourse. To create safety paths regardless of individual choices. This is how we make more room for those with opposing views and beliefs to all be as protected as possible. And this is a responsibility and an obligation we all share, both in how we educate ourselves and in how seek to speak through this with others. Institutions of all kinds have major choices to make here. Collective work isn’t about expecting someone to come onto your side, it’s about making safety for all given where everyone is at. Yes, it jacks up the complexity considerably. But that’s how democracy works. We also need to consider everything from religious beliefs to historical context and seek to accept them in their complexity rather than hope they go away.

Photo courtesy of Brooke Hoyer