The metaphor of war has long been a part of public health. In responding to the COVID-19 pandemic, the world’s public health agencies mobilized and shut down entire parts of society under the utilitarian goal of stopping the spread of COVID-19.

In America, entire states were locked-down, public schools were dismissed, government public services halted and businesses closed while grim pictures of death were painted, pictures of sick and dying on ventilators were broadcast and vivid dialogue of apparently overwhelmed hospital capacity were plastered on mainstream media. Journals and media outlets played along, streaming out content about the dangers of COVID-19 and the need for continued lock-down. Dissenting views on social media were censored by social media tech companies.

Ostensibly the public health response escalated over time while new real-life data emerged that contradicted the severity of the COVID-19 forecasts. What was supposed to be a short lockdown response dragged on for months; the American economy faltered and sank in the wake of the response and American state governors extended their short-term emergency powers to extend the lockdown period.

The Imperial College models, upon which the lockdowns were based, predicted millions of deaths for a virus that would stick around for years. However, a month later, the forecasts for these models were downwardly revised in light of the real-world data. Subsequently, data from various countries indicated that the virus had spread much earlier and farther than originally believed and that mortality rates were far lower than expected.

Despite this, the public health rhetoric regarding COVID-19 dangers remained unchanged. A notable exception in public health policy came with the flip-flop on masks. While the original recommendation was against public usage of masks, the CDC suddenly recommended widespread mask wearing and even extended this recommendation to children in schools.

Consistent in the public health narratives though is the rhetoric that only a coronavirus vaccine will bring things back to normal. These thoughts were succinctly summarized by Bill Gates in a blog post:

“Realistically, if we’re going to return to normal, we need to develop a safe, effective vaccine. We need to make billions of doses, we need to get them out to every part of the world and we need all of this to happen as quickly as possible.”

Might there be other possible solutions to the pandemic other than vaccines? Public health officials and government officials seemed to double down on this assumption in advance of suitable vaccine candidates.

Possible alternatives that did not involve the vaccines were lambasted by health officials. Public health officials were quick to dismiss the potential of hydroxychloroquine, citing published research that they said showed failure, which was then retracted for serious data problems and completely ignoring research that showed its effectiveness. Public health officials continue to chant the mantra that our hope against COVID-19 is the vaccine.

Public health officials themselves disseminate the war mentality with the repeated message that we are at war with an invisible enemy that must be eradicated. War mentality emphasizes the need for self-sacrifice in order to stop COVID-19 spread. And the weapons of war are glorified; public health authorities glorify its chief weapon of vaccination.

Like any war, there is collateral damage. The collateral damage here are the bedrocks of medical ethics, informed consent, human rights, civil liberties and even science itself. How can proper science be conducted when one goal―deliver a vaccine at “warp-speed,”―is emphasized over healthy scientific skepticism and public discourse? The ultimate collateral damage, of course, is among those damaged or injured by decisions resting on faulty science.

A further examination of the public health response to COVID-19 reveals a deeper problem: the metaphor of war and the assumption of vaccine fundamentalism has long been part of the public health mindset.

Vaccine fundamentalism – does nothing else matter?

The war metaphor leads to a reductionist thinking style that leads to two exclusive outcomes. We either 1) win by eradicating the disease in question; or 2) the pandemic continues and threatens all of humanity. Peaceful coexisting is seen as a kind of surrender.

Citizens are given sham choices: either participate in the war effort or side with the enemy. Psychological shaming is used to coerce naysayers into participating; after all, who wants to be on the pro-disease side? Efforts to destroy the threat are prioritized as the most important consideration. Central to public health is the weapon of vaccines and it has a sacred status in public health.

Vaccine fundamentalism is the belief that vaccination is the most important public health intervention that it is above criticism and that increasing the metric of vaccination uptake rate is the core purpose of public health agencies.

A public health official might defend the practice of vaccination through the often-repeated standard dogma of vaccine fundamentalism that vaccines have saved millions of lives, represent cost-efficient public health intervention and countless scientific research have shown time and time again to be safe and effective. Due to their importance, vaccines are above reproach and neither questioning them nor criticizing them is permitted.

While the practice of vaccination does have a place in the public health repertoire, the repercussions of such fundamentalist thinking cannot be ignored and must be completely understood.

The chief consequence of vaccine fundamentalism is that public health policy over-emphasizes a single reductionist metric: increased vaccination uptake. And consequently single-minded pursuit of any goal can lead to other detrimental outcomes which have been almost entirely ignored.

Charles Eisenstein, in his book “Climate: A New Story” explained:

“This pattern of thinking is called fundamentalism and it closely parallels the dynamics of two defining institutions of our civilization: money and war. Fundamentalism reduces the complex to the simple and demands sacrifice of the immediate, the human, or the personal in serious to an overarching ulterior goal that trumps all.”

War-making in the efforts to drive vaccine uptake

When vaccine fundamentalism is combined with the war metaphor, public health takes on the mantra of increasing vaccine uptake to fight disease at any cost. However, the behavior of public health institutions to achieve that goal can lead to perverse consequences that are seemingly the opposite of policy goals.

Public health institutions have lamented the rise of anti-vaccine sentiment. In response, they have developed elaborate strategies to deal with vaccine hesitancy. But they are missing the crucial point that mistrust of public health institutions arises from their ulterior goals of increasing vaccine uptake at whatever the cost.

All of the strategies used by the public health institutions to increase vaccination uptake rely upon a key assumption that the core of vaccine refusal lies with the refuser’s ignorance of scientific knowledge and acceptance of misinformation delivered by vaccine deniers.

The war-making is evident here. There is a separation of the people into two separate groups: those who comply and those who do not. The latter are given a label of vaccine hesitant or vaccine denier. Public health implicitly sees these groups as a form of deviance that must be corrected through the good efforts of public health.

Public health authorities also embed an important assumption that those that question vaccines do not have valid concerns. The war metaphors of public health permit a callous dismissal of any vaccination concerns and grievances that occur within the medical setting. This diminishment of concerns and grievances naturally leads to more distrust amongst the populace of public health institutions.

There are numerous problems with the war mentality that public health officials ignore. Charles Eisenstein summarized:

“The war mentality represents an unfortunate confluence of ignorance, fear, prejudice and profit… The ignorance exists in its own right and is further perpetuated by government propaganda. The fear is that of ordinary people scared by misinformation but also that of leaders who may know better but are intimidated by the political costs of speaking out on such a heavily moralized and charged issue.”

Vaccine fundamentalism erodes public health trust

The war mentality dehumanizes the enemy as unworthy of engagement on an equal level. Similarly, public health officials have taken the policy of refusing to initiate two-way dialogue regarding vaccine concerns for fear of legitimizing vaccine concerns. However, these strategies backfire in that those same concerns grow in the public.

What public health officials also fail to realize about the refusal to engage in productive two-way dialogue with those with concerns is this action is a form of epistemic violence.

Philosopher Kristie Dotson defined epistemic violence as a:

“…refusal, intentional or unintentional, of an audience to communicatively reciprocate a linguistic exchange owing to pernicious ignorance. Pernicious ignorance should be understood to refer to any reliable ignorance that, in a given context, harms another person (or set of persons).”

The pernicious ignorance on part of public health authorities lies in the refusal to fully investigate any criticisms brought forth against the vaccine program. Instead, these criticisms are immediately labeled as vaccine misinformation to reduce their legitimacy in the public eye. Public health authorities respond by extolling the virtues of vaccines.

Dissenting voices are drowned out by a strawman argument; the virtues of vaccines are used as a response to legitimate concerns without actually addressing the concern at hand. Thereby an insidious form of confirmation bias occurs; the presumptive rationale for vaccines comes from a one-side assessment from the past that is never revisited.

This strategy backfires because those people bringing the grievances feel unheard. In response to the deafness of public health institutions, these people must do the equivalent of yelling louder.  They band together, form coalitions, begin grassrootscampaigns and advocate for change with legislators. As a result, well-organized organizations (Children’s Health Defense and ICAN) have arisen whose primary purpose is to advocate for those whose concerns are not heard and to push government for public health reform. These organizations have had some success with the court system in getting acknowledgement of gaps of understanding from public health authorities.

The war metaphor then encourages public health officials to double-down on forceful activities to stifle inroads made by vaccine critics. Public health agencies in partnership with social media tech companies began censorship campaigns of vaccine misinformation, public relations agencies pushed out increased negative press on so-called anti-vaxxers, and previously unrelated institutions started calling for increasingly draconian policies regarding vaccines.

Paternalism in public health has long been criticized, but war metaphors elevate this charge. Public health agencies have taken a hard paternalism stance. They have positioned themselves as a necessary police figure that defends society from the threat of pandemic, one that is willing to override citizen concerns, censor free speech and engage in violence in pursuit of its goals.

Public health broadcasts a message that is essentially elitist in nature, asking the people to have faith in the public health experts without question. Public health sees itself as society’s primary epistemic authority on public health related matters and any questioning of its authority is met with umbrage.

The public is aware of these problems and distrust of public health has been increasing over the past few decades. Vaccine fundamentalism is dangerous, because the very strategies used by public health officials to increase vaccination uptake also ironically lay the groundwork for undermining the public good on which the entirety of the public health system is based.

Vaccine fundamentalism as a threat to medical ethics

Vaccine fundamentalism is at fundamental odds with the bedrock of medical ethics.

Public health agencies have acknowledged that intervention on part of doctors and healthcare providers is an effective means for addressing vaccine hesitancy.

According to the American Medical Association Code of Ethics, a core precept of medical ethics is, “A physician shall, while caring for a patient, regard responsibility to the patient as paramount.”

How does the responsibility to the patient as paramount work when at odds with state public health goals? Ideally there is the assumption that what is good for the state is in line with what is good for the patient but this is not always the case.

Vaccine fundamentalism has the perverse consequence in which doctors may be inculcated to deliberately ignore or undermine patient concerns in service to the primary public health metric of increasing vaccination rates.

While public health agencies do actively collect and classify the types of concerns that parents have, these are activities are done under the goal of addressing vaccine hesitancy; due to vaccine fundamentalism, there is an assumption that the proper decision for the individual is to take the vaccine, regardless of personal circumstances.

Rather than use data to facilitate open dialogue, they use this knowledge to create strategies against vaccine hesitancy, for example, training materials that teach healthcare providers how to achieve greater conversion of individuals from vaccine hesitant to vaccine compliant.

Medical ethics acknowledges the importance of informed consent in preserving both patient dignity and trust in the medical system. The healthcare providers’ use of behavior modification techniques to achieve increased vaccine uptake is questionable and deceptive.

Even doctors are not immune to the pressures of vaccine fundamentalism as the war burden ultimately falls upon them to ensure their patients are compliant with public health vaccine recommendations.

According to research undertaken by Dr. Paul Offit, providing vaccine information in order to obtain compliance is time consuming. It was found that 53% of physicians spend 10 to 19 minutes discussing vaccines with concerned parents and 8% of physicians spend 20 minutes or more with these parents. They also reported that pediatricians experienced decreased job satisfaction because of time spent with parents with significant vaccine concerns.

Frustrations in obtaining vaccine compliance can end with the ultimate resort of patient dismissal by the patient’s doctor. Interestingly, the American Association of Pediatrics says that patient dismissal is an acceptable last-resort option. Interestingly enough, the collateral damage of vaccination fundamentalism includes the undermining doctor-patient relationship through the creation of adversarial positions regarding vaccines.

There can be no true informed consent if the patient cannot freely refuse the treatment nor is there true informed consent if the consequences of refusal include the potential repercussion of terminating the doctor-patient relationship. Certainly medical ethical guidelines can do better.

Further undermining informed consent is the removal of vaccine exemptions for public schools at the state level. According to a 2019 report by the National Vaccine Information Center:

“[in 2019] 40 [legislative] bills were filed to either remove or restrict vaccine exemptions in the following 22 states: Alabama, Arizona, California, Colorado, Connecticut, Iowa, Illinois, Massachusetts, Maine, Minnesota, Missouri, Montana, New Jersey, Nevada, New York, Ohio, Oregon, Pennsylvania, Texas, Vermont, Washington and Wisconsin.”

According to bioethicist Nir Eyal, “Coercion, deception, manipulation and other violations of standard informed consent requirements seriously jeopardise that trust.” The value of informed consent does not show up in any epidemiological model but it has a powerful intangible value to all those involved.

Is vaccine fundamentalism so important that it warrants destroying the trust in the medical system?

Nate Doromal is an activist and writer within the Vaccine Awareness and Vaccine Safety movement. He is a veteran software engineer, formerly with Google, who now works in finance. He holds an MS and an MBA in Computer Science from the University of Chicago. He holds an Executive MBA from the Smartly Institute. He was originally trained on vaccines and vaccine activism by Dr. Sherri Tenpenny in her Mastering Vaccine Info Bootcamp. He has also studied immunological science extensively with Dr. Tetyana Obukhanych through her Building Bridges Course.

Read ‘Vaccine Fundamentalism―War Metaphors in the COVID-19 Response, Vaccine Policy and Public Health, Part 2’