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When Is A Vaccine 'Mandate' Not A Mandate? 'Vaccine Hesitancy' Author: When It’s A Requirement (Yes There's A Difference)

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Maya Goldenberg
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University of Guelph
Dr. Maya Goldenberg is the author of "Vaccine Hesitancy"

When the Food and Drug Administration gave its full approval of the Pfizer COVID-19 vaccine, health experts were quick to express optimism that more Americans would step up to be vaccinated. And economists added that they expected more private employers to enact so-called vaccine mandates.

But Dr. Maya Goldenberg, professor at the University of Guelph and author of “Vaccine Hesitancy,” says while there may indeed be consequences for people who choose not to be vaccinated, the word “mandate” is misused, and the word “requirement” would be more appropriate.

“’Mandate' comes from the word ‘mandatory,’ but there is no modern vaccine mandate this day that makes people need to be vaccinated,” said Goldenberg. “So, people have this sort of knee jerk reaction to vaccine mandates.”

Goldenberg visited with Morning Edition host George Prentice to talk about her research and how using the proper terminology while building trust is a much more effective way to increase vaccination rates.

“There is no ‘mandatory’ vaccination such that you have no choice on vaccination. You have the choice not to vaccinate and take certain consequences for that choice.”
Dr. Maya Goldenberg

Read the full transcript below:

GEORGE PRENTICE: It is Morning Edition on Boise State Public Radio News. Good morning. I'm George Prentice. The big news this week has been the FDA giving full approval of the Pfizer COVID 19 vaccine; and a similar full approval is expected in the coming weeks for the Moderna vaccine. Health officials have been quick to say that the full approval should have an impact on vaccination numbers; and more than a few economists have said that we should also expect to see more vaccine mandates from employers. But is “mandate” the right word? We're going to talk a bit about that this morning with Dr. Maya Goldenberg, professor in the Department of Philosophy at the University of Guelph and the author of “Vaccine Hesitancy, Public Trust, Expertise, and the War on Science.” And she joins us this morning from Ontario, Canada. Dr. Goldenberg, good morning.

DR. MAYA GOLDENBERG: Good morning. It's nice to be here.

PRENTICE: Let's start with words and that word “mandate.” It is that word appropriate? Is that the word that employers or governments should be using?

GOLDENBERG: Mandates is the terminology that we've used around vaccine policies; but it's been noticed by people who work and study so-called vaccine mandates that the terminology can be a little bit confusing. Specifically, mandate comes from the word mandatory, but there is no modern vaccine mandate this day that makes people need to be vaccinated. So, people have this sort of knee jerk reaction to vaccine mandates. We know that's why it's in the news right now. They say you're going to force people to get vaccinated, but no mandate that we have in the 100 or so countries around the world that have these so-called mandates actually requires vaccination. What it does, is it structures your decision and encourages vaccination. It's not passive on that issue. However, there are always exemptions, exceptions and consequences if you don't want to vaccinate. So, to repeat, there is no mandatory vaccination such that you have no choice on vaccination. You have the choice not to vaccinate and take certain consequences for that choice.

PRENTICE: Can we talk a bit about mistrust? Where does your research indicate where that mistrust lies? Is it in science? Is it in authority?

GOLDENBERG: Those two actually go together. So, the primary sources of mistrust in vaccines, according to my research and spelled out in the book, is mistrust of the scientific establishment. There are people who think that vaccine research is too tied up to big pharma and profit motives. And the worry is that the products that are made, the vaccines, are not being carefully tested and are not made with the public's interest in mind. Instead, we've got corporate interests… sometimes government interests as well. So, there is this worry that science is not done for the good of the people and that our governments are colluding with these large corporations instead of creating science that is responsive to the public health needs of the people. That's a long-standing concern around the motives of the pharmaceutical companies. We call it “big pharma” now.. the pharmaceutical industry as a whole is very profitable. And a lot of people think that it is corrupted by the huge profits that it makes. And because of that, when new products come out, there is pushback. That was the case with vaccines prior to COVID. And it's certainly the case with the COVID vaccines.

PRENTICE: Dr. Goldenberg… what works? There must be places on the planet where they're using the right language to encourage more people to get vaccinated. So what does work?

GOLDENBERG: Well, what we're seeing is that countries where there is general trust in the government structures - where things are going well in terms of the people versus in relation to the government - we are seeing more likeliness to get vaccinated. And that's been true of past epidemics. For example, H1N1…, if you trust the system that  regulates and authorizes vaccines, you're going to get more people likely to do it. So, when you see a population with a large amount of resistance to the vaccines, that says that something's not right in terms of their relationship to government and to experts. So, we're seeing communities of immigrant populations, communities of color, and other groups that have fraught relationships with health care or with government or with experts in general. They are more reluctant to get vaccinated. While communities that have good relationships with government, health care and other scientific institutions are more open to the vaccines and more trusting in the product.

PRENTICE: Is it your sense that just about everyone is in one camp or another? They're either going to get a vaccine or they have a vaccine or they're not going to get a vaccine? Do you have any sense that there is opportunity to… well, move the needle?

GOLDENBERG: I guess there is certainly still opportunity for that. We talk about vaccine hesitations as people who lie along a spectrum. Some are very open to vaccines, but maybe need a little encouragement, all the way to the other end of the spectrum where people are very unlikely to get vaccinated. But most people lie somewhere in the middle. We sometimes call them fence sitters, where if you use the right language, you might introduce incentives and you make the case that vaccination is a good choice for yourself and your community. You can get people to do it. And we've seen good examples of this in COVID. So, just to give an example there, it was noticed even before the COVID vaccines were brought out into the market that communities of color in the United States were much more reluctant to get vaccinated. So, what happened was there were groups that formed… that pooled together local talent. For example, scientists and health care workers from those communities who could offer town hall meetings, usually on Zoom or some kind of virtual platform where they could talk to their community, using culturally sensitive and even trauma-informed messages and provide information.  And what was important about local outreach was that people saw these scientists and these doctors as people that were like them. They were from their communities instead of this distant person from, let's say, the FDA or the CDC, that has not been very responsive to the needs of their community. So, the kind of local ambassador, local outreach, is a way of making those ties that we needed between marginalized communities and our expert systems and government.

PRENTICE: “Vaccine Hesitancy” is certainly a must-read. Do I have this right…? You finished this book in 2019. Right?

GOLDENBERG: It was published in 2021, but I finished up the manuscript in 2020. So, I know you're going to ask me, “Was this research done before COVID?” And the answer is yes. I started the research in 2015, and the focus was on vaccine hesitancy towards childhood or pediatric vaccines. So back then, the big controversies were around measles, mumps, rubella. Do they cause autism? What do we do about unvaccinated children in schools? That was a hot topic. I think we'll come back to that topic in a few years. But right now, we've, of course, shifted to COVID vaccines.

PRENTICE: I'm going to ask the next obvious question, and that is - and I'm certain I'm the 100th person to ask - are you working on a sequel or an addendum?

GOLDENBERG: Not at the moment, but I am certainly paying a lot of attention to COVID. I've written a few small things, but I imagine if there's a second addition to the book, there would need to be a new chapter on what's the same or what's different from COVID vaccination, compared to what we saw around pediatric vaccine hesitancy.

PRENTICE: And again, it is titled “Vaccine Hesitancy” from Pittsburgh Press. And she is Dr. Maya Goldenberg, professor in the Department of Philosophy at the University of Guelph in one of the best places on the planet, which is to say, Ontario, Canada. Dr. Goldenberg, thank you so very much for giving us some time this morning.

GOLDENBERG: Thank you. It's a pleasure.

Find reporter George Prentice on Twitter @georgepren