Vaccine and science communications in the USA

Peter Hotez joins us to talk vaccine progress and how science needs to communicate in the USA, and philosopher of science Cailin O'Connor discusses our understanding of theories, facts, and how misinformation spreads.

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Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Gavin: Hello, welcome to another episode of the Lancet Voice. I'm Gavin Cleaver. In this episode, we're looking ahead to the US election next month by talking about communicating science in the USA. Later on, philosopher of science, Kalen O'Connor will join us to talk about fake news and communicating belief.

But first we're very pleased to have Peter Hotez discussing science and vaccine communications in the USA with my co host, Jessamy Bagonall. 

Jessamy: Peter, thank you so much for joining us and giving us your time. I know you're extremely busy and I just thought for our listeners it would be interesting if you could give a little bit of background to your career because it's been varied and wide and we'd love to hear some more about where you've come from in terms of your sort of theoretical knowledge and understanding and what you're doing now.

Peter: Yes, first of all, thank you for having me. It's an honor to be linked always with the Lancet in any way. I'm trained both as a pediatrician, a physician, and I'm also a scientist. So I'm an MD, PhD, predominantly laboratory investigator. That's been focused on developing vaccines for tropical diseases.

So what we call the neglected tropical diseases. So that's actually by what I would call my day job, developing vaccines for poverty related and neglected diseases and not only developing the vaccines with a team of scientists, but also trying to. Scratch out a business model for how you advance global health vaccines for the world's poor where there's no traditional market And I've been doing that ever since I was an MD PhD student at Rockefeller University and Cornell And so I've been doing this for 40 years and it's an amazing opportunity But the other piece that's a little bit unique Is I've also had a foot firmly planted in public engagement, and that really started in 2000 when the Millennium Development Goals were launched.

They had something called the Other Diseases in response to the Infectious Disease Millennium Development Goals in 2000. It was called Combat AIDS, Malaria, and Other Diseases. And I suddenly realized that everything I had done was now being called other diseases. And so we teamed up with colleagues like David Mullen, you at the Liverpool school of tropical medicine, Alan Fennec at Imperial college.

And we created this framework for neglected tropical diseases, which was really an advocacy initiative to get. People access to neglected tropical disease drugs and now more than a billion people have been treated annually. And so And then ever since i've been drawn into various Scientific issues around advocacy, which I love Which includes neglected diseases of poverty in the united states?

Which also includes now combating anti science movements anti vaccine movements in there The unique perspective is I have a daughter with autism and also intellectual disabilities and wrote this book called Vaccines Did Not Cause Rachel's Autism, which put me squarely at odds with this very aggressive.

anti vaccine lobby here in the U. S. 

Jessamy: And in fact, when preparing for this interview, I was reading about your PhD and maybe that's a good place to start and that you were looking at vaccinations for hookworm, is that right? Or in that sort of field. And I'd love, maybe we could start because we're going to be talking COVID 19 and how you see this huge progression.

in vaccines over the last 40 years and what some of the highlights have been and what that has meant for the last six months. 

Peter: I think, there's been a lot of exciting advances in vaccines and you're right. We started with hookworm vaccines and we still have that vaccine now in clinical trials.

When people talk about timelines doing this in months, I like to point out, we started our. hookworm vaccine, when I was a student in the 1980s about some phase two clinical trials, that's actually a more realistic timeline for most vaccines. I think the, for me the big game changers has been having something like the Gavi Alliance, vaccine alliance to scale up.

the world's vaccinations. To me, this has been such an important program. Probably, I think, the single largest contribution from the Gates Foundation that started it with 750 million dollars back in 2000. That's just been wildly successful. And has led to widespread vaccinations and declines and measles and pertussis and tetanus and haemophilus influenza type B that's been really meaningful to see because I used to take care of patients with those diseases and wearing my pediatricians and they were devastating conditions.

But the trend that i'm worried about now, and this is the topic of my next book So in between I also became a writer which I find very gratifying Is the fact that there's been a slowing or a halting of a lot of those gains even before covet 19 And I ascribe it to things that we ordinarily don't get trained to think about as physicians or scientists things like war and political collapse and climate change and anti science movements and urbanization.

And all of these are eroding a lot of our gains. And I identify a number of important areas of the world where we're losing ground in places such as Venezuela or the Middle East or parts of Sub Saharan Africa, or even in Texas, where we've seen where I work and live. Big declines in vaccination coverage, and that's a real threat.

And now it's superimposed on all that mess is, of course, COVID 19. And this, I think, is going to have long term implications for all of our system of global health governance. And I'm really worried that we are going to accelerate our reversals in those successes because of COVID 19 and the fact that it happened on top of an already threatening.

situation from these other social forces and climate change. 

Jessamy: We agree completely, and we talk about that on this podcast so often. 

Peter: Of course, Richard Horton at The Lancet has been one of the pioneers in this idea. He calls it planetary health. I don't use that name as much, for me, Richard has been one of the real sources of inspiration.

And actually, he's given me a lot of courage to speak out as a scientist. Richard Horton. taught me through his actions that it's okay, even as a scientist to express a flash of anger or emotion and to be passionate about an issue. And so I'm very grateful to him. 

Jessamy: Of course. And that is what scientists probably need to be more of.

And you're a great example of that as is Richard. So. 

Peter: Even before we get to vaccines, just to point out that. One of the reasons, and I talk about this in the new book, my, my premise is one of the reasons that anti science movements are allowed to flourish is because there is a vacuum, that there aren't scientists speaking out and countering the misinformation and part of it is our training, when I was getting my MD and PhD and my clinical training, you were taught, you don't, Speak to journalists.

You don't speak to the public. That's a form of self aggrandizement or grant grandstanding of some sort and all of those ideas of how you're supposed to conduct yourself as a scientist were created before something called the internet was invented and social media was invented. And my point is now we have to reverse that entirely because our silence and the fact that we're invisible.

has allowed this massive anti science movement to flourish and preventing us from fighting climate change and fighting and preventing us from vaccinating children and we need a new cadre of scientists willing to do that public engagement, but we've got to create the ecosystem to allow it to occur.

Jessamy: Completely agree. The sort of historical. cliche of a scientist being dispassionate and objective, I think, is no longer relevant for this world in a large part. And what needs to happen is that sort of communication and, the fact that Our world is based on science, capitalism, the, the wealth, the profit that we have is based on science and yet that sort of communication is not clear.

Yeah we completely agree. I think Gavin and I often talk about that. 

Peter: I often, I also like to point out, why do people admire the United Kingdom? Why do they admire the United States? I don't think it's because of our military. I think it's because of the strength of our research universities and research institutions.

That's a major reason why people admire us, and we train people all over the world on this front. And, but I think we often fail to recognize what powerful ambassadors we have in our scientists and we don't use them effectively enough to represent our nations. 

Jessamy: Exactly. And what potentially good source science can be for collaboration and for, improving the global work that we can do together outside of politics and everything else.

Peter: That's exactly right. And, the other piece to my public engagement is I've devoted my life to something I call vaccine diplomacy. That is the joint development of vaccines between nations. And we've always done this up until recently. We, when you look at how. The oral polio vaccine was made.

It was done because U. S. Scientist Albert Sabin got back channeled permission to go to the U. S. R. After the Sputnik launch at the height of the cold war. And that's where the vaccine was actually developed in the U. S. R. And tested on 10 million Soviet schoolchildren leaning to not led to licensure this.

Two countries putting aside their ideologies to work together, and this also happened with smallpox, and now we're starting to see that unravel as well. We, in its place, there's a new term that's popped up, this terrible concept of vaccinationalism, as they're calling it. So you have the Chinese vaccine, and the American vaccine, and the Russian vaccine, and the British vaccine, and the Indian vaccine.

It was never supposed to work that way, and it's going to fail unless we can figure that out. 

Jessamy: Why do you think it's so dangerous? I agree that it is, but maybe you can just articulate it for us. 

Peter: We'll fail for a few reasons. One, first of all, we won't get the best vaccines possible unless we have international cooperation.

If everything is siloed and everybody working on their own individual vaccine, we're not taking advantage of the expertise across the world. I think that's a big problem. And also, I think it will ensure that we will not achieve adequate delivery of vaccines, especially the people who live in poverty.

We're already starting to see that now. We're seeing a breakdown in the governance around vaccine, despite some well intentioned efforts by GAVI and WHO and CEPI through COVAX. For instance, we're hearing in Latin America, Latin American countries now are starting to say, hey, only 20 percent of our population is going to receive vaccine and which 20 percent is going to get it.

It's not going to be indigenous people and people who live in. Already right. And so what you're starting to see now is people are making one off deals in order to get vaccines. One off deals between countries and manufacturers. It's creating a very chaotic situation. So we're actually in discussions with some of the Latin American countries of my Science co partner of 20 years, Mary Elena Patazzi, who is originally from Honduras, where Zoom calls with the leadership of the Central American countries, Latin American countries, trying to help them gain access.

Maybe our vaccine that we're scaling up in India now with biological E, a low cost recombinant protein COVID 19 vaccine that uses the same technology as the hepatitis B vaccine, which you can make for a dollar, 2 a dose potentially. So we're having those discussions. And then you're seeing the Russians bypassing World Health Organization prequalification and they're cutting deals with the Cubans and the Nicaraguans.

This is terrible. It was never supposed to be that way. And so I'm quite worried that we're, again, beyond war and political collapse and climate change, we're seeing an acceleration of the collapse of global health governance. And I'm not exactly certain what's going on. I think part of it is.

Lack of American leadership. U the US in the past has been pretty good about providing some level of adult supervision, o over things either through U-S-A-I-D or Department of HHS, and I think that's all fallen apart as well. So this is going to be a real challenge for us. And again, it points out to the fact that a scientists.

We're not trained in these areas. We're taught to just keep our head down, stay focused on our grants and our papers, and writing and speaking for each other, and leave that, leave the other stuff to the politicians. And I'm saying, okay, we've done that now, and look at the result. It's global collapse and chaos, and now we need scientists to be out there in a leadership position in the public domain, if we can create the ecosystem to make that happen.

Jessamy: We've spoken a bit before with Calypso Chalquido about the sort of unilateral deals and some of the knee jerk reactions of governments to get deals with private companies for vaccines. And I guess part of it is, when you're in these exceptional circumstances and people seem to lose their heads, governments and every, everything else.

And when things start speeding up, then it disintegrates into even more chaos. How do you see this playing out now in terms of equitable access to a potential vaccine? And, we obviously have global infrastructures that are designed to deal with these kinds of situations. How do we get back to them?

Peter: Part of this was both predicted and predictable. At least I predicted it, and I did that because I pointed out that we were overly reliant on the pharma companies. And not sufficiently reliant on the ability to make vaccines locally. 20 years ago we were working with the Brazilians to scale a production of our hookworm and schistosomiasis vaccine.

And there was a lot of expertise in places Manguinas and Institute of Butantan. And in Brazil, these are public sector vaccine manufacturers and the Cubans were making vaccines. Mexico had a pretty robust vaccine manufacturing and production capability and that started to collapse. So they're not nearly as effective as they were.

And now in Africa, of course there's zero ability to develop new vaccines and produce them. In the Middle East, the same. Things are a little better in places like India and Indonesia, but they're the exception. So I think I've been pushing hard for the G20 countries. Because so much of these is poverty related diseases are actually among the poor living in G20 countries, this Blue Marble health concept that I've promoted with mixed response from a reception from the international community.

But I think that's a major lesson is to build up vaccine development capacity among both public and private sector manufacturers in the disease endemic countries to avoid this over reliance on pharma. Because we, we've been able to successfully technology transfer our COVID vaccine to BioE in Hyderabad in India, and they're scaling it up.

They're amazing what they have the ability to do. They think they can make a billion doses of the vaccine that that we licensed to them and start clinical trials. We, in theory, we should be able to do this with multiple disease endemic countries. In places like South, especially the G20 and places like South Africa and Argentina and Brazil and Mexico and there's just not the infrastructure there.

I think one of the lessons is building that up again. The pharma companies are going to do what the pharma companies do and not to diminish their contribution. They've made, it's an extraordinary impact. Look what Merck did with Merck and company did with Ebola, right? They.

Basically prevented a catastrophe with lots of help, of course, with Gavi and WHO and UNICEF and international organizations. But, that by taking on Ebola, they helped stabilize the African continent, but it's not enough. We need parallel mechanisms in place, and we need to develop that pretty soon.

Jessamy: It's all pretty urgent. And moving more on to vaccines and the sort of science behind them. What platforms, what vaccine platforms are you hopeful about or excited about? Obviously other than your own, which presumably you're hopeful about and excited about. But maybe you could just walk us through some of those things.

Peter: I think, if there is a silver lining on all of this is the fact that we are accelerating multiple new technologies. That have never been scaled before to develop vaccine, human vaccines for global health. So I do like the innovation, right? Looking at mRNA vaccines and DNA vaccines and adenovirus vaccine platforms.

I like looking at new adjuvants and all that is being now scaled up at a level we've never seen before. So that's a positive. I think we've tended to overdo it a little bit. I think we're over reliant on the new technologies and not balancing it enough with some of the traditional technologies.

At the end of the day, COVID 19 is an old school problem in virology. As the science writer Carl Zimmer says the COVID 19 virus, the SARS CoV 2 virus is clumsy prey. It's all about inducing high levels of immunity to the spike protein, and there are lots of ways to do it. And I think, for instance, the Chinese Sinovac vaccine is going to turn out to be an okay vaccine.

It's, again, as old school as you get, an inactivated virus. Yeah. On alum. And I think we, we rushed a little too much into what I sometimes disparagingly call the shiny new toys. I've made a few people upset by using it, 

Jessamy: but 

Peter: I do it to strike home a point that, there should be a more balanced portfolio on innovation is great, but when you're in a crisis like that, having technologies to fall back on it is good also, because you never really know how this is going to pan out, especially when you start bringing it to scale, we'll get a better sense from the Moderna Pfizer.

No VO vaccines for RNA, DNA, and adenovirus vaccines. When we start doing 30, 000, as we go through the 30, 000 people in phase three trials, but there is risk there. And it would be good to have some older vaccines in there as well. So as I said, I think of it like a. a stock portfolio. You want a few old standbys as well as some new and innovative startups as well.

Jessamy: Can you talk about the virus being easy prey, but are you hopeful for a vaccine that will give full protection or do you think we're going to see something with partial, obviously nobody can predict the future, but just thinking about it from a sort of empirical, just logic point of view.

Peter: We don't have the correlates of. protection yet. But 10 years ago when we were making our parasitic vaccines, we also picked up a coronavirus vaccine program because our colleagues at the New York Blood Center felt that coronavirus vaccines have been orphaned. These are important pathogens and came to us about taking it on.

And we did. And now we've been making coronavirus vaccines back then. Nobody cared about coronavirus does. But What we learned from that was high levels of virus neutralizing the antibody was a pretty good correlative protection. It may not be the only thing you need. You clearly need T cell help as well.

But if you don't get high levels of virus neutralizing antibody, no matter what you're not, we don't seem to get protection. And Dan Baruch's group at Harvard medical school is, looks like he's shown the same thing in non human primates with COVID 19 vaccines. And I think that's probably going to be a pretty good indicator.

And what we're seeing are varying levels of the ability to induce virus neutralizing antibodies. So some of the shiny new toys as. as they were, don't seem to do very much in a single dose, you need to give at least two doses. And I think that's probably going to be true of all the vaccines. And then the question is, whether we can see a correlation between levels of virus neutralizing antibody and levels of protection.

So for instance, maybe some vaccines will induce only modest levels of virus neutralizing antibody. An important question. Will those Be partially protective, meaning they'll reduce severity of illness, which is important, but they may not reduce virus shedding. And I think that's a possibility we have to recognize.

And then vaccines that would give very high levels, might be completely protective. So I think what we have, and this is why public health communication is going to be so important. You may have we may wind up first of all, I'm pretty optimistic. We're going to have several vaccines, but a varying degrees of efficacy.

So you'll have some vaccines that maybe it'll be as good as a measles vaccine, which, gives 97 percent protection against infection. In two doses and could actually, if enough people get vaccinated, can create herd immunity to stop transmission at the other extreme. We may have vaccines that look like a flu vaccine in a year where there's not a good match between the virus and the vaccine, which will reduce severity of illness, which will be important.

And then you're going to have a pretty careful communication strategy to explain it. People who've got this versus that what their expectations should be and there might be some countries that only use the one that's only partially protective, in which case you're going to need. It's not, these will not be replacement technologies.

These will be companion technologies where you still have to wear masks and do contact tracing and that sort of thing. And that's going to be important to message. And then we remember, we know nothing about the durability of the immune response for these vaccines. So it's possible some may be protected for only a year and may need a booster.

Almost all of them probably will need boosters down the line. How do we explain that? How do we create the system to do that? And remember, every time things are not perfect, whereas in the past, the anti vaccine groups were fringe groups. Now we've enabled IR silence. We've created a monster. They dominate the internet and social media.

So any weakness in our vaccine system and messaging will be exploited by those guys. And this will also have catastrophic consequences. So we're going to need A level of communication and advocacy that we've never seen before, and nobody wants to touch it. Nobody wants to take the 50 or, just, I've been pushing this really hard and All of our big time players, the U.

S. government, the Gates Foundation, CEPI, WHO, have, they've seen this as the third rail of science funding and they haven't really wanted to take it on and I've been saying it's only a matter of time before this undermines everything. And I think we're at that point now, and, I can't imagine how much time I've spent convincing foundations, both small and large and government organizations to take on the anti vaccine movement.

And I think part of it is they look at how I get beat up all the time and say, who wants that? Why, we could do so many better things we could do with our money. And I think we're just going to, we're going to have to confront it. The World Health Organization's credit in 2019, they did list vaccine hesitancy as a major global health threat.

And I think Heidi Larson in London had a lot to do with championing that. But and I've been working on the U. S. side to do the same, but I've not really made a lot of progress on the U. S. side. We still pretend it doesn't exist or we use excuses to say why it's still a fringe group and it'll just go away, but we're going to have to address it.

Jessamy: Yeah, and the sort of level of communication to convey that sort of narrative. We haven't shown so far that anybody has the ability to do that, which is, extremely concerning, really. 

Peter: I think some of the cable news networks like CNN and MSNBC and even Fox News have given me the opportunity to talk about it.

And I'll always, I get this flurry of emails. Some of them are, some of it's hate mail, right? The anti vaccine crowd, that's to be expected. But overwhelmingly, it's been really positive, from people I've never met before, often lamency, nobody's ever explained that to us like that before.

Thank you. Yeah. Doing that. Oh, I didn't realize that. And or, so I'm sitting here with my husband and said, we know, no one ever told us. that about vaccines or that's how vaccines work. So I think the public is clamoring for someone to speak to them. And I think the way the problem, the way we do science communications, if we do it, or most of the time we don't do it at all.

And when we do it very badly. We make one of two mistakes. Either we bring somebody on who is a scientist and fills it with jargon that no one can understand. But more commonly, the mistake that's made is Someone comes on and dumbs it down to the point where it doesn't even make any sense. And I see this with the White House Coronavirus Task Force.

But I think what happened was, in schools of communication across the United States, told everyone that you have to speak to people like they're in the sixth grade. And people are a lot more sophisticated now, and they want to know. Some details they want to understand the science, but it does take more time to explain it.

But once you do, people get it. And so one of the things that I, and as opposed to what the Rhinos Coronavirus Task Force, they'll state the conclusion of their own internal deliberations and present it as dogma, and it doesn't make any sense to people. So the thing that I do is, I explain to audiences, assuming I get the time to do it, how I derived it, how I came to this conclusion what's my thought process, and people love it if you get the airtime to do it.

BBC's a lot better at doing this than some of the US TVs but overall that, that needs to happen. We need to rev up science communication like we've never done before, and as far as I know. One of the only schools universities that's taken this on is Imperial, Imperial College. They've had a program in science communication around for several years now, and we just need more of that.

We actually have to build it into doctoral, post doctoral training. We need to build it into medical training. And so far, there hasn't been a lot of appetite to do it, but I think that's going to be very important. 

Jessamy: Yeah, it's interesting, isn't it? Especially with vaccinations because we there's been such rapid progress and we have us this, in this situation where it's almost accepted dogma that this is what happens, you take your child, but ultimately you're still taking your child to someone else to inject them with something that most people don't understand.

Peter: And now parents are coming in ready for a war, right? They've downloaded all the misinformation. There's now 480. anti vaccine misinformation websites out there. And then, so the parents come in with this misinformation, and they explain this to the pediatrician, and the pediatrician's I never heard that before.

And they're made to feel stupid as though they're not keeping up with the literature. Of course, they are keeping up with the literature. They're not just, but they're not keeping up with the literature. And this is creating a lot of problems for them as well. And it's getting worse. And I think the other thing that the foundations have done, and the U.

S. and U. K. governments have done, is They've always somehow seen this as not only as a fringe group, but somehow walled off to North America and Europe, not recognizing how This is happening among the middle and upper classes across India and Brazil and Argentina and it's now causing huge issues like we saw in Samoa last year in the Philippines and this will only get worse.

Jessamy: The narrative is very much, once we have a vaccine, this is all over and we can, go back to normal. 

Peter: This makes me crazy. This is what Operation Warp Speed when the few times they have communicated or the White House, they make it sound like it's 1956 and they're going to bring all the journalists to the University of Michigan auditorium to hear about the results of the Salk vaccine.

You're going to pull back the black curtain, like the Wizard of Oz and all of a sudden everyone's going to. pop champagne and go dancing in the streets, and it's just not going to work that way. And that's the way they're setting themselves up. We're setting all of us up for failure because of the way we're handling this.

Jessamy: Yeah. And I think that's concerning in terms of, civil unrest and that sort of, that cycle between misinformation, disenfranchised groups. Civil unrest, all of that is a movement where there seems to be a, a huge kind of Potential here because we're not managing that side of the communication and we're not managing the narrative at all.

Peter: We now have Richard has charged us, when I say us, I mean myself with Saad Omer, who's a Professor Yale to create a Lancet Commission for vaccine hesitancy in the U. S. And trying to do a deep dive in this none like previous facts and commissions. We hope to do something a little bit differently, and so much in the past has been about fine tuning our message.

around vaccine hesitancy, and I've explained that's fine to do that. But right now it's a message in a bottle in the Atlantic Ocean. It's not being heard. So what I think is going to be necessary is something that makes everybody very uncomfortable, which is we're going to have to figure out how to directly confront the anti vaccine and anti science movements.

In some cases, dismantle them and directly challenge and be confrontational. And the minute I say that everybody runs out of the room. But I don't know 

Cailin: why. 

Peter: Yeah, it's because, that's not what we do as scientists, right? You know how, especially academics, you know how we are. The worst, you mean, the, if you really want to destroy somebody, you damn them with fake praise.

And that's how we do it, right? We say something less than amazing about them, and then, people want to jump out the window. But but we're going to have to take this on in a really substantive, aggressive way. And I don't know. It may never, we may never get there. It's, because our certain, our way of doing things is so ingrained.

And it, it takes a culture change in our, in the way we do science to, to make that, or at least the way we talk about science and communicate science. 

Cailin: Yeah, 

Peter: but we haven't made changes, right? We do things we've never done before. Some of the innovation coming out of places like the Lancet.

Yeah, people like Richard being examples of how Richard Horton of how we can express emotion and have frank discussions in that. Couch everything in careful academic terms, but say, be able to speak frankly and openly and it's so it is getting better. It's just happening at a rate that's slower than the pace of that.

The opposition is working. 

Jessamy: I don't think we can leave it on a kind of all hail our leader, Richard Horton, although I would like to, because obviously that is an optimistic note, but perhaps you could just tell us, we've talked a lot about the concerning things but what are some of the high points of the last sort of six to nine months?

Maybe we can try and end on a, on an optimistic note outside of Richard Horton, which is obviously an important note as well. 

Peter: There's not been a lot of silver linings to COVID 19, but there are a few. I think one is the fact that people are starting to hear from scientists more now than Perhaps before.

So if you turn on the cable news network, you can hear directly from a scientist. It's been a long time since that's happened. And I think overall, people like what they're hearing. They like the explanation. They like hearing from the source. They don't like everything filtered through our elected leaders.

And in some ways, the sign there's more trust of scientists. Then some of our elected leaders and you're hearing this, especially around Tony Fauci, you know how say, I don't want to hear from you. I want to hear this from Fauci, Dr Fauci and that's a positive step. I think that's happened.

So that's one of the few things that have happened. I think making progress on accelerating a vaccine. Is really an extraordinary undertaking, especially if you can, this was a pathogen which nine months ago, no one ever heard of. And now we're already talking about vaccinating the world. So that is a testament to our institutions.

It's a testament to organizations like the National Institutes of Health and the Wellcome Trust and the British MRC and and also the Gates Foundation has had a very important role in that. In that sense, things have worked well on the science and technical end, where, and CEPI as well, and I think what they've done is very important, where things have, of course, not gone well as is all of the governance around it.

So our technical ability to make vaccines is outpaced our once again, our political, social and financial institutions to make it work. So the one silver lining, I think, is science is now being held in a higher regard. even despite all the anti science activities than it has been previously. 

Jessamy: That seems like a nice note to end on, Peter.

It's been such a pleasure talking to you. 

Peter: And thank you and Lancet for giving this so much attention. I think these types of podcasts are so critically important. 

Gavin: Some incredibly important points about the difficulties the scientific community will encounter trying to accurately communicate the nuance of vaccine development and delivery there.

Really interesting to hear.

Jessamy also spoke with philosopher of science, Kaelin O'Connor, about how we communicate facts and how the U. S. needs to look at the problem of misinformation. 

Jessamy: Kaelin, thanks so much for joining us. Perhaps you might be able to tell us a little bit about what your background is, where you work, what your kind of research area is.

Cailin: Yeah thanks for having me. I'm really delighted to speak with you, Jessamy. So I'm a philosopher of science. A lot of people haven't heard of that area, but it's interdisciplinary between philosophy and the sciences. And we do a lot of different things. A lot of my work involves looking at how scientific communities work and in particular, how they make knowledge and trying to think about are there ways that science can improve and how does this process happen and how do we get to good theories and what things go wrong.

And I've, in particular, thought a lot about false beliefs and cases where there have been false beliefs spreading in science or the public. 

Jessamy: Yeah. Like I said, I'm so enjoying your book and I do feel like it's required reading for, anybody who is either in the scientific community, like making their own research or journals, physicians, whatever, there's so many great examples in it.

Thanks. What kind of led you to write the book? 

Cailin: So I wrote this book with my co author and husband, actually, James Owen Weatherall. So he's another philosopher of science. We wrote it actually after first the Brexit vote in the UK and then the 2016 election in the US. So these two really big political events where misinformation played a key role and really came out of left field, really surprised people how important misinformation was in these events.

So before that. A lot of the work I do involves modeling, so building computer simulations that tell us things about real world societies. And I had been doing a lot of modeling work on scientific communities and trying to understand the spread of good and bad beliefs in scientific communities. And Jim had written some more popular or trade work before.

And after these big events, he said why don't we take the kind of work you're doing and other philosophers of science are doing in this area and other philosophers in history. Historians of science have done before and use it to try to understand what's happening on social media today. 

Jessamy: Yeah. And it's such a good analysis of it.

I thought we could start off briefly by just, a small but simple question that, we might just chat through, which is what is our relationship with truth? 

Cailin: You can say that's a small, simple question, but if you're talking to philosophers it was ironic.

It's like a question philosophers have been grappling with for literally hundreds of years. Thousands of papers have been written on this topic. It's 

Jessamy: the surgeon in me coming out, just what's the answer? Let's move on, what's truth? What's 

Cailin: truth? So one thing we talk about in the book, which is interesting, is this really old, huge problem called the problem of induction, which is essentially at the heart of it is that we can never know anything for 100 percent absolutely certain.

So if I ask you how do you know the sun's going to come up tomorrow? If you tell me the sun is going to come up tomorrow, I ask you, how do you know? You could say all sorts of things like It's always come up before or I know these things about the sun and the earth and how they move. But it's not actually guaranteed that it'll come up tomorrow.

An asteroid could hit the earth, something could change. And that is really true of most. matters of fact, right? How do I know for sure that eating swordfish is safe? I don't actually know a hundred percent for sure. It's just that I'm very confident in it, right? So what we promote in the book is instead this framework where instead of thinking of knowledge and certainty, we instead think of ourselves as having beliefs that come in different levels of strength.

I might be very sure it's safe to eat a tomato, a little less sure that it's safe to eat? I just ate some California buckwheat out in the preserve by our house because I had read online that it was okay. I was less sure about that, right? And so we have these strengths of belief and the kind of evidence and information we get from those around us and from the world can contribute to how strong those beliefs are.

One reason we like this kind of view where we're thinking about levels and strengths of belief is that a lot of people have tried to use certainty as this kind of false ideal of science and corrupted that. So for example, you hear people in oil and gas saying things like climate change is really just a theory.

We're not 100 percent certain the climate is going to change in these predictable ways. And so since we don't know, we can't act on it, but of course that's not the right picture. We're pretty sure. And so we should act. 

Jessamy: And I guess that's a theme that comes through again and again, through all the examples that you write about is this idea of kind of people introducing doubt as a way of stopping progress or stopping a kind of movement towards the truth because, unless you can be certain, then we can't act on it, whether it's the tobacco industry or climate change. And that just seemed to be like a really running theme. 

Cailin: Yeah. We really draw there on the work of Naomi Oreskes and Eric Conway, these historians of science.

They wrote this amazing book called merchants of doubt, where they go through all these cases where people in industry tried. basically to confuse the public and policy makers about some matter of fact. Is tobacco dangerous? Do CFCs wreck the ozone layer? Is acid rain coming from coal plants? Is climate change happening?

And in every case they were trying to promote just enough doubt to stop action or policy on these matters. 

Jessamy: Yeah, exactly. Exactly. So I'm interested to know what your thought is about this sort of newly coined term, the infodemic that's, the COVID 19 and how that fits into your view on what misinformation is.

Cailin: Yeah, so I think that this is a really good term and an important concept. So with the advent of the internet and social media, I think many people were very optimistic about what this would do for our states of belief and knowledge, right? We have the internet. None of us ever have to be wrong about anything.

Again, all of human knowledge is right there at our fingertips. But of course we've seen this. It's really surprising, almost paradoxical effect where this increased connection between people has, in fact, led many of us to be exposed to a lot more misinformation, conspiracy theories, and, outright disinformation.

People trying to confound us, control us, spread false beliefs or cause division. And so I think naming that is really important. Of course, with COVID. I don't think it's different in principle from what we've been seeing for the last five, six years. But there is a lot of misinformation and a lot of disinformation to people trying to use the panic of the pandemic to promote whatever agenda they have.

Jessamy: And I guess that kind of leads us on to this thing that you touched on earlier about models. So maybe you could just briefly tell us a little bit about our understanding of how scientific theory is communicated and how a community might either come to the right or the wrong decision.

conclusion. 

Cailin: Yeah. So in the book, we draw a lot on models to try to think about the spread of belief and false belief and why things go right or wrong when we're trying to learn about the world around us. And so there's a lot of ways to learn about that, right? But if we think about things like the internet or a scientific community, they are very large.

They're extended in space. They involve, hundreds, thousands, millions, billions of people. And so these processes where yeah. Beliefs spread from person to person socially, or a community decides that something's true or false, or a scientific community changes from one theory to a new one, are very difficult to study empirically because they're so big, so extended.

So using models where you build something like the scientific community, or just a, community of people on the internet learning, and then study that, and then try to, understand something about the real world on the basis of it can help. They're not perfect, but they can do something for us and allowing us to get a grip on how some of these processes work.

Jessamy: And I was particularly interested by something that you talk about, this sort of the Zollman effect. Can you just explain like what is that? 

Cailin: Yeah, so this was an effect that was identified by a colleague of mine in philosophy of science, Kevin Zollman, so he's a modeling person, and he was thinking about this question, suppose you have a community of people who are trying to decide between two beliefs, and maybe these are cigarettes are dangerous for you, they cause lung cancer, and they don't, and they're trying to figure out which of these two things is true.

So he looked at models where people have a kind of decision problem. They can get some evidence about these problem or about these questions. They can use that evidence to change their beliefs. They can gather more evidence. They can share their ideas with others in the community. He was looking at a model like that and he found that.

surprisingly in this model, sometimes when the community is really connected, they do worse on average, which you wouldn't think that would be the case. You would think you would want scientists to be communicating with each other as much as possible, right? Because they need to share their ideas. They need to share what they find with each other.

And so the Zolman effect. happens when a community that's too tightly knit actually ends up settling on kind of the wrong theory preemptively. And basically, the reason you have this happen is that there is a benefit to scientific communities and, communities of everyday people of what we might call transient diversity.

So think about it this way. There are a lot of possible theories about the world. If everybody holds the same theory right at first, you're unlikely to have settled on the right one. So ideally you want people to be exploring many different theories. Maybe tobacco smoking is harmful. Maybe it is safe.

Maybe it causes lung cancer. Maybe asbestos is causing lung cancer. You want people to be investigating a lot of different things. And that way you're more likely to settle on the most promising or successful theory. And so if people communicate too much, because we all influence each other we can settle too quickly on the wrong thing and so that's this kind of surprising reason why you might want to have not a totally unified always communicating scientific group.

Jessamy: I haven't finished the last chapter but I know it's a little bit about fake news and I just wondered whether you could tell us the history of fake news and why do we feel it's more common now? 

Cailin: Yeah so fake news is as old as people communicating is, right? So one way I like to think about this is, humans are these deeply social learners.

Most of what we know or we think we know, we've just learned directly from other people. And that is so useful to us. This is why we can have culture, technology, science. It's why we know almost anything, right? Think about the things that you yourself have figured out in the world. It's just a tiny fraction of your knowledge.

So that's great. But the way I like to think of it is like that opens a door. between people and good ideas can come through and as soon as it's open, bad ideas or false ones are going to come through too because we can't check every idea by ourselves. So we're always going to have some level of misinformation, false beliefs, false rumors spreading from person to person.

That, that's just the state of being human. So it's an old phenomenon. But one thing we see is whenever there are new innovations in media technology in the kind of structure of how information passes from person to person. There are also changes in the scope of misinformation and the way that it can spread.

So think about the advent of the printing press. That means that now, rather than a false rumor having to pass from one person to another because they're telling each other, people can print a false rumor and get it to a much, much wider audience. much quicker. So we see things like yellow journalism and, misleading pamphlets and propaganda pamphlets and things like that because of this new technology.

With the advent of radio, we see people setting up, what you think of as fake news radio channels that were blasting the airwaves with nonsense. And all of these new media required, new social technologies to control the spread of misinformation and fake news. So if we think about print journalism, what we end up is this kind of technology where we have media sites, newspapers that have really good reputations and to protect their reputations, they have to fact check their news and those are the people we trust.

And so we end up kind of controlling the spread of misinformation that way. Now, what's different today is that we get the internet, we get social media, this explosion of new information, technologies, and new opportunities for information, ideas, beliefs to pass from person to person. And now it's not just that you can broadcast to people in a country, you can put something online.

It could be everywhere in the world in a second, in just no time. So we have this once again, a change in our media structure, we're trying to regulate it. We're seeing an explosion of misinformation on it. It's changing so quickly. It makes the problem much less tractable, right? So we can try to fix up Facebook.

But even if we're fixing up Facebook, WhatsApp is popping up with a whole new kind of structure of information sharing. And so I think that's part of the reason we see what they've called an infodemic right, right now. Yeah. 

Jessamy: Yeah. So what does the, what does the future of information look like in an ideal world?

Cailin: Okay. So my coauthor is much more of an optimist and I'm much more of a pessimist. So he's thought more about the ideal world and I'm more like, what is the worst?

But in an ideal world, what we want. are social media structures where we can exchange ideas freely, where we can have debates, but where we're not constantly inundated by nonsense, misinformation, disinformation, fake news, and conspiracy theories, right? And the reason we want what you might think of as a kind of clean informational environment is that individual humans, we only have so much capacity to figure out this nonsense.

That's not really how we're designed. We're not. designed to try to get to the heart of every false claim. We're designed to trust each other and the things that we hear. So it's very hard for us to be in these dirty or occupied information environments. So the question is, how can we do this?

How can we have places where free speech is protected, but we're keeping out. Some of these conspiracy theories and, the Russian government trying to polarize other countries and, people from oil and gas trying to convince us that they're, now their technologies are clean, they have clean coal, or, whatever it is.

Yeah. So that's a really big, difficult problem. It's something, social media platforms are grappling with different governments are grappling with. The EU has done a really good job about being proactive in thinking about this and working about this. There are a lot of like little things people are doing that are effective and hopefully will lead to better information environments.

One thing that makes us especially challenging is that misinformation is constantly changing. And evolving, as we learn how to adapt, say with fake news sites, and those become less effective because we figured out how to deal with them, propagandists are developing new techniques to mislead us, right?

They're making deepfake videos and funny memes and YouTube conspiracy videos and things like this. 

Jessamy: So it's pretty hard. It's hard. Sorry, that was just such a bleh. No, but I feel like I'm with you on this sort of slightly pessimistic. It feels, like an issue where that we've just started scratching the surface.

We've just maybe just coined it basically, we've just named it and now we have to, we've done the diagnosis and now we have to find some kind of a treatment, which seems a long way off. 

Cailin: I'm hopeful that in 10 years, we'll look back and we'll have come up with good technologies for controlling misinformation in the same way that, during the 70s, a lot of countries figured out how to control litter in their cities or have clean air, right?

I hope that we'll look back and see that. For now, we're doing a lot of dealing with last year's problem today. It's hard to know what is the most potent misinformation online right now, because it's usually of a kind of new form. And then it's a couple months later, we look back and say oh yeah, that was really effective the way, whatever it is, the Russian government had made Facebook groups and we didn't realize, or, these people had been engaged in some kind of conspiracy.

conspiracy mongering against some politician. Yeah, so hopefully we get better at identifying and dealing with these things as they're happening. 

Jessamy: Yeah, I hope so. 

Gavin: Thanks to Kaylin and Jessamy there. There's so much to think about in terms of how we as a community discuss scientific knowledge and progress and what is really an extraordinarily crucial time for science.

We'd like to thank you for listening to this episode of the Lanza Voice. If you've got any thoughts on these topics or really any other feedback, please drop me an email on podcasts at lancet. com. We'd love to hear from you. Join us again soon for more.