The company of the dead: part three
Why we shouldn’t ignore the risks of vaccines
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“You’re saying it’s a weed?” the woman says, incredulous, as if I’d just said that the pink-flowered vine had been planted by aliens from Mars. “But it’s so pretty. And the fruit’s delicious.”
“Yes, it is,” I say, and I watch her expression change. She wasn’t expecting me to say that.
“The flowers are lovely, and I like eating the fruit too,” I continue.
She nods in agreement.
“So, if it’s pretty and it’s edible, how can it be a weed?” she asks.
“Well, a weed’s just a plant in the wrong place. And in this case, it grows all over the coastal forest. It’s really vigorous and it smothers the trees. Even though the fruit is edible, it produces far more than anyone can eat, and when it’s growing on steep slopes, over the top of forest, nobody can get there to harvest the fruit anyway. So it just spreads and spreads.”
It’s a conversation I had dozens of times when I worked on invasive weeds for the Department of Conservation. I would explain that a particular plant was a problem, and so people shouldn’t plant it, and they wouldn’t really believe me. Quite often, their counter argument was that the plant was pretty, or that the fruit tasted good. Or, in the case of banana passionfruit, both.
People never expected me to agree with them. I suppose they expected me to try and convince them that the plant we were discussing was horrible and ugly, so that they would like it a bit less, and not mind when one of the weed control crews went through and killed it. But that would not have helped. Beauty might be subjective, but most of the plants I was talking about had originally been garden ornamentals. As a rule, they were the kinds of plants that people thought were attractive.
I faced a similar, but potentially even trickier, situation when I talked about pesticide use. A common reaction was for people to say, “but it’s toxic”. That, of course, was true. A pesticide has to be toxic to something, otherwise it doesn’t do its job, which is to kill things that we have decided are pests. The word “pesticide” has the same Latin origin – the verb caedere, meaning to kill – as words like homicide and suicide. It’s a word that sounds dangerous.
To deny the lethality of pesticides, even some of the relatively innocuous herbicides used for weed control, was never going to win people over. Even the most innocuous herbicides have some negative effects, such as killing the wrong plant if you aren’t careful enough when you apply it, or being an eye irritant. I could have produced reams of safety data, but even in those days, before there was such a thing as Facebook, people could dig around on the internet and find reliable information suggesting that the herbicides we used could not be considered completely safe – at least not when fed to rats in high doses. That didn’t mean the herbicides couldn’t be used in ways which managed the risks – but there’s a gulf of difference between something which has manageable risks and something which is “safe”.
So, when someone made the point that a particular pesticide was toxic, I wouldn’t disagree. I would always accept their point that using a pesticide had the potential for harmful effects, even if it was one of the least toxic herbicides. Once I had done so, they were usually ready to discuss the reasons I might want to use herbicides, and we could have a sensible discussion about the risks and benefits of controlling invasive plants.
When I first started talking to people about invasive species and the use of pesticides on public land, I wasn’t following any particular communication strategy. But, around that time, a colleague lent me a book called “Responding to Community Outrage”, published by the American Industrial Hygiene Association – an organisation for occupational safety and health professionals and not the sort of group you would expect to publish a riveting book. I did find it riveting, though, and I read the whole thing in a couple of hours. When I’d finished, I had completely changed the way I thought about my work.
The book was a simple, practical guide to having sensible conversations about risks such as chemical spills from factories, especially when a company had caused the problem or covered it up and people were, justifiably, angry. While I doubt the author, Peter Sandman (whom I mentioned in my previous article), had ever considered invasive species management in relation to his work, it was immediately clear to me that everything he said applied. I found his book encouraging, because the approach I had taken naturally was on the right track, but Sandman explained why my approach worked, and what else I could do. He also explained why people tended to behave the way they did when discussing risks – why technical experts play down the risks, company executives try to hide the evidence and the public get angry over things that don’t seem like much to anyone not directly involved.
When we think about the risks of skiing, or pesticides in our food, or a factory being built in our neighbourhood, Sandman explained, we aren’t thinking about how likely we are to get sick, injured or killed. Instead, we weigh up a range of factors such as how much control we have over the risk, how familiar the risk is, whether the consequences are something we dread, how fair the risk is and how much we trust the people who have given us information about that risk. Collectively, he termed these factors “outrage”. Whenever people are upset about something that might be a risk to the health of themselves or others, the chances are that they are more upset by the outrage factors than by the magnitude of the risk.
Reading Sandman’s book, I realised that by acknowledging that invasive plants could be pretty, or herbicides toxic, I was establishing myself as someone who told the truth. Had I denied the facts, even rather subjective facts such as whether or not a plant was pretty, I would have immediately lost credibility, because I would have been dishonest. And if I was dishonest about one thing, people would immediately start wondering what else I was dishonest about. Perhaps I wasn’t telling the truth about the harm those plants did. Perhaps the herbicides were a lot more toxic than I was admitting. Perhaps I was just some sort of fanatic who hated all plants that weren’t native.
Most of the time, the kinds of situations I dealt with weren’t particularly controversial. People don’t get as upset about killing plants as killing animals, and herbicides are nowhere near as toxic as the pesticides used to kill possums and other mammals. But, sometimes, I did find myself in discussions about 1080, which is probably the most controversial pesticide used in New Zealand today. And that gave me the opportunity to see just how heated some debates about risk can become.
The toxin sodium monofluoroacetate, better known as 1080, is not one of the nicer pesticides used in New Zealand. It can be lethal to a wide range of living things – particularly mammals (including us) and birds, but it is also toxic to reptiles, insects and even algae. Dogs are the most sensitive animal known, and they are particularly vulnerable because of their tendency to eat carcases of dead animals, including those which have been poisoned by 1080. There’s no antidote either, and once a dog is showing symptoms of poisoning, they have a poor chance of survival.
With all I have just said, you may well be wondering why organisations as diverse as the Department of Conservation, Federated Farmers and Forest and Bird would be united in their support for 1080, especially its aerial application over thousands of hectares. Surely there is a better way to control possums? The answer is both yes and no. Without a doubt, a trap such as the A24, which kills possums almost instantly, is more humane as well as being less controversial. A toxin like brodifacoum, which has a specific antidote, is much less likely to poison dogs. But when it comes to controlling possums and other invasive mammals over large areas of inaccessible terrain, there’s nothing else that comes close to 1080. It’s not just that it is effective, but that taking all the other factors into account – the risk to people, the risk to native species, livestock and other animals we value, and the cost – there isn’t anything better, at least not right now.
However, it’s also easy to understand why 1080 upsets people. I’m sure that nobody who is concerned about the welfare of animals likes the idea of poisoning possums, and potentially other animals as well. But it doesn’t necessarily follow that they oppose its use. Many people, myself included, accept 1080 as the “least worst” option, a necessary evil until we have a better way to protect our forests and native species from invasive mammals such as possums.
Others, of course, do not accept it at all. Opposition to 1080 has been around for years but has been rising. At times, it has turned nasty, with Department of Conservation staff subjected to threats and abuse. It’s also clear that some opponents of 1080 are not above using dishonest means to make their point. In 2018, a number of dead birds were dumped on the steps of parliament as part of an anti-1080 protect. Post-mortem examination of the birds found that they had died from a range of causes – two were hit by vehicles, two probably flew into windows, one had been shot and one was too decomposed to determine the cause of death. In 2014, Fonterra and Federated Farmers received anonymous threats to poison baby formula unless 1080 was banned. The threats were accompanied by formula which had been laced with 1080. The blackmailer was later found to own a company which made an alternative pesticide.
When opponents resort to these tactics, it’s tempting to characterise them as fanatics and nutters. It’s certainly hard to imagine people involved in this kind of protest being convinced by the kind of discussion I outlined earlier, when I was talking about invasive weeds. But that’s not the point. There’s an odd paradox in risk communication, something that Peter Sandman points out in his book – two opposing sides are not held to equal standards of behaviour. When activists – the most vocal opponents of a particular risk – exaggerate by saying a risk is more dangerous than it actually is, they don’t necessarily lose all credibility if the risk is shown to be lower. But a government agency or industry group which underplays the risk will lose their credibility if the risk is shown to be higher. Sandman points out that the activists’ exaggeration is like a smoke detector going off when there’s no fire – inconvenient and potentially annoying, but not dangerous. But if the smoke detector fails to go off when there is a fire, that might kill people.
Particularly passionate believers in a cause may well be so attached to their beliefs that you can’t convince them otherwise, but, Sandman says, that is no reason not to try. Alongside the fanatics, there is a much larger group who aren’t dumping dead birds on the steps of parliament, but are concerned – the most recent survey I could find, from 2014, reported that 40% of those asked opposed the use of poisons such as 1080. The less strident opponents, Sandman points out, will look at how supporters of 1080 respond to the most fanatical of opponents. Will 1080’s supporters act in a trustworthy manner, treating the activists with respect and acknowledging that there are legitimate reasons to be concerned about 1080? If they do, many opponents will then be willing to listen to 1080’s supporters. If they don’t, then there is no chance of a sensible conversation.
But the point of this article was never to discuss 1080. Invasive mammals in New Zealand are a serious, important issue, but there is something else going on right now which is a matter of life and death for millions of people. New Zealand has just had a frightening reminder that, even with what are among the best efforts in the world, we are facing a very tricky virus. The world won’t be going back to anything resembling normal until we have a safe and effective vaccine – and enough people get vaccinated.
At first glance, there isn’t much that’s similar between dropping a dangerous poison from the air over thousands of hectares of forest, and vaccination. But they do trigger the same kind of vocal, fervent opposition, and that may be, in part, because of the way we talk about them.
Those who support the use of vaccination will generally describe vaccines as safe. Statistically, that is absolutely true. Adverse reactions are rare – in my previous article I mentioned the one in a million chance of dying from the smallpox vaccine, or the up to one in 100,000 chance of a severe allergic reaction to MMR. But vaccines are given to millions of people, and among those millions, a small number will experience genuine adverse effects. In addition, there is the possibility, however small, of someone making a life-threatening error, as happened in Samoa.
But even with a situation like Samoa, the numbers favour vaccination. Less than two years after the deaths of the two babies in 2018, and the resulting drop in vaccination, 83 people there, mainly children under four, died of measles.
The numbers don’t tell the whole story, though. Imagine, for a moment, how it must have been for those two mothers. They took their beautiful healthy babies to the hospital for a routine vaccination they had been told was safe. The nurses injected them. Within minutes, the babies were dying in their mothers’ arms. How must they have felt? If that isn’t painful enough, you can read what they have said about those awful events. Or watch an interview.
However, when it comes to vaccine opponents, most of them don’t focus on the documented adverse effects or tragedies like Samoa. Instead, they focus on arguments like the thoroughly discredited link between the MMR vaccine and autism. The original paper which made that assertion was found to be not merely flawed, but fraudulent, with the intent of financial gain. But the myth linking vaccines with autism has been remarkably persistent, and understanding it better is important if we are to convince enough people to accept a brand new vaccine for Covid-19.
If you think back to the first article in this series, where I talked about childhood mortality, you will remember that, on average, a quarter of babies used to die before their first birthday, largely from infectious disease. Today, those numbers seem incomprehensible to us. Even countries suffering terrible ongoing conflict and deprivation, such as Congo and Yemen, are doing much better than that these days. Both of these countries have infant mortality rates which are around one in twenty – still high from a modern perspective, but much better than historical averages.
As a result, we lack the personal experience of seeing babies and young children taken from us by infectious disease. We no longer have the company of those children, alive only in our memories, reminding us how dangerous childhood diseases can be. What we do have is a prevalence rate for autism of about one in a hundred. That means everyone will know people affected. And a proportion of parents are going to look for answers in all the wrong places, stumble across some misinformation and find themselves validated by a community of people who can understand what they are going through.
As a foster parent, I’ve learned a lot about parents and parenting, but one of the most important lessons is this: nobody intends to be a bad parent. You might find it hard to imagine how I can take this from the experience of caring for children whose parents may have done terrible things. But I’ve almost always been able to see the signs of good things that their parents have done in the words and actions of those children. I’ve also interacted directly with the parents of a number of the children I’ve cared for, and I cannot say that they struck me as people who didn’t care for their children.
It’s a lesson that we sometimes lose sight of when we start talking about people who don’t vaccinate their children. Since, on social media and in real life, I largely associated with people who support things like 1080 (even if reluctantly) and vaccination, I sometimes come across jokes about people who oppose vaccination (these are a relatively mild selection). Sometimes, I admit, I think they are funny, and if one of my friends posts one, I may even like or comment on them. But I also think back to my experiences with risk communication about weeds and herbicide, and I feel rather uncomfortable. Because laughing at people and implying that they are stupid – or worse, implying that they don’t care about their children’s survival – isn’t going to win them over.
A recent, global study found that around 7% of people disagreed with the statement “vaccines are safe”, with a further 11% unsure. In general, it was in wealthy countries and where childhood mortality is lowest that people were most suspicious of vaccines. France had the highest proportion disagreeing that vaccines were safe, around one in three.
As I mentioned earlier, the original article linking vaccines and autism was deliberate fraud, but the vast majority of people who are concerned about vaccine safety are not morally bankrupt people who care nothing for their children, or even others’ children. I am quite certain that they are people who genuinely want to do the best that they can for their children. They are worried about the frightening experience of taking their healthy babies to be injected with something which, they have heard, might be harmful. Perhaps they’ve heard misinformation, but perhaps they are aware of real situations where there have been adverse reactions or appalling errors.
In order to communicate with people about vaccination, we need to follow the rules of good risk communication. Peter Sandman succinctly describes those rules as “kindergarten lessons – tell the truth, ask first, clean up after your own mess, share, say you’re sorry”. As tempting as it may be when we are frustrated by misinformation and conspiracy theories, good risk communication practice doesn’t include calling people idiots or implying they don’t care about their children. We have to assume that they want to do the best thing for their children, and have an honest conversation with them, acknowledging their concerns and helping them to put them into perspective with the still-real danger of infectious disease.
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