Vaccine Hesitancy: Public Trust, Expertise, and the War on Science by Maya J. Goldenberg

Abstract

Reviewed by: Vaccine Hesitancy: Public Trust, Expertise, and the War on Science by Maya J. Goldenberg Jacob Steere-Williams Maya J. Goldenberg. Vaccine Hesitancy: Public Trust, Expertise, and the War on Science. Science, Values, and the Public. Pittsburgh: University of Pittsburgh Press, 2021. xii + 251 pp. Ill. $32.00 (978-0-8229-6690-6). In December of 2020 the United States Food and Drug Administration authorized two mRNA vaccinations for emergency use to protect individuals sixteen and older from SARS CoV-2, the causative virus of the COVID-19 pandemic. The New York Times called it a “turning point in the pandemic,” and many in the scientific and public health community believed that the technological solution of safe, effective, and widely available vaccines would either end, or drastically-reduce rising COVID-19 infections and deaths. The majority of the public, in other words, would trust the science and get vaccinated. But that did not happen, and as of August 2022, only 67 percent of the American population is vaccinated against the disease. Leading up to the rollout of the COVID-19 vaccine, historians and philosophers of public health warned that technological solutions alone do not solve public health crises. As Mark Largent and Elena Conis have argued, vaccine hesitancy, skepticism, and anxiety have long been entrenched in American public health [End Page 171] debates. Even if we did not listen to the historians, our collective hubris might have been a product of short-term memory loss; in January of 2019, for example, the World Health Organization listed vaccine hesitancy as one of the leading global health threats, alongside the likes of air pollution, climate change, and warfare. In the words of philosopher of science and medicine Maya Goldenberg, the COVID-19 pandemic has been a “clear global test case in public trust between health and government bodies and members of society” (p. ix). But what frameworks do we have for understanding the broader patterns of scientific mistrust that have risen to levels of palpable public health crisis in the past two and a half years? Maya Goldenberg’s new book, Vaccine Hesitancy: Public Trust, Expertise, and the War on Science, is the siren call for critical health studies scholarship that we all need right now. Historians, public health practitioners, ethicists, and clinicians will all find this book relevant. Written in the years leading up to the COVID-19 pandemic, but published in the pandemic crisis year of 2021, Vaccine Hesitancy is a cogently-written and lucidly-argued account of the rise of vaccine hesitancy as both a public attitude and an analytical concept. So where does the public mistrust of the science of public health stem from, and why are so many Americans skeptical of the safety and efficacy of vaccines? Many public health practitioners, Goldenberg argues, have relied on a “knowledge deficit model,” which suggests that public mistrust is a product of the misunderstanding and ignorance of scientific ideas. The policy implications which follow from this approach, Goldenberg maintains, are broad-based attempts at science education in order to reinvigorate the idea that scientific experts should guide public policy. In other words, vaccine hesitators are often dismissed as morally-bankrupt, confused, ignorant, or ideologically-driven. This war-laden set of metaphors, which Goldenberg argues are common in the public health community, create a false dichotomy between righteous, bias-free ‘science’, on one side, and an irrational public on the other. Goldenberg rejects the knowledge deficit model, resolving that “characterizing vaccine hesitancy and refusal as a war on science is both descriptively inaccurate and normatively unhelpful” (p. 12). In place of this dichotomous framing, Goldenberg argues for a contextualist reading of vaccine hesitancy, one which focuses on the historical and structural reasons for public mistrust that lie in a wide-range of factors that comprise social identity. In this way, debates around vaccine hesitancy need to be understood alongside those about climate change and genetically-modified organisms. What is at stake is not a war on science, but a negotiation about deeper cultural values of democracy, the environment, and governance. Vaccine Hesitancy is organized into two parts. The first four chapters in Part 1 analyze and disambiguate the war on...