Persuading the right audience

It’s hard to persuade someone if you don’t understand what they’re already thinking. There’s a strange debate going on in the media right now about whether the FDA/CDC’s “pause” on the Johnson & Johnson vaccine for COVID is likely to improve vaccine hesitancy or make it worse. As of now, there have been six serious blood clots among people who have had the shot, and one person has died. Proponents of the “pause” say that by confirming the safety of the vaccine, people will eventually feel more confident about it. Opponents say that this just adds ammunition to the anti-vaxxers stock.

As far as I can tell, people who think that this pause will increase vaccine confidence just don’t understand who they’re trying to persuade. Some media and academic types have observed that many anti-vaxxers right now are Trump voters, and this is true. But I don’t think I’ve seen much about what can be done to persuade them to get the shot. These are not typical anti-vaxxers; their objections are not necessarily about the safety of the vaccine. Rather, their objections are about the necessity and sufficiency of the vaccine.

Folks who work in public health are sort of by definition going to think differently than very populist libertarian types who think public health is at best meddlesome, and at worst a subtle (or not so subtle these days) means of illegitimate control. So consider this brief post an attempt to reconstruct the populist view, and then see if you think the pause will help convince these people to get vaccinated.

Because it’s necessary these days, let me pause <wink> and put some cards on the table. I think it is hard to conceive of any moral justification for the FDA/CDC’s decision. I grant that they have a reason to act as they did. But merely having “a reason” is not good enough. No moral theory or system that I can think of would justify this decision. (And yes, I do think I have the relevant expertise to say this.) I am also generally well-disposed toward public health efforts and good healthcare, and I think public health is a legitimate function of government. I am…not a fan of Trump.

For some data to support the following analysis, refer to this latest YouGov poll. (Yes I know it’s one poll; it’s just an illustration.) Yet most of my reconstruction below comes from actually talking to some of these people about this.

(Partial update: YouGov compared results from people who took the poll before the announcement vs those who took it after. There’s a big drop in confidence in J&J’s vaccine. I’d interested to see the demographics of the change. Even a question like “After hearing the CDC’s announcement, are you more or less confident in the safety of the vaccine?” I suspect Trump voters’ opinions aren’t the ones changing.)

These populist anti-vaxxers (PAVs) think that vaccines are unnecessary. They think that COVID in general has been overblown. The risk is no where near as high as the “liberals” in government have made it out to be. Most people who get COVID won’t get terribly sick, most sick people won’t infect anyone else, and the economic and social fallout from a year of tight restrictions will be far worse than the disease. (Note that these beliefs aren’t obviously false.) COVID has just become an excuse for the government to impose on citizens’ lives and to infringe on their liberties. (See poll question #6.)

The “pause” just boosts this belief. If the government were really worried about COVID, they would be doing everything possible to get shots in arms as fast as they can. But now they’re willing to stop giving one of the shots—the one that is the most convenient on several dimensions—possibly for a few weeks to assess the risks implied by one death.

If you’re disposed to think that this is really about government control, and that vaccines would end the pandemic and thus the political cover for that control, it is hard to see how the decision would do anything but strengthen your belief.

(Again, for clarity, I think these folks are wrong about the risks of COVID. And also unfair about the motivations of public health officials.)

PAVs also think vaccines are not sufficient. (Poll questions 22-24.) A decent number of Trump voters (and ideological conservatives) believe that it is not necessary to wear a mask right now. They also think that travel is safe. Some of these beliefs imply that the vaccines aren’t necessary. But it also shows that they think getting vaccinated won’t really change anything. The FDA, CDC, and other public health figures have not helped on this point. Refusing to describe an “end-game” to the pandemic has been a constant source of frustration to these folks. The goal posts keep moving. Remember “15 days to slow the spread”? Yeah.

So suppose that the CDC and FDA do the review, and determines that the vaccine really is safe still. Yay! (Does anyone really think that there will be a different result?) What has changed for the PAVs? Not much, it seems. They didn’t really doubt that the vaccine was safe. (See poll questions 11-19.) They just doubt that there’s any point in taking it, so what’s the rush? And look! The CDC agrees that there’s no rush!

The trouble throughout is that public health types believe that these anti-vaxxers don’t trust the vaccine. But that’s not right. They don’t trust the government, and especially the unelected federal bureaucracy.

So I think the “pause” will have little notable effect on populist hesitancy. (Though compare poll questions 14 and 18. It will be interesting to see how #18 changes in the next couple of weeks. And see this NY Times piece on the worldwide impact.) It won’t do anything to address their actual concerns. If anything, the pause will likely entrench their belief that their government really doesn’t have their interests in mind, and doesn’t really believe its own messaging. And honestly, I’m not sure how to show they’re wrong about that.

What is a public health ‘guideline’?

We are now entering year two of COVID-tide, and an effective vaccine to stop the pandemic appears to be soon at hand. It has been a tough year, and probably will continue to be abnormal for a while, if public health and epidemiological experts are to be believed.

The pandemic has forced many people to learn a lot about the world very rapidly. Many of us have had a crash course in epidemiology, immunology, and public health over the last year. One thing we seem to have also learned is how complex and impotent our public health institutions are.

One of the problems in public health is that many public health experts have no real practical authority. They’re academics, and most of their conversations in ordinary circumstances are among themselves. The public health officials do have some authority, but it is often limited to medical providers and the adjacent industries (think CDC, FDA, etc.). In ordinary circumstances few people would think there is anything strange about this constrained mandate. Indeed, there is a vigorous (though small) cottage industry of ferreting out strange make-work regulations from these agencies, thereby indicating that even the limited mandate may be too broad in ordinary times.

The trouble now is that these public health agencies (and even more, academics) can’t really make rules for the general public. They issue "guidelines". Both a rule and a guideline are a kind of norm, and so it is common to see the words used interchangeably, particularly in these quasi-medical contexts. There is, however, an important difference between a guideline and (what I will call) a rule, and I want to think out loud about this difference for a bit.

Put simply, a rule requires enforcement, whereas a guideline is merely advice. If we distinguish these two concepts in this way, it helps illuminate the problems we’re having with all the various pieces of public health and medical advice we’ve gotten over the last year.

Start with a rule. If don’t enforce compliance with a rule, it is hard to see what practical import it has. Enforcing public health rules is really, really hard. Enforcing rules in general is hard, but in this case, we’re trying to deal with many kinds of behaviors performed by many kinds of people in many kinds of situations. It is implausible that a single one-size-fits-all rule could cover every case. And so it is hard to enforce the rule in a non-draconian way.

Consider, for example, the recent news that NY governor Andrew Cuomo was going to levy fines and other penalties for not following the state’s vaccination "guidelines". This action is totally reasonable and incredibly stupid all at once. It is being made by the proper person: only Cuomo, or someone elected official like him, plausibly has the authority to punish in this way. It also gives a powerful extrinsic motivation to comply. However, it is far too powerful, and in this way quite stupid. In a time where vaccines have extremely short shelf-life and are in very limited supply, while also being extremely effective, making people second-guess their use of the vaccine is a bad idea, for it makes it more likely that vaccines will be wasted. Better for it to go in the wrong arm than in no arm at all.

Other public health measures have proven very hard to enforce. Mask-wearing is a notable case. I can’t think of much actual argument in favor of the moral or civil right to go unmasked. (This essay complicates matters somewhat, though I don’t think it makes a case for a right.) Preventing social gatherings has also been difficult, not least because there are many different sorts of them, and some have been "approved" for political or religious reasons.

Any rule that is simple enough to remember will necessarily have some exceptions in the wide variety of relevant contexts. This adds another difficulty to enforcement, because it is not the case that every instance of non-mask-wearing (for example) is wrong, or even against the rules. Trying to suss out every possible case is a fools errand, and a waste of political or moral authority.

Because the rules are hard to enforce, and because they are often issued by people who have no practical authority, they often come in the form of "guidelines." A guideline is basically a kind of structured advice, given in the style and tone of a rule. It is notable in that it is effectively unenforceable by the one making it; if it were enforceable, it would be a rule, and it would require real enforcement.

Some public health "guidelines" are actually rules, particularly when the constrain the action of various other actors. Medical guidelines, for example, are often really rules for medical professionals. Failure to comply can earn one a hefty penalty. Cuomo’s order mentioned earlier is like this. The NY public health officials promulgated "guidelines", but Cuomo’s actions reveal that these are really rules, since there are penalties for non-compliance.

The trouble with true guidelines is that they have only as much authority as advice does. Guidelines about the size of gatherings, for example, depend on groups deciding to follow the norm. Other groups may decide that they care about their fellowship more than the guideline, and it is hard to clearly say what is wrong about this. (To be clear, I think there often is something wrong about flouting the guidelines, for reasons I’ll get to momentarily.)

Advice is a peculiar thing. Agnes Callard offers a helpful distinction between three different things: "instructions", "coaching", and "advice". Asking for advice, in this trichotomy, is "instructions for self-transformation." That is, it is asking for coaching delivered in the form of instructions.

I think a lot of guidelines are trying to do almost exactly this. And this is why they fail. When public health experts issue guidelines, they are appealing to epistemic authority rather than practical authority.

The transformation that people are seeking in public health guidelines is increased knowledge of what to do in a novel public health emergency. Few of us have any personal understanding of all of the complex features of a global pandemic. We need to know what to do for our own safety and well-being, and we look to experts to give us insight. But the experts can’t give us a graduate-level education ("coaching") in epidemiology or any other technical field. (And often they are unable to even explain their own field to non-experts—a real weakness of many kinds of expertise.) They’re forced to give fairly generic and vague bits of practical wisdom. Fundamentally, they’re trying to supply an education in the form of practical instructions. They need us to think differently about various activities, but they lack the time and opportunity to teach us how to understand. So they give instructions—practical maxims that looks more like rules.

It turns out that a lot of people seem to be genuinely looking for just this sort of thing. They want to know what they can do, and generally are willing to follow the instructions, even without external enforcement. Yet because the instructions are generic and impersonal, individuals can gain knowledge without complying. There is some evidence that this is how a lot of people are operating.

(A topic for a different post: some people already have the relevant knowledge, and often it’s far deeper and broader than the guidelines can provide. E.g., people who live in E. Asian countries and have past experience with pandemics. It isn’t unreasonable to listen to them for advice rather than or in addition to "science.")

Yet when people use guidelines to increase their knowledge, but then supplement that information with their knowledge of their own particular circumstances, sometimes they choose to not obey the guidelines—the instructions—even as they benefit from them. Thus the guidelines "fail" to change behavior, which is what they are intended to do. How then is it ever possible to promote compliance with the public health norms without turning them into rules with official enforcement?

There is a large class of norms that aren’t enforced (or enforceable) by the state, and yet substantially constrain our actions. We might call these "manners". Having bad manners won’t get you fined or put in jail, but it will have consequences, most notably your exclusion from certain types of society.

Manners are famously opaque to those outside the society that uses them. They seem pointless or excessively fussy, and often the social opprobrium directed at mannerless behavior seems to far exceed the immediate practical consequences of the faux pas.

Something similar seems to be true of many current public health guidelines. There seems to be little public health need to wear a mask while jogging, for example. Yet at least in some places, appearing outdoors without a mask for any reason is treated as a serious error. To those who care, this treatment is enough to promote compliance (and, crucially, to perpetuate the norm by "enforcing" it against others). To those who don’t care, there is little one can say. If someone doesn’t want to be part of the mannered society, it is hard to justify complying with any of its norms. In this way, manners resemble instructions. Instructions are useful only if you want what they aim at. Some people just don’t care whether others (usually described as "elites" or "liberals") approve of them, and so the informal social enforcement mechanisms just don’t engage.

Further, as I hinted, mannered behavior gets perpetuated by being enforced by the participants, rather than by some central authority. We’ve seen this too. Ordinary citizens berate one another for not following certain guidelines, as if the guidelines empower the man-on-the-street to enforce the norms. If you asked these self-appointed police whether they believe they have any legal authority, they would say of course not (most of the time). But they clearly think they have some right to demand compliance with the norms. This makes a lot more sense if the norms are like manners, where there is no central enforcing authority and each participant is at least somewhat empowered to police the standards of right behavior.

Finally, there are reasons to comply with manners, even if you think they’re stupid. Often manners are the way that a society demonstrates respect for its members. There may be many different possible systems of norms that indicate respect or care for one’s neighbors, but within a given context the individual usually doesn’t have a choice about which system to follow. Following public health guidelines often takes this form. It may be true that in a particular situation a mask is unnecessary (e.g., while jogging), but wearing it demonstrates that one is willing to limit one’s own freedom out of care for others, and that is a useful message on its own. Similarly, forgoing group gatherings to limit the rapid spread of infectious disease may demonstrate respect for the health care workers that are physically, mentally, and morally exhausted, even if you know that no one in your group actually has the disease.

In sum, I think there are good reasons to comply with public health guidelines, but I also think there are some real limits on how much we can say to those who don’t want to. Fundamentally, most of the norms coming from the public health and other science-tinged domains are just advice. It’s probably mostly good advice, but it’s also not irrational or immoral to ignore it. The same is not true for rules that public officials have issued. If you think you are obligated to obey the government, then you should obey their public health mandates. But public officials should be clear too. For those norms that are really important, public officials who have the relevant authority need to use that authority and actually enforce the norms. Though, as I suspect many have realized, doing so may cost them their job. So be it.

Crying wolf and doing our part

A number of people have noted that it is hard to persuade people to take COVID-19 seriously because it feels like the boy who cried wolf. Previous outbreaks of infectious disease, from ebola, SARS, MERS, etc., have been generally contained in a few regions, so the cries of pandemic have seemed overblown. To some people’s minds, this latest outbreak is just another in a long line of cases where media and public officials have restricted liberties and spread what feels like unnecessary panic. More cynical observers might even say these crises are pretexts for greater government control over citizens’ everyday lives.

The trouble is that this particular outbreak looks a lot more like a real wolf. As of writing, the growth in cases around the world exhibits the classic signs of exponential growth, and there is compelling evidence that many countries are severely under-reporting the actual number of cases (including, it seems, the United States). Furthermore, this virus seems to be in the "sweet spot" for a public health concern, for it isn’t so deadly that it burns itself out (like ebola), nor is it so mild that medical facilities can absorb it (like the common cold or the seasonal flu).

But there is another aspect of "crying wolf" to consider. The way to combat this virus is to create "social distance" so that the virus doesn’t spread as rapidly. This is a classic collective action problem, because for the vast majority of people, there is little personal benefit to social distancing, and often quite a lot of personal cost. Typically the government and media persuade by showing how a particular behavior is in an individual’s self-interest. In this case, mitigating the risk for those for whom this virus is very dangerous requires people who have almost no risk of their own to massively alter their behavior.

In short, we need everyone to pitch in and do their part, even if it doesn’t seem to benefit most people directly. But this kind of rhetoric is also common, and often has looked like crying wolf.

One can hardly walk through a museum or a zoo without being bombarded with claims about what dire things will happen if we don’t all contribute to the cause-du-jour, even when some of these causes are distinctly out-dated and poor candidates for action by individuals. Individuals can only rarely affect many of these causes, such as reducing pollution, minimizing plastics, divesting from fossil fuels, mitigating acid rain, protecting the ozone layer, conserving water, preventing species extinction, etc.. All of them may be good things to do, but the problems are ones of public policy or technology. Acid rain, for example, wasn’t reduced by ordinary citizens’ acting together; it was mitigated by better public policies and improved technology. The typical visitor to the museum can have only the tiniest effect on the problem, and often at a personal cost that makes this sort of ostensibly-virtuous action available only to the relatively well-off (e.g., using less fossil fuels).

But now, with COVID-19, we seem to have a real case in which it actually is important that we generally act in a coordinated way, and for which we have no time for improved public policies or technological solutions. But to people who have learned to ignore the overstated "we all have to do this together" messages in our society, and who have internalized the "what’s in it for me" style of advertising, it’s hard to explain why this time it’s different.

If everything is a crisis, then nothing is. I think our cultural elites (not a pejorative) have too often made everything they care about into a public crisis, evangelizing for their current interests, only quietly revising their predictions, rarely moderating their confidence, and almost never conceding error. And then a real crisis comes along, and no one is willing to listen.

Back to blogging

In the interest of having somewhere to write that I can control reasonably well, I’ve restarted this blog. I’ve had some content at this domain before, but I haven’t updated it in years. That’s mostly because I was using Jekyll, which is cool technology, but hard to maintain (and kind of a pain on Windows).