By Peter Schlosser, Ayrel Clark-Proffitt and Manfred Laubichler
This month, total known deaths from the pandemic topped 6 million. The true figure is certainly higher–estimates put the excess deaths between 14–24 million. No disease, terrorist attack or natural disaster has led to such a staggering death toll on a global scale in the past 50 years. The world has failed the stress test forced upon it by COVID-19 during the past two years.
And yet, it is undeniable that the past two years also demonstrate that humans can develop extraordinary measures, quite rapidly, in the face of extreme pressures. Across the globe, we mobilized science and technology to develop testing and vaccines. Governments passed assistance programs to protect businesses and put money directly in peoples’ pockets to slow bankruptcies. Essential workers, including nurses and doctors but also police, firefighters and grocery store clerks, placed themselves at great risk mostly without being adequately rewarded to make sure people received treatment, could buy food and were safe. There were stories of hope, courage and community, from Italians in lockdown serenading neighbors from their balconies to lift each others’ spirits to Los Angelinos applauding and banging on pots in a nightly salute to health care providers.
So why are millions of people–more likely tens of millions of people–dead? The novel coronavirus–SARS-CoV-2–is highly contagious and made more pernicious by the fact that asymptomatic carriers can still transmit the disease. However, it is not the most communicable or deadly pathogen that infects humans. Could we have done things differently the past two years to reduce the death toll?
The answer is yes. We, society, failed to recognize the complex nature of the pandemic and respond with the appropriate set of measures. People and governments assumed that a straight-forward fix, like public health guidelines, a vaccine and possibly therapeutics would solve the crisis. This is reflective of the powerful metaphor of a “Magic Bullet” that still dominates medicine and public health. We didn’t consider whether people would embrace the solutions. Human decision making is complex, so no matter how we respond with technology, medical advances or financial support, it comes down to whether or not the public is willing to accept and use the available options.
The global pandemic, which is still ongoing as evidenced by recent spikes in China and central Europe, continues to highlight the vulnerability of our society’s increasingly complex, interconnected systems. How we behave in response to shocks as well as long-term events, such as climate change, is key to global futures. Here, we dissect decisions made during the past two years as an artifact for the future–a time capsule for those who inhabit this planet during the next emergency. The novel coronavirus–SARS-CoV-2–that causes COVID-19 will not be the last virus the world will face, and COVID-19 is not the last crisis the world will confront. Human societies already face multiple, overlapping threats beyond COVID-19, including war, inequality, food insecurity, water scarcity, loss of biodiversity, climate change and more.
Human decision making is complex, so no matter how we respond with technology, medical advances or financial support, it comes down to whether or not the public is willing to accept and use the available options.
Breakthrough: Rapid development of solutions
The swift response to COVID-19 proves that humans can overcome exceptional obstacles when forced to do so. The ability to operationalize science, as well as financial and medical resources, to quickly develop solutions has been one of the few bright spots during the pandemic. After the SARS CoV-2 genetic sequence was released in January 2020, the world saw unprecedented mobilization of research dollars to develop vaccines. Researchers relied on past discoveries, innovations and new applications to bring forward vaccines at an unprecedented rate. Within two years the World Health Organization approved 10 vaccines for emergency use against COVID-19. The first of those vaccines was available within 12 months of the earliest identified cases. Historically, vaccines take five to ten years–sometimes longer–to be available to the public. For instance, the polio vaccine took seven years to move from discovery to testing to approval. Through the application of known scientific advances–particularly alignment of decades of investigation into messenger ribonucleic acid, or mRNA–as well as overlapping trials, the speed of COVID-19 vaccine availability reflects a historic endeavor that certainly has saved countless lives. Nearly 11 billion doses of COVID-19 vaccines have been administered across the world.
When fear of the disease, combined with government-mandated shutdowns, left people without paychecks and business owners struggling to remain solvent, governments across the world rolled out economic stimulus packages to prevent recession. Global economic stimulus has taken many forms, including direct payment to citizens, financial support for businesses, loan payment deferment, reduced interest rates, increased funds to health sectors and tax forgiveness. Additionally, governments promoted public health guidelines to help reduce the spread of the virus. For example, Japan’s ubiquitous messaging to avoid places with the three Cs–closed (indoor) spaces, crowded spaces and close contact–provided actionable information to the public to help reduce the spread of the virus. After initial confusion regarding the effectiveness of masks, face coverings were adopted as an additional tool to prevent transmission.
Breakdown: Human decisions
Most of the health solutions put forth during COVID-19 required individuals to make a decision. People asked themselves: Should I stay home? Should I wear a mask? Should I get vaccinated? This is why the measures offered to reduce deadly disease were options, not solutions. They did not take into account the complexities of human decision making. In the early days of the pandemic, people were dealing with new and real struggles, including fear and uncertainty. Many people got sick and many people died. Many struggled with being confined and attempting to home school their children. The proposed measures added new levels of stress to individuals and societies. Almost as soon as they were proposed, these measures were also politicized and became yet another feature of societal polarization and perceived as limiting our freedom. Thus, in addition to protective measures such as face covers and physical distancing, vaccines seemed to have the highest promise towards a way out of the pandemic and the return to “normal.” But when vaccines became available, a large fraction of the population did not take advantage of them. People’s decisions are shaped by worldviews, by group dynamics and by emotions. Unfortunately, individuals do not always make choices that are in their own best interest, let alone consider what is best for the public. Human coping mechanisms lead us away from despair. In the face of mass death, disasters or illness, we withdraw, become too numb to act.
The complexity of human decision making prevented us from applying obvious measures to reduce suffering. In doing so, we accepted death–on a massive scale. We were willing, across much of global society, to trade extensive loss of human life for short-term gain. We accepted death as a consequence of our decisions, whether it was conscious or not. We ignored recommendations to get vaccinated, wear masks and avoid indoor gatherings. We spread a lethal virus to our family members, friends and colleagues. We treated healthcare and frontline workers as expendable. In the United States, more than 975,000 are confirmed dead from the virus–that’s the equivalent of roughly three 9/11s each week since the beginning of the pandemic. Rather than come together as a society and take some responsibility for our actions, we normalized death from COVID-19. However, people did not normalize death in a vacuum.
Vaccine hesitancy: A pre-existing condition
Vaccine availability alone will not end this pandemic. Even prior to the first cases of COVID-19, low global vaccine rates for preventable diseases, such as tuberculosis, rotavirus, and in some parts of the world, measles, led to unnecessary deaths. Rates for the pneumococcal vaccine, which helps prevent pneumonia, meningitis and sepsis, are also significantly low in some countries. In 2019, the World Health Organization (WHO) selected vaccine hesitancy as one of its top 10 most important health issues. There is no one reason why people choose not to get vaccinated. Some may think the illness is not severe, others may not trust the vaccine’s safety or efficacy. Researchers have also found that trust in government plays a role in vaccine acceptance. Furthermore, vaccines have become somewhat of a political litmus test. What is interesting here is that globally no clear pattern exists. While in the U.S. conservative Christians have a higher rate of rejecting vaccines than liberals, in Germany vaccine hesitancy runs the political spectrum, which incidentally created some very interesting images during large-scale demonstrations with far right anti-government activists marching side-by-side with liberal mothers. Plus, a not insignificant number of people are afraid of needles.
People’s decisions are shaped by worldviews, by group dynamics and by emotions. Unfortunately, individuals do not always make choices that are in their own best interest, let alone consider what is best for the public.
An epidemic of distrust
Trust–in government, in science, in corporations, in each other–is an important building block of a functioning society. Trust is also complex, varying by person, economic status, historical context, political affiliation, geography, etc. Nearly universally, trust in science increased during the pandemic, especially among those who felt they knew little about science. However, trust in government, especially among many western countries and in particular the United States, has steadily declined for decades. Prior to the spread of SARS-Cov-2, the United States was considered the most prepared nation to deal with a pandemic, according to the Global Health Security Index. But buried in the report was a harbinger of things to come: the United States had the lowest possible score on public confidence in government. This lack of trust almost certainly made Americans less likely to comply with government regulations, safety protocols and vaccine recommendations. When one considers the country’s peculiar two-party political system, and one of those two parties has been openly anti-science and anti-government, it is not at all surprising that of the 6 million confirmed deaths from the virus, more than 15% are in the United States, despite the U.S. making up only about 4% of the global population. The tragic results of COVID-19 in the U.S. should serve as a parable for the detrimental impact of citizens’ lack of trust in government.
Trust related to past government decisions is also an important driver of vaccine hesitancy–particularly among Indigenous and marginalized communities who have good reason to distrust government-sponsored vaccines. Historical traumas perpetrated by colonizers, many directly related to disease and “medical care,” lead to logical suspicion among these communities. A lack of quality health care in these communities, as a result of institutional racism, further impedes vaccine uptake.
There are also serious trust issues concerning the for-profit pharmaceutical industry. The industry as a whole has an image of profiteers, enjoying massive gains off human illness and suffering. The industry’s role in the opioid crisis, high prices for medications and steep cost hikes, lead “big pharma” to appear more villainous than heroic, further complicating vaccines as a be-all-end-all solution for a pandemic.
Confirmation bias fed by misinformation
Where there is doubt and mistrust, there is someone prepared to take advantage. People are susceptible as they seek out information to back up their beliefs–confirmation bias. For the vaccine hesitant and those fed up with lockdowns, content claiming that vaccines don’t work or that COVID-19 is a hoax can be alluring. Enter anti-vaxxers who, like climate deniers, ignore scientists and broadcast falsehoods via podcasts, social media and other biased platforms that often masquerade as legitimate news outlets. The misinformation spread by this global movement confused the populace and contributed to decisions to view the vaccines as unsafe. Across the world, tens of thousands of protesters have blocked streets and disrupted government buildings in places as far apart as Canada, Australia, New Zealand, Austria, the United States and Germany, among others.
Pundits act in concert with anti-vaxxers, exploiting the vacuum left by government officials’ poor communication. They sow discord by berating health officials, pushing boycotts of masks and stay-at-home orders and spreading misinformation about vaccines. Last year, Sky News Australia posted videos on its YouTube channel that claimed COVID-19 was not really a pandemic and promoted unproven treatments such as ivermectin and hydroxychloroquine. In the United States, politicization of treatments and misinformation has led to the “polarization of death.” Data suggest that U.S. counties with higher percentages of people who voted for former President Trump in the 2020 presidential election also have higher COVID-19 death rates.
Media moved on
At its best, the media can remind us we are part of a collective society and a connected world. As the novel coronavirus spread throughout the world, reporters flocked to hospitals to show the world what was happening. Media outlets released images and articles that conveyed the anguish. Coffins lining church aisles. Parking lots and shipping containers as makeshift morgues. Funerals devoid of loved ones.
Most media outlets are predisposed to simplify complex issues. They were good at covering the immediate crisis, but very bad in making people understand complex interdependencies or the inherent uncertainties of a science, especially when it unfolded at the rapid pace of the pandemic. Many news outlets cut science reporters over the last two decades, although societies are more dependent than ever on science and technology. And a few exceptions notwithstanding, scientists have not been able to fill this communication void.
Like people, the media has a short attention span. For example, news outlets shared wall-to-wall stories and photos of Russia’s invasion of Ukraine during the first days of the war. But one month into the aggression, coverage is beginning to taper off. The pandemic is now in its third year. With the exception of the initial push to chronicle the disease and special milestone projects to memorialize the victims, most coverage of the pandemic is rote reporting, reflecting the media’s desire, as well as the public’s, to move on to the next story. In daily coverage, journalists merely updated the previous day’s article with new infections, hospitalizations and deaths. Plug and play. Repeat. The public became desensitized to virus-related deaths, particularly in locations where the number of infections and deaths had no connection to changes in safety measures.
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Scientists have referred to COVID-19 as a dry-run for climate change. It has long been assumed that significant death would tip the scales toward action to reduce emissions, increase renewable energy and change behaviors. The pandemic makes clear that even the immediate deaths of millions of people isn’t enough to change behavior. There were options to actually help ameliorate some of the hardships, such as staying home when possible, wearing a mask and receiving a vaccine–but those options were not accepted. How much more difficult will it be to get people to change behavior for a less immediate threat that can be felt directly?
If we, society, are part of the problem, then we are also part of the solution. When dealing with complex problems, we must remember that the solution is rarely–if ever–simple. We must incorporate a complex-systems approach into global dilemmas, such as pandemics, climate change, hunger, inequality and other crises. We must begin with the human response, evaluating psychological coping mechanisms as well as external influences, including value systems, group dynamics and historical contexts, among others. We must rebuild trust. We have the capacity for change. In preparation for the next variant, virus or threat, we must make the right choices with urgency to build a thriving future for all humankind.