Speakers
John Gerrin,Professor of Government, University of Texas at Austin
Ilona Kickbusch,Founder and Chair, Global Health Centre, The Graduate Institute Geneva
Council on Foreign Relations, Global Health, Economics, and Development Roundtable Series
SOURCE: https://www.cfr.org/event/virtual-roundtable-preparing-democracies-pandemics
The coronavirus pandemic has
not been an advertisement for the healthy effects of democracy. There
have been some notable success stories among democracies, but it is also
true that nine out of the ten nations with the highest cumulative
COVID-19 cases are democracies. One possibility is that the mechanisms
that ordinarily produce better health in democracies—accountability
through free and fair elections and freedom of expression—may not
function to produce the same result in a pandemic. In this Council on
Foreign Relations roundtable, Drs. John Gerring and Ilona Kickbusch
discuss this possibility and their work from a new BMJ series on democracy and health.
Thomas Bollyky: Well, thank you. Welcome. My name is Tom
Bollyky. I’m the director of the Global Health program at the Council on
Foreign Relations. It’s my pleasure to welcome you to this roundtable
entitled, “Preparing Democracies for Pandemics.”
It is fair to say that the coronavirus pandemic has not, to date,
been an advertisement for the healthful effects of democracy. Several of
the countries that have acted quickly to contain COVID-19, such as
South Korea, New Zealand, Uruguay, are democracies, but as of yesterday
when I last looked, eleven out of twelve of the nations with the highest
number of cumulative reported cases are democracies too. This mixed
performance of democracies represents a departure from the success of
this political system in confronting other health challenges relative to
other forms of government.
Today, in this roundtable, we are going to discuss why the potential
mechanisms that connect democratic government to better population
health may not work as well in a pandemic—and we’re going to also
discuss how to better prepare democracies for future pandemics. In doing
so, I’m going to commend to you a new special collection of articles
recently published in the BMJ on democracy and health that
considers these questions. I will concede I am biased because together
with Ilona Kickbusch, one of our great speakers today, I was a guest
editor of the series, but it really is well worth your time, and I
recommend it to you. Both the series and its publication in the BMJ
were made possible by a generous grant from Bloomberg Philanthropies,
for CFR’s involvement and my involvement, and with support from
Konrad-Adenauer-Foundation to the Graduate Institute of International
Development Studies for the involvement of Ilona and her great team.
I’m really pleased to have two terrific speakers today to help us
explore this topic, generally, and this series. I am going to grossly
truncate their biographies and just tell you their current titles, but
you’re welcome to look at their biographies as well. Ilona Kickbusch is
the founder and chair of the Global Health Centre at the Graduate
Institute of International Development Studies in Geneva. John Gerring
is a professor of government at the University of Texas at Austin. Ilona
is going to start us off with a few minutes on the reason for this
project in the BMJ and on the continued importance of political
determinants for health, democracy in particular, despite what we’re
seeing in this pandemic. John is going to educate us on some of the
lessons from his paper in this series on whether or not health is even
politically relevant, drawing on some experimental evidence during this
global pandemic.
We are fortunate to have a number of the other authors of papers from
this series here as well, and I’m going to try to loop in some of them
in our discussion too. With that, I’m going to turn it over to Ilona
with just one caution, of course, is that this meeting is on the record.
It is for attribution. Anything you say can and will be used against
you as part of your vetting process for the next administration. So,
keep that in mind. And with that, I turn it over to Ilona to start us
off.
Ilona Kickbusch: Thank you very much, Tom. Welcome to everyone
to this discussion that, of course, we think is enormously relevant at
this point in time. Tom has asked me to say a word or two about how it
came about. That relates to the work of the Global Health Centre at the
Graduate Institute. We’re an institute of international relations and
development studies, and I have long been pushing that there needs to be
a stronger contribution of the political sciences and international
relations to the global health debate.
In global health, there is a strong discussion around what we call
the determinants of health. Initially, the focus was on social
determinants and particularly issues of inequality. That then moved on
to get a better understanding of what we call the commercial
determinants of health—how market forces actually drive the health of
nations—and then moved on to say, what is it actually about the
political determinants of health? This was also driven by the fact that
the present director general of WHO very frequently says health is a
political choice. And, therefore, the question arises: do certain regime
types make better political choices in relation to health?
So, that was the starting point of our thinking, and I was incredibly
lucky that, at the same time, Tom was thinking about things like that
and had published his article around that democracy does matter in
global health and that was in relation to responding to NCDs
[noncommunicable diseases]. So, our interests came together, and as he
indicated, we found some others who were ready to support us. We were
able, with the authors, to have two meetings—one in Berlin and in
Washington, DC—and then COVID-19 hit. And then our questions started to
change because the question then also became: does democracy matter in
response to a successful COVID-19 response? And as Tom has already
indicated, it seems that democracies reacted very, very differently.
Even if you take into account that there are different types of
democracies, it does seem so, though, that democracies that are built on
a binary system of the Westminster model seem to face, in some cases,
stronger divisions than some consensus-oriented democracies. But then as
we started discussing that, it took us even further that in the face of
populism, of nationalism, critique of science, info dynamics—all those
things that we’re going to come back to—we ended up with an even larger
question that our project hasn’t yet answered, but that we are hoping to
tackle in some of these dialogues. That is, and I’ll formulate it in
this way, how can democracy save the lives of its citizens and itself?
And this is related to the fact that it seems many democracies, or
some democracies, were not well prepared for the COVID-19 challenge on
many counts. Also, in terms of their regulations, in terms of their
parliamentary processes, in terms of involving their citizens. So, if we
ask now, and I’ll end with that, the interest is what can we learn from
the experiences of different democracies to actually say, is there a
way to—and we put this in inverted commas—to actually “pandemic proof”
democracies. And we’ve seen that some democracies have already started
this process. Two countries I know of, both Taiwan and Germany, have
already changed their infectious diseases law, for example, to allow for
more participation of parliament in these big decisions. So, those are
some things that we might take up as we move forward. Thank you, Tom.
Thomas Bollyky: Great, thank you so much, Ilona.
So John: the central theory for the connection between democracy and
better health is accountability. Accountability enforced through free
and fair elections means governments are more motivated to provide more
effective health services to a broader share of their population because
they’re subject to regular free and fair elections. But the United
States has the most cases and the most deaths in this pandemic. We saw
in the recent U.S. presidential election that 93 percent of the most
currently affected counties in pandemic voted for the president. Despite
all the U.S. challenges with COVID-19, the election ultimately swung on
forty-five thousand votes in three swing states.
What does your research tell us about what we’re seeing on how
democracy and that accountability function might operate in a pandemic
and whether it might be different from how it operates on broader
health?
John Gerring: Well, these are great questions, and I’m
delighted to be here and really grateful to you and to Ilona for this
initiative, which I think is really incredibly timely and important. As
you know, Tom, I’ve been working on this issue of democracy and public
health, and, like you, I’m convinced that there is a positive
correlation, and the way that we would like to think that democracies
seem to perform a little better than autocracies on measures like infant
mortality, but the relationship isn’t incredibly strong. In fact, it’s,
I guess you might say, surprisingly weak. And there’s also a question
about why it exists at all. What are the mechanisms at work? And I think
that’s—you know, both of these issues were driving, piquing my
curiosity.
So, in the paper that you’re referring to that became part of this symposium at BMJ,
I teamed up with a sociologist, Aaron Reeves, and economist, Arnab
Acharya, and we tried to enlist experimental evidence to address this
question. I guess we’re struck not only by the weakness of this
relationship between regime type and mortality, but also that in
democracies, one generally finds that economic issues are more salient
than health issues. And so, even now in the United States in the midst
of this terrible pandemic, as you pointed out, the U.S. is one of the
worst affected countries, it’s still the case that a much higher number
of Americans are very worried about the economy than are very worried
about the infection; this is a series of tracking polls that FiveThirtyEight
has put together the past year. And we can also see that Trump’s
approval ratings have held steady despite what many would consider to be
a disastrous handling of this pandemic. You know, I think we’re now at
about a quarter million deaths and, you know—so what is really going on
here?
Well, so our approach is to develop an experiment—a survey
experiment, as it’s called—where we recruit people, we expose them to
different treatment conditions that convey information about the health
pandemic and its economic effects, and then ask them outcome questions
about politics to see if that information moves the dial—if it affects
their view of the incumbent or their willingness to blame the incumbent
for what’s gone wrong. I’ll give you a little bit of detail on the
research design. I don’t want to get too much into the weeds, but
basically, we have a survey experiment that was run simultaneously in
three countries—in the United States, United Kingdom and India. So, two
rich countries and one poor country—all democracies. We used a
recruitment platform, known as Mechanical Turk, which is run by Amazon,
and fortuitously MTurk has lots of people in those three countries,
especially in the in the U.S. and India. And so, we were able to recruit
over thirty-five hundred respondents in the first round, and then in a
follow up round an additional two thousand respondents. And this is a
pretty high-powered experiment, so we don’t have to worry too much about
stochastic threats to inference.
So, there were—the way the experiment was set up is that people are
randomized into these different arms or treatment conditions. The
control condition—the people are told nothing, just, you know, the
basics about would you like to participate in this survey. And then
there was a treatment arm that conveys information about the economic
effects of COVID-19 on their country. So, in the United States, we said
some estimates suggests that the economy could shrink by 3.2 percent
this year, 52.8 million people could end up without work, and that the
value of stocks and shares could fall by around 30 percent. This was is
back in April. April through June is when the first round was
administered.
And then we had a health arm which conveyed information about the
likely health effects of COVID. And then, we did a second round of the
U.S. survey, not in India or in the UK, but in the U.S., we did a second
round several weeks ago in which we, you might say, primed the
treatment even more. So, we told them that the United States has one of
the highest infection rates of any country in the world, that an
estimated 250,000 people have already died, and that some people blame
this catastrophe on Donald Trump and the Republican Party. We say
according to one estimate, approximately 50 percent of American
deaths—roughly 125,000 deaths—would not have occurred if Trump had
publicly acknowledged the severity of COVID-19 and followed expert
advice on how to manage the shutdown of schools and businesses, social
distancing, and the distribution of masks. So, this is a very strong
treatment—not, I don’t think, a dishonest one—but, we’re really pointing
the finger.
Thomas Bollyky: Not an entirely a fanciful set of facts.
John Gerring: No, no, not at all. We tried to keep this as
real as possible, both for ethical reasons and also just in terms of
generalizability.
So, the two outcome questions were: one, would you support the
incumbent party and party leader if an election were held today, and
two, do you hold the government at fault for allowing the disease to
spread? And what we found is that there was no treatment effect across
any of these treatment arms—even the strongest one that we added in the
second round of the U.S. survey. And just to be very clear about this,
what this means is that the respondents who were told nothing, their
responses to these two outcome questions were the same, on average, as
those who were given information about the severity of COVID, its
economic effects, and so forth.
Thomas Bollyky: And to be clear, you found that in all three countries.
John Gerring: That is correct.
Thomas Bollyky: And is that similar to what you found on health in general?
John Gerring: Well, we did find that the experiment was
effective in raising the salience of the issue and anxiety about it, but
we didn’t find any political ramifications. And so, if this is to be
believed, it means that there are no repercussions. As we put it in the
title of the paper, it’s possible that public health—even a major
pandemic of this sort—is politically irrelevant.
Now, there are a number of possible explanations for this, and I
don’t want to consume a lot of time by going into them, but I’m happy to
do so later on. And certainly, there are questions about the extent to
which we can generalize from, you know, this one set of experiments with
a sample that is not a random sample of the general populations. And
there may be some special things going on, which I’m happy to elaborate
on or discuss, and I’m sure people out there have some thoughts on this.
So, our view is these are some pretty, I guess you might say, shocking
results and we need to know more. You know, we would very much like to
do some follow up work in different countries with random samples using
other, you know, a variety of public health issues, not just COVID, and
where we have a purely economic treatment as sort of the baseline. So
that’s what I’ve got, and I’d be delighted to hear what people what
people think.
Thomas Bollyky: Great. Great.
John Gerring: Thanks.
Thomas Bollyky: Thank you for that, John. And just to be
clear, do I remember that one of the responses indicated most of the
respondents considered the government was somewhat responsible for
health generally, is that accurate?
John Gerring: That is correct.
Thomas Bollyky: So, one possibility is that people view pandemics differently than health generally?
John Gerring: It’s possible.
Thomas Bollyky: Possible. Interesting. All right, I’m going to
try to pull in one of our participants, who’s one of our authors for a
different paper, because it gets at a separate mechanism by which
democracy is meant to improve health.
So, I’m going to call on Steven Wilson and ask you to indulge me on
this, but I think you’ll find it really quite revealing. Steven is an
assistant professor of politics at Brandeis and looked at a separate
mechanism by which we believe democracy affects health—freedom of
information. The theory is that in democracies when people are more able
to share information freely, there will be more accountability for the
government. People will also learn of more healthful practices and that
feedback will inform the practice of government in providing health. So,
lots of good things come–-we think–-from free expression. But I want to
pull in Steven on the question of whether or not the free expression
also has a downside in democracies when it comes to disinformation and
social media. Please tell us a bit about your paper with Charles
Wiysonge and how it connects to what we saw, perhaps in this pandemic.
Steven Wilson: Thank you very much, Tom. It’s been a pleasure
to be part of this process, and we found some really interesting things
in our research that I’d like to share with you. So most of my work in
general has nothing to do with health. It has to do with the internet
and the effect of social media on democracy and authoritarian regimes.
So that’s sort of the way that I came into this.
But I think all of us have been concerned over, say the last decade
or twenty years, in terms of the rise of anti-vaccination sentiment on
social media, in particular, and concerns that, paradoxically, it is the
richest, most educated countries that are seeing the largest resurgence
in diseases that have effectively been defeated by vaccines over a
period of time. And we’ve also become very aware that the internet and
social media has played a major role in this spread–-the spread of
Facebook groups and anti-vaccination content on Twitter and what have
you. And there’s a concern here of how do we deal with this? Because,
just on principle, freedom of speech matters. I don’t think we’d find
very many people, especially in this call, that would argue that that’s
very foundational to what we believe in. But in terms of
anti-vaccination content, we’re wondering why is this happening, and
what effect is it actually having? Like is it just, we can see it
happening, but does it actually have an impact on real world outcomes?
And a secondary part of that is the rise in visible disinformation
campaigns online where there is conscious effort by malicious actors to
push false information, especially from foreign services, trying to
influence domestic politics and countries. And one of the things that
we’ve picked up on, through both scholarly research and then the Senate
report a couple years ago that delved into this, is the overwhelming
prevalence of Russians, both automated campaigns through bot networks
and intentional disinformation campaigns, pushing and amplifying
anti-vaccination content.
And so, what our paper tried to do was see can we actually measure
some type of effect going on? So, we have lots of research that shows
individually or one country case studies or experimentally, people’s
exposure to anti-vaccination content having an effect. But we wanted to
see is there an actual measurable problem worldwide? Like, if we look at
data across every country in the world, or as many as we can get data
for over the last decade or twenty years, can we actually see a
measurable and substantive impact or is this just sort of concern for
concern’s sake?
So, the basic design that we put together was relatively simple. We
have some very good measures of the level of foreign disinformation
campaigns on social media and countries from the Digital Society
Project, in addition to measures of to what degree do citizens of each
country use social media to try to organize offline action. Okay, so we
use these as sort of measures of are people actually organizing online,
so that way we can connect this to outcome measures, such as levels of
vaccination rates that we got from WHO and also from survey data across
countries from the Wellcome Global Monitor in terms of over time, are
people more likely to say that they have safety concerns about vaccines
in general. And we also took a different set of data in terms of a set
of all the geo-coded tweets in the world over the course of several
years and analyzed those for any discussion of vaccines and also through
some sentiment analysis tools to understand whether people were
negatively talking about vaccines.
And sort of the end result function that we got was, we found a very
surprising substantive level of effect, where over time, a one-point
shift in this five-point disinformation scale is associated with a
two-percentage point drop year over year in mean vaccination rates in
countries. We found that the same disinformation scale predicts a 15
percent increase in negative tweets about vaccines, and we also found
that the use of social media by a population in a country to organize
offline action of any kind is associated strongly with an increase in
doubts about vaccine safety.
Now, there’s a lot of issues with the research that we did in terms
of what we’re picking up is fundamentally correlative rather than
causal, in the sense that we’re basically looking at: do these numbers
on this side predict these numbers on the other side? But there is a
pile of research showing the mechanism happening. And so, our look was
just can we link the outcomes that we are scared that are happening to
the mechanisms that we have seen in other research. And the fact that we
did, I think, provides some very concerning information about the
effect of social media and the internet and, in particular, it’s use by
both malicious external forces through disinformation campaigns and just
through the population itself, in terms of having bad outcomes, in
terms of accepting vaccination.
Thomas Bollyky: That’s terrific, Steven. Thank you. And thank you to you and Charles for this great piece of work.
So many questions. I’m going to ask two to Steven first, and then I’m
going to go back to John and Ilona, and then after that round, I’m
going to turn it over to the audience, just so you can start to think of
your questions.
Steven, I have two questions. You can answer them together, if you’d
like. The first is on the scope. Obviously, your paper focused on
vaccination, but from the lived experience of this pandemic, you wonder
how much social media disinformation played a role in other behavioral
interventions and their public adoption. So, did we see anything in
connection to mask wearing and non-pharmaceutical interventions that
promote healthful behavior? The second question is also timely––we’re a
couple weeks away from potentially a rollout of the first vaccines. What
are you and your colleagues seeing now? Is there anything you can
update us on what we’re starting to see with the ramp up to vaccine
roll-out? Obviously, your research looked at historical data, but this
is a live issue that we’re going to see in this pandemic, and I’m
curious if you have observations to share with the group.
Steven Wilson: Sure, in terms of the scope in terms of other
interventions––mask wearing and such––we didn’t look specifically at
disinformation about particular things like that. But we do have a lot
of documented evidence over the last couple of years, in particular, of
disinformation and organization around stuff besides COVID. So, for
example, the 2019 Ebola outbreak, in which foreign disinformation
campaigns were just pushing this overall narrative of don’t trust
foreign health workers. And it led to a straight line you could draw to
the dangers on the ground for foreign health workers as part of that.
But, in addition, we have some other projects in the works where we
are looking at, and finding, that distinct connection of the moment that
there were interventions possible––where okay we need to wear
masks––there was an instant creation of disinformation networks focused
around going against that. Basically, any intervention on any health
issue that we come up with, there almost instantly seems to be a
backlash of those that have doubts about it, and then pushing that
information online.
And I think that there’s a deeper mechanism going on here, which is
sort of part and parcel with how the internet works both in good ways
and bad ways. Which is this notion that you might have heard of: the
long tail effect, where the idea is because communication is so cheap
and easy, and finding other people is so trivial through internet and
social media, it means that any fringe group can find other people that
agree with them and find their own little bubble and start amplifying
their effect on the world. And this has some great things, like the fact
that repressed minorities can find other repressed minorities and
communicate and organize safely. But it also means that the Nazis and
the anti-vaxers can all find each other also. And we’re kind of seeing
the repeated pattern that way, in terms of both health interventions and
everything outside of health also.
Thomas Bollyky: Great, that’s terrific. So, we promised, with
the title this event, to also talk about preparing democracies for
future pandemics And I want to do a round with our speakers where we to
talk a bit about solutions, but also what you’ve been seeing in this
pandemic. For each of the speakers, please put forward an idea of what
you think might make democracies better, more, as Ilona put it,
pandemic-proof for the future, or ideas on addressing the deficiencies
and the mechanisms that John talked about or Steven talked about on the
accountability—through free and fair elections for John and this freedom
of information for Steven. Ilona, let’s start with you.
Ilona Kickbusch: Thank you, Tom. I think there’s a number of
elements. I don’t think we’ve really realized in the past, how much the
basics of democracy and particularly of demos—meaning, you know, that
there is a community that people are willing to debate and discuss with
each other––how important they can be in terms of health. We tend, and
maybe that’s also one of the outcomes of, you know, a strong focus on
American democracy, we tend to continuously highlight the individual
liberties that come with democracy, the individual freedoms, the
individual rights, and they are incredibly important. But a democracy is
not only about me, it’s about us, and it’s the us also, you know, what
you are experiencing now. I see this from afar, with the American
elections, that, you know, whoever wins, then speaks for the whole
country and tries to move it forward.
So, some of the real basics of how our modern democracies function
come to the fore in a situation of a pandemic. I think that’s one issue
that we need to look at much more carefully, and we see that. We also
see that a lot of our pandemic preparedness plans, laws, regulations,
etc., are actually made for very short pandemics. You know, it’ll be
over in three weeks kind of thing. And therefore, we don’t need to worry
about decision making processes. I live in Switzerland, and what has
made Switzerland really, really nervous is that, you know, basic
functioning of democracy. The parliament didn’t meet. Some of the
decisions that needed to be taken by a popular referendum had to be
moved. So, if a pandemic takes a long time, your basic functioning of
democracy and who takes the decision. And this is, you know, of the
largest concern now also in this revision of the German infection law,
particularly if you have a democracy that functions at various levels
and no matter, you know, how knowledgeable your chancellor is on what
exponential growth means, she still has, you know, a whole bunch of
state ministers that she has to get into a consensus.
And so those kinds of issues are becoming clearer and clearer
that––who has the controlling power in a democracy in a period of an
extended time of a pandemic? And I don’t think we have really been
prepared for that. And this is also what the colleagues from Taiwan have
told us. Even SARS was relatively short term. But what happens over a
period of one or two years?
Interesting, if I take, you know, John’s results is that Germany, in
the first wave, went through relatively well through the pandemic. In
the second wave, not so well but still better than its neighboring
countries. The two most popular politicians, you know, Merkel is up
there with, you know, 80 percent approval rates, but the health
minister, at present, is the second most popular politician in Germany.
About 45 percent of the population in a recent survey think the
government is doing enough. 25 percent think they should be doing more.
And in relation to Steven, yes, while this new law was discussed in
parliament, outside of parliament we had, you know, very, very emotional
collection of people protesting from right-wing groups to homeopaths to
anti-vaxers, who are calling out the corona dictatorship and who are,
if we are talking about foreign financing, by the way, actually,
financed also with American money.
So, these are the kinds of tensions that are there, and you have to
see which are these key points that keep a democracy stable and how big
the health literacy, the digital literacy, and the civic literacy of
your population is. And sadly, in many of our societies, we have deeply
neglected really pushing and practicing our civil literacy, not just our
civil liberties.
Thomas Bollyky: Great, thank you, Ilona. I’m going to ask John
and Steven each to take a couple of minutes to answer the question as
well. But for those of you that have questions, you can start raising
your hand. I’m going to call you after John and Steven speak, in the
order that I see you. Again, we also have authors of our other BMJ
papers, including Roopa Dhatt, on the phone, who had a great paper on
participation. So, I’m hoping she will get involved in this discussion,
too. And I think Simon Wigley and Tara Templin also on autocracy and UHC
[universal health coverage].
But let me turn to John for a couple of minutes. How important is it
to have more of an accountability function attached to pandemic
performance to shore up democracies? Is there, what do you think, is
there something that needs to be put in place to make that more of a
salient connection between pandemic performance and accountability? Or
is that the wrong way to think about it? And for Steven. How do we
preserve freedom of speech but still address disinformation on social
media? How do we save the baby and still get rid of the bathwater?
Please go first, John.
John Gerring: Well, thanks. These are these are big topics
and, of course, super important ones. I’m not sure that accountability
is the best prism through which to view this sort of a challenge. I
think of a pandemic of this scale is like a war. And by that, I mean a
total war that really threatens the entire country and requires
coordination at every level. And in a war, I guess, there’s the ideal
that parties come together, you know, that there’s some cross-party
consensus, that they work out a plan and listen to the generals and so
forth. And so, the analogy here would be you listen to the public health
experts. Now, I think this is a somewhat unusual situation in that the
public health experts weren’t entirely sure which way to go with this,
and hence you see different, you know, countries take somewhat different
directions.
But at least that that would be the prescription that I would have,
and party politics doesn’t play into this so much. I think it’s more
about having some kind of consensual culture, which, I guess, maybe we
used to have in the United States. We don’t have so much anymore. and
Ilona mentioned the problems of majority rule—first past the post
electoral systems—that tend to exacerbate this sort of left, right,
us-versus-them dynamic, where the out party feels its job is to
criticize, no matter what goes on. And since they have a certain number
of supporters, then those supporters become, you know, alienated. And
that that can play out very badly because you really need everyone’s
participation in a situation like this. So, I’m not sure that, I mean,
maybe we can learn from this, maybe, going forward, democracies will be
more capable.
But I do want to call attention to one issue that I think is
sometimes neglected in this debate. Maybe I’ll be a little contentious
here. I think that the public health community are people like us, you
know, very highly educated, generally pretty well remunerated, and we
have jobs that can carry on, you know, electronically. A lot of people
don’t. A lot of people’s job depends on face-to-face contact. A lot of
people are living, you know, from paycheck to paycheck, and I’m not sure
that––I mean, their voice is reflected in President Trump’s rhetoric.
And we can debate, what’s in their best interest. But I think we can
also appreciate that their interests are a little bit different from
ours. And so, I don’t think this sort of debate can be a just a sort of
consult the experts type of discussion.
And in the United States, where we have a very weak welfare state,
where a lot of people don’t qualify for unemployment, or not very much
unemployment, you know, of course health care is a problem, and the
stakes are much higher. And it’s easy to see why you get this dynamic
of, no, I got to keep my job. I don’t care. I’m willing to lose lives. I
think that’s a little less true in Europe where welfare states are more
robust.
Thomas Bollyky: Great, thank you, John. Lots there to get back
to you if we have time. Steven, I know you’ve thought about this, and
we’ve talked about this in the past. What can democracies do to protect
themselves against this onslaught of social media disinformation?
Steven Wilson: Sure. I think there’s sort of two levels to
look at it with, which is very tactically in terms of how do we deal
with COVID right now, and strategically in terms of the long run issues
that we’re seeing.
So, I think the idea of fighting misinformation being intertwined
with freedom of speech is sort of inaccurate. Because this isn’t a free
speech issue, even if some people are insisting that it is, and this
comes back to just the very, very old like cliched arguments we have
where, you know, you have a right to your political opinion. You do not
have a right to your own facts. You don’t, you know, freedom of speech
doesn’t mean you get to yell fire in a crowded theater, like all of
these kind of generic examples.
Saying that vaccines cause autism online with fake scientific
information is not a free speech issue about political opinion. It’s the
same thing as yelling fire in a crowded theater, especially in the
middle of a pandemic. It might have been one thing a year ago or five
years ago, but at the current moment this is actively hurting the health
of society. So, I don’t think this is a free speech issue, so much as
it’s an issue of we need to have coordinated action against
misinformation online. And the social media companies have been doing a
much better job over the last few months, and they have been over the
last few years, I would definitely say that, in terms of trying to
systematically take down just absolutely false content.
The secondary thing is the fact that intentional disinformation is
playing a major role in this. And the bottom line is that we know where
it comes from, and we know the motivation for it. This is coming out of
pseudo-state actors from Russia––is a huge proportion of this anti
vaccination amplification through bot networks––and this means that it
is a political problem that has political and diplomatic solutions. If
you want them to stop, apply diplomatic pressure. What the actual in
between there of how do you make this happen is up to the diplomats, on
some level, I think, but it’s not an unknown problem with an unknown
solution.
I think there’s a larger strategic issue, though, in terms of the
elements of free speech and such, going back to that right to your own
opinion but not right to your own facts. At this point, there is, say,
an epidemic in the middle of the pandemic, of distrust of experts and
distrust of educated authority in the Western world going back for quite
some time, over the last, probably, generation of politics. And this is
a larger issue that we somehow have to figure out how to grapple with,
because there’s a large proportion of people that simply say the expert
doesn’t know what they’re talking about. The guy I know online does. And
that’s a larger issue that we have to combat that I think is
intertwined with the internet and is causing issues with COVID in
particular, but is a larger, say, crisis of democracy in the long run if
we don’t, fundamentally, have a trust of people who know what they're
doing. This is a societal crisis in general.
Thomas Bollyky: Great, terrific and provocative points. We
have three people in line and thirteen minutes, so without further ado, I
want to turn to them. We have Henry Greenberg first, and then Roopa
Dhatt, who’s one of our authors in this series, and then Sonya Stokes.
Henry, please. And if everyone will state their name and affiliation
when you ask your question. Thank you.
Event Manager: Mr. Greenberg, please accept the “unmute now” prompt. I’ll move on to the next question.
Thomas Bollyky: All right, we’ll circle back to you. I’m sorry for that. Roopa, please.
Roopa Dhatt: Thanks, Tom and Ilona and John. I just wanted to
act on the prompt of really trying to answer a bit of the question
really around just, you know, what are the other pillars really needed
for a functioning democracy? And I think one of the things that this
pandemic has really shown us is that we need public trust, and to really
have public trust, we need to have civil society that is engaged,
funded, and protected.
And part of the paper that I wrote together with colleagues,
including Loyce Pace and colleagues from Kenya, as well, particularly
Allan and Nerima, the perspective we really wanted to highlight there is
that it’s also very critical that the decisions that are being made are
truly representative of the population. So, this is a challenge in
achieving the dream of democracy, do we truly have leaders in leadership
that represent the population? And so, there really is an opportunity
there to make sure that the civil society pillar is a way to build
public trust, that civil society is engaged––civil society from diverse
backgrounds, especially the most marginalized backgrounds. Every nation
has an underserved community, whether it’s women, sexual minorities,
migrants, abled people, and all those different groups are not
necessarily represented in decision-making. And I think the point that
was alluded by John earlier about the fact that there is a difference
between health literacy in the population. But if we use civil society
as an engagement mechanism and really, you know, bring them into the
conversation when it comes to public health, it can help bring public
health trust, but it needs to be an intentional part of building
democracy and an intentional part of creating strong health systems. So
yes, I encourage everyone to check out the paper. We do have some very
concrete recommendations around this, but it is a very much part of
increasing health literacy and also increasing, as Ilona said, about
civil literacy as well.
Thomas Bollyky: Great, thank you, Roopa, and I’m glad you
spoke up. It’s a terrific paper––I recommend it. Roopa does not just
write about the role of participation and improving health, she lives it
with the organization that she runs too. So, I do recommend that you
check out the paper. With that, let’s try Professor Greenberg, if we can
go back to you again, and see if we can manage to get you online and
unmuted, that would be terrific to get your question.
Henry Greenberg: Thank you. I’m Henry Greenberg from Mailman
School of Public Health. President Elect Biden’s panel on COVID does not
include a single epidemiologist. And I’m just wondering, does that
reflect a broader view of what American public health is doing, or does
it reflect something else? You know, I have my own opinion, but it’s
rather a striking observation that in what must be considered the most
epidemiological phenomenon in the world, the best panel put together by a
thoughtful and committed politician includes no epidemiologist. What
does that tell us?
Thomas Bollyky: Provocative question, thank you for that. I’m
going to give Sonya Stokes a chance to ask her questions, and let the
speakers take them both. Sonia.
Sonya Stokes: Thank you so much, Tom. And thank you so much
for this panel. Dr. Dhatt may have answered part of this question, and
I’ll have to review her paper. Thank you so much. But the resistance, a
reluctance, towards vaccines is prevalent not only among my patients,
but even among some of my fellow providers across the U.S. In New York
City, I’m part of a working group of physicians looking at strategies to
improve vaccine acceptance within our communities. The solutions that
have been discussed on this panel so far––health and media
literacy––these things do take time. And even though they’re welcome
solutions, are there any shorter-term solutions that you are aware of
that can help us more immediately through the next several months ahead?
Thank you.
Thomas Bollyky: Great question. So, to broaden Henry’s
question, you know, what’s the role of trust in experts and in
particular epidemiologists, and are we likely to see greater acceptance
of them in democracies? And then Sonya’s question––do we need broad
societal change before democracies can perform better? Or can we do
something for the near and medium term? Why don’t we go through the
group in order and start with you, Ilona. Keep in mind, we have seven
minutes. So, let’s make sure we have time for everyone.
Ilona Kickbusch: Yeah, I leave the epidemiology questions to
the American colleagues, except just saying that we have found that
nearly all groups have always tended to exclude someone. You know, the
social scientists have not been considered in many of the German groups.
For example, we had loads of epidemiologists and virologists and
whatnot, but I guess you’ll have an answer to that.
I think when we talk about making democracy pandemic proof, what
we’re learning now is really that the light is being shone on those
things that we have really neglected for decades. You know, like the
inequality issues, like certain participation issues, like health
literacy and science literacy issues. And if we look, you know, all the
things that were stopped in our schools, at least in Europe—you know,
learning about democracy was thrown out because, you know, supposedly
you needed other things in life more than knowing how your own political
system functions and what your own role in it was. So, I do think we
have to face up to some of those long-term issues.
In terms of short-term recommendations, I think a lot of professional
organizations have tried to develop guidelines. How one talks, you
know, one-to-one, and it’s really, you know, like knocking on every door
during an election campaign, talking one-to-one with patients who don’t
want to vaccinate their children, who don’t want to participate in a
vaccination program. And it’s incredibly hard work, because, you know, I
can see it in Germany, the government can say until it is blue in the
face, there will be no––what’s the English word––there will be no
vaccination that everyone has to take––what’s your word for it–– you
know, the compulsory vaccination. Irrespective of that, you know, there
are groups who, either for reasons of wanting to sow discourse or
because they fundamentally don’t believe in their political system and
that they can trust it. So, it’s an incredibly hard job. But we have to
face that job, and we have to train people to do it, and we have to
invest in them. And I hope, you know, Germany, for example, has spoken,
you can’t believe it, you know, public health was neglected for decades.
Suddenly, Germany is putting an enormous amount of money, in the
billions, into public health, and we would hope, you know, that those
kinds of jobs are also created so that you have that interface with
civil society, with the population, and with the people who fear for,
example, a vaccine.
Thomas Bollyky: Two minutes each for John and Steven. Pick one
of the questions how to better incorporate experts in policymaking
moving forward, or what democracies can do to protect themselves in
their short and medium term. John, in this lightning round your two
minutes come first.
John Gerring: I really don’t have good answers to these great
questions. So, I’m going to cede my time to the distinguished gentleman
from Massachusetts.
Thomas Bollyky: All right, distinguished gentleman from Massachusetts.
Steven Wilson: Thank you, distinguished gentleman from Texas.
I’ll just quickly answer “the what can we do right now to make an
impact” because these are very large issues that take social change over
a large period of time, but I emphasize that doing simple things like
taking down fake information about vaccines online really does make a
short-term difference, not because it’s going to sway the people that
are extremists, who insist that vaccines are giving their kids autism
and cancer, etc., etc., but that it reaches that very large gray area of
people where vaccine hesitancy is the problem. Where the reaction is
not, “Oh, vaccines are terrible.” It’s the: “Well, I saw some people
talking about it, so I’m going to wait a few months to get the COVID
vaccine even once it’s available because even if it’s a small chance,
why take the risk...” And I think that’s where we can make an immediate
short-term difference is in that gray area of hesitant individuals
making sure they’re not seeing this disinformation content.
Thomas Bollyky: Great! Steven, you are not alone. I just had a
long conversation with Peter Hotez, who if you don’t follow him, you
should. He’s terrific on many issues on the challenge of dealing with
the anti-vaxxer community, and the fear is heading is that the U.S. has a
broad strategy of just engagement and communication and as a solution
to the problem that will not be enough. Heading into what will be our
largest vaccination campaign in history, that we need to censor
effectively and take on the anti-vaxxer empire and take down websites.
So that’s, you’re not alone in that regard.
Ilona, as the co-editor here, do you want to say any final remarks in your last minute, otherwise we’ll sign off?
Ilona Kickbusch: No, I just think we really, really must
continue this debate. I think we’ve seen how many open questions there
are. I’m delighted that political scientists are getting involved in
these issues. I plead with them to stay with us—with us public health
people, even though I’m a political scientist myself—and that we really
seriously invest in making our democracies pandemic-proof because, as
our colleagues in Taiwan said this morning, we are already preparing for
the next pandemic.
Thomas Bollyky: Great, perfect timing. Again, I recommend the
audience members take a look at the series. You heard a lot about the
great papers today. There are even more in there, including a paper from
Jennifer Prah Ruger, and a paper from Simon Wigley, Tara Templin, and
others. I commended them highly to you. And thank you for joining us
today and look forward to the next roundtable.
Ilona Kickbusch: Thank you.
