Trust, Science Education and Vaccines

"A vaccine education that students and their parents trust will be one that does not castigate those who are hesitant about vaccines."

As the phenomenon of vaccine hesitancy lays bare, there are great differences in the extent to which people trust vaccines. Relatedly, trust in others (people and institutions) varies greatly, both between countries and within countries, and depends on the characteristics of both trustor and trustee. In this article, Michael J. Reiss presents an argument to connect the phenomenon of vaccine hesitancy to the issue of trust, illustrating what an education about vaccines in school science might look like. Specifically, he argues that, to foster students' trust in what they are learning, such an education must take seriously the notion of respect for students, including students who hold views about vaccination with which science teachers might disagree.

Reiss explains that vaccines are sometimes taught in school science as a topic in their own right, often with the ultimate aim of improving public health through enhanced vaccine uptake. Often, though, they are taught as examples of the application of science, after such topics as the immune system and disease have been taught. In this conceptual piece, Reiss explores what the science education community (academics and those who determine school curricula, write textbooks, prepare students to be teachers, and contribute to formal science examinations) can do to improve and enrich the quality of vaccine education in schools.

Looking at the meaning of "trust", Reiss presents the following way of framing it: "If I trust you, I am less likely to make checks to ascertain the veracity of what you tell me; I am more likely to assume that you will not act against my interests. While reality is important in the determination of trust, so too are judgements and perceptions; there is therefore a social dimension to trust." Per the Wellcome Trust (2019), worldwide, 73% of people would trust a doctor or nurse more than any other source of health advice, including family, friends, religious leaders, or famous people, and 72% of people trust scientists, even though 57% do not think they themselves know much, if anything, about science. Worldwide, levels of trust in science, in scientists, and in doctors and nurses all increased during the first year of the COVID-19 pandemic (Wellcome Trust, 2021).

Next, Reiss examines a number of reasons why some people reject vaccination. Less is known about the perceptions and decision-making processes surrounding vaccination in school students than in their parents and the general public, though research on school students began to increase in the light of COVID-19. In general, it seems clear that vaccine hesitancy among school-aged students can be high.

From the origins of vaccination in 1796, there has been hesitancy among some people. Reiss suggests: "Today's objections to vaccinations have similarities with those of the past - vaccines do not work, they are not safe, they infringe personal liberties - but have colonised new areas." For example, one moral objection to certain vaccines (e.g., poliomyelitis) has arisen because of the historical use of aborted foetuses in their manufacture. Non-religious objections to vaccines stem from a number of sources.

An example of how these objections connect to trust around vaccinations comes from Pakistan in the early 2000s. In its attempts to locate Osama bin Laden in the wake of the September 11 2001 attacks in the United States, the Central Intelligence Agency (CIA) used a fake hepatitis B vaccination project to collect DNA in the neighbourhood of Abbottabad, where he was hiding. News of the CIA initiative led to attacks on polio vaccination workers in Pakistan, an anti-vaccine propaganda campaign by the Pakistani Taliban, and the refusal of some parents to have their children vaccinated, as they feared that polio vaccination campaigns were a conspiracy to sterilise the Muslim population. Since then, "in part because of the rise of conspiracy theories, there is in a number of countries greater scepticism now about government advice and the activities of big business, including pharma..."

Having looked at a more recent example - trust (or lack thereof) in COVID-19 vaccines - Reiss turns to his vision of what good-quality vaccine education in schools might entail. His argument is based on the assumption that school science education should benefit all learners and should be respectful of students, even if they do not hold mainstream scientific views. The type of education he advocates treats vaccination as a controversial issue - not that there are deep controversies among scientists about the fundamentals, but that it is contentious for a significant proportion of the general public. The following excerpts illustrate his central claims:

• "A school curriculum for vaccine education needs to take history seriously. At present, school vaccine education too often gives the impression that everything gets better over time: originally there were lots of horrible diseases; thanks to the advances of science, we first found a vaccine for smallpox and then for many other infectious diseases....But there is also an evolutionary perspective in which there is something of an arms race between the immune system and pathogens, with uncertain outcomes...with regard to changes in infectiousness and severity over time. Then there are the increasingly diverse ways in which vaccines can be produced, each of which has its own advantages and disadvantages."
• "In terms of the science of vaccines against infectious diseases, it should not be thought that even determining the numbers who die from a particular disease is straightforward....For example, in the case of COVID-19, it is clear that many countries under-report deaths resulting from it....Students could be encouraged to look at data on COVID-19 fatalities and compare the different ways in which such data are determined."
• "The topic of vaccination also provides a wonderful way of helping school students better understand aspects of the nature of science - which can be understood as encompassing what science is, how it is undertaken and the fact that, while reliable, it is a human endeavour and its findings are always open to revision..."
• "Students can (should) also be helped to appreciate that the role of science (taken as the natural sciences) in addressing objections to vaccination is more limited than is sometimes thought. Objectors who cite concerns about safety and the effectiveness of vaccines are typically not saying that a cost–benefit analysis on the grounds of efficacy or safety comes down against the use of vaccines - indeed, such cost–benefit analyses very strong support vaccine efficacy and safety. Rather, objectors may be saying that vaccines do not always work and are not totally safe."
• Teachers could facilitate students' consideration of ethical issues around vaccination, such as "whether vaccinations should be mandated or strongly encouraged (for example by making them a condition of public schooling or access to sporting events or restaurants), the validity of religious and other objections to vaccination (including a discussion as to whether this is comparable to conscientious objection to military conscription or eating certain foods), health care rationing and whether we have a duty to be vaccinated (or to vaccinate our children)."
• More broadly, "good teaching is helped by a teacher surveying the views of their students and using these to inform their teaching. It is also the case that science lessons themselves can make more use both of interdisciplinary teaching and of the various approaches, such as discussion, role play and debate, that are typically more often found in some other school subjects. There is evidence that such teaching can be more motivating for many students and lead to better learning..."
• In light of these suggestions, "vaccine education would benefit from cultural competence in teaching....Cultural competence is...a pedagogical approach that is comfortable with learner diversity and respects individuals with a range of views. It would be good to have science education studies that researched the effects of a range of school teacher pedagogies on what students get from their vaccine education, including students who reject or are hesitant about vaccines. What we want...are teachers who are respectful of all their students but still teach them about the safety of vaccines and their role in public health."

Reiss concludes that, while students have misconceptions about vaccination and the immune system, as they do about most scientific topics, "there is more to vaccine education than conceptual change and the correction of misconceptions, important as these are. There is much to be said for vaccination being considered in school science education as a socio-scientific issue that addresses social and ethical issues and is for some students of sufficient personal significance that it would benefit from sensitive teaching....In particular, it should not be assumed that simply teaching more about the facts of vaccines will lead to more people accepting them, as this is not necessarily the case for other controversial science topics....However, and encouragingly, there is evidence that greater knowledge of the nature of science and a more mature view of how to mitigate scientific disagreements each relate positively to acceptance of evolution, climate change and vaccines..."