Physicians are taught to respect individuals' autonomy, guiding decision-making for their medical care beneficently, without maleficence, and justly. What do we do when patients make potentially harmful medical decisions for themselves or others? Hippocrates tells us, "Primum non nocere," or "First do no harm."
Recent testimony in Congress has been given about this very debate regarding vaccination and the potentially 200,000-300,000 lives that could have been saved in the U.S. amid the COVID-19 pandemic.
In 2020, I was an infectious diseases fellow physician during the COVID-19 pandemic's onset, later serving as an mRNA COVID-19 vaccine clinical trial site investigator under my mentor. Now, as an attending physician, memories of that disquiet remain indelibly seared.
Having seen many hospitalized patients with severe COVID-19 dying and some fighting to live—when vaccination was unavailable—I was initiated into infectious diseases fellowship. I recall how time-consuming filling out remdesivir use paperwork was—the only early antiviral available. One night on call, my phone unceasingly rang, amid the COVID-19 surge, while triaging endless calls prior to streamlined protocols. With dark circles under my eyes, I went to the hospital the next day to do it all again.
At the time, knowledge was scarce. Personal protective equipment (PPE) was scarce. So much so, the hospital accepted PPE donations. Anxieties were heightened. Given isolation precautions, critically ill patients existed on islands. With the sheer volume of COVID-19 illness and death, health care workers became overloaded. I remember the trauma of family members saying goodbye to hospitalized loved ones through iPads, while prohibited from visiting to say farewell.
During sociopolitical tensions, debates over masking, vaccination, and social distancing escalated. Disturbingly, xenophobic, racially targeted, violent acts toward Asians arose. As an Asian American physician, tragic irony of hearing peoples' conversations using politico-propagated, racist terms like "kung flu," while walking home after treating COVID-19, was not lost. Yet, the ultimate tragedy frankly was their nescience—"not (ne) knowing (science)"—put simply, "anti-science."
To see where we are now—having emerged as a society—is a true testament to science's sacredness, clinician-scientists' determination, amid Operation Warp Speed. As a fellow, I learned extensively about COVID-19 prevention, treatment, and management. Yet, unbeknownst to me, I would have to learn to combat an "infodemic" in an era of denialism.
I would learn a different education—to be a better, more empathetic listener to understand root causes of barriers, and resultantly, a better communicator—to communicate these lessons learned to denialists, skeptics, and the hesitant. Barriers were opportunities to create nuanced responses based on individuals' internal resistances. I tried to meet individuals half-way.
It was not always easy—the walk to freedom for truth and moral autonomy is long. Barriers to receptiveness of COVID-19 vaccines ranged from insufficient literacy or receptiveness to unvetted social media propaganda. Respected physicians were persecuted for rational, evidence-based messaging; tried-and-true scientists were tried by juries of social media panelists in courtrooms without judges.
Part of our job is understanding why individuals are compelled to their decision-making, understanding processes of reasoning—respecting autonomy—even when flawed, influenced by rhetoric. Some trial participants were vaccine-hesitant, given misinformation regarding vaccine "chips;" others believed this prophylactic was treatment. Learning such nuances divulged origins for flawed thinking, which were crucial educational inlets, remedial outlets for unsound messaging.
We took time providing individual, community-based education, partnering with trusted community liaisons to share COVID-19 vaccine messaging. We invoked less jargon when encountering impaired literacy.
In August 2020, we enrolled the first participants in the COVID-19 vaccine clinical trial. Scores lined up for—no, demanded—the 50 percent-50 percent chance of getting the then-experimental mRNA COVID-19 vaccine versus placebo. I did bear witness firsthand to the safety and efficacy of these vaccines. Adverse effects, if observed, were carefully noted. Ultimately, data published demonstrated BNT162b2 mRNA COVID-19 vaccines were safe, and remarkably, 95 percent effective against COVID-19. Our hardworking team enrolled over 500 participants in adult, booster, pediatric COVID-19 vaccine trials. Yet, while scientific progress was made, some propagated the antithesis.
There had been, are, and will be misinformation preachers, praying to altars of anti-science deities, ready to attack sound principles of scientists at any cause—deeming them subaltern. This "anti-science disinformation empire" phenomenon, a precarious paradigm backed by house of straw-based science—from false testaments about vaccines or COVID-19 misinformation—could be blown away by winds of fortified evidence. Yet, it was propagated by social and public media platforms.
How do we prevent repetitive errant schemas? Former NIH director Francis Collins, a recent medical school graduation ceremony speaker, said it well—in a foreshadowing—telling our graduates to avoid "culture wars," "societal malaise," and seek "objective truth;" as if mentally preparing these think tanks for impending cognitive anti-science battle. Along with vanguarding science, safeguards include dampening misinformation spread through evidence-based messaging (like the World Health Organization's Stop the Spread campaign and source verification like reporting misinformation).
An estimated 14.4 million lives were saved globally in the first year of COVID-19 vaccination. Research on how many lives could have been saved with COVID-19 vaccination—"the cost of undervaccination"—estimated 318,981 COVID-19-related deaths in the U.S were vaccine-preventable. As opposed to clinician-scientists conducting research and clinical care, the uncredentialed fundamentally cannot be primary arbiters of health messaging.
We physicians and scientists refuse to allow snowballing of misinformation to accelerate the collateral of lives lost—in veneration to autonomy, beneficence, non-maleficence, and justice.
During a burgeoning global pandemic, what I learned could not be summarized in a textbook. We are not just ideologues, but rather stalwarts of nuanced, individualized dialogue with our patients and community. We are resolutely the vanguards of truth in addressing the humanity, the health of the greater good—for each individual and the collective community—for which we promised, in the word of Hippocrates, to serve.
Jessica Tuan, MD, MS, AAHIVS, is an assistant professor of medicine in the section of infectious diseases and Department of Internal Medicine, and associate director of the Yale Antivirals & Vaccines Research Program at the Yale School of Medicine. She is a Public Voices Fellow with The OpEd Project in partnership with Yale University.
The views expressed in this article are the writer's own.
