Virtually every Bangladeshi and Rwandan believes that vaccines are safe. Fewer than half of Japanese or French do so. In western Europe, almost one in six of those with a college education reject vaccines. In southern Africa, you are twice as likely to do so if you attended university.
These are among the often disturbing facts that have tumbled out of a new study, the Wellcome Global Monitor, published last week. The survey of 140,000 people from 140 countries is at heart an exploration of the relationship between science, trust and attitudes to vaccination.
Trust has become a vital political issue. Many worry about the erosion of confidence in expertise and in public institutions, and about the social consequences of that erosion.
One is the growing refusal to believe medical authority, especially about vaccination. From measles outbreaks in the US and Europe to the spread of Ebola in central Africa, skepticism about vaccines has had devastating effects.
The Wellcome survey suggests that the relationship between scientific and social trust and attitudes to vaccination is more complex than many imagine.
For instance, some might believe that better scientific education and greater confidence in healthcare professionals would be linked to greater trust of vaccines. It is not.
There tends to be greater skepticism about vaccines in richer, better-educated countries than in poorer states in which people have less education and are more skeptical about the benefits of science.
Western Europe shows some of the highest levels of trust in scientists and healthcare professions: 88 percent have “high” or “medium” trust in scientists, 68 percent have “a lot” of trust in medical professionals and 78 percent believe that science benefits people like them.
However, with the sole exception of eastern Europe, western Europe also has the lowest level of trust in the world in vaccines.
Compare this with north Africa, where just 61 percent have trust in scientists, medical professionals are trusted “a lot” by less than one-third of the population and fewer than half think that science benefits people like them.
Yet, whereas only 59 percent of western Europeans believe that vaccines are safe, 85 percent of north Africans do so.
In low-income countries, 81 percent of even those with low trust in scientists have confidence in vaccines. In rich countries, that figure drops to less than half.
Poor countries remain ravaged by diseases long eliminated from Western nations. Globally, about 2.5 million children younger than five die every year from vaccine-preventable diseases.
In countries such as Bangladesh and Rwanda, vaccination programs have helped transform the lives of millions. In richer countries, medical advances, including vaccines, have been so effective that many no longer recognize their importance or the consequences of rejection.
However, there are deeper problems than just a lack of historical memory. Trust is shaped by myriad social forces. Inequality is one.
The Wellcome report found that the more unequal a nation, the greater the distrust of science.
In rich and poor countries, those whose lives are more precarious are more skeptical of science than those who say they are “living comfortably,” a trend particularly pronounced in rich nations.
There is also the question of the relationship between scientific and political trust.
“The level of confidence people have in their national institutions — their government, judicial system and military — was a good predictor of their level of trust in science,” the survey found.
Skepticism of authority is good. Too little skepticism allows those in power to maintain power. It also allows for the spread of disease when, for instance, there is an unwillingness to challenge religious authority. Indispensable to the project of creating a better, fairer society is the questioning of authority and of received wisdom.
However, today skepticism about authority has become an end in itself. Rather than leading to more rational views of society, it often drives people toward conspiracy theories about elites and experts, and to believe in all manner of irrational claims.
The anti-vax movement has exploited such skepticism to foster wild fears about vaccination, and not just in Western nations.
A study last year suggested that in the Democratic Republic of the Congo (DR Congo), nearly half the population thought an Ebola outbreak was being fabricated to destabilize the region or for financial gain.
The result was Ebola “spreading under the radar” as skeptics often evaded treatment, the study said.
Trust, or, rather, the lack of it, clearly shapes much of the political landscape, but it can also have direct effects on physical well-being.
From the US to the DR Congo, distrust without reason could be a matter of life or death.
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