Accepting uncertainty

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You’ve probably heard the old saying that goes something like: ‘To retain respect for sausages and laws, one must not watch them in the making.’ After the last 18 months, we can add science to that list. 

Throughout the COVID-19 pandemic, we saw how medical and scientific advice, as played out in public policy, changed. At times, the advice even seemed contradictory. At first, masks didn’t help quell the spread of disease, then they did. We needed to be worried about surface spread, then, oh wait, it was probably less of a concern than we thought. Respiratory droplets were the main source of contagion, and then it was aerosols.

To the casual onlooker, this flip-flopping may indicate that the so-called experts have no idea what they’re doing. If you’ve spent any time in a comments section on the internet (my condolences), you will have seen how this changing advice led to doubt and scepticism among the general population, evidence that scientists and public health officials have lost the plot. But instead, what is actually happening is that we are seeing the proverbial sausage of science being made in real time through our public health discourse.

The pandemic has been a clear demonstration that science is a method, not an endpoint. It is an ongoing process of hypothesising, testing, and interpreting the results of those tests through public policy. Though the hypothesis may be accepted or rejected, these interpretations are unlikely to be absolutely definitive statements or recommendations and are usually made with varying degrees of certainty.

And herein lies the problem that we are facing on a social level: in times of uncertainty what people understandably crave is certainty. For many, it is not enough that we can say with a very high degree of assuredness that, for example, society-wide mask wearing significantly reduces the spread of COVID-19. People desire a security in certainty that nobody can provide: an assurance that if you do this simple thing, you will be absolutely safe.

I use mask wearing as the prototypical example during this pandemic because it is one where the public health advice has clearly changed since the start of the outbreak. Early in 2020, it was unclear whether the benefits of mask-wearing outweighed the potential risks. At the time, the public health advice was affected by concerns around mask shortages impacting health-care providers (who definitely did need them), and even concerns that mask-wearing would promote risk-taking behaviour in the general public. Based on the evidence available at the time, the public health advice was that we generally shouldn’t wear masks. However, as the pandemic went on and evidence emerged about the benefits of mask-wearing on a societal level, the advice changed.

 

'We need to learn to embrace the discomfort of uncertainty. After all, if we truly wanted to be safe, we would never leave the house in anything short of a hazmat suit.'

 

Does this mean the science was wrong and that we can’t trust it? No. It means the science is working exactly as it should: our knowledge was incomplete, and we did more research, and adapted public health advice as a result. The fact that our institutions are paying attention to the constantly updating science and changing recommendations based on this information should be a comfort to us, but instead it tends to breed uncertainty.

But even if people do accept that certain actions can help reduce spread, our desire for certainty strikes in a different way. One common refrain from anti-maskers has been that masks are not worth wearing because they don’t completely stop the spread of COVID-19; they only reduce the risk. This same logic is now being applied to vaccines by the ever-shrinking cohort who remain unvaccinated. It doesn’t matter that vaccines can reduce the risk of catching COVID by about half (maybe more), and lowers the risk of serious illness by more than 90 per cent, breakthrough cases are used as proof that the vaccine is ‘ineffective’. Considering something not worth doing unless it completely eliminates risk is unhelpful black and white thinking. And here, many of us are letting perfect be the enemy of good. I don’t know about you, but I’ll take my chances with a 90 per cent reduction in risk of severe disease over a 0 per cent reduction.

Trusting in the process of science, as it plays out in public health policy, sometimes involves uncomfortably abandoning ideas that provide a false sense of safety. This discomfort is one of the reasons many struggled to let go of hydroxychloroquine and ivermectin as miracle treatments, after both these drugs showed some early promise in managing COVID-19. Unfortunately, as more research has been done, we have seen contradictory evidence for their efficacy and we cannot responsibly say with any substantial degree of certainty that these drugs are appropriate for the treatment of COVID-19 (at least at the time of publication).

The most telling example of our certainty fetish is the never-ending discussion around vaccine safety. No one is guaranteed a vaccine with zero risk of an adverse reaction. Over the last few months, much was made of these risks in media. Yet risk is a factor in any medical intervention, and even paracetamol and aspirin can elicit serious adverse reactions. Nothing in life is truly ‘safe’; it’s all degrees of risk.

While no one is promised a vaccine without a small chance of side effects, what is promised is that the enormous quantity of safety data shows the risk posed by any vaccine is so small as to be statistically negligible. What is also promised is that any risk from taking the vaccine is an order of magnitude safer than the risks of catching COVID. Despite this, there is a small but strident subsection of the population who refuse to reduce their overall risk of serious illness because an absolute promise of vaccine safety cannot be made.  

What is the solution? We need to learn to embrace the discomfort of uncertainty. After all, if we truly wanted to be safe, we would never leave the house in anything short of a hazmat suit. That is, of course, not practicable and we do have to make compromises.

But when it comes to interacting with other humans, there is a relational element to navigate. Unfortunately, no silver bullet will cure another’s anxiety, but we do have some understanding of what can help sway people’s decision making.

The vaccine hesitant are afraid: afraid a vaccine might hurt them, afraid the government might exert too much power or control, or any one of the many fears and doubts sowed by bad-faith actors. In my experience, few admit to these fears, preferring to project a mask of anger, condescension or pride. Though it can be hard to muster in the face of people making dangerous and illogical arguments, empathy is the key to bridging the divide. The overwhelming majority of people are not truly ‘anti-vaccine’, or ‘anti-science’, they just haven’t had all their questions or concerns answered yet.

Uncertainty is frightening. The cold, hard hand of science is good at giving the answers we need, but not necessarily the assurances we want. This is where the human element can come in to bridge the gaps. We can’t promise our friends and family absolute safety in an uncertain world, but we can remind them there are steps we can take to improve our chances and help others who are more vulnerable than ourselves. Hopefully we can all be communally minded and listen to the ongoing recommendations of those with expertise in this area, even when they can’t promise us the certainty we seek.

 

 

Tim HuttonTim Hutton is a teacher, masters student and freelance writer based in Brisbane. He writes on politics, education, media, societal issues, and the intersection of all of the above. His writing can be found at www.timhutton.com.au

Main image: Novel coronavirus (2019-nCoV), people in white medical face mask. (Angelina Bambina / Getty Images)

Topic tags: Tim Hutton, science, public health policy, masks, Covid-19, vaccine

 

 

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Existing comments

Fear. Uncertainty. What about utter cynicism? I don't trust our prime minister, I don't trust the deputy prime minister, I don't trust many others who are supposedly leading our nation through the two big crises of our time, the huge crisis of climate change and the more immediate crisis of covid 19. My distrust it not because I am a poor, uncertain, fearful person who needs reassuring, but because of what our political leaders have done and said. Instead of focussing on "uncertain" members of the populace, why not focus on the leaders who behave so badly? Sorry Tim Hutton, but empathy will not solve the problem we have in this nation, and elsewhere. We need a return to integrity in our leaders and in the system that promotes them to leadership. Then we might get somewhere.


Janet | 22 October 2021  

It's not necessary to wait for established science to adopt scientific principles related to the risk of the unknown. There's an amount of security that goes with putting controls in place to mitigate the effects of hazards which might be encountered; nobody would question wearing a hard hat or steel cap boots on a work site even though some locations there's no evidence of danger. It took the WHO more than a year (May 2021) to acknowledge evidence of covid being spread by aerosols; our health professionals and government imposed risk on the Australian public for months making health and allied directives on claims of "our modelling shows" but the numbers weren't produced or varified here; not "ours" at all. It's almost incredulous to remember the government tried to stimulate domestic tourism in 2020 only to then lock travellers away from returning home. If you've done all you can to address the uncertainty by controls you can at least take comfort in the preparedness, even if it doesn't work out... Despite our best intentions we can ALL be carriers; continued ministerial ambitions to revive the economy without due consideration of risk management is negilgence.


ray | 22 October 2021  

While I sympathize with the theme of this article, society itself conditions people to believe that all risk can be mitigated so long as we grant government and “experts” absolute power. Better a paternalistic cradle-to-grave government safety net than a chaotic world of individual decision-makers. But that is the road to authoritarianism.
Most people don’t distrust science but find it difficult to separate real from fake science.
In 2005, epidemiologist John Ioannidis said that less than 50% of scientific papers were true. In 2015, Richard Horton, editor of The Lancet, stated, “much of the scientific literature, perhaps half, may simply be untrue.”
US chief medical advisor Anthony Fauci denied funding gain-of-function research at China’s Wuhan lab, but the NIH has now admitted they did just that.
Facebook, Google and Twitter censored eminent scientists from distinguished institutions who differed from a mythical “consensus”: Martin Makary (John Hopkins); Jay Bhattacharya (Stanford); Sunetra Gupta (Oxford); Martin Kulldorff (Harvard).
Appeals to scientific authority are no substitute for scientific debate. Remember that eugenics was once considered respectable cutting-edge science.
A healthy civilization requires risk-taking.
Unfortunately, what many believe today is not determined by truth, principles or science, but by which side you are on.


Ross Howard | 22 October 2021  

You are spot on about both science and certainty/uncertainty, Tim. In Queensland I think we've got it pretty much right. Many anti-vaccers tend to believe in a sort of voodoo science, which they get from nutters who make bizarre podcasts. These are similar to flat earthers. I hope, once enough of us are vaccinated, as long as we continue to follow sensible precautions, we can get on with normal life.


Edward Fido | 22 October 2021  

If good can be equated with what is true and evil with what is false, an irony of the Fall, which was caused by a search for clarity between what is good and what is evil, has resulted in a situation that whenever there is a question about something of great moment, the waters get muddied. The connection between the emotion that led to the Fall and those that are commented upon by this article is the curiosity that is occult. People can’t wait for the rationality of allowing things to settle: they must have opinion and judgement now. That impulse not to wait but to take a short-cut to knowledge is the supernatural occult of the Fall and its descendant practices of, for some, the divination of witchcraft, and, for others, the divination of viral social media.


roy chen yee | 23 October 2021  

A much-needed piece, Tim, hammering home the 'degree of precision' issues central to any discussion of bioethics. Epidemiologists can do no better than that, except for being heaps better than flat-earthers or those who won't cross a road for fear of being flattened. More to the point, your argument has profound bioethical implications. It follows, from what you say, that we need mandated vaccination to protect the health, safety and future prosperity of humankind. I profoundly hope that Catholic bioethicists will counter flawed moral objections to vaccine mandates so that the threat from Covid-19 can be further reduced. With borders opening and (UK) casualities burgeoning, compulsion is necessary. With 4.5 million deaths, untold numbers with disabling complications, psycho-social havoc and burdens on health systems the last thing we need is a very serious public health emergency in the form of hospital lock-jamming. In such contexts restrictions on liberty and personal choice are secondary. While persons have a right to bodily integrity, including the right to refuse vaccinations, the state has a prior right to sanction them in the interests of the common good, subject to penalties, loss of employment and benefits, travel restrictions, business/services access and entry-denial to government positions.


Michael Furtado | 23 October 2021  

Given that one of the purposes of religion is to provide certainty in place of uncertainty, and that it does it very well, it might be worth considering what role religion plays in encouraging and nurturing this discomfort with ambiguity, uncertainty, and on-going discovery.


Ginger Meggs | 23 October 2021  

I think, in your normal unpompous, succinct and insightful way you may have hit the nail squarely on its head, Ginger. Doubt is at the heart of the Classic Carmelite Mysticism of St John of the Cross. He worked through a very long Dark Night of the Soul. But he didn't waver in his prayer and devotion. He was a great reformer and was actually incarcerated by those in his religious order against reform. His name and the charism he was graced with live on and are alive today. John Donne and the saintly George Herbert, in the Anglican tradition, also came through doubt. We need to heed them today.


Edward Fido | 26 October 2021  
Show Responses

Thanks Edward. I'm reminded sometimes of the ardent Anglican, so proud of his own Church's traditions but unwilling to consider that Methodism had anything to offer, saying that if the King James version of the Bible was good enough for Jesus it was good enough for him.


Ginger Meggs | 01 November 2021  

I remember that a British statesman once said (approx)"When circumstances change I change my mind.What do you do, sir?"


Lenore Crocker | 26 October 2021  

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