When India’s polio eradication efforts kicked into high gear in the mid-1990s, the country was seeing as many as 150,000 annual cases of the disease.
Experts re-worked vaccine protocols to fit the on-the-ground context: they used cluster immunization to quickly cover large groups, tweaked the vaccine schedule where needed and spared no effort going door-to-door and tracking people down in informal housing.
But after an optimistic start, the country’s ambitious childhood vaccination campaign began to lag as healthcare workers increasingly encountered people refusing to vaccinate their children.
The tide turned when the campaign mobilized people from communities to go door-to-door with vaccinators, where they listened to people about their concerns, offering reassurance and gathering data about how to tweak the messaging.
Community members, including religious leaders, doctors and schoolchildren, helped to run a ground-level messaging campaign – with even barbers deputized to spread the word to clients as they sat for haircuts.
Vaccination rates started to tick up. Now, India hasn’t recorded a single case of polio in more than 12 years.
The Indian vaccination project’s success emphasizes the importance of context, and how that contributes to trust in science – a key lesson for scientists working on the “wicked challenges of the 21st century,” argues a new report from the ISC Centre for Science Futures.
Entitled “The Contextualization Deficit: Reframing Trust in Science for Multilateral Policy”, this new working paper by the International Science Council think tank, reviews what research and practice in a range of fields from journalism to regulation have learned about trust in science in recent years, and the implications of that knowledge for policy-makers.
“The report suggests failures in compliance with COVID mandates reflect long entrenched problems with adapting policy for social contexts,” explains Nick Ishmael-Perkins, who led the report.
DOI: 10.24948/2023.10 ‘The Contextualization Deficit: Reframing Trust in Science for Multilateral Policy’. The Centre for Science Futures, Paris. https://futures.council.science/publications/trust-in-science, 2023
The report comes as surveys show an alarming decline in public trust in science. A 2022 survey in the U.S. showed a 10% decline in the number of people who said they had confidence in scientists to act in the public’s best interest – at 39% in 2020 to 29% in 2022.
That decline can in part be explained by the COVID-19 pandemic, but many observers believe it reflects a broader, global trend, the ISC report notes.
At the same time, a recent survey by Elsevier also found a huge increase in online threats and harassment targeting scientists.
All of this also threatens science’s key role in the multilateral system, the report argues. “What we’re seeing is that science, which is one of the last languages for global diplomacy, is coming under threat,” says Mathieu Denis, Head of the ISC Centre for Science Futures.
Skepticism vs. distrust
Data show that trust in science comes down to many factors, tied to context and history. What may look like distrust in science is actually often a lack of trust in government or institutions, the report notes.
“We need to think quite carefully about the contextualization of science, and then think about how that would lead people to express trust or mistrust,” Ishmael-Perkins says.
In many cases, communities have good reasons to distrust authorities. The report notes the infamous Tuskegee study, which involved U.S. government public health researchers deceiving Black study participants, leaving them with untreated syphilis – leading to many preventable deaths and additional infections.
The study only ended when it was reported in the media in 1972. A recent survey found that 75% of Black adults in the U.S. were aware of the study, and that many didn’t trust medical ethics to guard against similar misconduct.
During India’s polio eradication campaign, many parents refusing vaccinations hadn’t been able to access expensive healthcare and were suspicious of something the government was so eager to offer free of charge, or remembered forced sterilization campaigns during the 1970s. Others had seen their livelihoods wiped out in a changing economy and, feeling forgotten by authorities, shut the door when government doctors knocked.
Those same contextual details also explain why people who generally have a high level of trust in science may not support particular science-driven policies. “What might pass as a wholly accepted, settled science in one situation might be disputed or resisted in another,” Ishmael-Perkins adds.
The report also notes a crucial point: skepticism is key to science. And the scientific process inevitably involves mistakes and uncertainty. “‘Failures’ are a natural part of the scientific process, and iterating and adaptation is to be expected,” notes Denis.
This played out during the COVID-19 pandemic, when scientists were trying to communicate their understanding of a rapidly evolving situation – with sometimes conflicting messages on issues like airborne transmission and masking.
“Listen to the science” became a mantra, the report notes – but these conversations tended to focus on trust in key messages like mask-wearing or vaccine safety, and less on the overall trustworthiness of science and policy institutions.
“Misinformation cannot be trumped by messaging alone. Nor does it make sense to advocate a blanket trust in science, stripped of context,” explains Sujatha Raman, one of the authors of the report and a UNESCO Chair-holder in Science Communication for the Public Good.
“Science is critical for multilateral policy-making and diplomacy. But to make the best use of science, we need to invest time and effort to understand and engage with contextual realities and forms of knowledge,” she adds.
All of this points to the need to re-work how science is communicated and how scientists and policymakers engage with the general public, the report argues.
“How can we restore the integrity of the science-policy interface, and have a more constructive engagement with political discourse?” Ishmael-Perkins asks. The report makes several recommendations – among them, that scientists and policymakers focus on “achieving trustworthiness, rather than blanket trust.”
Trustworthiness is a product of “ongoing transparency and accountability,” the report notes. Communication is a key part of that process. “The traditional linear model of disseminating scientific knowledge to policy-makers and the public is outdated,” the report argues.
That approach is based on the flawed assumption that “trust in science is solely a matter of educating the public and addressing misinformation.” Instead, the focus should be on encouraging public participation in science and in developing policy, as well as encouraging partnerships that bring together scientists from different disciplines.
“Science communication has become more reflexive and attuned to the knowledge and priorities of different actors and creating opportunities for dialogue between them,” Raman explains.
The report notes a recent good example from New Zealand, where a “citizens’ assembly” informed by Māori principles brought together Auckland residents and water experts to work together to choose the region’s future water source.
In the project, which was supported by Auckland’s public water utility, Watercare, and Koi Tū, The Centre for Informed Futures at the University of Auckland, experts presented a range of options, answered questions and encouraged debate. Residents ultimately recommended recycled water, which is now being tested in pilot projects.
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The information, opinions and recommendations presented in this article are those of the individual contributors, and do not necessarily reflect the values and beliefs of the International Science Council.