COVID-19 and the enforcement of safety: Do mandates work?

KOSTA: Hello everyone. Welcome to Undesign. I’m your host, Kosta Lucas. Thank you so much for joining me on this mammoth task to untangle the world’s wicked problems and redesign new futures. I know firsthand that we all have so much we can bring to these big challenges, so listen in and see where you fit in the solution as we undesign the topic of public safety, bandaids, and freedom in the age of COVID-19.

Now the pandemic pretty much needs no more explanation. It seems that it has affected almost all aspects of everyone’s lives, anyone anywhere. What seemed to have emerged as a problem however, is the polarization that comes with it, from face masks, lockdowns, contact tracing apps to vaccinations. There seems to be two groups of pros and cons. Those who pursue public and community safety and those who pursue individual freedom.

The notion that the government can dictate what a person should and should not wear and inject into their body seems to be seen as invading personal rights to freedom. Where do we draw the line between civic responsibility and personal responsibility? Or should the two walk hand in hand anyway? Helping us untangle this week in our latest episode is our special guest, Dr. Katie Attwell. Katie is a senior lecturer in the school of social sciences at the University of Western Australia and an Australian research council discovery early career researcher award fellow.

She’s interested in the intersection of policy, identity, attitudes and behavior, as they pertain to health consumers, healthcare providers, and governance. In 2014, Katie researched, designed and delivered and evaluated and internationally recognized public health campaign, I Immunize. She also leads the large interdisciplinary research project, Coronavax, preparing community and government with colleagues from UWA and the Telethon Kids Institute.

In this incredibly relatable and approachable conversation, Katie eloquently helps us to untangle what health mandates look like both pre and post COVID-19. She then takes us through what we know about the many fears and doubts people have on vaccination and even going so far as to share a very personal experience of hers, as well as her own research. Ultimately, what it comes down to is discussing how we encourage the community to use our privilege to realize public safety together. 

KOSTA: All right, Katie, thank you so much for joining us this afternoon. How are you?

KATIE: I’m well. Thank you.

KOSTA: I imagine you had a really, really busy few months and probably about the topic that we’re here to talk about today. I’m just going to dive straight in and let’s just get straight to the fundamentals, right? From your point of view, how do you define a health mandate? What exactly is it when we talk about this topic that everyone seems to be banding about right now?

KATIE: So with health mandate, do you want me to talk about a health mandate or a vaccine mandate?

KOSTA: Actually both. And how those two things are related, I guess.

KATIE: Sure. Well, I guess other health mandates relating to behavior such as wearing masks or quarantining or checking into venues are usually more underpinned by the force of the law. As in, there will be a penalty applied to you in the form of a fine, if you don’t comply. Vaccine mandates are a bit of a broader category. So when it comes to vaccine mandates, the definition I usually use of a vaccine mandate is something that kind of makes non vaccination consequential. It imposes a sort of serious consequence that you can’t really get out of. So if, for example, you need to be vaccinated to go into pubs and hotels, no one’s saying you’re going to get fined if you go in, they might say that, but they might actually just be saying, “You’ve got to show proof in order to go in.” And somebody will probably get fined, it might be the hotel that gets fined if they let you-

KOSTA: Yeah, sure

KATIE: It’s not necessarily about the behavior being extracted from you via a stick, which is why some people think of them as more like incentives. Although I think it’s very much in the eye of the beholder, one person’s stick is another person’s carrot. So really it’s about not being vaccinated means there are consequences and that could mean it could even be as simple as, and we see this in South Australia with a member of federal parliament, not being vaccinated meant you got dragged off into hotel quarantine for 14 days when you arrived, being vaccinated might mean you just cruise in and go to the pub. It’s where there’s a kind of cost associated between not being vaccinated or being vaccinated. And that’s deliberately done by the youth policy levers to apply a cost to not vaccinating. And by the way, not just governments, but also the private sector might do it too.

KOSTA: Sure. Any examples of that?

KATIE: Yeah. Well, so the private sector and governments can do it to people in quite a few ways. So you can do it in employment. Governments can say everybody working in their healthcare sector needs to be vaccinated in order to keep working or everybody who’s a teacher needs to be vaccinated in order to keep working. But the sector themselves can do it. So a mining company can say, “If you work for us, whether you’re out on the mine or whether you are in the head office, in the city, you must be vaccinated.”

Now we’ve seen that one such mandate was recently overturned that BHP had sought to introduce to one of their mining sites in, I believe New South Wales, that was overturned and the grounds are not being lawful because they had not consulted, which is interesting. But when government decides to do it, which they’ve done in WA, they haven’t necessarily consulted, or if they have, it doesn’t have to have been very clear and transparent. They just-

KOSTA: Yeah, sure.

KATIE: … think this is a good idea. That’s the private sector or government doing it to people through work, but they can also do it through going into places. So the government, like in New South Wales and Victoria, they’ve got requirements to be vaccinated in order to go to the pub or go to the pizza restaurant. And government says that, so government says, “We will bust an individual venue if they’ve let you in because we’ve said they can’t.”

But then my hairdresser in Fremantle, Western Australia has said, “I’m not cutting the hair of anybody who’s not fully vaccinated. Show me your vaccination certificate every time you come and have your haircut by me. If I can’t see it, I don’t want to see you.” That’s her as a private business imposing her own mandate. And she can do that for a variety of reasons. She could be doing it because she has health condition, but actually she’s not, she’s doing it because she saw health workers overseas getting sick and dying of COVID. And she would really cross at the people in her circle who didn’t vaccinate. And she’s a very in demand hairdresser, so she can actually turn people around away.

KOSTA: She’s got some leverage.

KATIE: She’s got leverage and she’ll use it, so that’s her decision. You might say, “Well, she could be accused of discrimination.” But the law is pretty clear that governments and businesses are allowed to discriminate in this way, because not vaccinating is not a protected status. Unlike something I can’t control like the color of my skin.

KOSTA: I was going to say.

KATIE: Or a disability, that stuff you’re kind of stuck with. But you choosing something to do with your vaccination status is a choice. If you genuinely can’t be vaccinated, then you would have a medical exemption. And then you were treated as if you were vaccinated under all of these policies. It’s very clear that you don’t use the stick against people when it would not be reasonable to ask them to be vaccinated.

KOSTA: That’s right. Where it breaches basic principles of justice and equity really, where you’re punishing people who otherwise can’t comply with a public order like that. Hearing you speak about that, Katie, I guess discrimination legislation as we know it, that’s very attribute based, whereas the decision to vaccinate or not vaccinate in the absence of an exemption is not an attribute, which is unlawfully discriminatory. Even drawing the distinction between health mandate and vaccine mandate is something I hadn’t actually considered before. Because the way that we talk about mandates at the moment seems to obviously be driven by the vaccine at the moment or the efficacy of it.

KATIE: This mask mandate as well, people don’t [inaudible 00:08:42].

KOSTA: I was going to say, what is our history with mandates of this nature generally? And what are our attitudes towards them from your point of view?

KATIE: Well, again, a mandate is sort of in some ways a bit of a loose concept. And to tighten it up really means that you are using law. And as we talked about, not all of these are about using law or some of them, they might be using regulations or they might just be about using orders, which is a little bit different. I guess, obviously some well known mandates from history would be like making people wear seat belts, which again, that usually has the word compulsory attached to it. Compulsory is a little bit different as well.

I mean, what does it mean when it’s compulsory voting, you do it or you get fined, you wear your seat belt or you get fined. It’s pretty binary and it’s kind of got the power of the law behind it. But if you want to think about mandates as behavioral tools more broadly, there’s actually a mandate for rich people to get private health insurance. Basically if you earn lots of money, you either have to pay a Medicare levy, which is a certain percentage of your income. And I know as a high income myself, I pay it. And it’s non trivial, it’s several hundreds of dollars.

And so that was put in by the Howard government and the alternative, the way to get out of paying that levy is to take out a private health insurance policy of sufficient level that you are off getting treated in the private sector. Now for myself as someone who’s ideologically opposed to private health insurance and the concept of private health, I’ve chosen to pay that only and think of that as money I’m putting back into the health system.

KOSTA: For sure.

KATIE: Probably not. It’s probably going on something else. But that is actually a mandate. And likewise, I’m not as well informed about this. My colleague, Dr. Adam Hannah is much more informed about this as a US health policy and social policy expert. But he talks about how the same sort of thing was connected to Obamacare, the Affordable Care Act. And again, this is not my area of expertise, but that was a big, bold move to make sure that everybody in some way would be covered by insurance and stop the horrific or mitigate, I guess, some of the horrific really perverse consequences that institutes in Americas kind of lack of a public health system. Certainly that was talked about there a lot as a mandate.

KOSTA: Interesting.

KATIE: And then you get governments who get elected and they’re like, “We’ve got a mandate.” Mandates have a weird meaning. And I don’t know that all of them line up super well. But I can see the commonality between the one like the Medicare levy and sort of the coercion towards private health. I can see that makes sense to me in the same way that you’re like, “Well, if your kid’s not vaccinated, they’re not going to childcare.” It’s the same thing. It’s like we’re going to impose a consequence, it’s your choice. But find yourself choosing between vaccinating and something pretty rubbish, or find yourself choosing between private health insurance or we’re going to slug you another way.

KOSTA: Wow. I really failed to appreciate how much this echos some of my legal training, like in a previous life when I studied law and thinking about coercion versus having to honor a contract term, which is onerous. These sorts of principles between choice and consequence is really interesting. Because I mean, from my initial research into this space anyway, is just this looking at discourse. And again, I know you’ve interviewed people about their attitudes towards various types of mandates, particularly in the context of a vaccination mandate.

This thing keeps popping up between like, essentially I’m as good as being forced into doing something if all these options around me are taken away. So it’s like you’re just existing on this island because all these options are taken away from you. And then the language of human rights gets invoked about like, where is that line? Is there a clear line?

KATIE: No. Because of course to even think about that way is to situate yourself within the position of the individual who is being asked to make a choice. And this has been, we are seeing this in the anti-vaccination protest, anti mandate protests that it’s bringing up in Australia now. I’ve been studying people’s attitudes and responses to no jab, no pay, and no jab, no play policies. And then policy makers justify those decisions.

The trouble with all of it though, is if you’re to put yourself in the position of a person who’s saying, I really, really don’t want to be vaccinated and therefore I’ll walk away from my job or I’ll homeschool my … not homeschool, that’s more of an American thing, but my kids won’t go to childcare or we’ll do without Centrelink. For those people, they’d feel really coerced. And the policy makers will say, “Well, they’re not coerced. They’ve got a choice. They can drop the consequence we’re giving them or they can vaccinate.”

But here’s the reason I don’t think there’s a clear answer. For every person who feels coerced, another person gets to move more safely in a community, so that person’s human rights and their freedoms have to be part of the mix as well. And that’s why governments and us as voters have got really big responsibilities to sort of weigh because for every teacher who says, “That’s it, I’m out of the classroom, I’m being coerced. I don’t want to do that.” A parent of a kid with comorbidities goes, “Thank God. My kid’s going to be a little bit safer going back to school next year.” And that’s the thing.

And one of the ways you can navigate through that pathway is to try and have really good evidence about what the mandate’s doing and what the intervention is doing. So for example, if we know that … and one of the things that we’ve been finding out about the vaccines for example, is that if you’re vaccinated, you’re about half as likely to transmit the disease to somebody else. So nevermind how sick you get. And of course you get a lot less sick and that’s [inaudible 00:15:01] it all. And that’s part of the reasons, but not whole reasons why you’re less likely to transmit it to other people.

But let’s say if we work from the rule of thumb, that someone who’s vaccinated is about half as likely to transmit over to somebody else and to somebody who’s unvaccinated. Then that’s become some of the data that you kind of want to bring into this consideration. Because then you’re looking at like, well, okay, so here’s a cancer patient who’s going to be immune compromised for six months, nine months, while they’re going through chemo and recovering. What kind of decisions can that person make? Does that person go, oh, that’s it. I’m just staying at home in a chamber, like the bubble for nine months. Or does that person go, “Yeah. Okay. I’m going to go into places where I’ll go to a restaurant occasionally, but only if it’s well sanitized, but I’m definitely not going to the Royal Show. You can imagine all those considerations that that person might make.

And so in some ways a mandate is like doing a bit of work for that person and saying, “Okay, we know that you are going to go into these settings and they’re not risk free. You might still get sick. And if you get sick, it might still be really bad.” But we could have taken away like half of that risk. And risk is weird and we all have to, as well as having government policies that manage it for us, like a certain level of risk, everyone wears a mask. A certain level of risk, everybody stays home. A certain level of risk, you can’t leave. All that stuff.

But at some point we all then have to grapple with what we think is the appropriate risk for ourselves within those settings. The kind of risk that an immune compromise person might have to grapple within a setting where government’s gone, we’re going to take some of this heavy lifting for you. We can make these places, at least half, I’m going to get the maths wrong, but we can make these places a certain percentage of amount safe for you and-

KOSTA: Potentially makes sense.

KATIE: Yeah. And then you might still decide it’s not safe enough in which case stay home. But if you brave it, you’ll be safer than if we hadn’t done it.

KOSTA: Yeah. Again, Katie, hearing you reframe it like that as like people’s resistance to mandates being, seeing it from the point of view of someone like feeling coerced and not seeing it from the point of view of someone who’s probably like in the inverse situation where they have to make these decisions to stay away from situations we all readily enjoy because of conditions they might have that might be exacerbated. I mean, I see a role in good public health messaging in that sense, to tell those stories or to foreground those stories.

KATIE: I do as well. And I can tell them as much as I can.

KOSTA: Sure.

KATIE: And try and talk about people with those experiences. I think it’s quite helpful as well because they’re both sort of smaller groups, actually people with comorbidities would be a much bigger group than people who vaccinate. But then both non mainstream experiences. And they’re both the groups whose liberties will be most put under strain. Whereas everybody in the middle might have some discomfort about mandates or might not be that excited about getting vaccinated, but is doing it.

But yeah, most of us are kind of muddling along in the middle. But also to be clear, those of us who are muddling along in the middle are also kept safer in society where more people are vaccinated or when unvaccinated people are not allowed in certain settings. But again, to play devil’s advocate, you do want to have some scientific veracity to back that up. You don’t just want to do mandates because it seems like a fair thing to do for that immune compromise.

You do want to be able to somehow quantify what … because it’s a trade off, you’re not only cutting off the freedoms of some people, you’re also potentially cutting off their income stream. Also you’re potentially radicalizing them and sending them off into the arms of the far right. So if you want to do any one of those things, you want to be really clear what you think the projected benefits for other people are.

KOSTA: Do you think that’s become a bit of a challenge? Looking at this in a political climate where university spaces and resourcing seems to be shrinking, there is this sort of quote unquote and I hate using this term like cultural war between left and right and progressives and conservatives and all that jazz, where academic work and research tends to be the domain of more left, like in this really class binary where research evidence comes from the left institutions. Do you think that task becomes harder in relying on an evidence base like that because people who are already radicalized or polarized in one way or another interpret that as propaganda or as poke holes in it or whatever it is, and it kind of results in more of a division, I don’t know. Do you have any thoughts on that?

KATIE: I do. I think the way you’ve put it is really interesting and sort of a bit different from the ways I’ve thought about it previously.

KOSTA: Sure.

KATIE: What I would think more is that for people who are not believing in COVID or not believing the science or not believing the medical recommendations, they’ve already discredited universities as places. So never mind the left right thing. They’ve seen universities as places that are captured by pharma or by other interests. They see government the same way. In terms of, sorry, that thing else I was going to add as well. So you were saying, oh yeah, so are they going to get radicalized? Is it going to get into the culture? Yeah, that’s right.

The other thing I was going to say was certainly in America and I’m not … I think you could probably extrapolate that here as well. But in America I’ve been doing some work there on California in particular, where they got rid of … basically they made childhood vaccination more mandatory than it ever been before. And that you couldn’t get out of it very easily. So writing a book about that at the moment. Finishing a book, in fact, I should say with my dear [inaudible 00:21:09], professor Macniven, who-

KOSTA: Oh, good. Oh, amazing.

KATIE: … [inaudible 00:21:11] scholar. As part of that, we’ve been looking at kind of political trends in other states over time or pre COVID, but then also during COVID. And basically there’s a very clear trend whereby it’s the Democrats who are so the more left. The ones who are prepared to go hard on public health governance and squeezing vaccine refuses. Whereas the political right is always more willing to go, well, we value your dignity, we don’t want to tell you what to do. We don’t like the big state.

But also interestingly from one paper that came on 2017, looking at earlier data, I think that was the year it was published. But I think the data that it was looking on was a bit earlier than that, compared to some work that I’ve just led with. In fact, wonderful success story I want to share.

KOSTA: Please.

KATIE: My beloved second year student intern, who was working with me, just published a lead author paper, little research paper in the Journal of the American Medical Association, JAMA, which is huge impact factor, so widely read. So this lovely little teenager published his paper.

KOSTA: Oh, that’s so good.

KATIE: That was so good. Anyway, so I was a co-author on that with her, along with a couple of American scholars. One of the things we found, just even changing … well, not that we found in that paper, but what we could see comparing that to the earlier paper I was talking about is that 2017 paper shows, sorry, it was always Republicans who were trying to make it easy to get out of vaccinating. But it was both Republicans and Democrats that in some cases were trying to make it harder to get out of vaccinating.

KOSTA: Oh.

KATIE: But certainly the Democrats are much more likely to want to make it harder to get out of it. They want to make the Republicans … Sorry. The Democrats want to make you vaccinate. The Republicans want to make it easier for you not to. But there were Republicans also trying to make you vaccinate. That was in 2017. Come the period we’ve just looked at, we looked at how many legislative interventions had been introduced, legislative or executive orders governor decrees, et cetera.

And they were so politically polarized, like all of the ones to make it more difficult to require vaccination, to make it easy to get out of it. They were all Republicans by then. And then the ones seeking to make it harder to get out of that state were all Democrats. So just in a few short years, they have completely polarized. So the Democrats have become the party of big state, big health and big coercion, for better or worse. And you take your pick on that.

And the Republicans have become the party of resisting that and of really allowing that individual to have their choices. But of course, taking out of the frame, the impact for society. Whereas the Democrats are like, well, we are doing this for the good of society. We’re doing this for the immune compromised.

Now let’s flash over to Australia. If you look to where the dissent is coming from for our vaccine mandates, it’s not coming from the Labor Party and it’s not coming from the Greens. It’ll be coming from some people who the Greens rely on as voters. I know that the Greens, there’s been a bit of disruption at sort of the grassroots of the Greens because they’re kind of hippie progressive people who vote for the Greens. Some of them don’t want to be vaccinated and then they feel very locked down by the Greens, because the Greens are like, “Well, we’re evidence based, so we’re supporting vaccination.”

Even if they’re not spotting mandate, they’re supporting vaccination. But there’s the descend. Well, it’s on the far right of the spectrum, but it’s also on the far right of the Liberal Party and the National Party. You’ve got those people, you’ve got your George Christensen. You’ve got your Alex Antic. You’ve got these guys breaking rank and to me it’s entirely predictable and expected that you-

KOSTA: I was going to say, is that pretty to be expected?

KATIE: Well, aligning with the American stuff, yes, it is. Because number one, they don’t like it personally. And so they’re better in for themselves. But number two, they want to prioritize the individual. And I think if you want to prioritize the individual, you look for the closest shackle. And if someone’s making me do something I don’t want to do, that’s a very clear shackle I want to throw off. And if I come to you and say, “Yeah, but what about the person with lupus? They want to be free to go to the pub too.” It’s a bit too abstract. It’s a bit too, oh, blah, blah, blah. But making that other person have the vaccine, oh, that’s bad. Undermine to the freedom of the person with lupus.

KOSTA: Gosh. And that speaks so much to sort of social capital theory basically where it’s just kind of this idea of, I mean, I think it was Robert Putnam when he did the bowling alone stuff around like people’s attitudes towards different religions. And the variable that he found that made the most difference was just kind of like exposure to people from different faiths in your ordinary social life as well. And it’s kind of similar here where it’s like, well, when you’ve got exposure to people who are in vulnerable sort of positions, it would make sense that you might be more inclined to empathize.

Whereas what I feel like I’m hearing a lot of, even in my own personal networks is just most of the people around me are exposed to are just that small number of people who are resistant or hesitant or full blown anti-vax or whatever. And they’re finding it really hard to bridge sort of that gap that they’re feeling with loved ones who have a very different view on these things. And I’ve had a few conversations, people reach out. Again, because my background’s in extremism and terrorism and radicalization and people are like, “Oh, how do you bridge that divide? How do I talk to someone that is so diametrically opposed that I really care about?”

And I get a bit stumped because it’s easy for me to say, “Well, try and understand the emotion under it. It’s a long game, not a short game.” What cards are you showing of yourself? Don’t go into a conversation knowing that, with this belief that you know more than the other person, trying as much turned it into a mutual quest for some sort of truth. But when we’re talking about public safety and people’s lives being at risk, it can be really hard to bridge that gap with people where you feel so diametrically opposed.

And I don’t know if you’ve got any thoughts on that, Katie, around how mandates affect how society interacts with each other. You kind of touched on it there in that example. But do we know the long term effects of say very oppressive or just coercive, strict mandates, hard mandates on how societies then coexist after such measures?

KATIE: Well, so this is one of the things that Macniven and I are grappling with in our book is we finish our final draft and sort of pull the arguments from all the chapters we’ve been writing together. And I think we still have to have a few more conversations about this in the next month as we sort of finalize our draft. But one of the things that really strikes me is that if you follow the California story where the Democrats, with civil society taking the lead, the Democrats lead this reform to really … what they did was they got rid of an exemption for personal belief.

You might say, “What is the point of a personal belief exemption?” The point of a personal belief exemption is you want to make vaccination the norm. So you require people to be vaccinated in order to enter school or childcare, things like that. But then you say, “Look, if you really want to get out of it, you can go and see a doctor and they can counsel you that you’re making a bad decision. And then at the end of that, they can give you an exemption and then you don’t have to vaccinate because you’ve got the exemption.”

And having that kind of intervention there is better than just having a free for all of like nothing at all. Because it cues the norm of vaccinating. So what California did in 2015 was get rid of that exemption. Oh my God, then there were all these other dramas like, then everyone flocked to medical exemptions, because they were pretty easy to get. Then they had to [inaudible 00:29:19] in those, but there’s all these dramas.

But anyway, to go back to what we’re grappling with is that that victory that the Democrats won and that sort of those civil society pro vax activists won in 2015 could very well be the difference between that sort of 2017 paper I just described where you’ve got Democrats and Republicans both supporting vaccination through what we’re seeing now in 2021, which is-

KOSTA: Extremely polarized.

KATIE: … really polarized. And so one of the things we’re grappling with in the book is like the long … and we are sort of drawing a direct line to the people that stormed the capital to the school, into the full Trump fiasco. We’re not saying the Democrats and the civil society, pro vax activists who brought this about, there’s not a smoking gun going back to the people. And indeed I wouldn’t want to say that because I had a lot of sympathy for what they did as well.

KOSTA: Yeah, sure.

KATIE: I support their efforts to make society safer for vulnerable people. However, one of the things that vaccination social scientists talk about is reactance, and they talk about it often at an individual level. You’re going to make me? Well, I’m not doing it. And people keep anecdotally saying this to me about the mandates that have come in Western Australia. So-and-so was maybe going to do it and now the mandates come in and they’re not going to do it.

And I think, well, really, if they were going to do it, they would’ve done it by now, so I’m a bit skeptical. However, so people talk about reactance on a personal level. But I think there’s reactance at a identitarian level, at a collective level, at the level that my social and psychological identity is tied up with other peoples. So now we as a collective are shifting to the right or we are shifting to a non-science position. I think the risks of mandates are high. That said, I think the risks of COVID-19 are really high too.

KOSTA: Sure. Yeah. Very fair. And obviously the evidence that we have currently backs you on that too, otherwise you wouldn’t feel that way. What about in situations then where it’s a real … I mean, COVID is a evolving situation. But I throw my mind back to sort of mask mandates. In the early days of COVID, some of the really confusing public directions we were getting around like the efficacy of mask wearing. And I know there’s arguments about like people were initially discouraged from buying up all the masks because there weren’t enough of PPE for healthcare workers and stuff like that. What’s the role of public messaging in conveying changing information, or accounting for changes in what we know?

Because again, perhaps this might be a flawed social narrative we have about the nature of research, which is like, it is there to tell us exactly what the world is, not just what we think we know based on how far we’ve looked into something, at that point in time. So research is being a finite source of truth, as opposed to an observation of a particular set of variables at a particular point in time that needs to continue to be monitored. How do you deal with situations like the mask mandate or just mask directions where things change and the instructions were confusing or undisputed.

KATIE: Yeah. And gosh, I mean, I’d even go for an example closer to my wheelhouse than the mask mandate is changing advice around the AstraZeneca vaccine.

KOSTA: Ah, sure.

KATIE: That was a big struggle. Absolutely. And these beautiful people who do this really deep scientific calculations about what the risk should be, they are not all of them the same people who are gifted with the now sort of skills of public communication. Some of them are, some have got a job skillset and others are there noting out this evidence and then they’ve also got to figure out how to socialize it. And then the government’s got to decide if they’re going to listen to these people or if they’re going to bring in other considerations as well.

I think all of us in the last two years have had such a lesson in like … I call it sort of making policy on quicksand or getting advice on quicksand. And so a number of times I’d be out talking about, especially early in the rollout, I’d be out talking in the media about vaccination, about the safety efficacy of vaccination, about why it’s important and why people should be doing it. At the same time knowing that the ground I’m standing on is shifting as I speak. And how do I even feel safe to communicate as a communicator and with all the knowledge I have. And if I’m struggling, how’s the public going?

KOSTA: Yeah.

KATIE: I don’t know that there are clear answers to this. It’s during a crisis. Imagine there’s a massive earthquake and everyone’s just running in a million directions and it’s chaos. I mean, that’s how I imagine an earthquake is. But if you are in somewhere like Japan and you’ve designed buildings around it, or if you are like the risk … what do they call that? The disaster preparedness people. The way they would think about an earthquake is a bit different from the way I would, which is just to run screaming in every direction.

I guess what I’m trying to say is that we’ve all had a lot to learn about how to do this stuff better, but it also has been an earthquake and there’s just been a lot of running, screaming in every direction. And so I’d be one of those people in this setting who needed to be not the person running and screaming in every direction with the person going, okay, I think I’ve got something to bring to the table, I think I can help. Lots of other people could help in much more significant ways than I can in terms of figuring out the safety, the efficacy and what the rollout should look like and who should get what and when. Those are the absolutely crucial questions.

But those are the questions that can change over time. I think we need to keep having a public discourse around, like you talked about the fact that science is shifting. I’ll give you an example of how I think I was able to use that in a positive way. I was on Channel Seven Flashpoint earlier this week with a doctor and a political journalist who is very fired up and passionate. She’s got a kid with comorbidities. So we’ve I guess the pro vaccination side.

And then there was a teacher, police officer and a nurse who had all decided to give away their careers rather than be vaccinated. It was on a commercial station. It was pretty sensational as you can imagine. But it also was a decent civil civic exchange. And at the end of it, and unfortunately in my opinion, the better parts of it didn’t make it to air. So they put the whole thing on the Channel Seven Flashpoint Facebook page, which they said they were doing to not be accused of censorship and whatever. But actually I’m glad they did it because I think some of my points got better ventilation on the Facebook post. But so this didn’t make it onto TV, but it did make it onto the post, onto the broader video.

And at the end of it, one of the people said, which is a common argument the vaccine refuses will say, and they say, “I want the long term safety data. I don’t want to do it without it. We don’t have the long term safety profile of these vaccines.” And I was like, “Dude, it’s a pandemic. You want to wait five years while everybody around us dies, then we’ll have that data.” But the bigger point that I was making is that in the history of vaccination, we’ve never seen a vaccine that gives you long term problems.

KOSTA: I was just about to ask that.

KATIE: Yeah. So if there’s a problem, you see it in the short term, in the medium term. And I said to these guys, “We do have those signals. We do have those systems.” And in fact, that’s what broke our roll out. We were all supposed to have AZ and we didn’t because those systems did their job and we learned that the vaccine was not so safe in a context of no COVID. If you have COVID, you roll out that vaccine as they did in the Eastern states.

But in places with no COVID, and another vaccine available would be sort of drip fed, supplies more slowly. They made the choice to prefer one over the other. I kind of tried to use that as a way of showing that science is always changing and yes, it’s confusing, but it’s reassuring. So you might not have five years of safety data you wish you had, but you do have the evidence that the experts are watching what’s happening in real time and being agile in their response to that.

KOSTA: Yeah. Which is really reassuring, unless you are that 5% to 1% that has an adverse reaction or that has, you know what I mean, or has some misfortune that results from it. However, I guess the way I rationalize it in my head, Katie, and tell me what you think of this, but it’s reassuring in the abstract, but no one wants to be that 1%. And perhaps there is a bit of a negativity bias at play there with certain people that their fear is being that 1%. I know that there’s a 98% chance or whatever it is that I’ll be okay or I’ll get through whatever happens. But if I’m that 2%, I am screwed. And that makes the whole enterprise void or whatever it is. And do you think that’s a negativity bias just kind of flaring up maybe as a reaction to our own survival instincts kicking in?

KATIE: I think the research I’ve done and others have done absolutely backs that up. I remember doing some research years ago into people who were hesitant or refusing vaccines to their kids. One of them was sort of saying, “Oh, my kid was the one in however many that has this completely unrelated health condition. And then he’s the one in however many who they get treated for it and the treatment doesn’t work for.” I’m used to my kid being the unicorn, I’m used to my kid being this thing that bad things happen to. So surely when it comes to vaccination, my kid’s going to be unlucky yet again. Absolutely.

In our COVID-19 vaccination study called Coronavax, I found the same thing again. It’s basically people going, “I’m worried about those effects because I think that I’m going to be the one they happen to.” And I think, talking about it with you now Kosta, I do think this is possibly an unexplored area, because the way we think about, and kind of frame risk is very informed, not just by our experiences and our beliefs, but also perhaps by our personality and sort of, are we glass half full, half empty, all that stuff.

I absolutely think that, yeah, the statistics are no comfort at all if you don’t interpret them in that same abstract way that they’re presented to you. And I’ve got lived experience with this as a cancer survivor. I’ve looked at a lot of really ugly statistics. And actually as far as cancer goes, they were really good statistics. But I always zoomed in on exactly that. Well, I’m going to be … not even the unicorn. That’s not fair. I’m going to be one of the unlucky ones in this cohort.

And in fact I wrote a post about it on Facebook quite recently that’s now sort of three or four years, three years since I’ve been finished treatment for cancer. And I unpacked all those biases and was like, I wrote this post called You Are Going to Die. And it was every single piece of information they gave me, whether it’s consenting me for a medical treatment, telling me I’m not eligible to be in such and such a clinical trial, every single thing they said, all I’ve heard was, “You are going to die soon.”

And only later could I write about it and then even laugh about it and talk to you about it now. But at the time, I couldn’t even talk about statistics. I worried I couldn’t even do my job, which does involve talking about risk. It does involve talking about statistics because it was so triggering, I couldn’t even think about it. Thinking about it, now we’re talking to you now makes me think that way of thinking, if we can help some, and I was going to say if we can crack it, but that’s a very paternalistic way of looking at it.

KOSTA: Sure.

KATIE: If we can help people for themselves break through some of that bias and find themselves in the statistics in a safer way. Because I remember at the beginning when I was diagnosed with cancer, one of my colleagues, his wife had been through it and he was like, “Katie, it’s all big data, it’s all big data.” And I remember from the beginning trying to say to myself, “Yeah, Katie, it’s all big data. You don’t know what your journey’s going to be, but try and take solace in the data.”

But then I couldn’t because even though the data was okay, it was pretty good as far as cancer goes, I still was looking at the wrong part of it. I was looking at the minority stuff. I don’t know why. Although I wish if we could crack this in this vaccination field, if we could crack it in cancer, we could probably spare a lot of people suffering, but I don’t know. And actually I did come across the work recently that people were doing in cancer about fear and the fear of cancers coming back and stuff. Maybe they’re going to start cracking it. Maybe I’ll talk to them and say, “Hey, are you working with this? Are you working with the fact that people zoom in on the unlikely but awful outcome rather than the more likely and good one?”

KOSTA: Actually, Katie, and look, if you’re comfortable using your experience as a bit of an analog here, I wonder, are you able to identify anything that would’ve made you feel comfort in that time? So like going back to Katie of three to five years ago, is there something that could have actually alleviated some of that fear?

KATIE: I was suffering PTSD because I had a stage four scare. So they had to go and scan my liver. And if it was on my liver, I was fucked.

KOSTA: Right.

KATIE: And I had about four or five days of waiting to see whether it was on my liver, and it wasn’t. I got a good outcome. And we’ve been getting a lot of bad appointments where they’re like, “Oh, it’s cancer. Oh, it’s in your [inaudible 00:43:42].” And so, oh, it might be in your liver. And then it’s fully inspected to turn up, oh, it’s in your liver, you’re going to die. And it’s like, no, it’s not in your liver. Now you just got to have a bit of treatments then you can clear off.

I was really, really traumatized. And so every single statistic and risk and everything I encountered after that was filtered through my, not just my trauma, but the fact that chemo makes you feel like you’re dying. So you feel unhealthy, you feel horrible. And so I went to therapy, I did all the things and my therapist helped me to understand that when I felt okay physically, because sometimes you feel okay, sometimes you feel like hit by truck.

When I felt okay, I could leave the dark thoughts behind. When I didn’t feel okay I was so preoccupied with what it felt like to be dying, that it was all I could think about. I don’t know how you extrapolate that out to much wider populations, but maybe there’s something there in, I’m guessing people that are primed to be thinking negatively about what vaccine might do to them might be people who are worried about their health. And actually I can leave the personal aside here and go to research.

KOSTA: Cool. Yeah.

KATIE: When we looked at people worried about childhood vaccinations, they often fell into two camps. And one camp was my kid’s too sick to vaccinate. And the other kids, my kid’s too healthy, didn’t need to vaccinate.

KOSTA: Too healthy.

KATIE: So the whole, my kids too sick to be vaccinated. They’re the group that I reckon they’re my people. They’re like, “Oh my God, I’m primed for all the bad things.”

KOSTA: Got it.

KATIE: Going to be bad. But when I think about the people I went from that Flashpoint panel with, they all talked about how amazing their immune systems were. And again, we found this in a research too. My immune system’s so good or we have all these inputs, we have the organic food and the breast milk and the wooden toys and the Steiner school.

And so what was fascinating about those parents is that they thought their kids were qualitatively different from like neglected urban poor parents spent the Centrelink money at the races and was a goon bag, that unvaccinated kid was a qualitatively different kid from their unvaccinated kid. Even though you bring in an infectious disease expert, they’re like, “There’s two unvaccinated kids.” Right?

KOSTA: Yes.

KATIE: There’s so much differentiation within people’s motivations and reasons. Those people who think their immune systems are amazing. And in fact that’s what the people of the panel were saying. They’re like, “I’m not against this vaccine. I just don’t want it.” Which translated to, I just don’t think I need it of which there were elements of, if I don’t need it, there are some risks involved and I don’t want those risks because I don’t need those risks.

KOSTA: Yeah, sure. Which is just, again, an experience and a way of experiencing that choice in that moment through a very particular lens, which doesn’t look at some of the more vulnerable members of community that are just praying other people don’t infect them with something because it’ll be absolutely disastrous. Man, I mean, look, thank you for taking that to such a personal place. And I only asked you through that lens just to see if there was something in there about like, honestly, we’re all scared for our lives in some way. And we all, I would like to think are motivated by what we think is right in terms of like, we’re all concerned about safety, even if the way we conceive of that is different to each other and very individualized.

I guess my question was really trying to kind of unpack like how do we reach people through fear? Particularly if a lot of that fear comes from things that are already written before the stresses come into play. And that’s what resilience is about and prevention.

KATIE: Absolutely.

KOSTA: I don’t know about you. When COVID first hit, again, my specialties in prevention, not intervention. But I got a ton of requests for work. I got really busy. And I found myself just being like, “Bro, I am a prevention guy, we’re in the middle of a crisis. I can tell you what we should have done and what we can do. I can’t necessarily tell you how to fix what’s happening right now.” There are other more skilled people to do that. There’s a couple of things I picked up on as you were talking, I guess one of them is this idea of coming from a place of, I guess I’ll call it humility, in looking at science as a foundation made of quicksand.

And I love that image and just that’s what it feels like when you’re under pressure, you’re like, “I’m sinking, because I don’t know what is happening right as I’m saying this.” But kind of understanding that, look, for me, I’m a reasonably intelligent person, but I couldn’t tell you the first thing about the scientific basis of any vaccine. My entry point into the discussion is I’m putting trust in the people that study this stuff and speak the language of this stuff more than I would put my trust in someone on YouTube that decides they don’t like a particular part of an argument that someone has made or because they mistrust big pharma based on maybe some crappy stuff they’ve done in their business practices elsewhere.

I don’t see those two things as equivalent. The reality of business and capitalist system is so much more complex than just homogenous entities acting consistent with their own values, knowing what the left hand is doing at the same time as the right hand. For me, I know the reality’s more complex, but I know there are way people way smarter than me that do this stuff for a living. And I’m also not holding them to that standard forever because these things change human evolution and progress depends on us changing and understanding the world differently. So for me, it’s more like, look, the people I listen to are way smarter at this. They might not know it, but they certainly know a lot more than me. And they could be wrong, I could be in that 5% that has a really bad reaction.

KATIE: By the way you keep saying those figures, but those figures are much too high, it’s like 0.000.

KOSTA: Yeah, sure. There you go. Even I could be that 001% or whatever. It’s just like there’s a degree of kind of like, you know what, I need to sort of be clear on what I know and be open to what I don’t know until someone proves that. But that attitude of humility I think is really important even for someone such as yourself, Katie, who is in a position of relative privilege by virtue of you’re an expert and a thought leader in this field where that carries weight with people and you might be an authority to tell people, “Hey, this is the lay of the land.” But in an interpersonal level and interpersonal Katie, people who come to you as a friend might be expecting something very different from you.

So the conversation field changes and how do you even that playing field for people and universities as, again, like with these connotations of being a place of intellectual elitism. I feel like that always comes up in the discussion when we talk about this stuff, it’s like, researchers think they know everything or these people are smart asses in their ivory towers, they think they know everything. And it’s like, well, you’re not actually listening to what they’re saying. You might have a problem with the way things are said, but have we actually listened to what is being said? Have we listened to the way they’ve arrived at that conclusion?

The conversation needs to be a bit more nuanced in that sense. There’s that aspect of it that I think humility goes a long way in this. And I guess the other thing is just socializing it by focusing on making societies genuinely more inclusive and increasing the opportunities for us to interact and live amongst one another and to see diversity of people’s needs and gifts and experiences as a good thing that requires really good conflict resolution skills. Because when differences come into contact, they conflict, but they’re not necessarily always bad. It’s just about expending a little bit more into mental energy in that moment to resolve that conflict rather than trying to eliminate, make those things happen. Probably I’ve just had a bit of a sermon.

KATIE: Okay.

KOSTA: But you’ve really inspired me with your work, Katie. It’s really complex, but there’s so much overlap and it speaks to something deeply human is I guess what I’m trying to say.

KATIE: That’s good.

KOSTA: Does that track with you?

KATIE: It tracks completely with me.

KOSTA: It just feels like a real human reaction. As much as it mystifies me, and I have my questions particularly for vaccine refuses around or how do you keep other people safe? Fine, if you don’t want it, what is your plan for other people? Have you thought about other people? That’s where I go. But that again has a lot to do with maybe my orientation, my experience. How do I then just dial it back a little bit so I can just kind of … or should I be more selective with who I have those conversations with.

But hopefully everyone has those people in their lives where they can find that mixture of challenging themselves with, but also feeling supported by people that are kind of on the same page, if we’re just being realistic. Just to close us out, I just want to get some thoughts from you, Katie, on what you think will be worrying about going to the future and what we should be focusing on as these things roll out.

KATIE: Well, I guess, the sort of the two pressing things that are coming online are childhood vaccinations for five to elevens and boosters. And down the track we’ll probably be looking at vaccinating six months to five year children.

KOSTA: Right.

KATIE: That’s an expansion of the program. It’s also an extension of the program chronologically in that we don’t know how many boosters we’ll need. And what experts have told me is that it’s not necessarily like the flu where you need a new vaccine every year because the old flu just keeps changing it up. Of course COVID keeps changing it up too, but [inaudible 00:54:05] hold up pretty well against these new variants.

It could be that after three doses you’re laughing and then maybe you might need another one in five years or so, who knows? Or it could be that you need them more often. I don’t know yet. So for me as we kind of both extend chronologically, but moving from crisis into containment. But then also as we extend the reach of the program down into younger people, I’m not going to be out of a job anytime soon. These are all things that are going to need to be done carefully and sensitively.

We’re going to have the challenge with vaccinating our pediatric populations in that we know there are going to be definite benefits in vaccinating our kids for their own good, also for their secondary benefits in terms of schools being open, soccer happening on Sundays, family holidays being able to go ahead, visiting and living with parents, or just giving our kids a normal life, vaccinating them helps us give them a normal life that also benefits them.

But from childhood vaccination that parents in Perth are like, “Why do I need to vaccinate my kid against polio? There’s no polio here.” People are very attuned to what’s in it for my kid. I think that’s going to be a challenge to make sure we can adequately communicate to parents that there are both benefits for society, but benefits for their individual child in having the kid vaccinated against COVID-19 and then boosters. And that will be in part a question again around what policy levers, do we change the status of? Are you only fully vaccinated at some point if you’re boosted and the mandates kick in again, or could this work on a more voluntary basis or strongly encourage, but not required? I don’t know. I feel exhausted at the thought of all of it. And as saying that, as much as I feel exhausted about it, I also feel really excited about coming [inaudible 00:56:02] and solve those problems.

KOSTA: Oh, that’s so good to hear and we bloody need it. I’m really happy to hear that even if you deserve a massive break. Katie, thank you so much, not only for the questions I wanted to ask you, but for taking that into a pretty unexpected direction.

KATIE: I wasn’t planning to go there either, but I’m comfortable-

KOSTA: Yeah, I really appreciate that and I’m sure our listeners will really appreciate just how much you humanized that experience for them. And again, not to falsely equivocate experiences like that, but they’re huge windows into how we … like into very deeply human vulnerable moments that might hopefully give a lens to someone, like you’ve just given a lens to lots of other people to maybe look at this through. That’s just much more human, which then makes the more objective abstract information maybe a bit easier to process. Again, I just really want to thank you for letting us go there with you.

KATIE: No worries. And in fact, I’m pleased to have gone there too, because I keep thinking, what will I take from what I went through and how will that be something that one day I might work with professionally. So for me to think about that negative priming, that bias and my experience of that might be something I can bring to the work I do in vaccination. I hadn’t really thought about till I talked to you, so it’s been really fruitful for me as well.

KOSTA: Oh, I’m really pleased to hear it. And just as one last thing, Katie, where can people find you and your amazing work?

KATIE: Oh, thank you so much. So yeah, look, I’m a university academic, that’s my bread and butter. I don’t do much outside of that. I’m on Twitter. I think if you search for me by name, Katie Attwell, spelling it properly, you’ll find me.

KOSTA: Awesome. Katie Attwell with a double T. I’ve learnt that the hard way.

KATIE: Two Ts. And as well as Twitter, I have a university profile page where all my research goes. I do try and publish open access as much as I can.

KOSTA: Great.

KATIE: I’ve written lots of profiles for the conversation, so you can find me that way.

KOSTA: Thank you so much, Katie. All the best.

KATIE: You too, Kosta. See you.

KOSTA: [inaudible 00:57:57]. Bye. 

KOSTA: You have been listening to Undesign, a series of conversations about the big issues that matter to all of us. Undesign is made possible by the wonderful team at DrawHistory. And if you want to learn more about each guest or each topic, we have curated a suite of resources and reflections for you on our Undesign page at www.drawhistory.com.

KOSTA: Thank you to the talented Jimmie Linville for editing and mixing our audio. Special thank you to our guests for joining us and showing us how important we all are in redesigning our world’s futures. And last but not least, a huge thank you to you, our dear listeners, for joining us on this journey of discovery and hope. The future needs you. Make sure you stay on the journey with us by subscribing to Undesign on Apple, Spotify, and wherever else podcasts are available.