Herd Thinking

The daily reporting of the COVID-19 deaths during the pandemic has been a sobering, sometimes emotional, expression of the toll on our community. A reductive perspective on the pandemic has often pitted those lives versus the economy and they have been characterised as mutually exclusive, irreconcilable enemies, locked in a grotesque battle. In recent decades, gross domestic product (GDP) is a single number that dominates our lives. This concept of the ‘economy’ has been described as ‘trying to squeeze a frog into a matchbox’.¹ Imagine if we tried to encapsulate the full spectrum of medical activities into a single stat. Losing one’s job is a real and devastating event but beware the numbers: we could raise GDP at a pen stroke by including unpaid care work, a burden shouldered disproportionately by women.

The arrival of any vaccine will doubtless mean conversations with the nervous, the reluctant, and the outright hostile. We will present our case, back it up with solid data, and expect the evidence to do its magic. It’s a natural position for many medics, we’re comfortable (perhaps too much) with the positivist philosophical approach of an objective reality that we can observe and count. That is the appeal of GDP as well. Yet, to our horror, people will resist and we will label them anti-vaxxers. We will then be divided with heated spats sizzling and spitting across social media and in our discussions.

When it comes to these difficult conversations, it could be useful to recall social psychologist Jonathan Haidt’s analogy of the elephant and the rider.² When it comes to decisions, in reality, the elephant, our initial emotional reaction, is usually deciding the direction of travel. The rider can have an influence, but more commonly, sits astride the elephant, making it clear that the rider wanted, in a happy coincidence, to go this way all along. It can knock our sense of self as autonomous individuals but we mostly use our powers of reason for post-hoc rationalisation. We need to appeal to the elephant and not the rider, if we want someone to change direction.

Eula Biss has written beautifully on vaccination and its role in society noting that ‘immunity’ comes from the Latin munis meaning service or duty.³ Of course, immunity means to be exempted and therefore protected. Herd immunity has already been a controversial topic in this pandemic; the government flirted with it, keen to protect the economy, until someone actually noticed the potential death rate. In the GDP versus mortality contest the Government blinked and plumped for people. Small mercies, you may think. Biss also wrote that ‘Immunity is a shared space — a garden we tend together.’ ³ It could serve us to remember the collective nature of immunisation. Numbers will rarely trump emotion.

• © British Journal of General Practice 2020