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Taking Pleasure at the Ultimate Self-Own?

photograph of Herman Cain

Does Reddit.com’s r/HermanCainAward wrongfully celebrate COVID-19 deaths? To some, the subreddit is a brutal, yet necessary look at the toll of vaccine misinformation and the deaths that follow. To others, it is a cesspit of schadenfreude (taking pleasure in the pain of others) that has few, if any, redeeming qualities.

The description of the popular forum reads: “Nominees have made public declaration of their anti-mask, anti-vax, or COVID-hoax views, followed by admission to hospital for COVID. The Award is granted upon the nominee’s release from their Earthly shackles.”

An average post contains multiple screenshots of social media posts made by someone who expresses anti-vax views followed by screenshots of friends or family members reporting on the person’s sickness with COVID and, often, subsequent death. The victim’s social media posts are usually right-wing and often feature conspiracy theories as well as a set of common memes.

Outside of the nominations, one can find community support posts as well as “IPAs” or “Immunized to Prevent Award” posts, in which users report getting vaccinated after witnessing the horror presented in the forum. There are also “Redemption Awards” for those who change their minds about the vaccine, often as they are dying. (Last fall, the subreddit changed its rules to require that all names and faces of non-public figures be redacted.)

The Herman Cain Award is named after Herman Cain, a Black Republican who ran for president in 2012 and co-chaired “Black Voices for Trump” in the recent election cycle. Cain, who had prior health issues, opposed mask mandates and attended a Trump rally in Tulsa on June 20, 2020, where he was photographed not wearing a mask in a crowd of people not wearing masks. Shortly after, Cain tested positive for COVID and was hospitalized. Cain died from COVID six weeks later at 74 years of age.

To gain a better understanding of the rich, ethical dimensions the subreddit presents, there are a few questions we should ask: What is the narrative of HCA posts, and what feelings do these narratives engender? Do HCA posts, taken as a whole, accurately reflect the world around us?

Let’s start with the narratives. Perhaps the most obvious one is a narrative of righteous comeuppance. HCA nominees and winners have endangered not only themselves but also others, and they have reaped the consequences of their actions. This seems to be the primary lens of HCA viewers, who often make posts venting about the harms of anti-vax sentiments and actions.

This narrative tends to produce a sense of righteousness and stability, along with reassurance of one’s experience of the world and the moral responsibility that nominees bear. This sentiment acts as a counter to gaslighting resulting from widespread denial of the reality of the pandemic, perhaps expressed by close friends and family.

The second narrative lens appropriate for HCA content is tragedy. This is not necessarily distinct from the first lens, but it emphasizes more strongly the unnecessary suffering caused by the pandemic and our collective response to it. This lens, perhaps more than the first, encourages us to see HCA nominees as persons whose lives have value.

Pity might be too much to expect, given that the nominees are facing the consequences of their own actions, but the tragic reading does produce genuine horror at the suffering that could have been prevented. At best, this horror keeps us alive to the value of the lives lost. At worst, it devolves into a numbed-out nihilism, as we can no longer bear the burden of moral harms witnessed. It’s very easy to doom-scroll through r/HCA posts and lose hope at the possibility of change.

The third narrative is less noble than the first two. This is the narrative of the self-own — with motives that are tribal, petty, and wishing ill upon those who purport to make the pandemic worse. It is a narrative we might easily slip into from the first. This variant cares less about what is fair or appropriate and more about being right or superior. We might be especially worried about this, as the subreddit feeds off of other polarized dynamics that arise from tribal divides on the left/right spectrum. This, I believe, is the narrative that has primarily concerned those who have written against r/HermanCainAward, contending that it produces schadenfreude.

But what is troubling here is not merely pleasure in the pain of others but something stronger: pleasure in the death of others (and if not death, then extreme physical distress). Is it ever permissible to take pleasure in the death or pain of others? It seems acceptable to take comfort in knowing someone can no longer do any harm, but a preventable death is a bad thing that we should never see as good.

If we take pleasure in the deaths of others, we must either take up some view on which their death is deserved and proportional to their crimes or else discount the value of that person’s life. Neither is an attractive option. Even if nominees have caused the deaths of others by spreading the virus, it is a strong view to claim that their own deaths are deserved because of their actions. And assuming that their deaths were deserved, it still might seem unsavory to take pleasure in their punishment. But the predominant kind of gratification appears to fall into the category of feeling somehow superior to those who are dying. Self-satisfaction at the downfall of others is rather ugly.

These critiques do not rule out righteous anger or the recognition that r/HCA nominees have flouted moral requirements. But they do require that we not reduce them to faceless, nameless monsters that lose their humanity when relegated to a series of memes. The Reddit.com rule changes actively made this aspect worse, even if they helped to prevent doxing.

Does r/HCA currently represent the reality of vaccine denial? The answer seems to be no. The posts that receive attention on r/HCA are for those who are hospitalized and sometimes die from the virus, but there are other unvaccinated individuals who have relatively mundane experiences of the virus. Yes, the unvaccinated are significantly more likely to die, but r/HCA displays the same kind of data skewing as the programming on The Weather Channel — the most extreme cases are given the most attention.

Is there some version of r/HCA that could preserve its prosocial functions and avoid its morally problematic elements? Perhaps, but it would look drastically different from the current subreddit. First, the subreddit would need to include more representative individual stories that capture the variety of experiences of those living through a pandemic. Second, the people featured would need to be more humanized, with more details about their lives included beyond their online, meme-sharing activities. Third, the community should be reworked so it is not constructed in an us-vs.-them dichotomy, where pro-vaxxers are unequivocally the good guys and anti-vaxxers are unequivocally the bad guys.

Would the subreddit be as popular if it were reconstructed in that way? Probably not. But we might start to see each other as human again.

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On Booster Shot Boycotts and Participatory Democracy

photograph of lone wooden figurine holding sign

Recently, Daniel Burkett argued here at The Prindle Post that many people in the United States have a good reason to conscientiously abstain from receiving a booster-dose of the COVID-19 vaccine until others around the world have had a fair chance to get their initial shots. As Burkett explains, as is often the case with limited resources, the Global North has received a disproportionately high amount of the various vaccines recently developed to combat the global pandemic; for multiple reasons, ranging from duties of international care to utilitarian calculations of good-maximization to pragmatic concerns about potential virus mutations, Burkett contends that many of us have positive obligations to forgo our third jab. According to Burkett, “By refraining from taking the COVID-19 booster — at least until those in poorer nations have had the opportunity to receive their initial vaccine — we send a clear message to our governments that we will not partake in ill-gotten gains.”

Certainly, Burkett is right to identify the problem of global vaccine disparity for what it is: an injustice born from centuries of preferential treatment and abuse. In many ways, those of us in rich countries harbor obligations to reconsider how our privileged positions affect the citizens of poorer nations. So, I do not aim to disagree here with what I take Burkett’s main point to be: namely, that the COVID-19 vaccine (along with, to be frank, plenty of other things) should be made more readily available to people living outside the borders of the U.S., U.K., and EU.

I just think that a booster shot boycott is not, on its own, sufficient to provoke such a change.

For example, my current home state of Arkansas made headlines last summer when 80,000 doses of its vaccine stock expired before being administered. Despite the vaccine being readily available for months, Arkansas was evidencing one of the lowest state-wide vaccine rates in the country with just barely over a third of the population counting as “fully vaccinated.” According to CDC data, as of November 23rd, Arkansas (along with nine other states) has still not broken the halfway point to full-vaccination status for its nearly-three-million citizens. Despite pleas from the governor, local doctors, and the families of those affected by the disease, many people in Arkansas have simply refused to take advantage of the opportunity to protect themselves and their community from the novel coronavirus that has shaped so much of the last two years of our lives.

So, let’s imagine that someone in Arkansas grows convinced that the global vaccine supply chain is importantly unjust and therefore elects to forgo their booster shot as a form of protest: how might the state’s governor interpret such a choice? Even if large numbers of people join together and do this, without some clear kind of messaging or explanation defending their rationale for the boycott, it seems likely that the governor and other officials will simply believe that low booster-shot rates are additional symptoms of the already-clear problem of vaccine hesitancy in general — not that anyone is, say, protesting Moderna’s business practices. And I think similar interpretations would hold around the country, given the wide-ranging difficulties we’ve seen promoting vaccine uptake over the last few months.

That is to say, in order for a booster shot boycott to be effective at actually helping people in other countries receive the vaccine, it not only needs to be sufficiently large enough so as to attract the attention necessary to provoke action, but it needs to be clearly articulated in terms that will be relevant to the policy-makers who hold the power to affect the desired changes. At present, one key problem for global vaccine distribution involves the legal protections for pharmaceutical intellectual property; without considerable coordinated effort, it’s not clear how anyone’s individual choice to abstain from a third shot will make a difference on whether or not Pfizer or Johnson & Johnson choose to give up potential corporate profits for the sake of global well-being (or, conversely, for governments to force them to do so).

In short, in order for boycotts to be effective, they must operate within a robust sense of community engagement akin to how philosopher John Dewey understood participatory democracy to function in general. According to Dewey, democracies are not simply governments structured via the institution of citizens’ periodic voting, but manifest via the regular interaction of well-informed people sharing ideas, confronting problems, and encouraging each other to work together to develop solutions; as he says in his 1916 book Democracy and Education, “a democracy is more than a form of government; it is primarily a mode of associated living, of conjoint communicated experience.” Without explicitly communicating the motivations for the boycott — perhaps by organizing loudly and publicly around the kinds of institutional challenges regarding booster shot limitations levied by WHO Director General Tedros Adhanom Ghebreyesus — it’s unlikely that the potential boycott could substantively contribute to its intentions being actualized precisely because the other agents in our democracy would fail to realize the “mode of living” out of which the action stems.

And this is all bracketing the important question about the long-term efficacy of “full vaccination” status without a later booster: particularly with the still-live threat of breakthrough infections and high rates of unvaccinated individuals in local communities, the wisdom of a booster shot boycott should also be measured against its potential contribution to already-concerning winter forecasts.

In any case, while political activity can take many forms, misinterpretations of one’s political choices is always a risk that political agents face — preparing for and mitigating such possibilities is an important part of political organization. Without doing that kind of collective work, we wouldn’t be “protesting global injustice” by individually boycotting our booster shots; in fact, it’s not clear that we’d be communicating anything at all.

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Should Clinicians Have Soapboxes?

blurred photograph of busy hospital hallway

Despite the tendency to talk about the pandemic in the past tense, COVID-19 hasn’t gone. Infection rates in multiple countries are swelling, prompting some – like Kenya, Austria, the Netherlands, and Belgium – to employ increasingly stringent measures. Unsurprisingly, alongside increasing infection rates comes an increase in hospital admissions. Yet, there’s one trait that most of those requiring COVID-19 treatment share – they’re unvaccinated.

This trend isn’t surprising given that one of the points of vaccination is to reduce the seriousness of the infection, thus reducing the need for serious medical interventions. Simply put, vaccinated people aren’t ending up in hospitals as often because they’re vaccinated. The people who haven’t been vaccinated, for whatever reason, are more likely to have severe complications if infected, thus needing clinical care. So far, so simple.

This tendency for hospital beds to be occupied by the unvaccinated invites questions regarding the burden on healthcare systems. After all, emergency care services are better placed to respond to emergencies – like bus crashes, heart attacks, or complicated births – when their wards, ambulances, and hallways aren’t preoccupied with patients. If those patients are there because of their choice not to be vaccinated, it’s only natural to wonder whether they are equally deserving of that resource-use.

But is it appropriate for those working in the medical profession to voice such concerns? If you’re in the hospital seriously ill, does it help to know that your nurse, doctor, consultant, or porter may resent your being there?

This question’s been brought to the forefront of the COVID-19 discussion because of a recent Guardian article entitled ICU is full of the unvaccinated – my patience with them is wearing thin. In it, an anonymous NHS respiratory consultant writes, “I am now beaten back, exhausted, worn down by the continuous stream of people that we battle to treat when they have consciously passed up the opportunity to save themselves. It does make me angry.” Similar sentiments come from the Treating the unvaccinated article in The New Yorker, where critical care physician Scott Aberegg recounts:

There’s a big internal conflict… On the one hand, there’s this sense of ‘Play stupid games, win stupid prizes.’ There’s a natural inclination to think not that they got what they deserved, because no one deserves this, but that they have some culpability because of the choices they made… When you have that intuition, you have to try to push it aside. You have to say, [t]hat’s a moral judgment which is outside my role as a doctor. And because it’s a pejorative moral judgment, I need to do everything I can to fight against it. But I’d be lying if I said it didn’t remain somewhere in the recesses of my mind. This sense of, Boy, it doesn’t have to be this way.

It’s not unsurprising that clinicians feel this way. They’ve seen the very worst this pandemic has to offer. The prospect that any of it was avoidable will undoubtedly stir up feelings of anger, betrayal, or even injustice; clinicians are, after all, only human. While expecting clinicians not to have such opinions seems like an impossible demand, should they be voicing them on platforms with such a broad reach?

On the one hand, the answer is yes. Entering the medical professions in no way invalidates one’s right to free speech, be that in person or print. Much like how any other member of the public can pen an article in an internationally respected newspaper if invited, clinicians have the right to share their views. If that view concerns their increasing inability to accept the preventable loss of life, then, at least in terms of that clinician’s rights, there is very little to stop them ethically. To try would be to revoke a privilege which many of us would likely consider to be fundamental and, without a robust justification, unassailable.

However, those experiencing the pandemic’s horrors may have more than just a right to share their opinions; they might have a duty. Those working on the frontlines in the battle against the pandemic know better than most the state of the healthcare services, the experience of watching people die from the illness, and the frustration from having to cope with much of it is seemingly preventable. Given that they have this unique knowledge, both from a medical and personable standpoint, it would seem that clinicians have a responsibility to be as honest with the general public as possible. If that means sharing their woes and frustrations about the reluctance of people to take even the most basic steps to save themselves, then so be it. After all, if they don’t tell us this information, it seems unlikely that anyone else is.

But, such a principled stance may detrimentally affect trust in the healthcare system, and subsequently, that system’s effectiveness.

As The Prindle Post has recently explored, shame is a complex phenomenon. Its use in trying to shape people’s behaviors is far from simple. This complexity has been seen in several previous public health concerns where shame has had the opposite effect intended. As both The Wall Street Journal and NPR have recently reported, shame makes for a terrible public health tool as it deters engagement with clinicians. If you believe that you’re going to be shamed by your doctor, you’re probably less likely to go. For smokers and alcoholics, this chiefly detrimentally affects only a single person’s health. During a global pandemic,however,  it means there’s one more potentially infectious person not receiving medical care. Scaled-up, this can easily result in countless people refusing to visit hospitals when they need to – increasing infection rates and preventing medical assistance from getting to those that need it.

All this is not to say that doctors, nurses, surgeons, and countless others involved in the care of the vulnerable should be automatons, devoid of emotion and opinion about the unvaccinated. Again, they’re human, and they’re going to have thoughts about what they see during the course of their professional careers. But whether those opinions should be broadcast for the entire world to read and see is an entirely different question.

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On the Appropriateness of Shame

photograph of the Statue of Cain in Paris

Shame has taken up a prominent role in the public discourse recently. For instance, The Atlantic’s Conor Friedersdorf recently tweeted, arguing that Americans have an obligation to right past wrongs but not to feel shame over “wrongs perpetrated before our births.” Shame also plays a role in discourse about the pandemic. Earlier on, people might have felt shame over getting COVID-19: “If someone who thought they were being careful got the virus, well…maybe they weren’t being so careful.” And now the issue of vaccine shaming arises, with debates over whether people should be shamed for not getting the vaccine.

But shame is a nuanced thing. It is an emotion we feel, but it is also something we do to other people. I might feel shame, but I might also try to get you to feel shame: I shame you. This leads to two different questions: When is it appropriate to feel shame? When is it appropriate to shame somebody?

One mistake, a mistake that Friedersdorf makes, is to tie shame too tightly to wrongdoing. Some emotions are linked to wrongdoing. For instance, guilt tends to be linked to having done something morally wrong. And you certainly can be ashamed of your own wrongdoing. But there are more things in heaven and earth than moral rightness and wrongness. Some things are ugly, pitiful, or bad in non-moral ways. You might also be ashamed that you have a large nose, or you might be ashamed that you were too cowardly to take an exciting opportunity.

If shame were tied only to your own wrongdoing, then shame over wrongs perpetrated before your birth would be nonsensical. But shame isn’t even just tied to what you have done, hence the possibility of being ashamed of your nose. Shame is instead based on who we are. And shame is distinctly interpersonal: much of the time we feel shame because we know others think poorly of us (perhaps because of our looks or our inability to better ourselves). Further, who we are is based on our broader connections to other people: being in a family, being a fan of a certain sports team, or being a citizen of someplace or other.

So, you might be ashamed not of your own wrongdoing, but of the wrongdoing of your father. And you might be ashamed of your country, too. Nikole Hannah-Jones said that she was ashamed of America’s bombing of Hiroshima.

Now, you might question whether we should feel ashamed by things we haven’t done, by things we are merely associated with. For one, it seems perfectly reasonable to care about our non-moral qualities and to care about what others think of us. Secondly, shame and pride come hand-in-hand. Parents are proud of what their kids have done, and people are proud of their country’s achievements. Hannah-Jones was right when, responding to Friedersdorf, she pointed out that if you want to feel proud of your country – for what it does well now, and what it has done well through its history – you better be willing to be ashamed of it, too, for what it does badly and what it did badly in the past.

So, we can be ashamed of many things, including things we haven’t done. What about shaming somebody else? When should we shame people? Perhaps the obvious answer is: when they have done something shameful.

Though there might be a variety of forms of shaming, how shaming works should be fairly obvious: if you fail to meet certain standards, other people – remember, shame is interpersonal – can point out that they think less of you. For this to be effective, you need to then reflect on your failures, and this can involve feeling shame: you see why they think less of you, and you think less of yourself for it. Perhaps this process even must involve shame: to fully appreciate your failure might require that you do in fact feel ashamed of it.

So, when should we shame people? Again, the obvious answer is “when they do something shameful,” but that is too simple. It can depend on the relationship between people. You – a serial card cheat – might have no right to tell me that it’s wrong to count cards. You – a stranger on the street – might have no right to tell me not to be so rude to my wife (whereas our friends can step in and say something). So, shaming might be inappropriate if you are a hypocrite or if you have no business in judging me, whereas if you are a respected member of my community and my actions negatively affect my community, you might be well placed to shame me.

We must also keep in mind that some forms of shaming might carry costs: rather than making somebody feel mildly ashamed for a past misdeed, you might make them feel awful. And we need to be careful, as Kenneth Boyd noted in this venue, because shaming can be unfair, either picking out individuals who may have done something that was more acceptable at the time, and it can be a tool of bigotry, shaming people for being a minority and perpetuating harmful systems of oppression.

So, should we shame people for not getting vaccinated? Firstly, not all the unvaccinated have acted shamefully. In places where it can be hard to get time off of work to get the jab (or where people are not aware that they are entitled to time off), or in places where misinformation is rife, perhaps they are meeting or exceeding the standards we should expect of them as fellow members of the public. Or they may have genuine, conscientious objections.

But it is more likely that opposition to “vaccine shaming” turns on the idea that shaming is ineffective. Somebody might be acting shamefully: they might be failing to protect others, relying upon an overly individualized notion of rights (and failing to recognize how they interact with others in a society), and failing to evaluate the evidence properly because – though they should know better – they have been captured by petty, angry politics. It can be frustrating to be told not to shame these people. But if our aim is to get them to take the vaccine, we need to find an alternative strategy that doesn’t prompt a retreat into deeper skepticism.

Or, so the argument goes. But maybe that argument is wrong: there is some evidence that appealing to the sense of shame or embarrassment someone would feel if they spread COVID to a loved one is somewhat effective at increasing the vaccination rate. Ultimately, I don’t know when Americans should feel shame for what happened in the past. And I don’t know when we should shame people for their behavior in this pandemic. I do know that to have a well-informed public discussion, we need to understand the many facets of shame.

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Vaccine Hesitancy as Free-Riding

photograph of masked passengers on subway

As the pandemic rages on, attention is beginning to turn to the moral status of those who refuse the COVID-19 vaccine. Some of these individuals have succumbed to outlandish conspiracy theories concerning microchips and magnetic implants. But for most, vaccine hesitancy is instead the expression of a genuine concern regarding the safety of the vaccine. It was, after all, developed using a novel mRNA approach to vaccines, and approved in what seemed like an exceedingly short period of time. For these individuals, their hesitancy to receive the vaccine is not based on bad-faith conspiracies, but in a sincere — if scientifically unfounded — fear of the unknown.

There are many arguments we might make regarding those who are hesitant to take the vaccine. Some of these focus on the risk the unvaccinated pose to others who, for whatever medical reason, are unable to be vaccinated. Most of us agree that it is morally wrong of us to unnecessarily put others in harm’s way — particularly when that harm is as serious as hospitalization and death. Given this — and given the importance of ‘herd immunity’ to protecting the vulnerable — we might argue that it is morally wrong for those who can receive the vaccine to refrain.

But the argument I wish to consider here is different. It’s not based on the moral wrongness of failing to protect others, but instead on the unfairness of being a free-rider. What’s a free-rider? Put simply, it’s someone who affords themself a special privilege that they don’t allow for others. More specifically, free-riding occurs when someone receives a benefit without contributing towards the cost of its production. Suppose that my town runs a phenomenal public transport system. Suppose, further, that I frequently make use of this system — commuting to work via bus, and utilizing public transport to run all other kinds of errands. Because I’m particularly stingy, however, I refuse to ever pay a fare — instead sneaking onto buses and expertly avoiding those who would check my ticket. What I’m doing, it seems, is unfair on those who do pay their fare. Why? Because I’m carving out a special exception for myself; an exception that I don’t extend to others. I clearly value the public transport system, and therefore value the contributions of those who pay their fare (since, without those contributions, the system would cease to exist). At the same time, however, I refuse to make any contribution myself. This is deeply inconsistent. If I were asked why I can ride for free when others cannot, I would struggle to provide a good answer.

We might argue that the same is true of vaccine hesitancy. Mass vaccination is directed towards a clear public good — that is, the attainment of herd immunity. As such, we each must be willing to contribute towards the cost of its production. And that cost is receiving the vaccine.

But there’s one potential problem with this argument. As we’ve seen, someone is only a free-rider if they refuse to contribute to the cost of something from which they will benefit. In the case of mass vaccination, the benefit is the protection of those who are unvaccinated. But there’s the problem. As soon as someone contributes to this project by receiving the vaccine, they are no longer eligible to receive the benefit. Herd immunity doesn’t help those who are already vaccinated.

But this is to take an unnecessarily narrow view of the benefits of mass vaccination. Even if I am vaccinated, herd immunity might benefit me by protecting those who I care about — such as loved ones who are unable to receive the vaccine. Further, mass vaccination limits the opportunities for the virus to mutate into newer, more virulent strains (such as the Delta variant that has seen renewed breakouts around the world). And the benefits of mass vaccination extend even further than this. As a result of the pandemic, many of us have been — and continue to be — unable to work, unable to attend classes, unable to travel, and unable to reunite with loved ones. Our ability to do these things will continue to be limited to varying degrees until we find a way to end this pandemic.

All of  us can agree that the world returning to normal is an unequivocal good, and the scientific data suggests that mass vaccination (around 80-90% of the population) is the most effective way of doing this. Of course, more conspiratorially-minded individuals will disagree with this assertion. But this argument isn’t for those people. It’s for those who recognize that vaccination is required, but who — contrary to the evidence — still harbor concerns about its safety.

Essentially, it boils down to this: If a vaccine hesitant individual both (1) wants the world returned to normal, and (2) accepts that mass vaccination is the most effective way of doing this, then they must be willing to contribute to the cost of its production — namely, by receiving the vaccine. If not, then they need to provide a convincing reason as to why they get to be among the 10-20% of individuals who needn’t pay the cost of getting vaccinated. Some — like those who cannot receive the vaccine for medical reasons — will have good reason. But those who are merely hesitant will not. Many of us would love to “wait and see” what happens with the vaccine rollout, or avoid the inherent unpleasantness of an injection altogether. But we don’t have that luxury. The vulnerable must be protected, and the world must return to normal. By failing to contribute to this project, we are free-riding, and — like the fare-dodging bus passenger — treating those around us in a way that’s grossly unfair.

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What Morgellons Disease Teaches Us about Empathy

photograph of hand lined with ants

For better or for worse, COVID-19 has made conditions ripe for hypochondria. Recent studies show a growing aversion to contagion, even as critics like Derek Thompson decry what he calls “the theater of hygiene,” the soothing but performative (and mostly ineffectual) obsession with sanitizing every surface we touch. Most are, not unjustifiably, terrified of contracting real diseases, but for nearly two decades, a small fraction of Americans have battled an unreal condition with just as much fervor and anxiety as the contemporary hypochondriac. This affliction is known as Morgellons, and it provides a fascinating study in the limits of empathy, epistemology, and modern medical science. How do you treat an illness that does not exist, and is it even ethical to provide treatment, knowing it might entrench your patient further in their delusion?

Those who suffer from Morgellons report a nebulous cluster of symptoms, but the overarching theme is invasion. They describe (and document extensively, often obsessively) colorful fibers and flecks of crystal sprouting from their skin. Others report the sensation of insects or unidentifiable parasites crawling through their body, and some hunt for mysterious lesions only visible beneath a microscope. All of these symptoms are accompanied by extreme emotional distress, which is only exacerbated by the skepticism and even derision of medical professionals.

In 2001, stay-at-home mother Mary Leiato noticed strange growths on her toddler’s mouth. She initially turned to medical professionals for answers, but they couldn’t find anything wrong with the boy, and one eventually suggested that she might be suffering from Munchausen’s-by-proxy. She rejected this diagnosis, and began trawling through historical sources for anything that resembled her son’s condition. Leiato eventually stumbled across 17th-century English doctor and polymath Sir Thomas Browne, who offhandedly describes in a letter to a friend “’that Endemial Distemper of little Children in Languedock, called the Morgellons, wherein they critically break out with harsh hairs on their Backs, which takes off the unquiet Symptoms of the Disease, and delivers them from Coughs and Convulsions.” Leiato published a book on her experiences in 2002, and others who suffered from a similar condition were brought together for the first time. This burgeoning community found a home in online forums and chat rooms. In 2006, the Charles E. Holman foundation, which describes itself as a “grassroots activist organization that supports research, education, diagnosis, and treatment of Morgellons disease,” began hosting in-person conferences for Morgies, as some who suffer from Morgellons affectionately themselves. Joni Mitchell is perhaps the most famous of the afflicted, but it’s difficult to say exactly how many people have this condition.

No peer-reviewed study has been able to conclusively prove the disease is real. When fibers are analyzed, they’re found to be from sweaters and t-shirts. A brief 2015 essay on the treatment of delusional parasitism published by the British Medical Journal notes that Morgellons usually appears at the nexus between mental illness, substance abuse, and other underlying neurological disorders. But that doesn’t necessarily mean the ailment isn’t “real.” When we call a disease real, we mean that it has an identifiable biological cause, usually a parasite or bacterium, something that will show up in blood tests and X-rays. Mental illness is far more difficult to prove than a parasitic infestation, but no less real for that.

In a 2010 book on culturally-specific mental illness, Ethan Watt interviewed medical anthropologist Janet Hunter Jenkins, who explained to him that “a culture provides its members with an available repertoire of affective and behavioural responses to the human condition, including illness.” For example, Victorian women suffering from “female hysteria” exhibited symptoms like fainting, increased sexual desire, and anxiety because those symptoms indicated distress in a way that made their pain legible to culturally-legitimated medical institutions. This does not mean mental illness is a conscious performance that we can stop at any time; it’s more of a cipherous language that the unconscious mind uses to outwardly manifest distress.

What suffering does Morgellons make manifest? We might say that the condition indicates a fear of losing bodily autonomy, or a perceived porous boundary between self and other. Those who experience substance abuse often feel like their body is not their own, which further solidifies the link between Morgellons and addiction. Of course, one can interpret these fibers and crystals to death, and this kind of analysis can only take us so far; it may not be helpful to those actually suffering. Regardless of what they mean, the emergence of strange foreign objects from the skin is often experienced as a relief. In her deeply empathetic essay on Morgellons, writer Leslie Jamison explains in Sir Thomas Browne account, outward signs of Morgellons were a boon to the afflicted. “Physical symptoms,” Jamison says, “can offer their own form of relief—they make suffering visible.” Morgellons provides physical proof of that something is wrong without forcing the afflicted to view themselves as mentally ill, which is perhaps why some cling so tenaciously to the label.

Medical literature has attempted to grapple with this deeply-rooted sense of identification. The 2015 essay from the British Medical Journal recommends recruiting the patient’s friends and family to create a treatment plan. It also advises doctors not to validate or completely dispel their patient’s delusion, and provides brief scripts that accomplish that end. In short, they must “acknowledge that the patient has the right to have a different opinion to you, but also that he or she shall acknowledge that you have the same right.” This essay makes evident the difficulties doctors face when they encounter Morgellons, but its emphasis on empathy is important to highlight.

In many ways, the story of Morgellons runs parallel to the rise of the anti-vaccination movement. Both groups were spear-headed by mothers with a deep distrust of medical professionals, both have fostered a sense of community and shared identity amongst the afflicted, and both legitimate themselves through faux-scientific conferences. The issue of bodily autonomy is at the heart of each movement, as well as an epistemic challenge to medical science. And of course, both movements have attracted charlatans and snake-oil salesmen, looking to make a cheap buck off expensive magnetic bracelets and other high-tech panaceas. While the anti-vaxx movement is by far the most visible and dangerous of the two, these movements test the limits of our empathy. We can acknowledge that people (especially from minority communities, who have historically been mistreated by the medical establishment) have good reason to mistrust doctors, and try to acknowledge their pain while also embracing medical science. Ultimately, the story of Morgellons may provide a valuable roadmap for doctors attempting to combat vaccine misinformation.

As Jamison says, Morgellons disease forces us to ask “what kinds of reality are considered prerequisites for compassion. It’s about this strange sympathetic limbo: Is it wrong to speak of empathy when you trust the fact of suffering but not the source?” These are worthwhile questions for those within and without the medical profession, as we all inevitably bump up against other realities that differ from our own.

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Why Anti-Vaxxers Are (Kind of) Like Marxists

image of anti-vaxx protestor

On February 26th, the second-oldest Roman Catholic archdiocese in the United States issued an official statement warning church members about their COVID-19 vaccine options; in particular, it labeled the recently approved, single-dose vaccine from Johnson and Johnson “morally compromised as it uses the abortion-derived cell line in development and production of the vaccine as well as the testing.” In the following days, numerous representatives of Catholic dioceses around the country chimed in to agree, not actually forbidding the pious from being vaccinated, but rather advising that “If one has the ability to choose a vaccine, Pfizer or Moderna’s vaccines should be chosen over Johnson & Johnson’s.”

To those unfamiliar with Catholic dogma, this warning is likely peculiar: what do abortion practices (which the Roman Catholic church officially, if not pragmatically, opposes) have to do with vaccinations? But this critique of vaccines is far from unique to conservative Catholic clergymen: for some time, critics of vaccines in general have lobbied pro-life sentiments as anti-vaccination arguments: my goal here is not necessarily to respond to abortion-based anti-vaccine rhetoric, but rather to demonstrate what else that kind of thinking might require someone to believe.

In short, it’s kind of Marxist.

Let’s back up and explain some things first. The “vaccinations-are-pro-abortion” (or even the less severe “some-vaccines-are-tainted-by-abortion”) argument is rooted in the fact that several vaccines, including Johnson and Johnson’s one-shot COVID-19 treatment, have been developed, in part, by using celluar tissue taken from an aborted fetus in the 1960s. Understandably, biomedical research often requires human tissue samples for many reasons, but it can be difficult to collect and store cellular material in a way that is both efficient and effective for long-term use; typically, human cells die too quickly to be used in long-term experiments, but fetal human cells are not only inherently capable of reproducing themselves indefinitely, but scientists have developed techniques to intentionally grow them in cellular cultures in a way that effectively “immortalizes” them. So, medical researchers studying how to cure ailments ranging from Alzheimer’s Disease to spinal cord injuries to multiple kinds of cancer to, yes, diseases susceptible to vaccinations will typically rely on several immortalized cellular lines that have been cultivated for decades in order to test their experiments.

It is not the case that the Johnson and Johnson vaccine — or any other vaccine, for that matter — contains aborted fetal tissue (that is to say: absolutely no one is receiving literal fetal cells in their arm when they get their COVID shot). Nor is it the case that abortions are being done in order to develop vaccines today (each of the cell lines now in use, such as the MRC-5 and WI-38 cultures, originate in abortions performed in the mid-20th century — often for separately tragic reasons, such as the rubella epidemic of the 1960s).

But this is not to say that there are no moral questions that arise about the use of fetal cell lines (or any other human culture) in contemporary research contexts. For example, the HEK-293 line used in the development of several COVID-19 vaccines may have come from an abortion in 1973, but its exact origination is unclear and it is entirely possible that the original cells were collected from the remains of a spontaneous miscarriage. Either way, despite the fact that HEK-293 cells have been used to develop a wide variety of medical advances and medications (including many of the various antipsychotics today used to treat diseases like schizophrenia and bipolar disorder), the original donor of those cells (or their family) has never been compensated for their contribution to an industry enjoying billions of dollars of profit. Similarly, the story of Henrietta Lacks, an African-American woman diagnosed with terminal cervical cancer in 1951, is a terrible example of how biomedical research can be built on a blatant injustice: after doctors collected a sample of Lacks’ cells without her knowledge, they discovered that the cells unexpectedly possessed the same kind of propensity for “immortalization” that makes fetal cells so useful, so they patented and commercialized the “HeLa” cell line. Despite never receiving Lacks’ consent for her cells to be used in this way (much less compensating her for her donation), the HeLa line has developed into one of the most useful (and lucrative) cell cultures on the market today; Lacks’ family never even knew the cultures existed until two decades after her death.

Setting those issues aside for now, what can we make of the claim that the conditions under which a commodity is manufactured can irrevocably taint the commodity itself with immorality? This is, I take it, a core complaint of the pro-life critic of vaccine development practices: the goals of vaccine deployment might be laudable enough (namely, reducing the spread of disease), but the methods of doing so are, arguably, associated with something purportedly inexcusable. For some, the difference between contemporary abortions and contemporary immortalized fetal cell lines originating in initially-unrelated abortions a generation ago might be sufficient to distinguish morally between pro-life commitments and vaccination acceptance — that is to say, someone could easily be a critic of elective abortion and consistently still believe that modern vaccination programs are morally acceptable. (It is worth noting that several outspoken pro-life American religious leaders, including Robert Jeffress, Al Mohler, and Franklin Graham have spoken out recently in support of COVID-19 vaccination programs.)

But let’s suppose that this is inconsistent (as many of Graham’s fans argued after he publicly surmised that Jesus would be pro-vaccine); what might we be committing ourselves to if we affirm that the use of fetal cell lines in their development hopelessly entangles vaccines within a morass of morally unacceptable problems?

Firstly, it seems like we would also need to reject many additional medical advances made over the last five decades. Anyone who rejects a vaccination against the novel coronavirus (or any other disease) because of the abortion-based critique of vaccinations I’ve been discussing will seemingly also need to reject treatments for conditions ranging from various cancers, diabetes, Parkinson’s disease, and macular degeneration to Alzheimer’s, paralysis, strokes, organ transplants, and medications for a wide variety of conditions. Without some special reason to think that vaccines are uniquely susceptible to being morally tainted via their tenuous association to past abortions, it is unclear why one could be an anti-vaxxer and not also a critic of many other elements of modern medicine.

Secondly, this whole conversation reminds me of the broader Marxist critique of capitalism in general. In his essay “Estranged Labor,” Marx introduces the idea that, under capitalism, workers are alienated from multiple things, including the products of their labor, their fellow human beings, and even themselves. A society split into different class-divisions, Marx says, necessarily prevents certain people (workers) from being able to live lives as fully realized human beings, creating and enjoying both cultural artifacts and the other people within our cultural relationships. In later works, like the first volume of Capital, Marx would develop the further critique that capitalism is not only alienating but exploitative because it, by design, transfers the value created by the labor of workers to the pockets of business-owners; for one example, consider the connection between Jeff Bezos’ wealth and the often-cataloged, but rarely-prevented dehumanization of workers in Amazon distribution centers (another is the dangerous abuses regularly perpetrated against both human workers and nonhuman animal victims in factory farms). Nowadays, this critique is sometimes summarized in the sloganized observation that there exists “no ethical consumption under capitalism” — although Marx himself never wrote those words, it is a (somewhat oversimplified) distillation of his broader point: the conditions under which capitalism operates necessarily spreads a taint of moral corruption throughout the entire line of commodity production in a manner that should provoke us to rethink the structuring of that productive system as a whole.

Of course, if someone is apt to think that products are, in a sense, insulated from the moral conditions of their production, then they would be able to quickly reject the Marxist critique of capitalism. Notice that there is at least one person who can’t do this, though: the person who accepts that vaccines are necessarily morally tainted because of the conditions of their production.

In short, if someone is inclined to believe that their pro-life commitments require them to think that vaccines are morally tainted, then they are seemingly required (upon pain of inconsistency) to believe that their anti-abuse commitments will require them to believe that many additional products, including anything produced on a factory farm and, perhaps, even all products produced by capitalists, are morally tainted as well.

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Incentivizing the Vaccine-Hesitant

photograph of covid vaccination ampoules

Since the beginning of the COVID-19 pandemic, vaccine hesitancy has remained a constant concern. Given expectations that a vaccine would be found, experts always anticipated the problem of convincing those who distrust vaccines to actually get inoculated. A great many articles coming from the major news outlets have aimed at addressing the problem, discussing vaccine hesitancy and, in particular, trying to determine the most promising strategy for changing minds. In The Atlantic, Olga Khazan surveys some of the methods that have been proposed by experts. Attempts to straightforwardly correct misinformation seems to have proven ineffective as they can cause a backfire effect where individuals cling to their pre-existing beliefs even more strongly. Others instead suggest that a dialectical approach might be more successful. In The Guardian, Will Hanmer-Lloyd argues that we should refrain from blaming or name-calling vaccine-hesitant individuals or “post on social media about how ‘idiotic’ people who don’t take the vaccine are” because “it won’t help.” Similar to this “non-judgmental” approach that Hanmer-lloyd recommends, Erica Weintraub Austin, Professor and Director of the Edward R. Murrow Center for Media & Health Promotion Research at Washington State University, and Porismita Borah, Associate Professor at Washington State University, in The Conversation propose talking with vaccine-hesitant people and avoiding “scare-tactics.” Among the things that can help is providing “clear, consistent, relevant reasons” in favor of getting vaccinated while at the same time discussing what constitutes a trustworthy source of information in the first place.

In spite of all these good suggestions, to this day, Pew Research reports that only 60% of Americans would probably or definitely get a vaccine against COVID-19. Though confidence has been on the rise since September, this still leaves a concerning 40% unlikely to pursue vaccination. It is perhaps in light of these facts that a recent proposal is beginning to gain traction: incentivizing people by offering prizes. Ben Welsh of the LA Times reports that the rewards proposed include “Canary home security cameras, Google Nest entertainment systems, Aventon fixed-gear bicycles and gift cards for Airbnb and Lyft.”

But is it right to give out prizes to lure the initially unwilling to seek vaccination?

The answer depends on the moral system to which you subscribe. You might think that given the seriousness of the current circumstances it is especially crucial to get as many folks vaccinated as possible, and that the means of accomplishing this task are of secondary importance. This would be a consequentialist view according to which the moral worth of an action depends on the outcomes it produces. One might feel the force of this line of argument even more when considering that the consequences of vaccine hesitancy can carry dangers not only for the individuals refusing to get vaccinated but for the rest of us as well. Just recently, a Wisconsin pharmacist purposefully made unusable 57 vials of vaccine that could have been used to vaccinate up to 500 people because of a belief they were unsafe. So considering how significant the impact of vaccine-distrust can be, it is understandable that one might employ even unusual methods – such as prizes – to convince those who remain reluctant to join the queue.

On the other hand, if you do not feel the force of this outcome-based argument, you might think that there is something to say about the idea that changing people’s behavior does not necessarily change people’s beliefs. In this sense, offering a prize might not do much to alleviate the distrust they feel towards vaccination or the government. Consider another example. Suppose you do not believe that exercising is good. Yet your best friend, who instead does believe in the positive aspects of exercising, convinces you to go running with her because the view from the hill where she runs is stunning. In that sense, you may eventually elect to go running, but you will not do it because you are now a believer in exercising. You will go running just so that you can admire the view from the hill, without having changed your beliefs about exercise.

What is the problem of not changing people’s beliefs? You might be tempted to think that there is no problem, if you believe that the end result is all that matters. But even in that case, it is beliefs that drive our actions, and so as long as individuals still believe that vaccines are not to be trusted, giving out prizes will only be a marginal and temporary solution that fails to address the deeper, underlying issue. The worry is that someone who may opt to get vaccinated upon receiving a gift card is not deciding to get vaccinated for the right kind of reason. This argument picks out a distinction famously known in philosophy between right versus wrong kinds of reasons. The philosophical debate is complex, but, in general, when it comes to believing something, only epistemic, evidence-based reasons represent good reasons for actions. Should one, instead, come to act on the basis of reasons that have more to do with, say, wishes or desires, those would represent the proper kinds of reasons.

So what is the solution here? Well, there is no solution, as is often the case when it comes to philosophical positions that are fundamentally at odds with one another. But here is the good news: looking at the ways in which real life events connect with philosophical issues can help us figure out what we think. Examining issues in this way can prove useful in isolating the features that may help us understand our own particular commitments and convictions. Thinking through these tensions for ourselves is what allows us to decide whether we think the proposal to encourage vaccination efforts by offering prizes is a legitimate one.

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This for That: Trading Vaccinations for Stimulus Checks

photograph of gloved hand offering syringe and vaccine vial

Lawmakers are getting creative in breaking partisan deadlock over a long-overdue third coronavirus relief bill. After a months-long standoff, Congress remains at an impasse. While Democrats are advocating for a $900 billion starting point that includes state and local government funding, the Republican leadership has indicated they want something around $500 billion with a liability shield to insulate employers from coronavirus-related lawsuits that might be brought by employers over unsafe workplaces.

Part of this negotiation concerns whether to include another round of stimulus checks like those that went out in the spring. Despite popular appeal on both sides of the aisle, those opposed to direct payments stress the cost of such a policy and the need to limit government spending. They also argue that aid efforts should be more narrowly focused on providing relief for those who are most deserving (i.e., the unemployed who are actively seeking work).

In an attempt to appease these critics, former Maryland Representative John Delaney recently suggested providing $1,500 stimulus checks to individuals in exchange for them getting immunized. Its appeal to holdouts is fairly straightforward: rather than a cash giveaway with limited impact and so-so odds of success, this policy is more obviously goal-oriented. It’s a specific answer to a particular problem: only 60% of Americans say they would be willing to get vaccinated, but we need to at least 75% of the population to be immunized to start approaching herd immunity. In order to close that gap, “we have to create […] an incentive for people to really accelerate their thinking about taking the vaccine,” Delaney argues. By making stimulus payments contingent on showing proof of immunization, we can expect a great many more Americans to get a vaccine who might otherwise resist.

So is Delaney’s proposal just good policy or might it be objectionably coercive? Putting money in people’s pockets while stopping the spread of COVID-19 certainly has the potential to create a lot of good. And it does so without getting into sticky conversations about public health and bodily autonomy; we can leave all that anti-vaxx baggage at the door. As Delaney explains,

“If you’re still afraid of the vaccine and don’t want to take it, that’s your right. You won’t participate in this program. But guess what? You’re going to benefit anyhow, because we’ll get the country to herd immunity faster, which benefits you. So I think everyone wins.”

Delaney emphasizes that his plan would not force anyone to get vaccinated, it simply encourages socially responsible behavior by providing financial incentive. And “It’s not like we don’t pull levers to get people vaccinated,” Delaney argues. “We do that now.” There are already similar measures in the U.S. to encourage vaccinations like MMR immunization for children attending public school.

But school vaccinations look a bit different than withholding financial aid in a pandemic in order to effect compliance. For one, there is a distinct difference in exit options. Parents can avoid vaccinating their children by pursuing medical, religious, or philosophical exemptions relatively easily (as Kenneth Boyd has previously discussed here). But Delaney’s proposal doesn’t intend to make similar space. Clearly, one could choose to forgo government assistance, but the situation has the most vulnerable among us over a barrel: barter your beliefs or risk (more) financial insolvency. (And given the mild to moderate side effects from the Pfizer-BioNTech COVID-19 vaccine recently reported in the severely allergic, at least some (albeit few) of those beliefs surely qualify as legitimate.) This policy, then, threatens to severely undermine individual autonomy. With unemployment insurance benefits set to run out and the federal moratorium on eviction expiring, a $1,500 stimulus check might not save the day, but it’s not the sort of thing many could afford to turn down either.

Apart from these worries, though, there is concern that Delaney’s proposal fails to account for the reasons supporting relief in the first place. Political justifications for government’s obligation in this regard come in various flavors, but the two featuring most prominently at the moment involve causation — as lockdown orders have interfered with citizens’ ability to pursue their livelihoods they are due some financial consideration — or economic preservation — to lessen the economic downturn we will all experience (to greater and lesser extents), it behooves us to ensure that bills can be paid, goods can be bought, money moves through the economy and isn’t hid under mattresses, and that the workforce can be maintained and summoned back at a moment’s notice. At bottom, both these accounts rest on an understanding that the government is duty-bound to provide assistance to citizens, vaccinated or not, because our fortunes are inextricably linked. And while these two justifications might not necessitate that all citizens be treated alike, they also can’t justify differential treatment according to immunization status.

In the end, these two projects are simply too far apart. As Howard Gleckman, senior fellow at the Urban-Brookings Tax Policy Center, sums up, “It’s always nice to be able to kill two birds with one stone, but in this case I think the two birds are flying off in different directions.” Those most in need of direct payments are the same people most likely to abstain from vaccination, and those more likely to get vaccinated are the same ones less likely to put that stimulus check back into the economy. We’re trying to solve two collective action problems — herd immunity and economic recovery — by tying them together, but they may be less connected than they might first appear.

But let me not overstate the case. This is not an argument against the use of financial incentives or psychological nudges in general. It isn’t even an argument against incentivizing people to get vaccinated. I’ve merely tried to offer an explanation for why Delaney’s particular proposal can’t be considered a solution to Congress’s current problem. There are reasons regarding fairness, justice, and autonomy that speak against holding direct relief payments contingent upon vaccination and for keeping the issues of economic stimulus and immunization separate.

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Novak Djokovic and the Expectations of Celebrity

photograph of Djokovic on stage at mic with trophy in front of packed stadium

Novak Djokovic created controversy amidst the coronavirus pandemic. While a vaccine for COVID-19 has yet to be developed, the world No. 1 of men’s tennis expressed resistance to possible compulsory vaccinations for professional tennis players when the tour resumes. “Personally I am opposed to vaccination and I wouldn’t want to be forced by someone to take a vaccine in order to be able to travel,” he said in a live Facebook chat.

Rafael Nadal, the world No. 2, waded into the debate and rebuked Djokovic’s apparent refusal to comply with the potential compulsory vaccination. “If the ATP or the International Tennis Federation obligates us to take the vaccine to play tennis, then we will have to do it,” Nadal said. “It’s about following the rules, nothing more than that.”

Djokovic’s resistance to vaccinations is a manifestation of his both belief in natural healing and prioritization of personal liberty. That he would risk severe penalty or possible cessation of his career, prematurely interrupting one of the greatest runs in the history of men’s tennis—and all of the complimentary millions in prize money and endorsement deals—is telling of how seriously the world No. 1 holds this conviction. That an athlete of such esteem and renown would express this conviction at a turbulent time in the health of the world is nothing short of significant. His public stand against vaccinations for himself represents an ethical dilemma about celebrity morality. This dilemma is reflected in one of his comments: “I have expressed my views because I have the right to and I also feel responsible to highlight certain essential topics that are concerning the tennis world.”

Given his fame and stature, should Djokovic exercise caution in taking moral stands? Does greater fame demand greater responsibility from celebrities? Or should they enjoy the same freedom that normal civilians do to express publicly the views they hold privately?

There are at least three reasons to believe celebrities ought to be constrained by greater responsibility. Firstly, the internet is conducive to a rapid and unfettered spread of information. A comment, phenomenon, or craze can promulgate and take hold of the public psyche before there has been a chance to assess its virtue or utility. Writing for the Journal of Business Ethics, Chong Ju Choi and Ron Berger assert that the internet has allowed the influence of celebrities to extend far beyond their respective industries of work. Now, more than ever, celebrities can be heard and listened to.

Secondly, younger generations in particular are susceptible to the influence of celebrities. Choi and Berger observe that “the younger generation is experiencing a combination of consumer crazes and bandwagon effects.” During a global health emergency, this effect could be rather damaging and dangerous. Many young people were already dismissing the gravity of COVID-19, opting to proceed with their travel plans unabated rather than help to mitigate the virus’s spread. Seeing a world-renown athlete mull over refusing vaccination could help justify their behavior or motivate similar behavior. (However, it does not logically follow from a celebrity’s public expression of a stance that the celebrity’s fans will adopt that stance as their own.)

Relatedly, celebrity morality can confer credibility and cache upon movements that are thought to be dubious. Celebrities have supplanted traditional sources of moral guidance (such as religious figures). Their endorsement is a desirable commodity for any movement. In Novak Djokovic, the anti-vaxx movement has found a spokesperson. Djokovic arguably rivals all celebrity anti-vaxxers and vaccination-skeptics in terms of global fame.

Conversely, there are at least three reasons to believe that celebrities ought not to be constrained by greater responsibility. While the attention of a wide audience and the power of global influence might be a reason to constrain celebrity morality, it is also a reason for precisely the opposite. Those blessed with the megaphone of celebrity can prove to be an effective voice for good. Attention for issues oft-ignored and progress towards a morally righteous end can sometimes only be achieved by the intervention of someone who has many followers. University of Virginia religious studies professor John Portmann argues that celebrities are able to elevate the presence of particular issues, “making ethical and moral debates important” to a public that idolizes famous people.

Among other stars of their time, Sammy Davis, Jr., Nina Simone, and Marlon Brando are credited with increasing the visibility of and spurring on the civil rights movement in the U.S. Ricky Gervais has been lauded for the attention he has brought to animal welfare and his financial support of animal charities. Just recently, former NFL receiver Anquan Boldin commended legendary quarterback Tom Brady for signing his letter asking for the FBI and DoJ to investigate the murder of Ahmaud Arbery, calling the endorsement of such a figure “significant” for the cause of racial equality. The celebrity voice can be the necessary succor that pushes moral goals across the finish line, radically transforming society.

Secondly, if one could develop a comprehensive, incontrovertible, and universalizable standard by which the public moral stances of celebrities could be evaluated and deemed as either morally “Fit” or “Unfit” for public consumption, perhaps then there could be constraints on what positions they take publicly. While that is a ludicrous near-impossibility, backlash against particular stances, such as Djokovic’s, suggest that some critics think there is such a standard. Indeed, celebrity interventions on moral issues tend to draw alarm only if they do not conform with the mainstream, however illusory that may be.

Lastly, fame does not strip celebrities of their membership in society. And as members of society, they ought to enjoy the same freedom to participate in the public debate on moral and ethical issues as those who do not possess their fame.

Since his initial comments, Djokovic has demonstrated an evolution of thought on the matter. In a recent press release, he stated: “I am keeping an open mind, and I’ll continue to research this topic because it is important and it will affect all of us.” This attitude may serve as a useful reminder for the general public, too. The celebrity voice might be simply one thing to consider while researching amidst the cacophony of moral proclamations.

Regardless of the view on expectations for celebrity morality, one thing is true: fame does not endow celebrities with moral authority. Perhaps it is best for the fans to remember that.

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YouTube and the Filter Bubble

photograph of bubble floating

If you were to get a hold of my laptop and go to YouTube, you’d see a grid of videos that are “recommended” to me, based on videos I’ve watched in the past and channels I’ve subscribed to. To me, my recommendations are not surprising: clips from The Late Show, a few music videos, and a bunch of videos about chess (don’t judge me). There are also some that are less expected – one about lockpicking, for example, and something called “Bruce Lee Lightsabers Scene Recreation (Dual of Fates edit).” All of this is pretty par for the course: YouTube will generally populate your own personalized version of your homepage with videos from channels you’re familiar with, and ones that it thinks you might like. In some cases this leads you down interesting paths to videos you’d like to see more of (that lockpicking one turned out to be pretty interesting) while in other cases they’re total duds (I just cannot suspend my disbelief when it comes to lightsaber nunchucks).

A concern with YouTube making these recommendations, however, is that one will get stuck seeing the same kind of content over and over again. While this might not be a worry when it comes to videos that are just for entertainment, it can be a much bigger problem when it comes to videos that present false or misleading information, or promote generally hateful agendas. This phenomenon – where one tends to be presented with similar kinds of information and sources based on one’s search history and browsing habits – is well documented, and results in what some have called a “filter bubble.” The worry is that once you watch videos of a particular type, you risk getting stuck in a bubble where you’ll be presented with many similar kinds of videos, making it more and more difficult to come across videos that may come from more reputable sources.

YouTube is well aware that there are all sorts of awful content on its platform, and has been attempting to combat it, although with mixed results. In a statement released in early June, YouTube stated that it was focused on removing a variety of types of hateful content, specifically by “prohibiting videos alleging that a group is superior in order to justify discrimination, segregation or exclusion based on qualities like age, gender, race, caste, religion, sexual orientation or veteran status.” They provide some examples of such content that they were targeting, including “videos that promote or glorify Nazi ideology” and “content denying that well-documented violent events, like the Holocaust or the shooting at Sandy Hook Elementary, took place.” They have not, however, been terribly successful in their efforts thus far: as Gizmodo reports, there are plenty of channels on YouTube making videos about conspiracy theories, white nationalism, and anti-LGBTQ hate groups that have not yet been removed from the site. So worries about filter bubbles full of hateful and misleading content persist.

There is another reason to be worried about the potential filter bubbles created by YouTube: if I am not in your bubble, then I will not know what kind of information you’re being exposed to. This can be a problem for a number of reasons: first, given my own YouTube history, it is extremely unlikely that a video about the “dangers” of vaccines, or videos glorifying white supremacy, will show up in my recommendations. Those parts of YouTube are essentially invisible to me, meaning that it is difficult to really tell how prevalent and popular these videos are. Second, since I don’t know what’s being recommended to you, I won’t know what kind of information you’re being exposed to: you may be exposed to a whole bunch of garbage that I don’t know exists, which makes it difficult for us to have a productive conversation if I don’t know, say, what you take to be a reputable source of information, or what the information conveyed by that source might be. 

There is, however, a way to see what’s going on outside of your bubble: simply create a new Google account, sign into YouTube, and its algorithms will quickly build you a new profile of recommended videos. I ran this experiment, and within minutes had created a profile that would be very out of character for myself, but would fit with the profile of someone with very different political views. For example, the top videos recommended to me on my fake account are the following:

FACTS NOT FEELINGS: Shapiro demolishes & humiliates little socialist comrade

CEO creates ‘Snowflake Test’ to weed out job applicants

Tucker: Not everyone in 2020 Democratic field is a lunatic

What Young Men NEED To Understand About Relationships – Jordan Peterson

This is not to say that I want to be recommended videos that push a misleading or hateful agenda, nor would I recommend that anyone actively go and seek them out. But one of the problems in creating filter bubbles is that if I’m not in your bubble then I’m not going to know what’s going on in there. YouTube, then, not only makes it much easier for someone to get caught up in a bubble of terrible recommended content, but also makes it more difficult to combat it.

Of course, this is also not to say that every alternative viewpoint has to be taken seriously: while it may be worth knowing what kinds of reasons antivaxxers are providing for their views, for example, I am under no obligation to take those views seriously. But with more and more people getting their news and seeking out political commentary from places like YouTube, next time you’re clicking through your recommendations it might be a good idea to consider what is not being shown to you. While creating a YouTube alter-ego is optional, it is worth keeping in mind that successfully communicating and having productive discussions with each other requires that we at least know where the other person is coming from, and this might require taking more active efforts to try to get out of one’s filter bubble.

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Vaccination Abstention and the Principle of Autonomy

image of 1960's polio vaccine poster with Wellbee Cartoon

The suppression or eradication of many serious diseases in vaccinated populations has been one of the great public health successes of the twentieth century. There have always been those who resist or refuse vaccination for a variety of religious, political, or health reasons. Though there can be some risk of negative reactions to vaccines in certain individuals, vaccination is very safe for the general population.  Continue reading “Vaccination Abstention and the Principle of Autonomy”

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The Ethics of Vaccination Exemptions

photograph of H1N1 vaccine bottles

On January 28, 2019, Washington Governor Jay Inslee declared a state of emergency in response to a spreading outbreak of measles in Clark County, WA. Measles is a highly contagious airborne infection caused by a virus in the paramyxovirus family. Before a vaccine was developed in 1963, the disease infected over 3 million people a year in the United States and resulted in 400 to 500 deaths annually. In 2000, thanks to a highly effective vaccination system in the U.S., the measles disease was declared eliminated by the Center for Disease Control. However, measle outbreaks have begun to emerge again in recent years due to a growing number of parents who refuse to vaccinate their children—often falsely claiming that vaccinations are either unsafe of unnecessary. Do parents against vaccinations, also called “anti-vaxxers,” have a legal right to refuse vaccinations for their children even if it means jeopardizing public health?

While the history of the anti-vaccination movement can be traced all the way back to the 1800’s, a study released in 1998 that claimed a false link between the measles vaccinations and autism has fueled much of the contemporary anti-vax fire. Author of the study, British doctor Andrew Wakefield, was found to have been paid by a law board to falsify evidence in support of a litigation case that claimed vaccines had harmed children. The study was formally retracted by its publisher in 2010 and Wakefield lost his licence to practice medicine in Great Britain. Since then, numerous studies (including one released on March 5th, 2019)  have failed to find any link between vaccines and autism.

There are legitimate medical reasons to delay or avoid vaccinations, but they are rare. While some doctors have decided to profit off the anti-vax craze by selling false medical exemptions to parents, most who refuse vaccinations for their children do so through non-medical, state-issued means. Most common is an exemption based on “religious beliefs.” Overall, no major world-religion has a theological objection to vaccinations. However, certain offshoots of ‘faith-healing’ denominations, such as Christian Science, reject modern medicine altogether. Some religious fundamentalists also claim that vaccines are unnecessary. Gloria Copeland, an Evangelical Christian minister who sat on the Trump campaign’s evangelical advisory board, claimed in a 2018 video on Facebook that Jesus was the best protection against the flu and people can avoid the disease by repeating “I’ll never have the flu.”

Many states also allow for “philosophical” or “personal” vaccine exemptions that do not require religious backing. Much of the motivation to acquire such exemptions stems from the spread of misinformation on social media sites like YouTube, Facebook, and Pinterest. Ethan Lindenberger, an Ohio teen who chose to get vaccinated against his parents wishes spoke of the necessity in addressing misinformation when he testified before congress on March 4th, 2019. Lindenberger said, “For my mother, her love, affection and care as a parent was used to push an agenda to create a false distress, and these sources which spread misinformation should be the primary concern of the American people.”

Non-medical vaccine exemptions (NMEs) endanger public health by reducing “herd immunity.” No vaccine is 100% effective, but when a population is highly vaccinated it prevents the spread of germs from one person to another—effectively protecting the population. The less vaccinated a population becomes the more susceptible both vaccinated and unvaccinated individuals are to diseases. This is why public schools require vaccinations for children who attend. In 2015, the Second Circuit U.S. Court of Appeals in Manhattan upheld a ruling that students who receive religious exemptions can be kept out of the classroom during a disease outbreak. The court stated, “The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or to the latter to ill health or death.”

Proponents of NMEs believe public health should not take precedence over individual liberties and that mandated vaccinations are a threat to personal autonomy. However, in the case of public spaces, such as schools, vaccines are analogous to other government mandated safety measures. Exceeding the speed limit, running a red light, or breaking other rules of the road is illegal when driving because it threatens the safety of others. The famous ‘harm principle’ of British political theorist John Stuart Mill argues that infringing on personal liberties is justifiable when it protects others from harm. Under this principle, vaccination exemptions should be highly restricted since they pose a threat to public health.

Dr. Barbara McAneny, the American Medical Association’s president, argues, “Protecting our communities’ health requires that individuals not be permitted to opt out of immunization solely as a matter of convenience or misinformation.” A 2013 measles outbreak in Brooklyn, New York that infected 58 people was caused by a single unvaccinated child. Such an incident shows that, to keep a population best protected from disease, vaccination exemptions should only be allowed for legitimate medical reasons. While preventing the spread of misinformation is paramount to combating the rising rates of NMEs that are endangering both domestic and global health, the most effective means of reducing communicable disease is to do away with NMEs all together.

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Pinterest’s Block on Anti-Vaccination Content

Photograph of hands of a scientist, under a sterile hood, preparing a vaccine

Pinterest, the good-natured social media site where users re-pin new ideas and things to try, has made recent headlines for their stance against anti-vaccination propaganda. In fall 2018, Pinterest quietly removed results to vaccination-related questions from the search bar.  Now, when you type “vaccine” or “anti-vax,” a pop-up will relay that there is no related content and will provide a link to the community guidelines. Reported first by the Wall Street Journal, Pinterest finally disclosed their choice to censor the questionable health claims made by anti-vaccination groups.

Pinterest’s decision to block vaccines in their search domain was widely based on the fact that the site had become a hub for anti-vaccination activists. These groups aim to educate parents regarding the dangers of vaccinations but with theories that are unsupported by peer-reviewed, scientific research. The tactics used are typically fear-inducing photographs or stories about harm to children caused by vaccinations without any scientific proof. The groups claim to offer parents the “most transparency” but also don’t mention the dangers of not vaccinating. Pinterest’s response aimed to discontinue the spread of misinformation and falsehoods on their website.

When it comes to vaccines, the spread of misinformation could have a devastating impact on individuals and the society. There has been an increase in confusion and mistrust among the public when it comes to vaccines in general. One of the most noteworthy fear-causing publications was by the doctor Andrew Wakesfield, who suggested a connection between the measles, mumps, and rubella (MMR) vaccine and the development of autism in young children. Although deemed fraudulent, it is considered the beginning of the anti-vaccination movement. This movement is equally seen in the cases of influenza in America. Last year during the 2017-2018 season, there was a record-breaking number of hospitalizations and deaths among children in the US with less than half of Americans receiving the flu shot. It is because of these that World Health Organization (WHO) has recently listed the anti-vaccine movement a top health threat for 2019. When Pinterest decided to curtail vaccine-related content on their site public, it raised the question; should social media censor for misinformation?

Pinterest’s new policy stems from the fear that misinformation can have “detrimental effects on a pinner’s health or on public safety.” The guidelines officially state that the website bans the “promotion of false cures for terminal or chronic illnesses and anti-vaccination advice.” A report found in 2016 claimed that 75 percent of posts on Pinterest referring to vaccines were negative. In addition, other studies have found that 80 percent of mothers and 38 percent of fathers in the US have used Pinterest. It is likely that mothers and fathers, looking for advice regarding their children’s heath, ran across posts on Pinterest with anti-vaccination rhetoric. One could argue that media sites have an obligation to censor this kind of propaganda for public health and safety reasons. On the other hand, even well-intentioned censorship threatens to intrude on our rights protecting free speech (also discussed in this Prindle Post article about the case of Alex Jones).

With a website that is used by mothers and fathers, restricting these groups’ ability to voice their concerns or opinions could be seen as a commentary on parenting styles. Vaccine hesitancy is often caused from worries about side effects, cost, moral or religious obligations, or lack of knowledge about immunizations. There is value in the autonomy that parents have in choosing whether or not to vaccinate their children because they have the right to make medical decisions focused around their own values. In addition, who is to say whose opinion is more valid regarding vaccinations? Who’s to say which opinions deserve censure? Pinterest approached this issue in banning all vaccine-related information, reputable or not. This absolute censorship, while avoiding the bias of what is considered a reputable source, could also be seen as problematic. It is taking the opportunity away from readers to decide for themselves what sources they think are credible or not and through Pinterest they cannot be educated on the subject to any extent. A spokesperson from Pinterest, Jamie Favazza says, “Right now, blocking results in search is a temporary solution to prevent people from encountering harmful misinformation.”

Vaccine misinformation isn’t only a Pinterest problem; other social media outlets like YouTube and Twitter have been infiltrated by vaccination misinformation as well. YouTube’s policy doesn’t allow ads for anti-vaccine videos. Twitter has no specific policy on the matter. A spokesperson for Twitter, Katie Rosborough, said that “We, as a company, should not be the arbiter of truth,” and also added that, “the company was working to surface the highest-quality and most relevant content first.”

Social media represents an open platform for people to voice interests and create spaces that unite beliefs. But should some spaces not exist and should some beliefs not be circulated? In the case of anti-vaccine movement, people continue to adhere to their beliefs which further energizes the movement and polarizes the theories. With our ever-growing reliance on social media for information, social media outlets have a reason to worry about the ramifications of their content, especially in influencing user’s decisions about their health.