GLOBALIZATION, PANDEMICS AND POPULISM

Reflecting on a series of political events - including the electoral victory of Donald Trump, and the Brexit vote – commentators have argued that the current political turmoil is part of a worldwide backlash to globalization, the rebellion of “globalization’s losers”.  There is indeed a vast mass of people who feel that their life conditions are deteriorating notwithstanding, of even because of, globalization. They mostly belong to the extended middle-class that benefited from the economic boom that followed the end of World War and granted one of the longest period of economic prosperity ever experienced by industrialized societies. Now, these people see their economic conditions and social status progressively degrading, without any actual possibility to invert the trend. Their agency is nullified, vis-à-vis epochal processes such as globalization, digitalization and automation, which totally escape from their control.  They feel (not completely wrong) that the wealth of the West is going to be redistributed at global scale chiefly at their expenses. This social group is only the peak of the iceberg, because many other categories  perceive themselves as globalization losers, although they are not in absolute terms. In other words, losers of globalization are not only those who have been marginalized, but are also those who feel that they haven't profited as much as others from globalization. These people, who feel that that they got just the crumbs of the cake, are still more full of anger and resentment, because they believe they have been misled and used as “cannon fodder”  by politicians, intellectuals, journalists, who advocate globalization.   

Even public health issues, notably those related to infectious diseases, are affected by the backlash to globalization. Not only many militants of populist movements are involved in anti-vaccine movements (for instance,  President Trump appointed Robert Kennedy Jr, a prominent vaccine conspiracy theorist, to chair a commission on "vaccination safety and scientific integrity"), but it is the very cultural climate, which surrounds populist movements, to be the same that  has fed, in the recent past, suspect, skepticism, mistrust, towards global health initiatives and vaccination.  

Economic and health globalization are indeed the two sides of a same coin. Germs travel together people, animals and goods; the increasing global mobility corresponds, epidemiologically speaking, to the confluence of all germs in one world pool. In the while, advances in sequencing technologies and in bioinformatics are making possible to explore interaction between germs, people, animals, and the environment at global scale, and mapping the global microbiome (the genome of the Earth's microbial community) and its role in the biosphere and in human and animal health.  This is providing concrete foundation for the concept of One Health, which was once a purely theoretical notion, and is today a concrete research strategy. Finally, Internet based epidemiological surveillance and outbreak intelligence play more and more a pivotal role in early detection and monitoring of infectious diseases; this has led, inter alia, to blurring of the distinction between civil and military (including bioterrorism) applications of epidemiological research,  as witnessed by the new concept of biodefence field.

Three conceptual political tools emerged to deal with these profound modifications of the epidemiological context, 1) the notion of global public goods for health; 2) the concept of global health governance; and 3) the model of global public–private partnership.  These three conceptual tools are today under attack.

The idea of global public goods for health is contested by people who argue that an increased global integration is not the right answer to infectious diseases. It is obvious – they argue -  that infectious diseases do not know national borders, but it is false – they add – that outbreaks can be addressed only at global scale. Instead of relying on buzzword such as "health as a global good",  one should consider  that epidemic risks are increased by global interconnectivity, which is altering "the geographic distribution of pathogens and their hosts, causing the emergence, transmission, and spread of human and animal infectious disease". To these people, less globalization would be the right answer to pandemic risks. Migrants are often accused to bring with them germs and infections, and research shows that the public perception of risks of outbreaks is strictly associated to social acceptance of migrants among resident population.

Still the notion of global health governance is harshly criticized.  Even admitting that protection against epidemics is a global good, shared by the global human community, this would not imply – criticists argue – that such a good needs to be governed at global scale. To be sure, some kind of international collaboration is necessary, but this is a truism. Apart from that, each nation is perfectly fit to deal with infectious outbreaks occurring within and across its national borders, as it was in the past, with the advantage that national approaches can pay more attention to the national context, its economic, social and cultural specific features. The notion of global health governance would then be – according to the populist perspective - just the gimmick used by global elites to infiltrate and weaken national governments. 

Finally, also the global public–private partnership model is strongly rejected. In the view of populist movement, this formula would hide a business alliance between major industrial players, world bureaucratic and technocratic elites, and global financial capital.  They would be responsible for creating and diffusing new germs, such as HIV, Ebola, ZIKA  (conspiracy theory supporters are quite common in populist movements); for experimenting dangerous medications and vaccines on indigenous populations;   for exploiting natural resources of low income countries and biopiracy; for altering and threatening natural environment and agriculture through genetic manipulation (populist groups are often also involved in anti-GMO movements).

Bill  Gates  and Mark Zuckerberg have recently taken position in this debate.  In their praise of globalization, and explicit polemics against anti-global populism, they both play the card of infectious outbreaks. The risks of new, deadly, pandemics would provide,  in their views, one of the strongest arguments in favor of globalization.  It is difficult to predict whether Gates and Zuckerberg’ support to globalization could be effective or risk to produce opposite results. Although they advocate more globalization, they speak eventually the same language of populists. By reading carefully Gates and Zuckerberg's texts it is evident that their ideal (at least, the ideal that they both advocate)  is a communitarian ideal, as it is the ideal of most populist movements. While populists dream of national communities, Gates and Zuckerberg dream of a global online community,  yet  both parties  share the same vision of an integrated, organic, community as an answer to contemporary challenges. Should one eventually opt for the Facebook global  gemeinschaft, to avoid falling back again into a national gemeinschaft?

I am not able to answer this question, it is difficult, however, to escape the impression that infectious outbreaks are only instrumentally evoked by both parties.

THE POST-TRUTH ERA

The Oxford Dictionaries Word of the Year 2016 is post-truth.

Every year Oxford Dictionaries selects a word or expression that has "attracted a great deal of interest during the year to date", post-truth has been the word selected for 2016. What is "post-truth"? "Rather than simply referring to the time after a specified situation or event – as in post-war or post-match – the prefix in post-truth has a meaning more like ‘belonging to a time in which the specified concept has become unimportant or irrelevant ", explains Oxford Dictionaries. So, post-truth refers to an epoch, our own, in which truth would have become irrelevant. This idea immediately raises two further questions.

The first one is an old question, which has been reverberating since that famous day in Jerusalem, during the Jews Easter, when the fifth Roman prefect of Judaea, Pontius Pilate, replied to Jesus, "What is truth?" ("Quid est veritas?"). For centuries, scholars have debated about the nature of truth and even mentioning  this debate would sound arrogant. "If there is such a thing as truth – wrote I.B. Singer  concluding his adorable short novel "A Crown of Feather" – it is as intricate and hidden as a crown of feather". Truth is never elsewhere – completely out from our reach – yet it is always a bit beyond ourselves. It is a horizon, which gives meaning and limit; as the horizon, it can never be grasped: when you move ahead, it moves ahead too, always with you, always away from you. Yet, the idea of a post-truth epoch does not imply any judgment about the question "what is truth?"  – even whether there is a truth –rather it implies that this very question has become totally irrelevant. Who really cares today "what is truth"?  "In the post-truth era we don’t just have truth and lies, but a third category of ambiguous statements that are not exactly the truth but fall short of a lie. Enhanced truth it might be called".

The second question stems from the previous one, and it is its obvious corollary. If truth is irrelevant, what is then relevant? In other words, what is "enhanced truth"? Enhanced truth –  call it truth 3.0 – is narrative. People are not interested in truth but in stories. This is efficaciously demonstrated by a recent BuzzFeed News analysis that found that "top fake election news stories generated more total engagement on Facebook than top election stories from 19 major news outlets combined".  False election stories diffused by hoax sites generated 8,711,000 shares, reactions, and comments on Facebook, while news distributed by authoritative and verified sources generated a total of 7,367,000 shares, reactions, and comments. Researchers found that hyperpolarized and hyper partisan information is more effective in delivering messages than neutral, fact based, information. 

Yet, assuming that the "populace" confuses narrative with truth would be a tragic misunderstanding.  Such a misconception would reveal a snobbish, pre "post-truth", way of reasoning. People simply don't care – or care much lesser than in the past -  of truth. They enjoy stories, which are much more amusing, exciting, and meaningful. Do you remember Descartes' Meditation, "I shall consider that the heavens, the earth, colours, figures, sound, and all other external things are nought but… illusions and dreams… I shall consider myself as having no hands, no eyes, no flesh, no blood, nor any senses, yet falsely believing myself to possess all these things’?  Nice statement, isn't it? Male adolescents of the past, when they "discovered"  philosophy, often used this statement to impress their girl-friends, pretending looking "very profound". Then, when they had to date the girls, they became immediately oblivious of hyperbolic doubts, looking eagerly at their watch. Methodological skepticism cant' afford abandoning lecture halls,  in real life it unavoidably becomes  a parody.

"Fake news, and the proliferation of raw opinion that passes for news, is creating confusion, punching holes in what is true, causing a kind of fun-house effect that leaves the reader doubting everything, including real news". This is the point. We live in post-truth epoch, because we live in an epoch that has made skepticism and cynicism commonplace. Mass skepticism is the almost unavoidable consequence of information overload, which is due to the digital revolution. It looks like as though there were today no alternative but between skepticism and gullibility. Who would ever prefer to pass himself off as a gullible person? Much better looking skeptical.  Yet, notwithstanding global 3.0 skepticism, truth always takes its revenge. Fake news draw their strength from the seeds of truth that they unavoidably conceal to be trusted. No narrative is pleasant and convincing without a kernel of truth. 

This is the main lesson for those who work on public communication, trying to debunk false messages. Always search for the kernel of truth concealed in falsehood, and when you find it, first address it effectively, if you want to be trusted.

Who is more "scientific"?

In January 2016, Mark Zuckerberg posted on his Facebook page a photo of himself holding his baby daughter with the caption “Doctor’s visit – time for vaccines!” Zuckerberg's post ignited a lively discussion. Pro-vaccination and anti-vaccination people took the opportunity to make comments and to turn on each other. Zuckerberg's post soon became an open online forum discussing vaccines. Overall, approximately 1,400 comments were posted. These comments - triggered by the same stimulus and hosted in the same Facebook page - represented a unique "natural" experiment about rhetoric and sentiments involved in the vaccination debate. 

A team of scholars from the University of New South Wales (UNSW) in Sydney, Australia and La Sierra University in Riverside, California, analyzed the language of both parties by using a text analysis program, the Linguistic Inquiry and Word Count (LIWC). Through the LIWC, researchers categorized words and sentences per some psychological variables. The study - A comparison of language use in pro- and anti-vaccination comments in response to a high profile Facebook post - was published in the October issue of Vaccine and its findings are quite interesting.  

Its main conclusion concerns the degree of anxiety and emotional involvement showed by pro-vaccination comments.  Rather counter-intuitively, people who supported vaccination were more prone to post emotional messages, poor in logic and scientific contents.  In comparison, anti-vaccination messages were more rational, more logically structured, richer in scientific contents.  One of the authors noted “skeptical comments (…) focus on health, biology, and research, they may be particularly compelling for parents who are uncertain about what decision to make about childhood vaccination and are seeking more information (…) This concerns us because the scientific evidence is very clear in demonstrating the safety and benefits of vaccines". Here, it is the paradox, pro-vaccination people defend their (scientifically grounded) point of view by using emotional and non-scientific arguments, while anti-vaccination individuals defend their (anti-scientific) position by using well structured, logic, and apparently, evidence-based, discourses.
   
Researchers commented that vaccination supporters are inadequate to defend their reasons because they tend to become overzealous and are not capable enough to master scientific arguments.  I partly disagree with this conclusion. To be sure, as the debate between pro-vaccination and anti-vaccination groups becomes over polarized, it is understandable that emotional arguments become prevalent in pro-vaccination people, but this does not explain the opposite process among anti-vaccination individuals, who seem to become more rational and less emotionally involved. 

If there is something that this debate clearly demonstrates, it is that both parties tend to play the game of the other side. Anti-vaccination people pretend being rational and scientific; while pro-vaccination persons "discover" sentiments and try to evoke fear in their audience.  I don't think that this happens only for trivial or casual reasons. I suspect instead that such a "mimetic fight" provides important clues on how scientific and health communication could work also in other circumstances. Brief, the discovery of this bizarre mirror game is likely to be more significant than researchers suspected and it would deserve to be studied more in depth.

SCIENTIFIC ILLITERACY

Sci Ed is a PLOS Blog devoted to "Diverse perspectives on science and medicine". Mike Klymkowsky, professor of Molecular, Cellular, and Developmental Biology at the University of Colorado Boulder, has recently posted on Sci Ed a very interesting article dedicated to science literacy, "Recognizing scientific literacy & illiteracy".  Inspired by a report of the National Academy “Science Literacy: concepts, contexts, and consequences”,  Professor Klymkowsky  poses a provocative question, "can we recognize a scientifically illiterate person from what they write or say?".  This is a bit mischievous question, because it implicitly suggests that the distinction between scientifically literate and illiterate persons is not that easy.

What makes scientific literacy is not what one knows, but how he knows it. Science – argues Mike Klymkowsky - is more a perspective, than a specific knowledge.   The article lists two main criteria for assessing scientific literacy. First, scientific literacy implies the capacity to understand scientific questions and recognize what an adequate answer should contain (which is not, pay attention, the "right answer" but the "right format of the answer"). 

Second, scientific literacy means the capacity "to recognize the limits of scientific knowledge; this includes an explicit recognition of the tentative nature of science, combined with the fact that some things are, theoretically, unknowable scientifically". Science is made of local perspectives, any perspective that aims to be universal, total, cannot be scientific (which does not imply that it is wrong or false, but it simply means that it belongs to a different register). 

Finally, Mike Klymkowsky addresses an important issue, say, "scientific illiteracy in the scientific community". Paradoxically enough, it is not rare that the very scientific community shows some forms of scientific illiteracy. How could it be possible? Mike Klymkowsky thinks that it is chiefly due to the "highly competitive, litigious, and high stakes environment"  in which most scientists operate. Often this situation leads them to make claims that are over-arching and self-serving. In other words, driven by a too competitive environment, scientists tend to draw unjustified conclusions from their empirical findings to best market their results. 

The article ends posing the question "how to best help our students avoid scientific illiteracy". The conclusion is that there is not a clear answer to this question but to try to establish "a culture of Socratic discourse (as opposed to posturing)". Such a culture could be summarized – per the author - into an ongoing attempt to understand "what a person is saying, what empirical data and assumptions it is based on, and what does it imply and or predict". 

Curiosity and ongoing inquiry could help to prevent scientific illiteracy, yet there are two other aspects of the Socratic approach, which are still more essential to the scientific discourse. They are self-irony and sense of transcendence.  These two elements are strictly interlaced, because they are both rooted in the deep conviction that truth is always a bit beyond the human reach. Socrates is not relativistic – as some commentators have erroneously argued – rather he is aware that humans can get closer to truth only asymptotically. This awareness prevents any form of scientific arrogance, the real origin of scientific illiteracy.

Mandatory Vaccinations

In the Oct 6 issue of the New York Times, Christopher Mele devotes an interesting article to risk communication in emergencies. In a nutshell, his argument is that – if one aims to communicate risks – one needs also to evoke fear. Mele’s point of departure is the recent evacuation of Florida, Georgia, North Carolina and South Carolina residents due to Hurricane Matthew. He reports that “even after all of the best practices in emergency communications are exhausted, 5 percent of the population will most likely remain in harm’s way, experts and researchers said”.  Actually, this figure is likely to be still over optimistic, for instance during 2013 Hurricane Sandy 49% of coastal residents who were under mandatory evacuation did not evacuate.  In 2014, a State University of New Jersey team led Dr. Cara Cuite, carried out a study on “Best Practices in Coastal Storm Risk Communication” concluding that effective communication should “stress the possibility that people who do not evacuate could be killed”.  This is better done by using implicit messages rather than direct, explicit, messages. For instance, if authorities ask people who do not evacuate to fill out a form on how to notify their next of kin, they communicate in a very effective way the actual possibility “that people who do not evacuate could be killed “without the need of warning them explicitly. Another important lesson concerns semantic, say, the specific words chosen to communicate.  In most cases, mandatory evacuation is excluded, since there is no way to enforce it. Yet, experts know very well that “a voluntary evacuation will have a lower rate of compliance than one labeled mandatory”. It is then critical to avoid using the expression “voluntary evacuation” and “make it clear that residents are being ordered to leave, even if no one is going to remove them forcibly from their homes”. 

It is possible to elicit from Mele’s arguments two general rules concerning risk communication, which could be adopted also in other situations, notably in outbreaks. 

First, in contrast to the standard risk communication account, one should focus on emotional responses rather than on mere rationality.  Risk communicators often aim to raise awareness and to provide the public with information, which is in principle laudable and it would be effective in an ideal world, ruled only by rational choices. Unfortunately, very rarely people make choices on a rational basis, even when they pretend doing it.  As a matter of fact, in real life “pure rationality” does not exist, is a fictional concept. Mental processes are an inextricable mix of logic arguments, emotional reactions, implicit and explicit memories, automatisms, conscious and unconscious processes. Very rarely – if ever – an action follows a rational decision; more often the so called “rational decision” is a post-hoc rationalization, used to justify decisions made in more or less irrational ways.  There is little that one could do to prevent this mechanism, notably in emergencies, when people are asked to take quick and momentous decisions. Among emotions, fear plays a pivotal role as one of the basic emotions that drive human behavior. There are two opposite mistakes that one could do in risk communication, over stimulating fear but also over reassuring people. Fear must be fine-tuned.

Second, if being able to deal with emotions is critical in risk communication, this implies that two variables become paramount, timing and words.  Timing is essential because human emotions are continuously fluctuating in each individual and they change over time. The same message could evoke completely different reactions according to the emotional context of the receiver and consequently a message could have very different effects according to the moment in which is delivered. There is not something like “the right message”; rather there is “the right message in the right moment”. Words are also very important. I’m saying “words” and not “contents”, because I’m referring to the very terms used rather than to concepts underlying words.  Words unavoidably evoke specific emotional reactions, which are – be careful – cultural bound and context dependent (say, one should avoid the mistake of thinking that the same words evoke the same reactions always, everywhere and in everybody). The word “mandatory” is a good example. At least in our society, if something is “mandatory”, for most people it is also important, while, if it is “voluntary”, it is not (or less). So to label something as “mandatory” does not imply necessarily that one is going to enforce it compulsorily. The term “mandatory” could be used also to transmit the importance of an action.  This is well illustrated by the wrong (in communication terms) policy to make most vaccinations “voluntary”.  To be sure, in democratic societies it is largely unthinkable to vaccinate compulsory people and notably children, yet the issue at stake is only in part the balance between voluntariness, persuasion, soft coercion, and compulsion. Words chosen by regulators communicate also the importance of a public measure. Health authorities and policy makers should pay more attention to the communicational implications of wording, even when choices seem to concern purely technical and normative aspects.