Gale Sinatra & Brian Michael Jenkins

Science, Plagues, and Denials

Air Date: October 17, 2022

Georgetown international health lawyer Alexandra Phelan, USC psychologist Gale Sinatra, and RAND security analyst Brian Michael Jenkins discuss the triple threat of COVID-19, monkeypox, and polio.


HEFFNER: I’m Alexander Heffner, your host on The Open Mind. Today we have an all-star panel on the pandemic, really three terrific people, writers, researchers, and scholars. Alexandra Phelan, who’s an international health law expert and a scholar at Georgetown University’s O’Neill Institute, Gale Sinatra, author of the new book “Science Denial” and a scholar and professor at the University of Southern Californian School of Education. And from the Rand Corporation, my guest today, Brian Michael Jenkins. Brian is an advisor at Rand and the author of another new book “Plagues and their Aftermath.” All of you, thank you so much for your time today.


JENKINS: Thank you.


HEFFNER: Let me start with Gale. Your book is most appropriate for this moment because it would be my stipulation, my contention, that science denial or denialism, however you want to call it, is partly to blame for what doesn’t just appear to be a COVID pandemic, still ongoing, but what we see with monkeypox and even cases of polio that have resurfaced. So I wanted to ask you directly to start Gale, is science denial responsible for our predicaments today?


SINATRA: Well, it’s certainly not helping. So we know that, we wrote the book, my co-author Barbara Hofer and I, before the COVID pandemic. So we were already concerned about the rising distrust in science and in expertise and in our institutions prior to the pandemic. And of course it’s been exacerbated through the COVID-19 pandemic. So it’s been a rising problem. It has gotten worse. And of course it is made worse by those who are propagating distrust, who are disseminating dis and misinformation. So it’s definitely a problem.


HEFFNER: One follow up for you. Is it also a problem in the medical expertise or lack thereof, because at some point doctors or medical authorities, whether it’s our CDC or individual doctors, said we don’t need to give the smallpox or monkeypox vaccine anymore. People they anticipated would be protected from future generations of smallpox or monkeypox through that vaccine. Likewise, with polio, it’s still, you know, given to many children, but it’s not required in a lot of contexts that it might have been in years past. So the question is, beyond the denial are our medical authorities partly responsible for where we are today, which was unfathomable to many of us, that two counties in New York State are reporting enough polio samples in the wastewater that there is polio and probably hundreds of cases of it as we’re recording it in New York State.

SINATRA: Well, it’s certainly been a challenge communicating accurate and timely information through the pandemic and science communication is challenging. But I would say looking back when the polio vaccine came out, everyone lined up and anxiously got the vaccine. So I think we’ve changed in terms of our trust in these institutions. And that lack of trust has been fomented. It’s been fomented by political actors and perhaps media personalities. So I don’t know that it’s specifically our doctors’ faults, but as we get more and more expertise in medicine, it becomes more difficult for the average citizen to understand the medical practices and that also leads to a good deal of suspicion when people don’t know what’s an mRNA vaccine, they don’t know how it’s made. So that opens up opportunity for bad actors to spread mis and disinformation and mistrust.


HEFFNER: Alexandra, give us an international context here, when it comes to the laws around the world not just in the U.S. that require vaccinations of COVID and also these earlier diseases for which we thought we were inoculating for a century, maybe not? So I thought you could give us a really keen assessment of the international landscape when it comes to where the COVID vaccine and also in the case of monkeypox or smallpox and polio, where these things are legally required and where they’re not.


PHELAN: Yeah. So I think the first thing to note is smallpox, the reason we stopped vaccinating for smallpox was because we eradicated it in 1981, it was declared eradicated. And so that was a momentous achievement for humanity and scientific research. And so that’s why you have this disparity of people that have been vaccinated prior to 1981, or in areas where smallpox vaccination was continued just to ensure that eradication had occurred. And so some people will have that additional protection for if they’ve been vaccinated for monkeypox there is that parallel, but that was a huge achievement. And the reason we could do that is because we don’t necessarily have a zoonotic reservoir for it to potentially come from animals into humans. And that’s not necessarily the same with other diseases. So polio we have two different vaccines, were used around the world, world one is the oral polio vaccine. And so there’s a little bit of, of nuance in the dynamics of when countries switch from using one particular type of vaccine to a different type of vaccine. And there are different risks and benefits there. So all that being said, there are very many different types of approaches that countries will take. Some countries will use mandatory vaccinations at different levels such as school age, and they’ll use laws and regulations as a way of requiring school entry. My home country of Australia and some jurisdictions try to incentivize vaccination in a different way by tying it to additional tax benefits or other payments. And there’s lots of different ways that we can go about regulating for vaccination around the world. I tend to believe that the incentivization approach is quite useful, but in the age of misinformation and disinformation, perhaps we are seeing a return to some form of more stringent use of laws, not necessarily mandates at the adult level, but perhaps for school age entry in areas where you have that high risk of transmission of diseases you can see these requirements. We’ve seen different versions of that with COVID-19 as well.


HEFFNER: Alexandra, you say eradicated and I want to believe you that in many countries certainly smallpox was eradicated. And then it, we could say definitively, globally, that it was eradicated. But, you know, with the exception of, you know, single cases reported outside of the U.S., we use that term eradicated in the U.S. as it related to polio for some time. And so it’s kind of groundbreaking to hear that there are samples of polio reported in two counties’ wastewater. And this was also the case in the UK. I think it was, it was first reported in the UK, outside of the incidents in Africa and in the middle east. But I say eradicated, really eradicated, because my sense, it was with respect to smallpox that there were scholars who said, if we stop vaccinating the public for smallpox, we’re going to get monkey, a monkeypox pandemic or epidemic.


PHELAN: So I’m not familiar with that particular argument. In terms of eradication with polio, we are and have been so incredibly close to eradication and like smallpox, there’s a reason why we can eradicate polio and that’s because we don’t have that animal reservoir in the same way. But what we are seeing now is very much as a result of lax vaccination policies or anti vaccination movements, where there are these opportunities for a disease to resurge in areas that we previously have deemed eradicated. That’s different to global eradication, like we’ve seen with smallpox.


HEFFNER: Right, right. Let me ask you, Brian you, you have reported on plagues in their aftermath historically. So my question to you is, are we in any sort of aftermath period yet, or not?


JENKINS: No, I don’t think that we can say that we’re done with COVID-19, or I should say that COVID-19 is done with us. And, and each time we tend to think we’re nearing the end and we have a surge of some new mutation, some new variant that causes another surge. And indeed, that’s one of the lessons that comes to us from looking at the history of previous pandemics. And that is, we tend to think of them as isolated historical events with a finite beginning and you know, finite event with a clear beginning and clear end. In fact, if we look at them, we, we, see that there were successive outbreaks of the disease. I mean following the Black Death in the 14th century, it wasn’t simply in 1348 and 1349. There were follow-on waves of the plague. And in fact, that continued for the next for the next several hundred years. And it really impeded the full recovery. If we look again at the cholera epidemics in Europe in the 19th century, what we saw was repeated outbreaks, so that if we were to look at it both chronologically on a map of Europe, we would see cholera outbreaks somewhere at almost any time with large waves where it may have engulfed a larger territory affecting more people. But no, we don’t get a clear ending. And that’s the point.


HEFFNER: Historically speaking, how do you compare the alertness or lack of alertness of our public during this period relative to other periods of plagues?


JENKINS: You know, that’s an interesting question. And that is one of the striking differences between COVID-19 and some of the major pandemics of history is that fewer people died in a world that had far more people. And, and so, you know, if we go back again to the plague of the Middle Ages, there we’re talking about an outbreak of disease that killed half the population of Europe. And we go through those various epidemics. And we see the death toll is extraordinary. In the case of COVID-19 we’re running, recorded deaths are running between six and seven million right now, that’s probably an undercount. It could be a factor several times that figure when we look at total excess deaths. But it is still only a fraction of one percent of the population. So, we don’t have, we don’t have, in a sense, bodies lying in the street. We don’t have mass graves. We don’t have the obvious signs of massive death and therefore, absent that, people can make their own decisions about the degree of danger.


HEFFNER: So you’re saying that is what can be correlated with the lack of alertness or the, or the relative lack of alertness in the U.S. over the course of this pandemic?


JENKINS: Yaa. You know, it’s not just lack of alertness. It, it is that people can look at those numbers and depending on their philosophy of life, depending in many cases on their political perspectives, they can look at exactly those same numbers and come to different conclusions about the degree of risk.


HEFFNER: Right. And it doesn’t seem to change the calculus of the American people at least that we were on the precipice potentially of not a single kind of pestilence, right? If you do take monkeypox seriously. And that’s not to say it ought to be viewed as acutely, severely as smallpox, but if you take that seriously, if you take the resurgence of polio seriously, then there would be a cumulative effect on that alertness, independent of, you know, the body bags or the mass graves. But it doesn’t seem like that trickling effect, you know, is moving people?


JENKINS: You know, that’s a good observation. And so we ask ourselves what is really pushing us against that? What are the impediments to that realization? I think there are a couple. One you’ve already touched upon. And that is the issue of the rejection of science, the substitution of bizarre conspiracy theories, extravagant beliefs, instead of, instead of science. And so we have seen really people arguing against the vaccination, against any kind of measures, even recognition of a problem. Now that occurred to a degree in previous pandemics as well throughout history.


HEFFNER: Let me ask Gale about denial. What is the most important thing we ought to know about the deniers out there as it relates to, you mentioned mRNA vaccine, but as it, I don’t really think folks are drawing those nuances in distinguishing between their denial about COVID versus now, if they were to deny the relevance of new cases of polio. So in that context, what’s the most important thing to know about the deniers?


SINATRA: Well, in our book we talk about a spectrum of denial. There’s doubt, denial, and resistance. So there are doubters, you know, doubting whether it’s real. There are resistors people who are, for example, vaccine hesitant. And then there’s the outright deniers, and they’re fortunately a smaller group. There is some, you know, good news too, right? I mean, over 220 million people have been fully vaccinated in the United States. It’s not probably the number we would like, but over 95 percent of seniors have been vaccinated. So while there has been resistance, there’s also been uptake. And I also think a difference between the current pandemic and the plague and other prior pandemics that Brian was talking about is the internet. So the internet has, was not around during the plague in Europe, and it is now both for good and for, for not so great. So the good is people can find out information about vaccines and where to get vaccinated in their community. However, it also is a source of spread of misinformation, conspiracy ideation, where people can find groups of like-minded people who are fomenting doubt and denial. So I think that’s a big difference between this current era of the plague as you were calling it and past eras of plagues is the internet is a big factor in sewing denial.


HEFFNER: And the most, the most necessary way to confront it, the most effective way to confront the denial, I suppose it depends on where they fall on that spectrum you described?


SINATRA: Right? So it certainly depends where they are in terms of what they’re denying. You know, in our book, we talk about solutions for educators and science communicators, and scientists, and policy makers. And there’s different ways to attack the problem of denial. So it depends. Are they coming from an identity issue where they are identifying with a conspiracy group or an anti-vax group? Are they coming from a point of fear? Are they fearful about the vaccine? Or is it misinformation? So for example, my niece was initially hesitant to take the coronavirus vaccine because she had heard from a Facebook friend that it caused infertility. That’s a legitimate concern, but it’s incorrect. And when she got that concern addressed with her doctor, she did get vaccinated. So sometimes it’s misinformation. Sometimes it’s fear. Sometimes it’s going with your group and not with the expertise that might be more relevant.


HEFFNER: Alexandra, do you think the denial problem is more acute in the United States than elsewhere around the world?


PHELAN: Well, I don’t think I necessarily have expertise in denialism specifically. I think there are unique challenges that the United States has been facing, particularly around nationalism and populism that has fed into certain perspectives. But that, that’s all, I’d be willing to say on that.


HEFFNER: But what are you willing to say in terms of the legal conditions where you are basically able to cultivate communities that, if they don’t mandate vaccines, they incentivize it like you were saying before. I mean, how much of the law, the reason I was so glad to include your perspective in this conversation, because I think that we’re going to find out soon, depending upon the increasing severity of pestilence, resurgence of polio, monkeypox, once again, whether the law needs to play a more active role in ensuring the safety and health of the largest number of people. And that’s really where I had hoped you might weigh in.


PHELAN: Yeah. I mean, you make a great point. I think something that is unique in the United States particularly, and something we’re seeing quite significantly is the unwinding of public health powers and the authority for public health agencies and leaders and governments to actually be able to take action. And some of that has been through court challenges. Some of that has been through legislative restrictions. I think that is a real preparedness problem for current and future pandemics facing the United States. Public health requires public trust, and that’s really where law is sometimes quite a blunt tool that can undermine public trust if used incorrectly or used too heavy handedly. So for example, when we are conducting surveillance for potential outbreaks around the world, we want to keep those channels of communication open. We want to have that freedom of expression and protecting whistleblowers and the, and freedom of speech is critical. And that’s something obviously that’s enshrined here in the United States. But we see governments often wanting to use laws to control rumor mongering or misinformation that can have the unexpected consequence of actually shutting down that important freedom of speech and, and sharing about, you know, outbreak notifications so we can respond early. So there are unique challenges here in the U.S. but that also raises those broader public health challenges and the role of law.


HEFFNER: And what are you most focused on in terms of your work at Georgetown in understanding the intersection of this pandemic period and legal frameworks that can help us through the aftermath of COVID and, you know, into potentially more tumultuous waters with other diseases?


PHELAN: You know, I think we, when we think about preparing for pandemics and preparing for outbreaks, we focus a lot on the laboratory capacity, on the technical capacities, on the scientific capacities, and we really underestimate the role of governance and good governance and good leaders. And that’s a really hard thing to measure. How do we assess is a country prepared for an outbreak based on governance, which we know is just so essential. So a lot of the work that I do is looking at, can we embed this into international law, that countries then adopt, such as the proposed pandemic treaty. Or how do we build in and rectify these issues with the undermining of public health powers that I mentioned? Can we rebuild that trust? Can we also rebuild the laws that empower public health agencies to act when we do have outbreaks?


HEFFNER: Tell our viewers about the treaty that you mention? I know it’s integral to your work.


PHELAN: So the proposed pandemic treaty, there’s not much detail at this stage. Countries are still working out the very early details of what they want to include in this international instrument. But as a treaty, what it would be is an international commitment and an agreement to certain empowering the WHO to do certain things, setting up certain mechanisms such as for the equitable distribution of vaccines, and committing to certain principles when an outbreak does occur and when a pandemic does occur. And how can we prevent, respond, and then also recover from pandemics. You know, the treaty itself, it’ll probably take a number of years to negotiate. But at the end of the day it will require countries to be signing up and consenting to be bound by this treaty and then implementing it domestically. So we’ve got a long way to go in this process, but right now we have the political momentum to be making that international commitment that is desperately required as we face, you know, the looming threat of more pandemics.


HEFFNER: And Gale and Brian, a final question to you, both and thinking about that momentum, I think Alexandra refers to it internationally and maybe that’s the leaders of US health agencies now. But I don’t think of the momentum moving in the right direction in the US right now, when it comes to denial and when it comes to what this next period looks like. We’re about out of time, but I wanted to give you each a minute, basically, just to make a closing point about the most prescriptive way to think about this period, because I know you both believe strongly that, you know, your peers and all those out there listening or watching can be part of the solution. So Gale, if I may start with you.


SINATRA: I think one of the challenges is that in the United States, it was somewhat worse than other countries because COVID got politicized. And that’s something that we probably should have avoided. So going forward, another important point is the director of the NIH said, you know, we did a great job developing the vaccine, but we didn’t think enough about how to get people to take it. So what I would say is depoliticize these pandemics, because COVID doesn’t care about your political orientation. And also give people the opportunity to hear the information that they need to hear and address the psychological issues of doubt, denial and resistance.


HEFFNER: And Brian, to you, that same question, how can we be most prescriptive in recovering in this aftermath as we expect some kind of blowback if you don’t want to call it aftermath yet?


JENKINS: Well, you know, again, looking at, looking at pandemics throughout history they required government to intervene in in our lives, in people’s lives, then that, that was beyond the tradition and invariably it provoked resistance. And and we certainly have seen that in COVID-19. What, what the current pandemic has done is to expose and exacerbate our existing political divisions. And while we can look at these various measures where we can mandate measures, mandate preparations, at the same time, I think we have to look at, realistically, at the limitations and the issue of resistance. It’s going to take a lot more persuasion going forward. And with regard to the US, again, we are a deeply divided society and COVID-19 deepened those divisions and created models for resistance that I fear are going to persist long beyond our current situation.


HEFFNER: Brian, thank you for your insight. Gale and Alexandra as well. Thank you so much for your insight. I encourage you to check out Alexandra’s work at O’Neill at Georgetown, Gale’s book denial, “Science Denial,” and Brian’s book on the aftermath of pandemics. Thank you all.


PHELAN: Thank you very much.


JENKINS: Thank you.


SINATRA: Thanks for having us.


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