Some of the language around Covid vaccines ticks the boxes of Biderman’s ‘Chart of Coercion’ (p142–3). In December 2020, the NHS published a document for health professionals called Optimising Vaccination Roll Out – Dos and Don’ts for all messaging, documents and “communications” in the widest sense.1 Although I talked about the possible propaganda aimed at encouraging vaccine take up in BAME communities in Chapter 8, ‘Controlled spontaneity and propaganda’, this messaging is a broader departure from the public health language for the wider population. Certain recommended phrases are emotionally manipulative in a way that would affect informed consent. For instance, ‘normality can only return for you and others, with your vaccination’ and ‘if you want to be able to do what you want, then having the vaccine is the fastest and safest way to achieving this’. Why can normality only return after vaccination? If you do not get vaccinated is the message that you prevent everyone else getting back to normality?
I discussed it with psychologist Gary Sidley, who said this ‘fits the definition of blackmail’ although ‘the blatant nature of it is a little surprising’. Public health expert and doctor Jackie Cassell agreed that the document contains ‘pretty extreme language’ and that ‘the whole approach is very much from the SPI-B playbook’.
Cassell was deeply uncomfortable about this extreme language. ‘I can’t imagine how a doctor could use these arguments,’ she said. ‘Using peer norms as a direct form of persuasion is not something that comes readily to doctors and we don’t speak that language. It goes against our professional training. A vaccine is a medical intervention and people have to consent to it. I wouldn’t use the arguments in this document in these ways.’ I wondered why the language was so at odds with how doctors are trained to work, and she responded that ‘it brings up some interesting disciplinary perspectives, if not fault lines. The behavioural scientists and nudgers occupy a very different space. They are thinking like psychology-trained advertisers, like they are trying to get us to buy fashion or whatever. Asking health professionals to use this kind of language could be profoundly damaging to the trust in government and health services.’
The coercive language in this NHS document shows how integral the behavioural psychology approach now is. This is also apparent in the recruitment of new behavioural science roles in the NHS, Public Health England and various government departments in recent months and years. And not everyone in public health agrees with it. If behavioural psychology is here to stay then it’s clear that, at the very least, the different disciplines need greater synergy to ensure that reflective thought about ethics and informed consent is not a thing of the past.
On the world stage, politicians as well as representatives of the WHO, United Nations, Gavi (the Vaccine Alliance) and the World Economic Forum have all parroted the same phrase: ‘No one is safe until everyone is safe’. Language is being coordinated – but by whom? The phrase is literally not true: if you have the vaccine, you have the protection it confers.
Boris Johnson announced on 25 March 2021 that ‘there is going to be a role for vaccine certification’.2 He justified the imposition of Covid certificates that might allow businesses to bar unvaccinated customers by saying that the public ‘want me as prime minister to take all the action I can to protect them’.3 The Sun duly ran the headline ‘No Jab, No Pint’.
There’s a feeling after a year of restrictions that people will do anything to ‘get back to normal’. But declaring your health status to use businesses and services has never been normal. The introduction of a health status ID to access products and services will cross a rubicon.
Some people are now overly anxious about other people’s immune status. In fact, the constant requirement for reassurance, through certificates and checkpoints, could actually ‘end up promoting fear and anxiety that are not proportionate to the perils involved’, according to Robert Dingwall, sociologist and government advisor.
Once the over-50s and vulnerable categories have been vaccinated, 98% of the risk of death and 80 to 85% of the risk of serious illness will have been eliminated.4 On that basis, the vaccine programme is a success for at-risk individuals and for society as a whole. So, what would the point of Covid certificates be? After all, the only thing that matters is your own immune status. If you are vaccinated, you are protected. If someone is not vaccinated next to you at the bar, it will not matter because you are vaccinated.
The push for certification is reminiscent of yet another behavioural science strategy. The kinds of people who populate the advisory panels close to government are very risk-averse. They are focused on the importance of vaccination, and ‘forcing’ their view of good health on to us, and perhaps dismissive of ethical and social considerations. Allowing private businesses to discriminate against the unvaccinated allows the government to avoid mandating vaccinations, but at the same time makes it impossible for people to go about their normal lives without vaccination. It is a form of coercion.
I asked Dingwall if he thought this push for vaccine certificates is a behavioural psychology ‘nudge’. ‘It’s a nudge for low-risk groups, once the high-risk groups have been vaccinated’, he said. ‘Perhaps the worry is about vaccination uptake among younger people. But why not cross that bridge if we come to it? Public health should not be about bullying people, it should be about advising them.’ Jackie Cassell also had reservations about certification: ‘Vaccines tap into our relationships with personhood and state. I hate the idea of biosecurity. We don’t have a passport for measles because, by and
