Gauging global attitudes to science and health is no easy task, but it was the goal of The Wellcome Global Monitor – a survey of over 140,000 people aged 15 and older, from more than 140 countries. On Wednesday 19th June, the Wellcome Trust released their report on the survey that was implemented in 2018. The results reveal some fascinating insights into how people around the world think and feel about science and major health challenges.
The report summary features an explanation from the Director of Wellcome, Jeremy Farrar, on what the report offers:
"Wellcome Global Monitor presents an unprecedented view of the relationship between science and society worldwide. No matter how great your idea, how exciting your new treatment, or how robust your science, it must be accepted by the people who stand to benefit from it. Vaccines, for example, are one of our most powerful public health tools, and we need people to have confidence in them if they are to be most effective."
The report presents data on the percentage of people who believe that vaccines are safe or effective, compares the sort of people who say they know a lot about science (by gender/level of education/country), and gauges levels of confidence in hospitals, governments, health professionals, and in “science” in general. The Wellcome Global Monitor of 2018 sets a benchmark on certain parameters, and will no doubt be of value to those invested in improving different aspects of public health.
The Wellcome website summarizes five key findings of the in-depth report:
- Three-quarters of the world’s population trust doctors and nurses more than anyone else for health advice.
- Globally, around 8 in 10 people agree vaccines are safe, and 9 in 10 people worldwide say their children have been vaccinated.
- People living in high-income countries have the lowest confidence in vaccines.
- In most parts of the world, higher confidence in health systems, governments and scientists is a sign of high trust in vaccines – but the picture is more complicated in Europe.
- In almost every region of the world men are significantly more likely to say they have a good level of understanding of science compared with women.
In Washington D.C., a live panel discussion marked the launch of the survey, featuring:
- Imran Kahn, Wellcome’s Head of Public Engagement
- Mae Jemison, physician, engineer, social scientist, astronaut for six years (also the first woman of color in space), founder of an international science camp on science literacy called The Earth We Share
- Julie Gerberding, Executive Vice President & Chief Patient Officer, Strategic Communications, Global Public Policy and Population Health, Merck
- Agnes Binagwaho, Vice Chancellor, University of Global Health Equity, Rwandan paediatrician, Ministry of Health of Rwanda 2011-2016
The discussion was hosted by Jon Clifton, a Global Managing Partner at Gallup – the polling company that partnered with Wellcome to deliver the study. Clifton posed questions to the panel about gender differences, trust, and perceptions. Inevitably, the discussion moved to vaccines, which was a focus of the 30-or-so questions that were posed.
This video summarizes how survey participants feel about vaccines.
Video credit: Wellcome Trust
Gerberding reflected on the point that 92% of parents around the world report that their kids had received a vaccination:
“When you turn that around, it means that 188 million parents aren’t. And that’s like punching a hole in the safety net that we’ve worked so hard to weave for the past many decades. Those unvaccinated children, to me, really represent the single biggest preventable global health threat that we face.. it’s tragic, because they’re our youngest and our most vulnerable global citizens.”
When Kahn, Wellcome’s Head of Public Engagement was asked what he thought of as the most significant finding, he commented on one central theme:
“All the things that people trust are really closely linked to each other. You can think of them as a trust eco-system. The extent to which people trust vaccines is partly linked to how much they trust scientists… which is partly based on everything from; do they have trust in their government? Do they have trust in their national military?... Although often we like to think about science as independent, as universal…in actual fact, when you look at how people perceive and react to science, and the impact that has on their health-seeking behavior, or their attitude towards technologies like vaccines, they’re all really closely linked. So if we as a science community want to make a difference on those issues, whether that’s trust in scientists, whether that’s belief in vaccines or anything else, if we don’t pay attention to the rest of how people feel, the rest of their context – how economically secure are they, what kind of country do they live in, do they live in a town or in the country-side – we’re going to stumble at the first block, we’re going to miss the opportunity. Taking the vaccines point, if we just try and tell people more about vaccines and ignore that there’s a complex trust ecosystem that is determining how they feel about vaccines, again we are missing a trick. So that complexity is the thing that jumps out for me.”
Clifton notes that when you look at trust in the healthcare system, the country that is leading the charge, with 97% saying they have trust in their healthcare system, is Rwanda (compared to 77% in the United States).
He posed the questions: what has Rwanda done so right? What can the rest of the world learn from it?
Binagwaho, who served as the Minister of Health in Rwanda for five years (2011-2016), emphasizes the value that lies in taking time to lay the foundations before implementing any public health campaign, i.e. “the way we proceed to provide health services.”
She notes that when the HPV vaccine was rolled out, they had to overcome the fact that a big proportion of the country were illiterate, and many women were not aware that they had a cervix. Cancer was a foreign concept. These concepts had to be explained, and only when there was a general consensus of understanding among everyone – religious figures, the media, teachers, mayors, the parliamentarians – then, vaccine participation was sought.
Binagwaho said that 96% of parents brought their kids along to receive the HPV vaccine. Her message was clear: “Never make it mandatory, create the demand... Take the time to make people participate. People feel protected – if we propose something to you (them), they know it’s for them – its not to make money, not to sell something, not because we are corrupt. This is what the world can learn: create the social capitalism – it’s better than have a big bank account with dollar.”
Binagwaho notes the progress Rwanda has made in a very short time; from experiencing the genocide of 1994, to sitting high on a leader board of trust. She credits the following:
- Giving space to words
- Telling the truth
Binagwaho also highlights the duty of scientists: “We are blessed to have some knowledge – some good life. We have to give back for a world that is of better equity, and better (more) human-centric. And this is my message: don’t tell me that you can’t do that here, with all the money you have. We have done that with nothing.”
After fielding questions to the panellists, Clifton relayed questions and comments from Twitter that questioned whether the survey was really necessary:
“Feelings really shouldn’t come into play where medicine and science are concerned.”
“Who cares how people feel about it? It’s science. It’s empirical. It’s not debatable. Therefore feelings don’t matter.”
Here are the panellists responses:
Kahn pointed out that feelings of mistrust are a barrier to sufficient vaccine coverage; people are messy, human, they have complex things going on in their lives: “If we as scientific organizations and health organizations don’t appreciate that richness, that complexity, that messiness, then we’re the ones that are ignoring the data – we’re the ones who are not being empirical and taking into account people’s contexts and feelings when it comes to science.”
Jemison believes that there is a lot of confusion about what science actually is – “Science is a body of knowledge that evolves” – and draws attention to the fact that science itself comes from humans. While things happen regardless of how we feel about them (e.g. climate change, biodiversity loss), “very frequently people’s feelings influence what solutions and datasets they throw out… how people apply science is definitely related to how people feel about whatever they’re trying to accomplish, whatever their ambition is. And so it’s a much more complex and nuanced thing than “science doesn’t care about feelings” - because that’s making an assumption that science doesn’t evolve and grow and that it’s not built from what we do, learn and observe... it’s a too naïve of a vision.”
Gerberding tells the story of how she created a “lab” in her basement for her 12-year old niece, so that she would have the opportunity to experience the thrill of discovery by running “chemistry experiments” and playing around with microscopes: “If we didn’t have emotions as scientists, we wouldn’t be curious, we wouldn’t probe and poke.. I think the two are necessarily linked. Having said that, I think we need to be clear that facts are facts, and there are certain observations that are irrefutable, and we shouldn’t let ourselves get confused by the interpretive beliefs that can really cloud and color those facts.”
Dr Binagwaho rounds things up by explaining the value of taking the time to consider people’s feelings: “People will listen to you better when you bring the facts. It may take time to care about the feeling(s) but at the end of the day you win time to explain and to use science for the public good. So take care about the feeling(s), don’t try to impose, and always make people participate – give them agency on their own lives. Then you will fly. So, care about the feelings." Leaving things on a lighter note, she jokes: "Care about my feelings at least!”
This report is the first time international and regional differences in attitudes have been studied at this level of detail, and the results provide a baseline of evidence to assess how attitudes change over time.
The Wellcome Global Monitor will be a key resource for those seeking strategies to improve the trust ecosystem, and improve engagement between the scientific community and the public.
Gallup (2019) Wellcome Global Monitor – First Wave Findings