Cognitive Dissonance, Trust, and COVID-19

Most of us have had our lives disrupted in some way as a result of the COVID-19 pandemic. As difficult as job loss and economic upheaval have been, it is the loss of life that is most tragic. Between March 1, 2020, and January 2, 2021, the US experienced 522,368 excess deaths, an incredible 22.9% more than expected. Though the vast majority of these excess deaths were directly COVID-related, deaths from other causes (heart disease, Alzheimer’s, and diabetes, for example) were also increased. Total COVID-19 deaths have now exceeded 600,000. Yet to hear some talk, you would think the coronavirus was nothing more than an excuse for the government to infringe on individual rights.

As the pandemic surged on, all anyone could talk about was controversy surrounding pandemic-related measures (masking and social distancing), COVID-19 interventions (hydroxychloroquine and bleach come to mind), and ultimately vaccinations. As illness and deaths mounted, an insidious combination of mixed messaging, misinformation and politics perpetrated an ironic and sinister distrust of science and healthcare.

It used to be common to joke about how little we trusted politicians. How is it that now we trust (some of) them more than scientists and doctors, even when it comes to science and medical information? There is cognitive dissonance here: A) Doctors are some of the smartest people around (so I’ve heard), and they are exquisitely skilled at preventing, diagnosing and treating illness; and B) Politicians are self-proclaimed experts at viral transmission, disease severity, drug effectiveness, and vaccine necessity.

Cognitive dissonance – holding on to conflicting or inconsistent positions – is not new in health-related matters. Smokers demonstrate it all the time: A) Smoking is bad for me; and B) I smoke. There is a fundamental conflict between what smokers know or should know (based on scientific facts) and what they do. Smokers resolve this internal conflict by trivializing (smoking is not that bad), rationalizing (at least I eat healthy and exercise), or trying to change or deny the facts (smoking didn’t cause my heart disease, COPD, or cancer). Deflecting blame for bad outcomes is common. The hard road to resolving the cognitive dissonance associated with smoking is to change behavior and quit.

I don’t mean to pick on smokers. Nicotine is addictive and quitting is quite hard. Every time I stop for a Ray’s bacon cheeseburger with onion rings or get an iced cookie from Confections (two of my favorite local eateries), I experience a bit of cognitive dissonance myself. I rationalize, I trivialize, I deny that it may be unhealthy. With diet, however, one can assess whether the hamburger or cookie is an occasional treat or a bad habit. The cognitive dissonance surrounding COVID-19 (and especially vaccines) is more problematic.

As a physician, I often do not know whether my patients believe what I say and will act on what I recommend. I strive to be seen as a trustworthy authority. Lack of trust – in me or the system – has consequences. Healthcare system distrust is associated with lower COVID-19 vaccination rates, especially in minority communities. In my field of oncology, distrust affects outcomes across the breast cancer continuum. Even before COVID-19, trust in doctors had plummeted by 75%. (The internet has turned everyone into an expert.) The odd anti-vaxxer, for example, used to be an easily dismissed anomaly. Now, a crippling vaccine hesitancy risks preventing COVID-19 herd immunity. The consequences could be devastating, as virtually every COVID death going forward is preventable.

Let’s consider: A) COVID-19 vaccines are readily available, wildly effective, very safe, and completely free (all verifiable facts); and B) Less than half of the United States is fully vaccinated. Cognitive dissonance. This isn’t just a problem in the United States. How are people responding to this inconsistency – this disconnect – between what we know (again, scientific facts) and what we do? It is the same playbook we saw earlier with smoking – that of trivialization, rationalization, and flat-out denial. Add in conspiracy theories and “it’s like choosing from which side of the flat Earth we’re going to jump off,” according to an obviously exasperated Dr. Luana Araújo, a Brazilian infectious diseases physician.

The apostle Paul struggled with the inconsistency between beliefs and actions in his letter to the Romans, admitting he doesn’t do the good he wants to do; rather, he does what he knows he shouldn’t do. Can we amen that? Paul even calls himself a wretched man as a result. That’s cognitive dissonance! Paul was instructing on the spiritual condition and the nature of sin and grace. I’m simply trying to get people to use common sense.

Where do you stand with COVID-19 vaccinations, and why? Seek the truth rather than trying to bend the facts to your preference. We have a misinformation pandemic where lies propagate across the internet further and faster than truths. What is the source of your knowledge? Is it science experts and doctors, or politicians promoting their own self-interest and conspiracy theories? Second, be willing to eat a little humble pie. Don’t throw logic and facts out the window in order to cling to pride or party. If you haven’t been vaccinated yet, you are allowed to change your mind! Making the wrong choice about vaccinations during this pandemic (especially with the newer, more virulent Delta variant on the rise) can have deadly consequences.

Hopefully we can get back to trusting the healthcare system and doctors more. Are we perfect? Of course not. We must earn your trust. I know I strive every day to do just that.