Are Public Health Institutions Honest?

By Rebecca Brown

The COVID-19 pandemic has highlighted various cracks in the function of our public institutions. One notable concern is the way in which scientific – including health – information is communicated to the public. Communication can serve different purposes. In the context of COVID-19, communication has been essential: describing the nature of the novel coronavirus, the risks it posed to health, the measures likely to reduce its spread. Some of this communication was aimed at changing people’s behaviour in order to control the infection. For instance, people were told to wash their hands regularly, for at least 20 seconds, and to avoid touching their face. Much of this information was uncertain. Emerging data on COVID-19 presented ever-changing estimates for infection and case fatality rates.

There are particular demands that are made of health communication. It needs to reach a wide audience, delivering often quite technical, uncertain information to people with varying degrees of health literacy. It needs to encourage behaviours likely to promote individual and public health and avoid causing unnecessary panic and alarm. It must also, one might argue, avoid misleading people about the facts as they are best understood. This last point suggests that health communication should adhere to the demands of honesty. 

There may be examples of health communication relating to COVID-19 which were not fully honest. Take the World Health Organisation (WHO), which stated in April 2020 that “There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.” This statement was made in the context of suggestions that those who had been infected and subsequently recovered from COVID-19 might be issued with ‘immunity passports’, allowing them to move around more freely. It was misleading for the WHO to claim that there was “no evidence” of antibody-mediated protection from SARS-CoV-2. At the very least, information from previous coronaviruses such as SARS and MERS suggested people were likely to have some form of immunity. It seems likely the WHO statement was intended to prevent complacency: they didn’t want those who had recovered from COVID-19 to ignore infection control measures out of a belief they were protected. While this intention might have been laudable, the WHO’s misleading statement regarding SARS-CoV-2 immunity appears, at first glance, dishonest.

How should we assess the honesty or otherwise of institutional actions? We are familiar with describing individual agents as either honest or dishonest: one who frequently lies or steals is clearly dishonest, whereas one who always tells the truth is clearly honest (at least in this regard). Miller (2021) has provided a description of the honest agent as one who: ‘reliably does not intentionally distort the facts as she sees them’. We can use this as a starting point to consider what an honest institution will look like.

Reliability

First, then, the requirement to reliably not intentionally distort the facts as the agent sees them. It seems we need to consider how an institution behaves over time to decide if it is honest, not just a snapshot of its actions. So, in the case of the WHO and other public health institutions, we need to look at a larger sample of their communications and behaviour to consider how frequently they make misleading statements. There were a number of misleading statements made about COVID-19 from public health institutions. In addition to the assertion above of there being no evidence of immunity to the virus, there were claims that it was not (primarily) spread via airborne transmission, that masks don’t work (and may make transmission more likely), that closure of international borders was unnecessary. Whilst we don’t have a numerical benchmark for what it is to reliably not distort the facts, the frequency of misleading statements here (the above were all made by the WHO) seems likely to cross the threshold.

Intentionality

Returning to Miller’s definition of honesty, the next requirement is that the agent does not intentionally distort the facts. It is therefore not enough to show that public health institutions have made misleading claims. For them to be dishonest they must have known they were making misleading claims. This is much harder to establish. First, it seems quite possible that the WHO truly believed there were risks to using masks, that evidence didn’t support airborne transmission, or that closing international borders would do more harm than good. Perhaps they were guilty of poor evidence gathering and weighing. But this is not the same as believing one thing to be the case and trying to convince the public of something else. The claim about there being no evidence of immunity is, to me, the strongest candidate for an intentionally misleading claim. Indeed the way the statement is worded suggests it could be an instance of ‘paltering’: misleading by telling the truth. Recall the claim: “There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.” On some narrow understanding of what counts as evidence, this was (perhaps) correct, but it seems clear it would be interpreted as meaning ‘there is probably no immunity to COVID-19’. This was not true, as the WHO surely knew. This may have been an instance of intentionally distorting the facts.

Agency

The final aspect of the requirement for honesty I’ll consider here concerns ‘…the facts as the agent sees them.’ Since we’re considering public health institutions, it is unclear whether or not we are justified in treating them as agents. One way in which public health institutions might be treated as agents is if they are deemed literally to be agents in the same way as individuals are agents. This idea of a ‘group agent’ or ‘group mind’ proposes a distinct entity – one which is not simply an aggregate of the individuals within it – which possesses agency and the trappings that come with it (the capacity for responsibility, intentional action, etc.) Although the existence of group agents is supported by some notable philosophers (e.g. Philip Pettit), it is metaphysically controversial.

We might stop short of claiming that group minds exist, and instead treat the institution as a metaphorical agent. This means that the structure of institutions is such that it makes sense to talk about them (and treat them) as if they are an agent, under some circumstances. The question we must ask, then, is whether or not public health institutions (and potentially other organisations) can sensibly be treated as agents for the purposes of assigning character traits such honesty. It seems to at least make sense to talk about institutions as honest (or dishonest). That is, on a common sense understanding of what honesty means, we can make sense of the claim that company X is honest whilst company Y is dishonest. But if we are to apply an account of honesty such as Miller’s then, in order to make judgements of honesty in a more formal way, we must be able to asses whether or not the institution intended to distort the facts as it saw them. This requires the institution to be capable, first, of intentions and second, of doxastic attitudes (beliefs).

Although it may initially seem unappealing to assign intentions and beliefs to things that may only be metaphorical agents, it does not seem that odd. Institutions, such as the WHO, certainly behave as if they are capable of forming intentions and beliefs. They act in a coordinated and organised manner, pursue long-term goals and strategies, and successfully interact with other ‘agents’. Statements that they make about, for instance, the health effects of contracting COVID-19 certainly seem to indicate intentions (such as the intention to discourage risky behaviour) and beliefs. For all intents and purposes, then, it may make sense to treat institutional agents as being capable of intentional action and holding beliefs.

Finding out what an institution’s intentions and beliefs are (or were) is another matter. It is impossible to look inside the mind of an individual agent and perceive their intentions and beliefs. It may be no less simple to look inside the ‘mind’ of an institution and pick out these features. However, there may be evidence, for instance in the form of internal and external communications, which make intentions and beliefs explicit, or which clearly point towards certain intentions and beliefs. It will not be enough that some individuals who are members of that institution hold particular intentions and beliefs. It may not even be enough that the majority or all of the members of the institution hold particular intentions and beliefs. The relevant intentions and beliefs need to be shared. Take ‘going for a walk together’: it is not enough that I intend to go for a walk around the lake, you intend to go for a walk around the lake, and our intentions coincide at the same time in the same direction. We still are not going for a walk together. For that, we need to intend to go for a walk together. The details are disputed, but some form of coordination or common knowledge is required in order to make activities that happen by groups of people distinctively joint or shared in nature.

Returning to the WHO example: did the organisation intend to distort what they believed to be the facts about infection-induced immunity to COVID-19? Truthfully, I don’t know. A reliable answer would require much digging. Perhaps we should give them the benefit of the doubt, and assume that the statements made by the WHO were believed to be true, and intended to communicate an accurate understanding of SARS-CoV-2 immunity. But there is, at least, some reason to doubt this: first, it seems unlikely that an organisation employing numerous infectious disease experts would believe that there wouldn’t be infection-induced immunity to COVID-19. They might well have been hesitant about how robust such immunity would be, how long it would persist, or how effective at preventing transmission. But they must have thought it was, at the very least, likely that there would be some immunity. Second, the statement looks like it was made to discourage the introduction of immunity passports – there was some motivation here to downplay the protective effects of immunity. These factors are suggestive of an intention to distort the facts as the WHO saw them, though by no means conclusive.

There is more that could be said here: perhaps the WHO’s intention to ensure people’s continued adherence to infection control measures was justified. Perhaps honesty isn’t something we should require of public health institutions. It seems, nonetheless, helpful to consider whether or not our public institutions are living up to the standards of honesty, how we might assess this, and whether or not we are comfortable with the results.

References

Miller, Christian B. Honesty: The philosophy and psychology of a neglected virtue. Oxford University Press, 2021.

Acknowledgements

This work is part of a project on Honesty in Public Health Communication, supported by the John Templeton Foundation.