Reagan’s famous quip is a bit of a contradiction, but nonetheless gets at something important about life. We cannot live effective lives without some level of trust, but blind trust can be quite counterproductive.
In a book entitled Trust, Francis Fukuyama showed that a certain type of social cohesion is associated with greater economic success. Corporations tend to do better in societies where people are willing to work with strangers, whereas the private sector in low trust societies often fails to evolve very far beyond small family-owned firms. Governments are also more effective in high trust countries.
I’ve met people who told me that they weren’t getting vaccinated because they didn’t trust the vaccines (and by implication the authorities that recommended vaccines), and were instead relying on a drug not recommended by experts—ivermectin. This got me wondering if this was a general pattern or just the people I happened to meet.
In Europe, there is a vast gap between vaccination rates in the east and the west. (This is from November 2021):
While 75.6% of European Union citizens are fully vaccinated, the share in Bulgaria is 26.2% and 39.6% in Romania. In countries outside the EU, the numbers are even bleaker. Only 20.2% of Ukraine’s population, and 36.3% of Russia’s, is fully vaccinated.
What is wrong with Eastern Europe? In a word: disinformation. The region is awash in it, a legacy of the breakdown of public trust in governmental institutions after communism. Feverish conspiracy theories have gripped these countries like the coronavirus’s shadow.
A Ukrainian doctor recently summed up the situation in her country: “Fake stories have spread widely, making people believe in microchips and genetic mutations … Some Orthodox priests have openly and aggressively urged people not to get vaccinated, and social networks have been filled with the most absurd rumors. Ukrainians have learned to distrust any authorities’ initiatives, and vaccination isn’t an [exception].”
In contrast, ivermectin is extremely popular in that region:
Veterinarians have seen a rush on doses of ivermectin meant for large animals as people battle to get hold of doses meant for humans, while black markets cash in and a fervent media campaign pushes inconclusive research.
The Czech Republic now allows its off-label use, while Slovakia imports tens of thousands of doses. Promising research on the drug’s potential to treat and prevent coronavirus, combined with desperation over rising case numbers and deaths and a tidal wave of disinformation, has led to use of the drug skyrocketing in Central and Eastern Europe, as well as Latin America and South Africa. . . .
The bombshell arrived on December 8, when U.S. physician Pierre Kory spoke before a Senate hearing on early outpatient treatment for coronavirus. Ivermectin, alongside other medicines such as vitamin C, zinc and melatonin, could “save hundreds of thousands of people,” he testified, citing more than 20 studies. . . .
Kory’s appearance reverberated across the globe. . . . Many miles away, in South Africa, a black market for ivermectin soon emerged. In Romania, stocks of ivermectin at both human and veterinary pharmacies were reported to be depleted in January.
Ivermectin has become so popular in places like Peru that it is increasing difficult to find enough non-users to do a clinical testy:
[C]linical trials in Latin America have struggled to recruit participants because so many are already taking it.
“Of about 10 people who come, I’d say 8 have taken ivermectin and cannot participate in the study,” says Patricia García, a global-health researcher at Cayetano Heredia University in Lima and a former health minister for Peru who is running one of the 40 clinical trials worldwide that are currently testing the drug. “This has been an odyssey.”
Interestingly, Peru has the highest official rate of Covid deaths in the world, roughly 650 per 100,000. But official death tolls can be misleading, and many believe that excess deaths are a far more accurate measure of Covid mortality. The Economist reports that 11 of the 12 highest excess death rates are in Eastern Europe:
Bulgaria’s excess death rate (nearly 1% of its population) is particularly shocking. BTW, excess death rates in a few countries with extremely low Covid mortality were actually negative; as social distancing resulted in fewer cases of the flu than would normally occur. So even the excess death data may undercount the true death toll for Covid itself. Also note that while the US excess death rate (337 per 100,000 in mid-February) is below that of Eastern Europe, it is far higher than in Western Europe and Canada (and higher than the official figures).
To be clear, I do not believe Ivermectin directly causes more Covid mortality. Most experts believe it has little effect, while a few claim that it is beneficial. Rather, I suspect that a third factor—low social trust—explains both the high use of ivermectin and the very low vaccinations rates in Eastern Europe. But there is also a risk that the people I met are not an exception; there’s a risk that many people around the world are avoiding vaccines because they view ivermectin as a substitute. In other words, a risk that ivermectin is crowding out vaccination. If so, that would be very unfortunate:
Derived from a compound discovered in a soil microbe in Japan, ivermectin has been called a “miracle drug” and “the penicillin of COVID” by Pierre Kory, a critical care physician in Madison, Wis. Kory is president of the Front Line COVID-19 Critical Care Alliance (FLCCC), a group of physicians and scientists who champion ivermectin, along with other drugs and vitamins with dubious efficacy against COVID. The organization, along with two others called the British Ivermectin Recommendation Development (BIRD) Group and America’s Frontline Doctors (AFLDS), have drawn criticism from many other physicians and scientists. Yet treatment protocols, links and videos from these groups are sweeping through social media, promoted by vaccine skeptics.
The notion that ivermectin is a miracle medicine gives people who reject vaccines a false sense of security, says Daniel Griffin, a physician and infectious disease researcher at Columbia University and Chief of the Division of Infectious Disease at the company ProHEALTH. A recent poll by the Economist and YouGov indicated that a total of about 56 percent of people who believe ivermectin is effective against COVID either do not plan to get vaccinated or are unsure about the vaccine. But unlike the data supporting vaccines, Griffin says, the evidence behind that use of ivermectin is questionable and unclear.
[My hypothesis works better for Eastern Europe than for Peru, which has a good vaccination rate. The vast majority of deaths in Peru occurred before vaccines were widely available. In contrast, Covid death rates in Bulgaria remained very high even after vaccines were widely available.]
Back in March 2020, the experts told the public that masks were not effective. I did not believe them. That wasn’t because I had expertise in the area; rather it was because their rationale made no sense. We were told that the masks were desperately needed by doctors treating Covid. I though to myself, “Well, if masks are ineffective, why do we need to reserve them for doctors?” We were also told, “Don’t rub your nose”. The best way to stop me from touching my nose when it itches is with a mask. That’s what I mean by, “Trust, but verify.” I trust that the widespread use of masks by medical personnel probably occurs for good reasons. But I also verify the pronouncements of authorities by considering whether their recommendations make sense. Subsequent studies showed that masks are modestly effective at reducing Covid among the general public (mostly protecting others, not the mask wearer), and the experts have now come around to my view.
One reason I trust the authorities on vaccines is that I’ve done my own look at the data and found that areas with low vaccination rates tend to have much higher Covid death rates, especially in the period after vaccines were available. (Obviously not in 2020.)
On average, the views of experts on a technical issue will be superior to the views on non-experts. Thus my default position is to trust the experts more than I trust my own intuition. But I never stop there. Where possible, I also look at the evidence to see if it makes sense. The mistake some people make is to reflexively distrust experts and instead trust random people on the internet that are telling them what they want to hear.
PS. My read of the ivermectin data is that a lot of low quality studies say it’s effective and several high quality studies say it is not. Given my general view of the biases in scientific research toward positive results, that’s not a very promising picture. (This also makes me skeptical of the vast majority of published economic research.) Overall, I am agnostic on ivermectin’s effectiveness, and believe it might or might not have a modestly positive effect. But evidence in favor of other generic drugs seems stronger than for ivermectin, so I personally would not take it without seeing further evidence of its effectiveness.
PPS. Interestingly, Uruguay seems to have the lowest Covid death rate in South America. It also has a relatively high level of social trust by Latin American standards.
READER COMMENTS
Andrew_FL
Mar 27 2022 at 3:22pm
Listening to your Orthodox Priest’s advice on vaccines isn’t low trust, it’s just putting your trust in a different place. The level of trust is conserved, people just put their trust in odd places instead of where they “should”
Craig
Mar 28 2022 at 10:55am
Would be helpful to see maps for answers to the questions “How much do you trust others in your (neighborhood) / (town) / (state-province).” Maybe add one for (extended family). This would show where trust is placed.
“…the private sector in low trust societies often fails to evolve very far beyond small family-owned firms.”
steve
Mar 27 2022 at 3:48pm
Thanks for this Scott. One of the things I teach med students is to ask themselves if the results of a study make sense and if there are secondary ways to confirm or make us question results outside of formal studies. As you note here, the areas that have used Ivermectin most extensively, holds for US also, have higher death rates. There is no good evidence that it directly causes deaths but it does support the idea that it does not successfully treat covid.
The other thing that non-medical people just dont get is that the claims for Ivermectin are for 60%-70% success rates. That would put Ivermectin in the miracle drug class. We just dont have many drugs that work that well. Go look at the NNT numbers and see how often you see 2 or less. If it worked as claimed it would be obvious. Based upon direct and indirect evidence it has no or a small effect.
Also, as an aside, for the “this is just the flu” group, reaching close to 1% of the country dying as we see in Bulgaria should give second thoughts as well as all of those others at 0.5% or higher.
Steve
Peter
Mar 27 2022 at 8:47pm
“On average, the views of experts on a technical issue will be superior to the views on non-experts”
The problem with that statement is we don’t hear from the experts. The experts are twenty levels down, don’t get a say, and are punished for speaking out. Talking heads are politicians, salesmen, or PR hucksters in fact the overwhelming majority of the time. Fauci for example is as much an expert on COVID as my neighbor the plumber. You are sorely mistaken if you think that the actual GS-12 CDC expert and Fauci have ever spoken or reports ever even passed up or written, much less read.
It’s not a matter experts can’t be trusted, it’s that experts are unavailable, filtered, or silenced. The only experts that get airtime are the yes men.
steve
Mar 27 2022 at 9:33pm
Mostly the experts publish. That is more available than in the past. There has also been no shortage of infectious disease experts, epidemiologists, economists, etc available print, on TV or on Youtube.
Steve
Ken P
Mar 27 2022 at 10:10pm
Peter has good points. Many expert opinions have been blocked and we know from FOIAs that Fauci intentionally coordinated a take down of opinions. We are also seeing FOIAs from NIH/CDC responded to nearly completely redacted. But many more scientists know better than to publicly push back against the official narratives of the grant approvers. There is a huge push to control narratives, and probably always has been. What is different is that people can get around all these blockades. Transparency and debate is the only solution.
steve
Mar 28 2022 at 3:12pm
What expert opinions have been blocked? I hear this and I cant find any examples. Who has been prohibited from publishing?
Steve
Monte
Mar 28 2022 at 7:40pm
Blocked, de-platformed, cancelled, castigated, etc. It’s all semantics. And one doesn’t have to dig too deep to find numerous examples. Here’s just one of many:
https://thefederalist.com/2021/04/28/cdc-punishes-superstar-scientist-for-covid-vaccine-recommendation-the-cdc-followed-4-days-later/
steve
Mar 30 2022 at 3:11pm
He lost a committee appointment because he acted outside of committee rules and that is being cancelled? Really? Ever served on some committees?
Steve
Monte
Mar 30 2022 at 5:29pm
Yes, I have. Are you seriously going maintain that a number of highly respected medical and other professionals have not been blocked, de-platformed, cancelled, mischaracterized, etc. through the balance of this pandemic based on nothing more than politics?
Kenneth P
Mar 27 2022 at 9:56pm
Many of the same people who pushed for vax mandates, were previously saying how dangerous it would be to allow vaccines before they were fully tested. Many of them also pushed the anti-GMO nonsense for the previous decade. Many on the left and right have phobias about biotech as a result. The CDC & FDA’s J&J “pause” definitely gave pause to the vaccine momentum. If I was in a minority group, I would have probably been suspicious of being placed first in line, especially when some states had huge fines for vaccinating out of order. Ironically, many have said that when they saw white people cheating to cut in line, they decided it might be safe.
Many recent statements are knocking trust going forward. Who really believes the White House that we don’t know if old people are more susceptible than young people? Who believes Pfizer about the benefits of a 4th dose? The data shows that only the elderly and immunocompromised benefit from an additional dose, but you don’t need to dig into the research to be suspicious of “hey you need a 4th dose of the 2yr old strain”. Then there’s the push to approve the vaccine for toddlers. We have major vaccine scientists leaving the FDA due to the pressure being put on them to advocate boosters to groups where there is no benefit.
I’m very pro this vaccine, but the lack of trust is no surprise with the behavior of those “experts”. The higher death rates is the result of manipulation of the public.
Weir
Mar 28 2022 at 3:22am
The consistently authoritarian stance would be that nobody should be allowed to voluntarily purchase any products with GMOs and also that everybody must be forced to consume one particular product with GMOs when they say they don’t want to. I believe that’s actually Neil Young’s stance. Since he hasn’t made any statements against Justin Trudeau’s policy or Joe Biden’s policy of forcing people to do what they expressly don’t want to do, Neil Young must really, really not have any patience for a guy with a podcast talking about the pills he took.
Jim Glass
Mar 27 2022 at 10:28pm
Back in March 2020, the experts told the public that masks were not effective.
Experts can be much more persuasive to the public when they are (1) honest, and (2) do their purported jobs. In March 2020 they didn’t know whether masks were effective or not for Covid. And they had a substantial number of studies showing masks are not effective for the flu. But Covid isn’t flu. So…
They could have (1) been honest at the start by saying to the public “We don’t know if masks are effective or not” and (2) “We are right now starting control-group studies to find out”.
Instead, after waiting through near two-years of policy flip-flops we finally got a decent control group study from Bangladesh(!) finding mask wearing reduced infection rate by 1 percentage point, from 8.6% to 7.6%, or an 11% rate.
Back at the March 2020 start – before any official policy and all the politicization – it would’ve been easy to do controlled studies here. “Who wants to wear a mask?” “We do!” “Who doesn’t want to wear a mask?” “Us!” And we’d have had the honest transparent-to-all answer then, before policy was made. Political fights averted. But the experts couldn’t say (1) or do (2).
We were told that the masks were desperately needed by doctors treating Covid. I thought to myself, “Well, if masks are ineffective, why do we need to reserve them for doctors?”
Are you suggesting the CDC knew masks were effective but lied to the public to keep them for themselves? I’m shocked! Let me rise to their defense…
The experts didn’t know masks were effective. How could they without any data?
Doctors need masks when treating severely ill Covid patients to avoid killing said patients by coughing/sneezing their own nasty non-Covid germs onto them, whether or not they can catch Covid from the patients.
the experts have now come around to my view
They should have trusted you, then verified!
zeke5123
Mar 29 2022 at 2:52pm
People have pointed out problems with that study, but the study (which actually does suggest some of the problems may not be that prominent) found that surgical masks result in the 11% reduction. Cloth masks, they found, did not result in any drop. It is far from clear how the Bangladesh results generalize to first world countries.
Jon Murphy
Mar 28 2022 at 7:22am
I am suspicious of the “disinformation causes low vaccine take-up” thesis as low vaccination is strongly inversely correlated with income levels and availability. In other words, it appears to be an availability issue, not a disinformation issue. On the margin, disinformation may be affecting take-up, but one thing we see over and over again in the literature (including my own research) is that poor folks are extremely sensitive to non-monetary costs, particularly time. Information availability does not affect take-up outside very specific circumstances. I suspect that is part of the reason vaccine take-up is so low among the global and domestic poor.
Rather, I propose an alternative explanation to your social trust thesis: relative costs. Vaccines entail high non-monetary costs (having to go get it administered by a professional, potential work-time lost, etc). Ivermectin, conversely, is widely available, especially in low-income areas. Ivermectin’s relative cost is considerably lower. Even if it is less effective, it is the prefered option given relative costs.
Scott Sumner
Mar 28 2022 at 1:24pm
I strongly disagree with this. There’s no obvious reason why vaccines would be far more available to Democrats than Republicans. I know people who have not been vaccinated, and in not one case was it due to lack of availability.
And there’s no major cost for being vaccinated for the vast majority of people. At worst you’d feel a bit under the weather for a single day. No big deal. If you are worried about work then do it on an off day.
Jon Murphy
Mar 28 2022 at 2:17pm
I was out of commision for a week, including a hospital stay, so with respect I must disagree with your worst-case scenario.
But, for many poor people, a day off is a huge expense. We see it all the time in various welfare programs: the time costs tend to be the major factors in determining who take up food stamps, for example.
To your point about Republicans and Democrats, I think that’s more correlation than causation for two reasons:
First: Republicans tend to be better informed (as measured by less error when guessing statistics of the pandemic) than Democrats.
Second: it cannot explain inter-city breakdowns. For example, Boston vaccination take up is strongly divided among the neighborhoods. The wealthy neighborhoods are around 90-100% vaccination. The poorer are closer to 20%.
Scott Sumner
Mar 29 2022 at 3:14pm
“But, for many poor people, a day off is a huge expense.”
So get vaccinated on a day you are not working. This sort of excuse is just wildly implausible. You need to face the fact that many people just don’t want to get vaccinated. It’s that simple.
Jon Murphy
Mar 30 2022 at 6:10pm
I do not deny that at all. My point is that the folks who simply do not want to get vaccinated are:
1) not a majority. Poverty, time, and relative costs appear to be more significant factors
2) are not necessarily misinformed.
We needn’t resort to assumptions about people’s mental capacities when good, ol’ price theory will do.
Mark Z
Mar 28 2022 at 3:07pm
For explaining intra-national differences cost may not be a huge factor, but then intra-national differences are fairly modest, but are vaccines really similarly available in Montenegro as in the US? Maybe they are, I don’t know, perhaps I’m just prejudiced against the capacity of poor eastern European countries to procure and administer vaccines.
I’d add that within domestic countries, being poor and making poor decisions are strongly correlated, so the cost may be small, but then the cost of not smoking is also small, much lower than the cost of lung cancer. I could see why the same kind of person who smokes and makes other poor life choices (again, disproportionately poor) wouldn’t bother getting a vaccine today while healthy and instead just seek treatment once already sick. The necessity of misinformation as an explanation seems to rely on an assumption of a certain level of intelligence and foresight that, well, can’t be so readily assumed among every demographic group.
steve
Mar 28 2022 at 3:21pm
When income is accounted for, Republicans are still much less likely to be vaccinated. If Jon’s idea was correct then poor Democrats and poor Republicans should have been vaccinated at the same rate. KFF has been tracking that. To be sure, being poor is also a factor. Can only speculate on why.
Steve
Monte
Mar 28 2022 at 7:36pm
I can’t speak for all conservatives, but information like this is enough for me to be vaccine hesitant:
https://fee.org/articles/cdc-natural-immunity-offered-stronger-protection-against-covid-than-vaccines-during-delta-wave/
Mark Z
Mar 28 2022 at 8:45pm
The difference between Republicans and Democrats is around 10% or so right? The difference between western European countries and eastern European countries is, according to the numbers in the post, around 40%. That’s an enormous gap to explain by sheer misinformation. There are poor countries, to be sure, that do quite well, but then they often only confound the explanation. Am I really to believe that China is one of the least misinformed countries in the world?
Jon Murphy
Mar 30 2022 at 6:11pm
Not necessarily. Not all poverty is equal. There are multiple interaction effects
Anon
Mar 28 2022 at 2:40pm
Scott,
How would you increase social cohesion and trust?
My guess is to enforce the law so strictly that people have implicit trust in the government and in society(they feel safe and secure). One thing would be to look at a place like China and see how social trust works over time, since I’m sure that the people in China have much more trust in each other today than they did in the 1960s or the 1970s.
tpeach
Mar 30 2022 at 12:08am
I don’t know about the data in that map.
Why would over 90% of people in Myanmar trust their government? (I can see that it was asked before the military coup, but still)
Or Uzbekistan?
There are also a lot of countries with relatively high scores that seem suss, like India, Cambodia and Laos.
Pat S.
Mar 30 2022 at 11:19am
Social cohesion and trust…
I pull from one of my favorite Tyler Childers song, Nose to the Grindstone.
“Keep in mind that a man’s just as good as his word
It takes twice as long to build bridges you’ve burnt
And there’s hurt you can cause time alone cannot heal
Keep your nose on the grindstone and out of the pills”
Appreciate the article and discussion thread.
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