Vaccine Rhetoric and Blood Transfusion

HELEN: Welcome to Talking About Blood. I’m Helen Osborne, host of this podcast series and a member of the advisory board for The Blood Project. I also produce and host my own podcast series about health communication, and it’s called Health Literacy Out Loud. Today I’m talking with two guests. Dr. Heidi Lawrence is an Associate Professor of English at George Mason University. She is a qualitative researcher who studies vaccine hesitancy from a humanistic and rhetorical perspective. Heidi’s research about this topic has been published in several medical and public health journals. She also is author of the book, Vaccine Rhetoric. Jessie Wiggins is a doctoral student in writing and rhetoric at George Mason University, and she’s studying the rhetoric of health and medicine. Jessie has experience as a qualitative researcher at a community health center. Her current research focuses on dangerous online health trends. Welcome to you both to Talking About Blood.

HEIDI: Thank you so much, Helen. Thank you for having us.

JESSIE: Yes, we’re so excited to be here.

HELEN: I need to just start from the beginning. You’re both interested in rhetoric, and you’re not physicians, you’re not scientists, but you’re experts on how people communicate and understand information. How did you both get interested in the topic of rhetoric, and what is rhetoric?

HEIDI: This is Heidi, and thank you again so much for having us, Helen. I’ll get us started thinking about rhetoric. We often have a pretty popular understanding of what rhetoric is. We think of rhetoric as political rhetoric, things where people are actively trying to convince one another to believe or think certain things or do certain things. But in an academic sense, rhetoric is, and I think the way it’s most helpful for your listeners, is to think about rhetoric as a frame for understanding discourse in action with a particular attention to persuasion.

HELEN: Okay, let me just get that. I’m breaking that down. A frame for understanding, what was it?

HEIDI: Discourse in action.

HELEN: Discourse is communication?

HEIDI: Yes. Yeah, discourse.

HELEN: And action is what people do as a result of that communication?

HEIDI: Exactly, right?

HELEN: Okay.

HEIDI: So we communicate with each other in the public sphere about all kinds of issues, again, with that attention to persuasion, but not maybe what we think of classically as just persuasion. So we think about persuasion as convincing someone to buy a certain product, or maybe convincing someone to take Ozempic versus Wigovi, or in COVID, getting people to get vaccinated. These are these overt forms of persuasion. And when we’re thinking about rhetoric, we’re also thinking about the ways that we convince each other to share common beliefs, to share in common forms of trust, and to share values. So we’re interested certainly in, for my research, understanding how people come to decide to vaccinate or choose a particular kind of drug or medication. But we’re also interested in that more implicit process of how we all come to even share a value of scientific knowledge, or share the value of appreciating or believing the CDC as a valuable source of information generally. So it’s not just, again, those marketing, which we might think about more typically, but really thinking, how do we come to all trust the same things, and how do we use language to do that?

HELEN: Thank you so much. That’s really helpful. I’m taking a few notes, and I really like how you talked about beliefs, and trusts, and values, and coming to that common understanding about that. Jessie, tell us about your perspective on this, and you’re particularly focused on rhetoric in medicine. So add to this body of information, please.

JESSIE: Well, that was a great definition to get us started with rhetoric, and that is the rhetoric Heidi just described. That was vaccine-specific. But as she was saying, there’s tons of information, and again, you noted earlier, I look at online discourse. So there’s tons of information online. But it’s how people come to believe the information that they do. So not everyone believes the same information. And persuasion, like Heidi said, is coming to share the common belief or trust in systems. So that could be government organizations, it could be certain websites that people frequent.

HELEN: So I was introduced to both of you specifically about blood transfusions, why people may refuse them, and also how that’s linked to feelings, and thoughts, and values, and beliefs about COVID, and the COVID vaccine specifically. That’s quite the interaction of the two. What’s the problem, from your perspective, online, in person, and Heidi, you talked about public health. Jessie, you’re talking about online information. What’s the problem here? And then we’ll try to unpack why, and who, and what can we do?

JESSIE: Right. Okay, I’ll take this one. This is Jessie. So, yes, at the heart of this project or this problem is people refusing blood transfusion because of vaccination, right? And so at the nexus of this is people with concerns about the COVID vaccine, for a host of reasons, whether it’s blood clotting, side effects, mRNA technology, and then these worries filter their way into blood, right? So concerns about the vaccine have extended into fears about receiving blood from vaccinated donors. And this is a new phenomenon. We haven’t seen this with other vaccines before. This is started with the COVID vaccine. And this moves into blood, blood transfusion, blood donation. And it’s been articulated or kind of manifested in three ways, like how this discourse has come about. So first, it’s when patients have a medical procedure or surgery. And so they’re during the informed consent process is when this conversation might come up, right? A second way this might come up or has come up is online discourse, which earlier. So there are some platforms online that perhaps exacerbate fears surrounding the need for blood transfusion. And so it leads to patients or just people in everyday lives that are actually not patients at that point, having concerns that they might need a blood transfusion. So what would I do if I need a blood transfusion? I have now this concern that I need a different blood supply entirely. And that’s our third pool, right? The third way this manifests is those that are concerned about blood banking, and they think that the blood should be labeled vaccinated versus unvaccinated. And that’s actually been seen in a few attempts at legislature. Nothing has been passed. Everything has failed. But there have been bills in Montana and Wyoming for blood at blood banks to be labeled vaccinated or unvaccinated.

HELEN: Jesse, that’s fascinating. As you laid out, I mean, we’re just moving along, I’m already learning so much about this. So you’re talking about people in medical situations. You’re also talking about perhaps the general public. They’re not sick at the moment, you know, but all these fears and rumors and as you’re talking about that, I’m certainly thinking of some media people and, you know, music singers or whatever it was who were, seems to me, I’m more of a medical person, who are engendering fear in there, whether it’s true or not what they’re talking about. And also the policy in there, the politics and the policy. That’s really fascinating about that. So what is the project? I know you two are working with other people. What are you doing to kind of explore this phenomenon a bit more?

HEIDI: I’ll take that one. This is Heidi. So we started a kind of multifaceted project where we’re using various humanistic tools to examine why it is that people, again, using the tools of rhetoric, come to believe in this set of concerns and why it’s so persuasive for people, you know, why this has sort of taken off so quickly. So we’ve conducted some interviews with a hospital partner. We’ve talked with physicians who have counseled patients through this process, who’ve encountered this problem and who, you know, worked toward a solution and making sure patients still get care despite these concerns. We’ve talked with patients who have these concerns themselves and have expressed them in the course of their care. And as Jesse said, we’ve also done a lot of online analysis looking at discourses in websites and social media where people are discussing this in real time and trying to make sense of what they perceive to be as threats or dangers and harms of both the COVID vaccine and then as it relates to blood. So those are our kind of three primary data sets that we’ve been analyzing.

HELEN: Oh, I look forward to hearing all that. I think our listeners do too. Let me tell you about the listeners of Talking About Blood. They may be seasoned physicians, often hematologists, people who have been doing this for a long time, who are in that medical sphere, who are dealing with patients and like Bill Aird who runs the Blood Project, he’s got some questions about what can he do and how large is this problem and is it just related to COVID and those practical considerations there. What can you do instead? I think we want to address some of those issues. I know you’re not medical people, but if we can start talking about that, I assume that you’re learning a lot about that. Our audience also includes people earlier in their careers who are entering into medicine or health sciences or just science of some sort. Jesse, you’re a graduate student now. You probably can be speaking to that. So how does someone get on board with the new up-to-date issue and start making your role in there? You have to realize it’s a problem and start figuring out what your part is in there. And the audience also includes people just like me who are just curious about these issues and curious about blood. So let’s address all of that. So as you’re learning about that, tell us more about the people who may be refusing these blood transfusions. And are we talking about just refusing it because of the COVID vaccine or is it all vaccines?

HEIDI: I think we can both maybe talk to this a little bit because we’ve focused on different parts of the project. But I’ll say, I think to some of your listeners, these problems might sound very familiar. And I think that that’s something that’s really common or tempting to do when it comes to problems like this. People having concerns about the safety of the blood supply is not new. Having concerns about the blood supply as it relates to who’s donating the blood, again, those aren’t new. And we do see this sort of complexity of this problem really emerges in those existing worries about the blood supply, whether it be from HIV AIDS or other concerns about that sort of safety aspect of receiving donated blood, along with those existing concerns of vaccines just kind of coming together in these really complicated ways where patients have a lot of worries about the safety and their own bodily integrity as it relates to accepting donated blood under the circumstance where they perceive it to potentially be dangerous.

HELEN: Can I add one more reason? I just did a podcast and that’s about why people sometimes refuse blood transfusions during surgery because of their religion and specifically Jehovah’s Witnesses. So I interviewed an anesthesiologist about bloodless surgery. So yes, it seems to run the whole gamut from people who aren’t even sick to people who are very sick about to have surgery and will need some way to replace those fluids in there. So thank you for that.

HEIDI: Yes. I think one of the things that’s difficult for practitioners that we hear from our participants is that we think of vaccine refusal and vaccine concerns as really more traditionally being this the paradigm of pediatricians, like this is something pediatricians or maybe even OBGYNs have to deal with, right? Because they’re thinking about perhaps vaccinating pregnant people or counseling new parents through pediatric vaccines. And I think if you think about the spaces where this is happening, it’s happening in surgery, hematology, transfusion medicine, people who didn’t really think about ever having to talk to patients about vaccines. That’s not been their training or maybe in their experience. And so I think it’s a unique new problem that we’ve been talking to people about because of that new area of medicine affected by this really hundreds of years old problem of vaccine hesitancy.

HELEN: Jessie, are you talking to people who are refusing or being at the recipient end of that conversation?

JESSIE: Yeah. Yeah, we have in our patient interviews. And so exactly. I guess the only thing I would add to Heidi as she said is, you know, over the past year conducting these interviews, I guess we’re emphasized that our data hasn’t supported any kind of stereotype of someone who would refuse a vaccinated blood.

HELEN: No stereotype.

JESSIE: No, because it’s just more complicated and messy than that. And there’s certainly been a range of patients, some who have received vaccines before, including the COVID vaccine. And now for perhaps side effects, right? In one situation, the side effects of the vaccine are now concerned about receiving vaccinated blood. So it’s not perhaps what we might have assumptions for as patients are refusing vaccinated blood.

HELEN: When I’m thinking about right now, and as you’re talking about new parents who are hesitant or perhaps refusing vaccines, and you’re talking about the COVID one, and you’re talking about people who might change their mind or, you know, along the way. My question to you, since you’re in the business of knowing about persuasion, what’s the role of the public media? That’s how I learn about it. I’ll see something on the morning news or, you know, read an article in the paper. And as you’re talking about refusing vaccines for an infant, I’m thinking, oh, it’s them. And I can tell you where in the United States I think that’s happening. Or you’re talking about COVID and I have my values about that. What’s the role of media in this? Social media, which is what you’re doing, Jessie, but also the everyday media that we, at least I keep listening to.

JESSIE: Right. No, I think there is that inclination, like you’re saying, to subscribe, like my values when I’m starting to look at this online discourse, right? And so it’s just kind of taking a step back in those situations. But yes, when I look online at social media and particular platforms, I do see specific media figures, if you will, who do tend to, there’s such a range. I don’t want to just give one generalization because it’s not always just for political or for monetary gain, but I do see that sometimes for certain figures. But online, the discourse ranges from what is being furthered by our patients and those that have fears themselves, and then those who are trying to perhaps capitalize on the fears of others. Right. And so it’s kind of split into two different ways.

HELEN: Can I add other audiences there? I was thinking of the role of traditional journalists too, writing or on major networks. And I’m also thinking about the scientific voice. And certainly from my perception during the early stage and mid-stage of COVID, that message got pretty muddied in there. So we have many voices. You have the patients, we have Jehovah’s Witnesses I was talking about, longstanding beliefs. You have people coming out with new thoughts based on their life situation. You have recognized journalists and you have scientists. How do they vary in this problem?

HEIDI: Well, I’ll say one thing first. I think one of the things that was true pre-COVID and is bearing out in the research we’re doing now is that people are most potently persuaded by their own physician.

HELEN: Oh, okay.

HEIDI: We show time and time again that this is true for childhood vaccination and this is what our participants are telling us, is that when their doctor takes the time to talk to them, answer their questions, to fully explain in this circumstance, what are the circumstances under which I would need a transfusion? Why are you asking me to do this? Rather than simply getting a form and being asked to sign it or something like that. Once they get their questions answered and addressed, all of our participants so far, all consented to getting the blood transfusion in the end and going through with their procedures. And again, this bears out in a lot of data over time of pediatric circumstances as well, where when physicians have a good relationship with their patients, when they talk to them and address their questions and concerns, parents are more likely to be persuaded to vaccinate. So I think that media is an important part of the conversation. I think the degree to which media can come at this issue with more understanding of the nuances of why people are concerned about vaccines, why people are worried or fearful of the COVID vaccine, balanced reporting, those types of standards I think are really helpful. But physicians are really the most powerful initial voice. And I know that there are a million structural constraints around everything I just said, that doctors want more time with their patients and they want all this stuff. It’s not that they don’t want to engage with their patients. It’s lots of constraints around them that keep them from doing that. But knowing that, coming at the situation from a point of understanding and listening on behalf of the physician makes a really big difference in the end outcomes for patients.

HELEN: Thank you. I’ve got a question about the physician part or a health practitioner dealing with a patient, somebody is sick or needing a medical appointment for some reason. Is there a difference between an emergency situation where something needs to happen right away versus a long-term chronic or an incipient condition there that’s just emerging? Is the way to talk about this different? And when an emergency, I would figure that the health professional may not have much of a relationship already with that patient. The person with a chronic disease, they probably do have a longstanding relationship. What do you recommend in clinical practice, again, knowing you’re not clinicians but what you’ve learned from your research?

JESSIE: Really quickly, I would, I guess, like to clarify something because it does connect to this. That last point when I was discussing online discourse, I just want to make it clear that the people I was describing weren’t actually patients at the time. So, most of what I see on online discourse is a fear of what if, and that is this emergent situation, right? And so, that’s kind of where this gets a little bit more tricky because we’re looking at online discourse, the chances that these people will ever actually need a blood transfusion might be quite low depending on who is engaging online. And I think that’s a little bit important to kind of counterbalance. And then, yes, it does bring us to this emergent situation, people who are concerned about emergencies, and we have seen that made up best in different ways, but I think I’ll kick it to Heidi. She heard us talk about the clinical perspective, thinking about physicians.

HEIDI: Yeah. I mean, I think that one of the things that we see time and time again, again, in medical rhetoric research is that relationship building is that, you know, again, coming from a place of understanding, compassionate discussion, careful listening, those types of practices really have a lot of benefits for patients in the end. I think when it comes to vaccines, there are practices where they’re, you know, vaccinate or leave practices, right? Where you’re unwelcome if you don’t want to be vaccinated or physicians talk about firing their patients because, you know, and I’m very sympathetic to this. You know, I have all this expertise. I know what I’m talking about. I don’t have all day. Every time you come in to answer a million questions about stuff you’ve seen on Facebook, you know, you either just get the vaccine or go, right?

HELEN: Right.

HEIDI: And I’m extremely sympathetic and understand that position. But we saw this with COVID, right? And this is the case for the patients that we’ve interviewed so far, our participants, is that they were very reactive to vaccine mandates. They were very concerned about the safety of the vaccine. And sometimes, like, just forcing someone to do what you want them to do has this kind of other consequence. They might do the thing you want them to do in the moment, but you might have broken the relationship or there might be something that happens to trust there. And so, you know, you’re right, Helen, to think about the contrast of, like, more chronic versus acute or emergency situations. Yes, like sometimes, obviously, doctors have to make calls and they have to do what they need to do. And, you know, they, of course, we, I think everyone, even our participants, right, when they understand that the doctor is doing something that’s truly necessary, they’re like, go ahead, you know, go ahead. Do the transfusion if you need to save my life. But understanding maybe from the patient’s perspective, their lived experience with that condition, what did they perceive this to be acute or an emergency problem? And if not, they want to talk and they want a moment to consider and they want to have those questions answered. And if they do, that’s a real opportunity for trust building and relationship building that might pay dividends down the road. That’s what our participants tell us and what we want to share with any clinicians who are listening today.

HELEN: Thank you. Heidi and Jesse, I know you’re not doing this alone. You said there’s a whole team. Tell us more about who you’re working with on this great project.

HEIDI: Yes. So we work with a small team of other researchers in medical rhetoric. They are Julie, Dr. Julie Gerdes and Temi Ojedeli, both at Virginia Tech. Dr. Gerdes is an assistant professor in the Department of English there. And Temi is a graduate student, just like Jesse.

JESSIE: Jesse, what can you tell us about someone newer in their career, newer in their exploration? Which would be you? You know, what do you want to tell people who are just at the beginning? Where do you see opportunities and interests and how does someone find that? You know, at first thought I’m thinking about just staying curious. As a graduate student, I never expected two years ago to be on a project as a writing student examining blood, like literally and also analytically. And it’s been so fascinating, such a cool assignment. And so it’s just what comes from staying curious, asking questions, whether they seem simple or not to, you know, and engaging in perhaps interdisciplinary, bringing your discipline specific knowledge to interdisciplinary situations when possible, because it leads to really cool new insights and knowledge. I’ve really enjoyed it.

HELEN: Thank you. I’m just listening to both of you. I love the part you bring in interdisciplinary, it certainly is. We’re talking to an interdisciplinary audience. You’re exemplifying that. And as you’re talking about the problem of why some people may refuse blood transfusions and what to do about it, I’m going back to what you said in the beginning. We all kind of need an inoculation these days of some way to build those trust and find our shared values and hear each other’s beliefs. Thank you so much for doing all your research. We all look forward to hearing your published results and reading about that. Thank you so much for sharing it with us and talking about blood.

HEIDI: Thank you so much, Helen, for having us.

JESSIE: Yes. Thank you, Helen. This was wonderful.

HELEN: As we just heard from Heidi Lawrence and Jesse Wiggins, it’s important to think about our beliefs and our values and building trust with all the people we care for and care about. And that includes issues of blood transfusions and why some people may, at that moment, choose not to do that. To learn more about The Blood Project and explore its many resources for professionals, for trainees, and patients, go to thebloodproject.com. I invite you to also listen to my other podcast series, and that’s about health communication. And it’s called Health Literacy Out Loud at healthliteracyoutloud.com. Please help spread the word about this podcast series and The Blood Project. Thank you for listening. Until next time, I’m Helen Osborne.