By Ross D. Silverman, Katharine J. Head, and Emily Beckman
As professors studying public health policy, narrative medicine, and how providers and the public communicate about vaccines, we recognize the power and peril of using the rhetorical tool of metaphors in vaccination and, more broadly, the COVID-19 response efforts.
Metaphors can be an effective shorthand to help people understand complex ideas, but we also must remain cognizant of the many ways metaphors may distort, divide, or misrepresent important details.
“A spoonful of sugar helps the medicine go down,” sang Mary Poppins in the classic movie. We recently learned the song’s inspiration came from news a needle-fearing boy shared with his songwriter father about the appealing approach school nurses used to deliver the polio vaccine. The metaphor has become an almost universally-adopted stratagem for overcoming life obstacles of all kinds.
Metaphors have a long history and remain pervasive in our everyday thought and speech. But what makes a good metaphor? Arguably, the most important measure is the perception of a metaphorical or semantic “fit” between the chosen metaphor and the everyday idea being referenced.
For particularly complex ideas the metaphor must fit the whole way through in order to produce the intended effects. Research has shown, for example, that when metaphorical depictions of a risk (e.g., UV exposure as a battlefield) are paired with matching metaphoric terms to ward off that proposed risk (e.g., sunscreen as armor), people are more likely to act in self-beneficial ways.
Metaphoric misfit, on the other hand, can have detrimental effects, such as encouraging people to think about a threat — and a solution — in unhelpful ways. Consequently, we must be careful with the metaphors we use to discuss sensitive and complex topics like health and illness, and that includes how we discuss pandemics and vaccines.
Many COVID-19-related metaphors represent attempts to build a common cause within the population. Most prominent and problematic are war-related metaphors. These have a long, mixed history in public health. Diseases often are portrayed as “us versus them” narratives, with foreign invaders and hidden carriers threatening our bodies and communities. In response, we’re incited to mount forceful, jingoistic defenses.
We also see war metaphors in our COVID-19 vaccine discussions. While vaccines may not be silver bullets for the pandemic, they are part of the nation’s “Urgent Battle Plan” against COVID-19 and could be a “turning point in the battle.” The unique innovation of Pfizer and Moderna vaccines, which use messenger RNA (mRNA) to mimic the SARS-CoV-2 virus proteins, is described as a finely-tuned strike disabling the virus’ “landing gear,” prohibiting SARS-CoV-2 from causing disease in our bodies.
Taken too far, war metaphors can become quite atrocious, complicating epidemic response, hindering testing and public health practices, fueling stigma, racism, hesitancy, paranoia, and misinformation, and spurring nationalist, or violently defiant, actions.
The U.S. government’s moniker for the coordinated vaccine development, Operation Warp Speed, is both a military metaphor while also linking the vaccine to ideas of travel. Warp Speed, a faster-than-light rate of movement many of us first learned from the science fiction show Star Trek, is an apt metaphor for the record-breaking pace at which these new vaccines were developed, manufactured, and distributed to the American public.
However, as many of us learned from the movie Spaceballs, such a metaphor also can evoke images of conflict, as well as concerns in some of the public about risks associated with prioritizing speed, despite data and expert analyses showing these vaccines to be both safe and effective.
Other travel metaphors evoke hope, such as the light at the end of a tunnel, while also reminding us of the long and difficult journey through the pandemic. Or, we might consider the boarding of the train and the subsequent journey as representative of the safe delivery/receipt of the vaccine. Both are potentially problematic, as the metaphors fail to capture the limited availability of seats on the train. Very different from train travel, mountain climbing metaphors imply months of preparation before a long and treacherous uphill journey.
Travel metaphors suggest movement toward knowledge or resolution, which is useful only if we all agree and are able to embark on the same journey.
With the uncontrolled spread of the virus, another common metaphor used by leaders has been that of fire. In terms of metaphorical fit, this one may be the most apt, with the virus described as a raging fire, individual vaccines seen as a cup of water, and mass vaccination seen as a fire hose. In addition, the metaphor of fire aligns well with a number of other important features of the pandemic response, such as attention to community responsibility to reduce contagion and the key role of essential healthcare workers (“firefighters”) to manage the fire.
A number of other metaphors have emerged in the public dialogue, including the long familiar herd immunity metaphor to discuss population-level protection, chess as a way to talk about the logistics involved in vaccine distribution, and even a likening of the technology behind the vaccine to playing a new XBOX game in an existing XBOX console.
Beyond the use of language, visual metaphors are also being adopted, such as the swiss cheese model, which shows vaccines as part of a large conglomeration of steps necessary to fight COVID. A group of Spanish academics have even started a crowdsourced multi-lingual open-source document with the moniker #reframeCOVID to capture the large array of COVID metaphors being used around the world.
The introduction of new vaccines have always been accompanied by metaphors. Since the late 18th century when the first smallpox vaccine was administered, people have responded to these interventions with both enthusiasm and concern, and nowhere is that tension more apparent than in the way metaphor was used to describe that first discovery. Strongly opposing mandatory vaccination, George Barnard Shaw famously referred to the smallpox vaccine as a “filthy piece of witchcraft.” On the other hand, 18th century English writer Samuel Butler characterized vaccination as the “medical sacrament corresponding to baptism.”
Metaphors are a natural part of human communication, and can help to convey complex information. While no metaphor will be practically perfect in every way, they, like the vaccines, are tools we can use in these critical efforts.
The importance of metaphoric fit when talking about COVID-19 response cannot be understated.
Therefore, we urge political leaders, healthcare providers, and the media to be careful in their metaphor use going forward, doing the work necessary to understand the intervention needs of the situation and the communication needs of communities they are trying to reach. In other words, we must be careful to choose the right tools for this critically important job.
Ross D. Silverman, JD, MPH is a Professor of Health Policy and Management at Indiana University Richard M. Fairbanks School of Public Health and Professor of Public Health and Law, Indiana University Robert H. McKinney School of Law. Contact via e-mail at firstname.lastname@example.org or on Twitter: @phlu.
Katharine J. Head, PhD is an Associate Professor in the Department of Communication Studies, IU School of Liberal Arts, Indiana University-Purdue University Indianapolis.
Emily Beckman, DMH is Director and Assistant Professor of Medical Humanities and Health Studies at IU School of Liberal Arts, IUPUI and Co-Director, Scholarly Concentration in Medical Humanities, Indiana University School of Medicine.