In June 2020 at the height of the COVID-19 pandemic, I sat in the hospital parking lot with my mom and brother in the early morning hours in shock and silence. After a nearly three-year remission, my father’s lung cancer resurfaced at about the time the COVID-19 pandemic virulently surged. He had just had his first chemotherapy treatment earlier in the day in an attempt to aggressively fight the cancer, and that night after having dinner and watching TV, he suffered what turned out to be a massive heart attack that he would not come back from.

After receiving the phone call, I rushed to the hospital to meet my family, assuming most of us would be waiting in the lobby with my mom perhaps allowed to go inside. But that was not the case. Nobody was permitted to step foot in the lobby, and thus we sat in the parking lot piled in one car waiting for news. As I waited, my thoughts turned to imaginary pictures of the doctor working on my dad who I could only envision via his voice on the phone from the parking lot. He had a strong, calming, yet authoritative voice. I pictured this strong man working behind the drawn pandemic line between my car and the hospital walls trying to save my father’s life while worrying about his own health given the virality of the pandemic.

We say a lot about doctors in the United States and not all of it is good. One of the pitfalls of the health information seeking age is that it has led to diminished trust in physicians and physician advice (Lu et al., 2018). Yet that night in the quiet parking lot, I had only noble thoughts about this doctor and his profession. The image of him serving at the height of the COVID-19 pandemic embodied what I thought of as altruism, a practice of selfless concern for the well-being of others.

Later, when I began to feel like working again, I recalled the physician who put his health at risk to try to save my father. Thoughts of his presence, of other healthcare workers working at the risk of virus susceptibility, of personal behaviors required of each of us to slow the spread of the virus, and of the need for SARS-CoV-2 acceptance all began to swirl in my head. With these thoughts, I began to recognize that altruism could be better leveraged as a variable in health behavior change strategies aimed at pandemic protective behaviors and beyond.

My decision to begin exploring altruism post my father’s death during the pandemic initially began with my interest in vaccinations. As a social science researcher who investigates vaccine promotion and behaviors, I have noted much scholarship that importantly decries that individuals who do not vaccinate take advantage of herd immunity, or the protection provided by the immunization of others. Given that a breakthrough SARS-CoV-2 vaccine has just been announced, the success of the strategy to globally protect humans from the pandemic will rely on the general public’s acceptability of immunization so that herd immunity is created (Schaffer DeRoo et al., 2020). That means we will need most of the population to vaccinate, including those who might consider themselves immune, afraid, or simply do not want to vaccinate, in order to protect the whole of society. Yet, while altruism appears to have been recognized for some time as a public health strategy for promoting preventive behaviors such as the wearing of seat belts (Giubilini & Savulescu, 2019), it has less frequently been applied as a public health strategy to vaccination adherence (Shim et al., 2012). I can clearly see how it could apply to vaccination uptake strategies because vaccinating could potentially, at times, provide greater protection to a community than to an individual by reducing the spread of disease in a vulnerable population, especially if herd immunity is already present (Shim et al., 2012).

Upon reflection, I set out my transcripts of interviews in progress with mothers about the human papillomavirus (HPV) vaccination decision-making process for their children and began pouring over their words. I was setting out to explore any signs of altruism, specifically, signs that showed mothers considered others in their decision about vaccinating their child for HPV. In most U.S. states, HPV is a recommended rather than a required vaccine, so parents have much freedom in deciding if and when to vaccinate. As I looked over their narratives, I found evidence of the theme of “me, myself and mine.” Stories about why mothers chose not to vaccinate, in particular, sounded like this: “My child does not need it; My child is not sexually active; I taught my child to put marriage first; I do not feel it is safe for my child.” Of course, mothers are responsible for their child’s safety, and aside from the most important fact that the vaccine will also protect “my” child from cancer, what about protecting a future partner or spouse from HPV-attributable cancers? I was not finding that but maybe I just was not asking the right question. So, I added a probing question to explore whether mothers had considered outside factors in their decision to vaccinate. While I primarily continued to find signs of altruism lacking from those who had not chosen vaccination, I began to hear signs of it from mothers who had accepted vaccination for their child. Many mentioned that they had considered and even talked with their children and spouses about the responsibility to protect others from cancers in addition to themselves. I had been blinded to altruism as a possible motivating variable in vaccine acceptance.

Although a SARS-CoV-2 vaccine is now being administered to select populations, until it is available to all, it is simple behaviors that can slow the virus. As Dr. Deborah Birx, response coordinator for the White House Coronavirus Task Force stated, “There’s no magic bullet. There’s no magic vaccine or therapy. It’s just behaviors … Each of our behaviors translating into something that changes the course of this viral pandemic” (C-SPAN, 2012). Thus, to continue to slow the virus, each of us will need to work to protect the other.

As someone working in Florida, I am vividly aware of the rising virus incidence rates in the state. Political leaders are stymied by how to encourage social distancing among people in bars, restaurants and beaches, where tourism is such a part of the state. It is rational and logical to follow public health experts’ behavioral advice, yet the influx of health and science misinformation that surrounds the COVID-19 “infodemic” has made it clear that humans are not always “logical, calculating or rational” (Nguyen & Catalan-Matamoros, 2020). Factual information is not enough to motivate adherence to public health expert recommendations during this pandemic, and thus it is going to take an understanding of “the interaction between rational factual knowledge on one hand and emotions, values and beliefs on the other, and how it shapes public engagement with the health and science issues at stake” to best strategize and mobilize adherence (Nguyen & Catalan-Matamoros, 2020). Because adherence may call for people to behave in ways they do not want or feel they need to behave, we, as health communication practitioners, must dig deep into ways to bring altruism to the forefront of consciousness.

Following this train of thought, I recently talked with a colleague who developed the terror management health model, which elucidates how the conscious and nonconscious awareness of death can influence the motivational orientation that is most operative in the context of health decisions (Goldenberg & Arndt, 2008). Generally, when death is at the forefront of the mind, people are motivated by health risk to take protective measures, but when death recedes immediate consciousness, people are driven more by ideological concerns. The conversation around the theory spurred interest in exploring whether one of the ideological concerns might be altruistic notions like collectivism. The question is whether the ideals could be encouraged to promote adherence to pandemic preventive behaviors and willingness to accept SARS-CoV-2 vaccination when death of the virus is not of immediate concern, as might be the case as incidence rates decrease or personal affectation is not present. Further, altruistic notions might even be used in the terror management model as a motivator to encourage individuals who do not believe COVID-19 to be a severe threat at all, whether due to misinformation, belief systems or risk assessment factors. A current study under review by myself and colleagues of mothers’ perceptions of COVID-19 risk and willingness to accept a SARS-CoV-2 vaccine alludes to the possibility. We found that a few mothers who expressed low perceived threat of COVID-19 for themselves and their young families still practiced preventive measures to protect their elderly relatives and were more accepting of vaccination for the elderly. The same line of altruistic inquiry might also apply to parents’ willingness to accept other vaccines such as HPV when a child’s cancer is thought to be a distant possibility or even when it is not thought to apply at all due to misinformation and/or lack of belief in its need.

Although not to its full capability, health communication researchers have recognized altruism as important to behaviors surrounding societal issues such as poverty, blood donations, and more (Enelamah & Tran, 2020; Ferguson & Lawrence, 2016). Although I grieve a different outcome for my father, my own experience feeling immense gratitude for my father’s surgeon at work during the peak of the pandemic heightened my awareness of altruism’s potential use in health behavior change strategies for vaccination, COVID-19 prevention and beyond.