The COVID-19 pandemic: a modern echo of historical patterns of vaccine hesitancy

Posted on Tuesday, October 19, 2021

Author: Maxime Lê

Lê & Co. Consultants


On Thursday, October 14, the ISSP hosted its kickoff event for the 2021/22 academic year, Food for Thought: How has COVID affected public trust in expertise? This blog is an adaptation of the speaker’s remarks.

When I was first asked to participate in the ISSP’s panel on How COVID-19 has affected public trust in expertise, it was at the peak of Canada’s 3rd wave. During that time, COVID-19 vaccines were being administered at a record-breaking pace, each day surpassing the previous days’ total. 

I thought it was a wonderful accomplishment that displayed Canada’s trust in the science of vaccination, and it showed that people understood—generally—that vaccines were the key tool we needed to get through the pandemic.

As of this writing, 81% of people 12 and over have been fully vaccinated against COVID-19. In the nation’s capital of Ottawa (home of the ISSP), over 90% of people born in 2009 or earlier are projected to be first-dosed this week

That Canada leads the world in vaccination uptake is certainly impressive, but it took a lot of work to get here. It will take even more work to increase our numbers further. At the root of that work, however, is the not-so-secret ingredient public health authorities everywhere are trying to cultivate: trust. It takes a lot of trust—between Canadians and their governments and industries, between Canadians and their public health authorities and experts, and between Canadians and their own neighbours—to have appreciably high vaccination rates. 

But for public health authorities, that trust had to be re-established. It had to be carefully managed, or even earned in the first place. Public health experts and communicators had to patiently play the long game; a tenacious exercise consisting of chipping away at peoples’ weary walls until the bridge of trust could be built, which would eventually support peoples’ journey towards vaccination. 

So how did we get here? And where are we going? Looking at current events, with anti-vaccine protesters heckling healthcare workers on their way to work, or unions fighting vaccination mandates in places of employment, one could reasonably think that distrust in public authority, in expertise, and in science is at an all-time high. However, I would wager that some people believe it is so due to recency bias, something many future government inquiries, graduate theses, researchers and historians will have the benefit of eliminating or at least accounting for in their quest for objective answers. 

Instead, I propose the following answer: that anti-vaccination and mistrust of authority, expertise and science is not new. Is our current experience the status quo from a macroscopic, historical point of view? Some would say yes, since popular zeal which empowers groups to clash with governments and experts for implementing and recommending health measures is always more fervent during a crisis, fading shortly after. Perhaps COVID-19 is no different, and only future retrospective studies will assess the accuracy of these affirmations. 

Regardless, whether it was vaccines against smallpox or measles or whatever other communicable disease, the introduction of new medical technologies and medicines have always been met with public skepticism at first. We’ve seen this precise skepticism play out with people weary of the COVID-19 vaccines and the revolutionary mRNA technology that Pfizer-BioNTech and Moderna use in their vials. In parallel, people were upset when the National Advisory Committee on Immunization changed their recommendations as the science and evidence evolved. But that’s how navigating uncertainty works. It’s calculated improvisation: doing the best you can with what you have.

For many, the rationale for shifting public health guidance was hard to understand, just like it is hard to understand for certain people why someone would reject or take a bit longer to think about vaccination. In fact, it’s normal for people to be vaccine hesitant. People have been anti-vax and vaccine hesitant since before vaccination was invented in 1796. During the first millennium, Eastern countries invented inoculation by various means to try and prevent smallpox, and many people learned firsthand to distrust such an idea, since the practice had developed a notorious reputation for being ineffective, seeming to propagate the disease it meant to prevent. And since vaccination was based on the principle of inoculation, the practice of which was likely introduced to the West via trade routes, this remarkable public health achievement has never been able to fully shed this reputation. 

In the modern era, hard-won gains in terms of health promotion and health protection resulting from vaccination are easily lost. Our society’s ephemeral memory made us forget how good we’ve had it: several cases of measles have been popping up in Canada in recent years due to low vaccination rates. We rejoiced when polio vaccines became widely available but have not been able to share such jubilation with certain parts of the world where polio is still endemic

Vaccines in general, and COVID-19 vaccines in particular, have been shown to be safe and effective. They have inoculated billions of people across the world. So why do some people still mistrust them if objective numbers clearly show they are beneficial? 

It should be no surprise by now that the answer is quite simply about trust—but not in public health officials or scientific authorities or governments. Instead, some individuals have found comfort and trust in groups that don’t pretend to be authority figures, and present themselves as representatives of the “everyday citizens” in the country. Indeed, there are some groups that have been actively trying to recruit or convert like-minded people, convincing them not to get vaccinated. One of those groups was the subject of my thesis on online anti-vaccine argumentation in Canada. These people question the legitimacy of science and authority. This perspective in particular is one that scholars categorize as a postmodern paradigm, and it’s hardly unique to anti-vaccination. Anti-lockdowns, anti-government, anti-science, anti-flavor-of-the-day... all of these groups share the postmodern point of view. And it works. Private social media groups and covert keywords that avoid certain filters are constantly spreading across the internet, slowly building an important membership and financial base. 

So, how did COVID-19 affect public trust in expertise? It helped unite people across the world against technocracy. The vaccine hesitant were able to find solace in groups that made them feel safe, welcome, heard, and understood. Yet these groups have always been present anywhere in the world and during any chapter of history. It’s just that we are more aware of them, and they are more connected.

Emerging from this pandemic will mean that public health authorities everywhere will have to try and shift their communications efforts from the traditional models of science communication towards something that is more tailored, personalized. One-size-fits-all strategies don’t work, especially if there are inherent cultural and educational differences between populations which are common everywhere people live, work and play. The strategy must be adapted, segmented for each sub-community. And, by taking a page out of the anti-vaccine playbook, we can try to spread pro-vaccination messaging not from “big government”, but rather, have them be delivered by trusted community members and leaders who can be trained on vaccine promotion. 

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