Quit mocking “anti-vaxxers” and understand roots of vaccine hesitancy

Posted on Friday, December 11, 2020

Author: Prof. Michael Orsini

Faculty Affiliate, ISSP
Full Professor, Feminist and Gender Studies and Political Studies, Faculty of Social Sciences, uOttawa

Has a smugness washed over the COVID landscape with news that a vaccine is on its way? 

Yes, there are logistical challenges related to the rollout. Will there be enough vaccine? Who will get it first? Will countries hoard it for their own citizens? These questions require attention, but a vaccine is a game-changer, right? There is no sense in quibbling about the small stuff.

Not so fast. 

Vaccines only work when we achieve ‘herd immunity’, which “happens when a virus can’t spread because it keeps encountering people who are protected against infection.” Scientists estimate that 70- 80 per cent of a population must get immunity, preferably from a vaccine, in order to achieve herd immunity from COVID-19. This threshold varies depending upon the reproduction number (the number of people that a positive person can infect), and the vaccine’s effectiveness. 

Will enough citizens simply agree to roll up their sleeves? Well, that depends on a few things. 

First, the public will need assurances that the vaccine is safe and that it works. One study published recently in Nature Medicine presented some sobering data in this regard. Canada ranked 12th – even behind the US - out of 19 countries surveyed in terms of the percentage of respondents who agreed with the statement: “If a COVID vaccine is proven safe and effective and is available, I will take it.” Just over two-thirds (68.7 per cent) of Canadians surveyed said they would. This may not seem catastrophic - that percentage may shift upward once we move from the hypothetical to the real - but it should be cause for concern.

Lest anyone be fearful of a draconian public health response, Alberta Premier Jason Kenney was first out of the gate to soothe his base with word that Alberta would not mandate COVID-19 vaccination. The governments of Ontario and Saskatchewan quickly followed suit. To wit: no one actually threatened to impose blanket vaccination mandates. Rather than fan the flames of fear, governments can expend energy on how to communicate with citizens who may have legitimate concerns about a COVID-19 vaccine.

Identified as one of the top global health threats by the World Health Organization (WHO), vaccine hesitancy “refers to delay in acceptance or refusal of vaccines despite availability of vaccination services”, and “Includes factors such as complacency, convenience and confidence.”

A singular focus on individual behavior, however, can overlook other factors that might account for the rate of vaccination coverage, such as the influence of social determinants. In addition, the painful legacies of racism and medical experimentation may explain the reluctance of some Black, Indigenous and racialized communities to get vaccinated.

It might be comforting to dismiss people who are vaccine hesitant as irrational, yet none of this really helps us to understand the emotional terrain on which vaccine hesitancy operates. People who are hesitant may not even know what they do not know. And we should properly distinguish people who are categorically opposed to vaccination from those who are genuinely unsure or indecisive. Lumping them together only muddies the water.

Vaccine hesitancy (and outright refusal) may be thriving in this era of post-truth, but it existed long before it. Indeed, conspiracy theorists have spent years tapped into longstanding anxieties about vaccines, including the now-debunked theory of the link between MMR vaccine and autism. While the journal retracted the study years ago, it persists in the public imagination. 

"We shouldn’t fight fire with fire", says health law professor Timothy Caulfield. “We should fight fire with science-informed fire.” The “information deficit” model incorrectly presumes that uninformed or misinformed people will be swayed by hard facts alone. We need to understand how to inform the public in compelling ways, recognizing that people reason with emotions. Social scientists can be indispensable in this regard, suggests University of Edinburgh sociologist Martyn Pickersgill in a letter to the British Medical Journal urging the government to engage researchers who understand the complex politics of vaccination uptake. 

As sociologist Arlie Hochschild explains in her account of polarizing debates in US politics, emotions help us to understand the deep stories that structure people’s lives. “A deep story is what you feel about a highly salient situation that’s very important to you. You take facts out of the deep story. You take moral precepts out of the deep story. It’s what feels true. I think we all have deep stories, whatever our politics, but that we’re not fully aware of them.”

So what should be done? The first step consists in probing these “deep stories”, which may help us to understand individuals’ reluctance or hesitance to vaccinate. A small subset of people is likely unreachable but for the others, it is not too late. 

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