“You know what’s really uncomfortable and annoying? When you die.”
These desperate words come from New Jersey Governor Phil Murphy attempting to rally residents’ vigilance and deter the spread of COVID-19. The social response to getting vaccinated for COVID-19, both in America and worldwide, is polarized.
The Pfizer and Moderna vaccines were approved for emergency use by the FDA at the tail-end of 2020. A survey conducted in January 2021 revealed that almost half (47%) of Americans have already been vaccinated or plan to be vaccinated as soon as possible. 31% of Americans plan to observe the vaccine’s effects for a while longer before getting in line, and the remaining respondents fall between extreme hesitancy (7%) and outright refusal (13%) to receive this vaccine. While global data about vaccines is harder to obtain, one meta-analysis across 13 countries showed that COVID-vaccine hesitancy has increased over time, with no significant changes in any particular demographic, but has recently begun to slow.
Vaccines depend on herd immunity in order to minimize spread between susceptible individuals. While early predictions said that 70-80% immunity would be sufficient, recent developments have provoked Dr. Anthony Fauci to raise that number as high as 90%. This margin for refusal is growing smaller, and tends to be reserved for those who cannot be vaccinated for medical reasons.
The scientific community is challenged to meet herd immunity due to a large vaccine-hesitant population.
While the vaccines are a solution for the scientific community, they have equally raised many problems. The diversity among groups that are hesitant to be vaccinated leaves public health leaders wondering how to address all of their concerns.
While vaccine-hesitant individuals of this era strongly diverge from anti-vaccination movements in the past, these historical moments can still inform present-day scientists of what work needs to be done moving forward.
While some consider “anti-vaxxers” to be a turn-of-the-century phenomenon, anti-vaccination movements are as old as vaccines themselves. The first vaccine trial in Western history was completed after Edward Jenner reported smallpox prevention in 13 subjects to the Royal Society of London in 1796. He created the term vaccine from the Latin variolae vaccinae (the scientific term for cowpox) because he conferred smallpox resistance in his subjects using active cowpox pustules. The United Kingdom began universalizing the vaccine throughout the 19th century, mainly through legislation. Most notable was the Vaccination Act of 1853, which required all infants to become vaccinated within three months of birth.
The backlash was immediate; the Anti-Vaccination League began in the same year, claiming that mandatory vaccination was a breach of personal freedoms. These groups inconsistently blended scientific, political, and religious arguments. The most distinct anti-vax writings from this time often included allegorical tales to captivate their audience more than any hard science from the intelligentsia.
American anti-vaccination movements arose later. Dr. Benjamin Waterhouse, a professor at Harvard University, successfully mimicked Jenner’s technique at the tail-end of the 19th century. Congress left individual states to decide what measures to take to vaccinate Americans against their own smallpox outbreak.
The main endeavor of the American Anti-Vaccination League and its affiliated groups was to remove government control over health requirements, health patents, and medical licensure. They wanted to bring more “everyday” health officials to the forefront and make medical practice more accessible in itself. Religious groups, pseudoscientists, and fringe anti-imperialists all converged into the Anti-vax platform with these ideas.
In fact, D.W. Ensign, the treasurer of the American Anti-Vaccination League, was simultaneously the owner of Ensign Remedies, a service that sold “potent” medicines direct-to-consumer. While Ensign and his partners were under constant legal fire for misbranding their products, he stood to make massive profits if pseudoscientific medicine entered the mainstream. For him and many other anti-vax ringleaders, ideology was a simple means to their financial gain. While companies like Ensign’s were dangerous, they also served as beacons of hope for people who couldn’t afford cutting-edge scientific treatments at their inflated prices.
A 1982 documentary entitled “DPT: Vaccine Roulette” on WRC-TV presented a famously lopsided take on the contemporary whooping cough vaccine. The main concern was a hyperfocus on the damage that vaccines can do compared to the damage of their contagious illness counterparts. While it sparked bitter controversy from several scientific and journalistic platforms, it established the core platforms that are seen in anti-vax movements of today.
What are the nuances of the COVID-specific vaccine discourse? And how does this discourse reflect the larger anti-vax framework?
While many refusers of the COVID-19 vaccines would not consider themselves broadly anti-vax, their ability to speak out is grounded in the original movement. The current vaccine debate has not only brought anti-vax to national attention but also throughout the world. These refusers reveal a crucial insight: anti-vax as a platform has evolved tremendously from its conception in history and from how the public has perceived it.
First, the motif of religious entities trying to demonize vaccinations has moved to the background. Anti-vax is a movement that is stepping away from spiritual fear mongering and toward scientific knowledge. Some are concerned about the vaccine schedule in young children, which is understudied at present for its safety and efficacy. While it has been proven safe in the past, the effects of new vaccines, like the ones for COVID-19, aren’t factored in. This is a major reason why the Pfizer and Moderna vaccines were first authorized for emergency use solely in people aged 16 and up. Many vaccine refusal platforms also discuss frightening concerns such as the numbers of healthcare professionals who distrust the vaccine and the lack of confirmation that the vaccine hinders viral transmission. These are all genuinely important issues that should be incorporated into the popular understanding of the COVID vaccine and are often overlooked by overzealous media.
Anti-vax movements have also grown in resistance to the “deficit approach” by scientific institutions. This approach refers to pro-vaccine organizations like the CDC continuously supposing that vaccine refusers lack the scientific knowledge to understand the issue. In reality, there are rational grounds for concern: this vaccine is new, untested for long-term impact, and is being rapidly pushed into the public.
There are more compartmentalized concerns among specific groups as well. Recent studies have found that black adults generally want to wait to get the vaccine, and 1 in 5 are in opposition to receiving the vaccines. Of course, aversion to medical practice among black communities tends to be fueled by past and present racial disparities in healthcare, especially the Tuskegee Syphilis Study.
Republicans are the most reluctant to become vaccinated; roughly 1 in 3 are somewhat or strongly opposed. Republicans have historically been more wary of vaccines than Democrats, which has only been fueled by a bizarre politicization of COVID-19. From the start of COVID-19 coverage in early 2020, media outlets served as a primary source of information regarding all areas of the pandemic. Yet, many of these media outlets were already incredibly polarized against the backdrop of an election year. Thus, the information related to COVID-19 that people received differed dramatically, usually along party lines. Because this information is both politically and emotionally charged, this information often lacks objectivity and, sometimes, factuality.
The vaccine debate seems to be at a stalemate. There are opposing interests, in every corner of the world, trying to disburse the information favorable to their personal stance on vaccines. Scientists could simply lay back in the face of previous vaccine debates, arguing that the vaccine data are proof in themselves. But with an entirely new vaccine, scientists as a community need to start over. When this vaccine snags in any way, scientists present a cohesive explanation that is both scientifically accurate and digestible to the public. Groups on either side of the vaccine debate constantly fight for control over online spaces. Media outlets, especially social media platforms like Twitter, have rapidly become the main source of vaccine information for many people, placing an exhausting focus on optics. The interconnection of different countries via social media has also carried the anti-vax platform to the global stage.
As more vaccines become available globally, it is likely that patterns of resistance will emerge that mirror those of the United States. International health organizations will have to come up with multiple solutions to address the overlapping vaccine concerns of the global population.
Journal on World Affairs, UCLA 