Did the pandemic actually cause vaccine hesitancy? Or did it precipitate underlying emotions that were always there? Both?
There have always been a multitude of ways for people to communicate their distrust of vaccines. Riots. Protests. Caricatures of people turning into animals after receiving the smallpox vaccine. A leading early anti-vaccinationist, Dr. Alexander Ross circulated a pamphlet widely that criticised the smallpox vaccination. Ross seized on the opportunity of increased health measures to gain authority, notoriety and personal fame. He painted himself the maverick in his story - the “only doctor; who had dared to doubt the fetish” of vaccination..”That was the response to the initial smallpox vaccine discovered by Edward Jenner in 1796.
Opposition to the MMR vaccine
One reason people can be susceptible to conspiracy theories is stress. I`ve written about this before, but our biggest fears as people are lack of certainty and fear of the unknown. In a hugely uncertain situation, like when parents have to make a decision about vaccinating their child. That fear is exactly what was exploited in a series of major controversies around the MMR vaccine. The first highly publicised vaccine controversy started with the airing of a documentary called Vaccine Roulette by the NBC affiliate WRC on April 19, 1982. Over the course of an hour, the documentary showed emotional stories of parents who believed their children to be vaccine injured, interviewed “experts'' with dubious histories, and emotive footage of children screaming, crying, spasming, and becoming severely disabled and retarded allegedly because of the pertussis component of the DPT vaccine.
The programme created a firestorm. The media exploded with sensationalist headlines. The radio station received thousands of calls praising the documentary and stories of American families worried about the vaccine. Local doctor's offices were overwhelmed with calls from concerned parents. National inquiries about the DPT vaccine increased by 25%.
Thus, concerns around vaccines can create an impact on a huge scale. One of the most famous vaccine controversies began with a paper published in 1998. It was published in the prestigious medical journal The Lancet. Titled “Ileal lymphoid nodular hyperplasia, nonspecific colitis and pervasive developmental disorder in children”, it implied a link between the triple-dose MMR vaccine and autism spectrum disorder in children. However, it was later discovered that the lead author Andrew Wakefield had altered details about the children's medical histories, manipulated data, and was paid by a personal injury lawyer called Richard Barr who was representing parents of children who were suing MMR vaccine manufacturers. Further, eight of the subjects in the study were client's of Barr`s. The paper was retracted. Following the longest-ever inquiry by England`s General Medical council, Wakefield was discredited and lost his medical licence. Further, the study itself was discredited with 10 of the authors removing their names from the study in 2004. Also, several large scale epidemiological studies finding no evidence of an association between the triple dose MMR vaccine and a risk of developing autism.
Given this history, it is unsurprising that tension exists around the subject of vaccines. However, it was always there. There was always underlying mistrust. Why? There wouldn't have been such a huge outburst to the events I described here if there wasn't. People don`t get this furious at single events for no reason. It's the same in any relationship. Emotional outbursts over seemingly small events are actually the manifestation of a lot of pent-up emotion. Which probably accumulated over many other, small events.
If someone feels repeatedly mistreated, for example, mistrust will grow. Maybe they got a strange look or word from a healthcare provider or other healthcare staff. It doesn't just have to be this, though. It can be seeing a video that slightly questions vaccines, which sends them down a rabbit hole online. Maybe one or more of these things happen. Scale that up to millions of people and you get the phenomenon of vaccine hesitancy. This tension really precipitated in the SARS-CoV2 pandemic in 2020, which is still ongoing as I write this in February 2023. But how did this actually show up?
One thing is very clear. There`s a common denominator under all historical vaccine protests - mistrust. It's not as if it was suddenly created by the pandemic. It was always there. People always hated feeling controlled. That element of it isn`t new. It's just that development of new vaccines, pandemics, and other public health events, brings underlying mistrust and other emotions to the surface. So what`s clear from this is that mistrust is established over a long period of time. Therefore, so is trust.
On that note, we need to start thinking about building trust between the public and health authorities in a long term way. Many people, including me, have said that “we need to build trust”. Very true. However, it's not just that. It's building trust in a long term, sustainable way. Trust is usually a feature of longterm relationships. That means it`s a priority all the time. I believe that that is the way need to think about the relationship between the public and health authorities. If strong trust is established in “ordinary” or non-pandemic times, that base of trust will already be there when the next pandemic or public health emergency does occur. Due to this, people will be more open to taking health precautions recommended by authorities. Why? They trust them.
How do you build trust in a longterm way?
So how do you do that? How do you build trust in a long-term, sustainable way? It's one thing to work on trust with one other person. However public health involves the PUBLIC. That can be thousands or even millions of people, depending on how big a country is.
How do you establish trust with such a diverse group of people? Who have such diverse value systems, cultures, and ideologies? Not only these, how do you make sure that trust extends to future generations?
Obviously, it's like any issue. Not everyone is interested or willing to engage. Of those who we do engage, it won't be possible to get through to everyone. As I say, people are diverse. It's naive to assume everyone will be open to listening. However, with that, there are several things we can do to reach the highest number of people possible.
I would say that the first thing to consider is that trust is a feature of longer term relationships. Meaning it's a priority. All the time. Establishing trust in this longer term way between the public and health authorities means that when the next pandemic comes (and believe me, it will), there will already be that strong foundation of trust. Which means that ultimately, people will be more willing to take precautions. That will also apply to pandemics further in the future. Which, again, sadly will happen. So it's as much about how we define trust as it is about actually building it.
This realisation really sparked a stream of thought for me because in truth, the cultural aspect of vaccine hesitancy has been hugely under addressed. Student house parties were a huge concern in Ireland in terms of COVID 19 transmission.. According to an article in the Irish Mirror published on 17th September 2020,parties occurred in student accommodation in Dublin 2 to 3 times a week despite COVID 19".
I`ll be honest. I was upset when I read this. It's easy to dismiss this as reckless behaviour. To not dig any deeper into this behaviour. However, let's think for a minute. What motivated that behaviour? Remember, these students had been in lockdown. Hadn't had the opportunity to socialise. I`m not condoning the behaviour or anything. It was still abhorrent, but if we don`t want that to happen again we need to get through to them. How do you get through to people? You understand them. Nobody listens to someone who calls them stupid, selfish, ignorant etc. They`ll tune you out! It doesn't actually help achieve any goals. For that reason, it's important to dig deeper into culture and reasons behind why people question vaccines. That is rarely the same between two people, which leads me to my next point.
From all the evidence, it's very clear that there are diverse reasons that people question or reject vaccines, or any public health precaution, which really provides a route into discussing how complex the issue actually is. People are very dynamic. They change. Their environments, influence they are under etc. constantly change. Culture changes constantly and quickly too. Look at how quickly we adapted to working, socialising, and essentially living online during the SARS-CoV2 pandemic.
The second thing that became clear to me was that these concerns don`t just vary with time. They vary by region too. My concerns, as an Irish citizen, might be very different from someone in third world countries, for example. Which in turn, may differ from the concerns of citizens in the United States or Britain.
So, we need to account for these caveats in any public health effort. How? By constant reviewing of public needs with regards to health, and how that varies with geographical location. Further, it`s important to actually implement measures that address their needs. Making it easy for people to access easily understandable, condensed information. When they sense effort being made, they`ll be much more willing to comply with health measures. So, we need to regularly update public health approaches. This will help us stay attuned to how public perception of health is changing across time and space.
So, what's the point of talking about all this? Why go to all this effort? Shouldn't people just adhere to public health precautions?
Well, in an ideal world…… yes.
In an ideal world, it would be that simple.
However if there's anything the past few years have taught us, it's that our relationship with health authorities is very dynamic. Nothing could happen for decades, everything seemingly running smoothly. Then a global pandemic happens and every public health process, every piece of information is put under the microscope for scrutiny. Why? Mistrust has been brought to the surface again. It will continue if we don`t address underlying mistrust and emotions.
Complex questions usually have complex answers. Especially when we`re dealing with people and society. This one isn't any different. Clearly, anger and mistrust towards health authorities is nowhere near a new phenomenon. The SARS-CoV2 pandemic did not “cause” vaccine hesitancy. It precipitated underlying emotions that caused it. Which is similar to the other events described here. That means that mistrust is a feelings established over a long period of time. So, so is trust. That means we need to look at building long term trust between the public and health authorities. So when the next pandemic comes (and it will), people will be trusting enough to take precautions. Trust saves lives. Let's remember that. Thanks for reading.
Copyright @ Irish Medical Times 2023