The US roll-out of COVID-19 vaccines from late 2020, known as Operation Warp Speed, will be the most rapid distribution of vaccines in history. Despite this monumental effort, effectiveness or ‘herd immunity’ hinges on the United States and other heavily impacted nations achieving a vaccination rate of somewhere between 60 per cent and 90 per cent. This is a challenge when we consider that December 2020 polls indicated that over 50 per cent of Americans are likely to refuse the vaccine when it becomes available. With less than half of the population vaccinated, population-level or herd immunity will not be achieved, leaving at-risk members of the community vulnerable.
Despite the global effort by scientists to produce vaccines for COVID-19, public acceptance is likely to be inhibited by a significant body of objectors. The success of vaccinations on debilitating illnesses such as polio, tetanus, whooping cough and measles has been their curse. With numerous once-devastating diseases effectively eliminated from the public psyche, a small minority of the population has gained traction in discrediting vaccination efficacy and safety.
Objections to vaccinations stem from two primary sources: religion and misinformation. Despite a lack of anti-vaccine sentiment in the majority of religious teachings, experts increasingly find ‘religious reasons’ cited to avoid the jab. However, this increase could be tied to falsehoods rather than faith. Despite the scientific community’s almost unanimous consensus on the benefit of vaccines, anti-vaccine sentiment permeates much of American culture, as well as Australian culture. Decades of circulating misinformation have resulted in a growing distrust of experts. Self-proclaimed authorities, including American actress Jenny McCarthy, strike fear into the hearts of parents with their anti-vaccine rhetoric. This is supported by popular talk-show hosts, including Oprah Winfrey, who have lent significant credence to the movement.
Ironically, anti-vaccine sentiment partly originated within the scientific community. Former British medical professional Andrew Wakefield provided support to a previously debunked claim of a connection between the measles, mumps, and rubella (MMR) vaccine and development of autism in young children. This causal association was later disproved by multiple subsequent studies and Wakefield’s research methods drew criticism for their flawed and unethical nature. Wakefield’s conflicts of interest were also revealed: he had received undisclosed funding from litigants against vaccine manufacturers. For these reasons, Wakefield’s paper was retracted, and he was barred from practising medicine in the United Kingdom. In the history of scientific investigation, no credible link between neurological disorders (e.g. autism) and vaccination has been identified.
In a world where truth is seldom more interesting than the latest conspiracy theory, anti-vaccine rhetoric has readily slithered its way into public opinion and sunk its fangs in deep. In the present environment, it is unsurprising that even those who eschew the ‘anti-vaxer’ label express fear and mistrust of the COVID-19 vaccine. Emphasis on the speed of development in the media suggests that the vaccine may not have been thoroughly evaluated. The years of research into similar coronaviruses or into novel vaccine manufacturing strategies are seldom mentioned. Although the development of a COVID-19 vaccine broke records for speed, never before have virtually limitless financial and scientific resources suddenly been made available. Medical research focused on anything other than therapeutics and vaccines against COVID-19 all but ceased, as scientists across the globe pivoted their efforts to the greatest worldwide effort in modern medical history. Regulatory red tape is as sticky as ever, but this is not effectively communicated through phrases like ‘Operation Warp Speed’ and ‘emergency approval’, or when the speed of vaccine progression through regulatory bodies is lauded. Couple this phenomenon to the generalised sense of vaccine distrust and it is unsurprising that a high percentage of the population wishes to avoid the COVID-19 vaccine, especially if they are ‘not in a high-risk group’. Too many young, healthy people earning a steady income throughout the pandemic have let these words fall from their lips.
Ironically, a large proportion of vaccine sceptics and/or those who plan to refuse the COVID-19 vaccine invoke an anti-establishment, libertarian view where individuals distinguish themselves by their ability to achieve upward social mobility and improved standards of living through hard work and calculated risk-taking. To put it simply, Republicans are less likely than Democrats to accept a COVID-19 vaccine. Indeed, 39 per cent of self-identified Trump supporters indicated that they would never obtain a COVID-19 vaccine, suggesting that some Americans view the vaccine as a political statement rather than a critical health choice.
For many who hold libertarian views, there is a certain pride in one’s ability to be ‘self-made’ and pay one’s ‘fair share’ for important services and amenities. In fact, proponents of liberal economics eschew government welfare and are staunchly against ‘free riding’, a term used to describe a situation when one party enjoys the benefits of a shared resource without paying for it.
Conservative and Republican values see as detestable the free-riders and ‘welfare queens’ who enjoy benefits at the expense of hard-working citizens. It is relatively easy to sympathise with the notion that free riders are, to use the Australian vernacular, ‘bludgers’.
It is seldom appreciated that this principle applies to vaccination. To effectively control a disease, i.e. the present COVID-19 virus, a majority of the population must be immunised. This allows the minority who can’t be immunised for genuine health reasons, e.g. allergies, to be protected by population-level immunity. It is possible for this small minority to be protected without obtaining a vaccine, but their health is dependent upon the goodwill of those around them. The problem arises when an excessive number of individuals decide that they can ‘free ride’ by rejecting immunisation. Outbreaks of diseases including measles and whooping cough arise when a critical percentage of a given population, i.e. a community, county or school district, is unvaccinated or under-vaccinated. Arguments relating to being ‘low risk’ do not preclude one’s responsibility to be vaccinated in order to protect those who are vulnerable. Without collective effort, immunisation will fail. We cannot all be free riders.
This places neoliberal values in a dilemma. Its principles of individualism, deregulation, small government and open markets have caused a shift away from collective responsibility towards individual freedoms and rights at the expense of coordinated responses to complex challenges such as disease control. As choices are made on an individual level, market failures and free riding remain largely unaddressed. Ironically, the very freedoms granted by neoliberal values are inhibiting the effective execution of collective efforts, such as mass vaccination—which aid the majority of individuals!
What are the implications for policymakers and scientists? Perhaps a media campaign along the lines of ‘Are you a vaccine cheat?’ would bring home an awareness that failure to be vaccinated is tantamount to shirking responsibility and seeking to live off the efforts of others. This comparison, in tandem with correcting misinformation to alleviate safety concerns, could allow the sector of the general population most likely to refuse the COVID-19 vaccine to fully understand the grave implications of going unvaccinated. Given the ideological and political leanings of most of those who express vaccine reluctance, this argument may reframe the decision to vaccinate and has the potential to markedly increase vaccination rates. Without change, society is at risk of an inability to quell COVID-19 transmission in areas where vaccination rates remain well below the required benchmark. Perhaps it is time to fully acknowledge the dichotomy between self-centred individualism and collective well-being.
Of Fire and the Plague
John Walker, 2 Jun 2020
In Australia we have no ‘herd immunity’: we still have plenty of ‘fuel’ for the virus to burn. The virus is still smouldering, largely stifled, in Australia, and actively burning in many other places around the world. Embers will continue to land here, and we have already gone through a lot of our resources and assets.
I’d suggest bringing a behavioural psychologist onto your writing team. In particular around how to message vaccinations for an impact on the fearful. Here is what I’ve learnt through direct conversations with anti-vax people: 1. Yes, many do believe it causes some childhood autism; 2. Many also believe there are agents in the vaccine that, if not immediately, will due to the repetitive schedule, large range of vaccines and the young age of delivery, will have long term health consequences – a ticking bomb so to speak; and 3. herd immunity is ‘spin’; 4. it’s everyman for themselves, you cannot believe in authority, authority is corrupt whether political or medical; 5. vaccination doesn’t give ‘me’ any benefit; 6. vaccinations are growing in number, not because of the health benefits derived but for the profits of the pharmaceutical industry. Anti-vax people are more likely to know of cases of scientific fraud than understand a scientific breakthrough (they often don’t have the education or propensity to read science and can’t see that anti-vax ‘evidence is opinion and poorly constructed causal logic). They are often unable to see that Dr Wakefield committed scientific fraud. Interestingly, in Australia, most anti-vax people are not climate change deniers, although their attitude is similar – the psychological profiling done on climate change denial might be helpful. although there are differences. The anti-vax group is not entirely individualistic, it is tribal with a strong echo-chamber tendency. It is very difficult to have a non-dramatic conversation with an anti-vax person. I find it doesn’t take more than a few conversational exchanges before an ad hominen attack is made e.g “Are you working for the pharmaceutical industry?” And, for all of these elements in the thinking of an anti-vax supporter the rapid rollout seems to them as using people as guinea pigs rather than take the time to make the vaccine safe. And, in Australia, the science community has been silent or ignored by media in regard delivering clear information on that, which makes it difficult for anyone not close to the vaccine research industry to make a case. For mine, the answer is partly in a widespread advertising campaign that talks to the historical record of vaccines on 3 fronts – visual images of children and adults suffering , maimed and dying from viral disease; the vast improvement on the disease outcomes, cycles and eradication; and the changes to vaccination production science including their lifelong safety. These ads need to impact at the fear level but also be a call to ‘one of the easiest ways you will get to make a life-saving contribution to the lives of hundreds, thousands, even millions of people’. If there is any shame factor invoked here, it would be to make reference to the trade off a person is making for an unknown possibility of a small health impact over a life-time compared to an immediate risk of someone else having a debilitating illness or early death. However, on another part of this issue as relates to COVID, there is also a sense of hypocrisy about it when compared to the annual flu. It has also highlighted that there is a community fear of death – few people I know care that old people die of the flu but when health authorities said that ‘you a middle aged or even young adult could die, then people got frightened and agitated. When the younger population looked around and saw that this messaging of younger deaths seemed inflated, it added to the distrust of health authorities. You can see where this reinforcement is not going to work out well. There is then a political fear – what losses at the polls will happen if I don’t get ahead of the numbers. Australian political fear has already won the Qld election and maintained COVID deaths at about 20% of annual flu deaths (Oh and narely a flu season to boot). Donal Trump lost an election in big part due to his failures in COVID policy. A politically skeptical community that is now of the belief that politicians are only in it for their salary, status and what falls of the back of a lobby truck, believes that politicians will sell their life, for a boost in the polls. Ultimately, when an anti-vax person tells me something that is incorrect, I just tell them so. Otherwise I am little interested in changing their minds. The changes that are required to move the vaccination message to higher ground requires a transformation in: politics, scientific information engagment with the community, science literacy development of the population, and the conversation about death.