Vaccine hesitancy is about much more than misinformation

When the first Covid-19 vaccines were developed, I felt cautiously optimistic. As a sociologist focused on public health, I believed these scientific breakthroughs would mark the beginning of the end of the pandemic.

Yet vaccine hesitancy presented an ongoing obstacle to public health efforts.  Public discussion names misinformation and political polarization as the primary culprits. Media outlets amplified this narrative, framing vaccine hesitancy as a product of gullibility or partisan identity.

But vaccine hesitancy is a complex phenomenon. My team and I analyzed 50 million vaccine-related social media posts to uncover the deeper forces at play. What we found was striking: Vaccine hesitancy isn’t simply about what people believe. It’s shaped by what they’ve experienced — inequalities, distrust in institutions, and moral values that guide decision-making.

Blaming misinformation was an easy and popular response during the pandemic. Social media platforms amplified conspiracy theories about microchips and 5G towers, as exaggerated fears of side effects spread widely. Political polarization, too, was often cited as a driver, with vaccine hesitancy linked to partisan identity. States that voted for Donald Trump in 2020 showed higher rates of hesitancy, reinforcing the narrative that political divides were at the heart of the issue.

Here’s the problem: Treating vaccine hesitancy as a political or information problem oversimplifies a much more complex reality. Our study found that vaccine-hesitant people do not cling to a single reason for their hesitancy. One moment, they may cite medical fears like side effects or doubts about vaccine efficacy. The next, they might argue against mandates as a violation of constitutional rights. This shifting use of arguments reflects something deeper: a lack of trust in the institutions promoting vaccination, and an emotional response to perceived coercion.

Similarly, while political divides play a role, they don’t fully explain the persistence of hesitancy. Vaccine hesitancy is not exclusively tied to partisan allegiance but is instead linked to broader social and economic factors. Focusing on politics and misinformation overshadows these deeper causes.

Our research highlights that vaccine hesitancy is influenced by multiple factors. Poverty and lower educational attainment, for example, show strong correlations with hesitancy when analyzed individually. But even seemingly unrelated variables, like the ratio of cat owners to dog owners in a community, show correlations with vaccine hesitancy when examined on their own. We included such arbitrary variables not because we believe pet ownership influences vaccine hesitancy, but to test the strength of correlations in the data. When we analyzed all factors together in a multivariate model, no single variable stood out as the sole explanation. Vaccine hesitancy emerges not from isolated causes, but from an interplay of interconnected social and economic factors.

We found that states with higher poverty rates and lower education levels were significantly more likely to see resistance to vaccines. These aren’t just statistics; they’re evidence of systemic neglect.

Communities facing systemic neglect often have little reason to trust public institutions. For decades, many of these areas have endured underfunded schools, limited economic opportunities, and subpar health care. When institutions fail to deliver basic services, skepticism becomes the default. Vaccine mandates, framed as public health necessities, can appear to these communities like just another demand from distant authorities who have long ignored their needs.

This distrust is not limited to one demographic, either. While rural white working-class communities often dominate discussions about vaccine hesitancy, marginalized communities of color — who have faced long-standing disparities in health care access — also report lower vaccination rates. Across these groups, the common thread is a shared experience of exclusion and institutional failure. When public health campaigns frame vaccinations as a moral obligation or use shame as a tactic, they only deepen the divide.

These challenges are not unique to vaccines. They reflect broader issues in how public health authorities engage with communities. If we want to avoid repeating the mistakes of the past, we need to rethink how public health operates.

First, we need to confront the root causes: inequality and distrust. Public health campaigns must go beyond correcting false claims or debunking conspiracy theories. They must acknowledge the lived experiences of marginalized communities and address systemic failures in education, health care, and economic opportunity.

Second, communication matters — but not just any communication. Messages need to be grounded in empathy and delivered by trusted local voices. Communities respond far better to leaders they know and trust than to distant institutions or national figures. It’s not enough to tell people what to do; we need to show them that public health is on their side.

Finally, we need patience. Rebuilding trust takes time, and it requires listening as much as talking. If we continue to push mandates or public health messaging without addressing the deeper issues, we risk alienating the very people we’re trying to help.

Huseyin Zeyd Koytak is a sociologist and visiting assistant professor at the University of Mississippi, specializing in public health, race and inequality.