How COVID Is An Opportunity to Address Deep Anti-Vax Sentiment

As much as anyone in the world, Berkeley anthropology alumna Heidi Larson is confronted by public resistance to the COVID-19 vaccines. Larson is founder and director of the London-based Vaccine Confidence Project, a nonprofit that conducts global surveys monitoring public confidence in immunization programs. With the Project, Larson helps quantify vaccine approval by measuring people’s confidence in the importance, safety, and effectiveness of vaccines. A professor of anthropology, risk and decision science at the London School of Hygiene & Tropical Medicine, Larson is also the author of Stuck: How Vaccine Rumors Start—and Why They Don’t Go Away.

California talked to her about the history of anti-vax movements and the ongoing challenges she faces. This conversation has been edited for length and clarity.

You’ve expressed dislike of the term “anti-vaxxer.” Why, and what would you use instead?

I think the term “anti-vaxxer” is overused and too often is used to refer to anyone who doesn’t agree to vaccines, when there is a highly varied spectrum of people who believe in and accept vaccines more broadly, to those who accept some and question others, to those who generally accept vaccines but have some reasonable questions, to the extreme vaccine-critical groups. I would consider “anti-vaxxers” to be in the extreme group, but the term is used and interpreted too generally, which is why I try to be more specific in how I refer to people at different points on this range.

You describe anti-vax movements as rooted in rumors. Can you talk about how they have grown from rumors to widespread movements that long precede COVID and extend far outside the U.S.?

Not all anti-vax movements are rooted in rumors or conspiracy theories—some are driven by deep seated beliefs. But, for those driven by rumors, the rumors are clung to as an explanation of uncertainties or reflect deeper distrust in the system.

In the late 1800s, the United Kingdom began enforcing laws that made the smallpox vaccination mandatory. That was too much for the public, and they went to the streets. This whole libertarian movement now has been going on since that first vaccine. That was also the origin of the term “conscientious objector.” The one thing that calmed, at least temporarily, this anti-compulsory group was when the government allowed a conscientious objector clause.

What keeps reigniting the flame of these movements, despite evidence to the contrary?

“COVID is a crisis, but it is
also a huge opportunity
to rebuild relationships, show empathy, engage with questions,
and have conversations around the new vaccines as a shared effort to restart.”

COVID is a perfect example of a situation re-igniting these movements, as it is a time of hyper-uncertainty, of people looking for explanations in a time where there are few answers, and a perfect opportunity for those against government control to join together in protest against disease control measures (masks, lockdown, distancing, and anxieties around COVID vaccines being compulsory).

For some people, especially ones from minority communities that have been abused, such as the Uighurs in China, there might be an element of fear of the government. But the broader thing is distrust; they don’t trust the motives. Are they [the government] doing this for money? Also, studies show that the more that you trust that your government has handled the COVID response, the more likely you were to take the COVID vaccine.

How have responses to the COVID vaccine compared with those to other major vaccines?

Some of the concerns about the COVID vaccine are similar to other new vaccines—such as concerns about them being “too new” and developed “too fast” (there were similar anxieties when the H1N1 vaccine was quickly made for the 2009 H1N1 pandemic). In addition, some of the COVID vaccines (mRNA) are made in ways that have never been done before for vaccines, which adds an additional layer of uncertainty. We do see some similarities in the country-level confidence rankings of general vaccines and COVID vaccines. France, for instance, is one of the countries with the lowest confidence in basic vaccines as well as COVID vaccines.

What are a couple of the most effective strategies for increasing confidence in vaccines, and can you illustrate how they are effective? Whose responsibility is this?

The most effective strategies for increasing confidence are those that involve the groups that the strategies are targeting. One good example was in Denmark, where they had HPV vaccine hesitancy issues—and brought young girls of HPV vaccination age together with the health authority to design a successful campaign engaging other girls their age. Similar efforts have been successful when trying to engage and build trust with minority or religious communities.

“We will never completely dispel fear around vaccines, as fears and anxieties around vaccines and government-driven vaccine programs are often due to historic
experiences.”

You want to understand who the trusted figures are. You want to find the trusted figure who believes in the vaccine. You want to give them information, but I think one of the important things is to try to get more of an understanding of what the issues are. If it is a church leader, they usually know their congregation pretty well; he’ll know what the anxieties are. It’s not just, give them facts for their megaphone; it’s really learning from [the trusted figures]. If we know what those histories are, it would give us a bit of empathy or understanding, and also it could frame how you do communication. You could think you’re doing a good thing, but you could be offending people. So, that kind of local knowledge is really important.

In your book, Stuck, you write: “A Babelian mix of truths, partial truths, and intentional lies has taken a toll on public trust in science. Waning vaccine confidence, skepticism about the safety and even the need for vaccines, and an overall tectonic shift away from trusting ‘experts’ to having more confidence in the opinions and ‘evidence’ shared in stories circulating among neighbors, friends, colleagues, and online social networks speak to a near reversal of the Age of Enlightenment.” So if the issue is a lack of trust in science, how do you go about restoring that? Do you think we can ever completely dispel the fears around vaccines?

We will never completely dispel fear around vaccines, as fears and anxieties around vaccines and government-driven vaccine programs are often due to historic experiences, and the consequent, even subconscious, reluctance is difficult to overcome. COVID is a crisis, but it is also a huge opportunity to use the year ahead to rebuild relationships, show empathy, engage with questions, and have conversations around the new vaccines as a shared effort to restart. As I wrote in the beginning of Stuck, “Now we have no excuses. There is no ‘normal’ to inhibit our new thinking.”

Milwaukee journalist Tom Kertscher was a 35-year newspaper reporter, whose has freelanced for PolitiFact and the Associated Press. His reporting on Steven Avery was featured in Making a Murderer. Follow him at TomKertscher.com and on Twitter: @KertscherNews and @KertscherSports.

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