Climate change deniers, flat-earthers, and anti-vaxxers sit around the same table when it comes to rejecting science in favor of conspiracy. They subscribe to skepticism, rather than trusting esteemed institutions of academia and healthcare. In 1966, 73 percent of the American public reported great confidence in healthcare providers. In 2012, that number plummeted to 34 percent. A recent poll conducted by the American Osteopathic Association found that a staggering 45 percent of surveyed American adults report doubts towards vaccine safety. In light of this resistance, the World Health Organization declared vaccine hesitancy to be among ten of the greatest threats to global health in 2019. The anti-vaxxer movement itself may be a public health crisis, but in context it is one symptom of a larger political culture of anti-establishment resistance and waning public trust in government organizations.
The post-World-War-II era was a critical time in the development of vaccines. In 1954, virologist Jonas Salk began a massive polio vaccine trial on 1.4 million children with an 80 to 90 percent success rate treating paralytic polio in just one year. This study, paired with favorable attitudes towards government leaders because of World War II victory and postwar economic boom, led to widespread public acceptance of the vaccine. However, the 70s brought with them the Vietnam War and Watergate, which severely eroded public faith in the government. Thus began the rise of an alternative-medicine movement. In 1998, British medical journal The Lancet published a study by now-delicensed physician Andrew Wakefield claiming a link between the MMR vaccine and autism. Wakefield’s study catalyzed the modern anti-vaxxer movement and was later discredited because of a meager sample size of 12 children, financial conflicts of interest, and misreporting.
Modern anti-vaccination attitudes are most commonly traced back to the rise of conservatism in the US at the turn of the 20th century. Conservative anti-vaxxers see mandatory vaccinations as a manifestation of big government, with Reagan-era attitudes that “government is not the solution to our problem, government is the problem.” Indeed, many of the most vocal anti-vax figures in the public belong to the Republican Party. While in office, Representative Dan Burton (R-IN) consistently argued that mercury in vaccines causes autism, spearheading at least 20 related hearings over a decade. Republican Governor Matt Bevin of Kentucky has decried required vaccines as threatening American ideals of freedom. For many conservative anti-vaxxers, it is the notion of government mandate that they see as encroaching on their personal rights, a similar sentiment felt among those protesting mandatory stay-at-home orders meant to curb the spread of COVID-19.
It is important to recognize that anti-vaxxers are not exclusively liberal or conservative. Staunch liberals are also susceptible to anti-vaxxer attitudes. Liberal enclaves like Boulder, Colorado and Marin County, California are notorious for using non-medical exemptions. Liberal opposition to vaccines can be partially attributed to distrust of the medicine-industrial complex and Big Pharma, which anti-vaxxers view as wielding disproportionate political power in regulatory bodies like the Food and Drug Administration (FDA).
Citing an aggregate study, the Cornell Alliance for Science concludes that the anti-vax movement is embraced at both extremes of the political spectrum. This trend is true on a global scale: extremist parties like the far-left Green German Party and far-right National Party in France and National League in Italy also oppose mandatory restrictions. The European Journal of Public Health finds that across Europe, vaccine hesitancy is strongly correlated with support for populist parties.
Despite opposition, all 50 states today require vaccines for students while allowing medical exemptions. Out of those, 45 states and Washington D.C. allow for religious exemptions, and 15 allow parents to cite personal, moral, or other non-religious beliefs to be exempted. Bans of these non-religious philosophical exemptions in state legislatures are often met by a replacement effect, in which those who had previously cited philosophical reasons now claim that vaccines compromise their religious liberty. After Vermont eliminated personal-belief exemptions in 2016, the state saw a 640 percent increase in religious exemptions. However, this trend in religious exemptions is doubly contradictory: Americans are more secular than ever before, and most major world religions do not expressly prohibit the use of vaccines.
If the primary aspiration of anti-vaxxers is autonomy and choice, mainstream rhetoric urging mandatory vaccines may be highly counterproductive. Consolidating the authority of the institutions anti-vaxxers are skeptical of will only energize their efforts. Instead, the public health community must focus on making these institutions more transparent through a threefold approach:
First, Congress should bolster funding for the FDA, which in 2017 allegedly received 75 percent of its budget for reviewing drugs from the private pharmaceutical industry. Making the FDA as independent as possible would assuage concerns for anti-vaxxers who see corporate interests as hegemonic in the regulatory body. This may satisfy the more liberal of anti-vaxxers.
Second, healthcare providers need to salvage the doctor-patient relationship. Over an eight-year time period, primary care visits to the pediatrician decreased by 14 percent, which can be partially attributed to increasing out-of-pocket costs and unforgiving insurance policies that encourage physicians to spend fewer minutes each visit. Problematically, the relationship between the physician, parent, and child is absolutely crucial to ridding anti-vaccination beliefs: a 2011 law in Washington mandating a conversation about vaccines with a doctor before receiving an exemption reduced exemptions by 40.2 percent.
Finally, the public health community should more proactively combat misinformation. Insofar as the organizing space of anti-vaxxers is overwhelmingly internet forums and social media groups, it is the responsibility of tech companies to monitor the information that is disseminated for users. While there are obvious concerns about censorship, social media platforms should prioritize content from reputable sources like the Center for Disease Control and Prevention and the World Health Organization. Some companies are beginning to do this: Pinterest, for example, will only show links to public health organizations when users search for vaccine-related content.
Responses to infectious outbreaks and diseases always serve as indictments of political systems and governance. The anti-vaxxer movement is illustrative of weak faith in governing institutions and high valuation of personal choice on both sides of the political aisle. The vaccination debate is also particularly timely: now an unprecedented global pandemic, COVID-19 has infected over one million Americans. According to the WHO, there are currently 90 vaccine candidates, with three already in clinical trials. Some anti-vaxxers seem to be wavering: a survey by the Vaccine Confidence Project in France, where 33 percent of the population is vaccine hesitant, found skepticism in only 18 percent of respondents. Still, others have doubled down, expressing fear of forced inoculation, pointing to weak health infrastructure to argue for the incompetence of institutionalized healthcare, and even spreading conspiracies that the virus was developed in a lab or that it is not nearly as serious as the media and public health officials claim it to be.
Confronting this skepticism regarding vaccines will take much more than mainstream mockery or renewed pushes for mandatory vaccines. Although the latter should remain a legislative priority, taking on anti-vaxxers will require addressing their concerns about untransparent institutions and the influence of money in healthcare. In this sense, confronting vaccine hesitancy means actually listening to anti-vaxxers.
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