Vaccine hesitancy: as old as vaccines

Although the coronavirus pandemic is new, vaccine hesitancy is not. The phenomenon has been around for as long as we’ve had vaccines, as Eva Higginbotham heard from the University of Oxford’s Paula Larsson...

Paula -  So I think one of the most really fascinating parts about studying the history of vaccination resistance is the way in which the same arguments are used over and over again for centuries. You have individuals in the mid 1800s who were saying that, first of all, that the disease itself was not such a problem. They would minimise the threat of disease quite significantly and say, "smallpox epidemic, maybe it wasn't happening". "Maybe it wasn't as bad as it was reported". And we see those same arguments today with COVID.

You also have people say that the vaccine itself is what's making people sick. They used to say in the past that vaccination would give you tuberculosis, syphilis, blood poisoning was quite often thrown around. And over the next hundred years, you saw consistent resistance throughout the UK, America and Canada. Those resistance movements would repeat those exact same arguments again, it's just that maybe in the 1800s, they'd say blood poisoning, but by 1920, they would say cancer. And by 1976, you see autism thrown in there.

Eva - And is it the same groups historically who tend to be nervous about vaccines that are being affected by this rhetoric?

Paula - When it comes to anti-vaccination movements in the past, you do see the same type of people who lead them. They often are led by people who are wealthy, middle-class and white. Usually individuals who have something to gain from a movement financially, as well as reputationally.

In, for instance, 1885, there was a really big anti-vaccination movement in Canada. And that was led by Dr. Alexander Ross, who was a homeopath, but also a medical physician. And he really wanted to fight against the vaccinators because he wanted to really change his reputation. He viewed himself as like a white knight crusader, and he had a stake in it, personally. The father of naturopathy, for instance, which really took off in 19th century North America, Benedict Lust, he had a lot to gain professionally from it because his practice of naturopathy was being pushed out and regulated from the profession of medicine.

And so there were reasons why naturopaths and homeopaths wanted to have anti-vaccination movements take place because it gave them more prominence in the medical field at a time when they were being pushed out of it. When they were being called cranks and quacks and not being given licence to practise their trade. So there were lots of financial and lots of personal reasons that people could lead these movements, but they're almost exclusively always movements that begin and are led by individuals that are white, upper-middle class likely, and usually are trying to gain something from them.

Eva - And what about the people who are vulnerable to these sorts of messages? Do they tend to be the same sort of people in terms of demographics over the course of history?

Paula - That is, I think the most complex part of this. The people who listen or who buy into anti-vaccination arguments are a diverse group and they usually pick up on parts of different arguments and only certain aspects of it. There's been many individuals who would, for instance, be against vaccination in the past because it was compulsory, not because they're actually the practice itself, but they just didn't want it to be compulsory. There were people who would be against vaccination because they believed it was a conspiracy of some sort. That was another argument that was repeated since the mid 1800s over and over again. And there'll be some people who believe that the vaccines themselves are dangerous and some individuals too will just believe that perhaps they're nervous or uncomfortable.

One vaccine, for instance, smallpox vaccine was compulsory for a long time and had many different adverse reactions associated with it. So there's a reason why we discontinued using it in 1971. So there could be a fear of just one vaccine, which kind of bleeds over into other vaccinations. In the 1980s, we saw a fear of just the pertussis vaccine come forward, the pertussis component for whooping cough. And there was suspicion that it could be linked to adverse reactions that could cause brain damage. And that led to a large anti-vax movement led by parents of children, who they perceived had been vaccine injured.

So people who follow or who listened to the anti-vax rhetoric, they often pick and parcel the ones that are actually informing their own identity and their own experiences. And that can change depending on which group or community they belong to.

Eva - And is there anything we can learn from history, how people previously managed to encourage people to take different vaccines? Is there anything we can learn from that in how we operate now to try to encourage people to take the COVID-19 vaccine?

Paula - So I think the most telling part of history have been the successes and the successes come forward when communities are directly included in decisions about policy. There's always a question about compulsion and that's been of course coming up over and over again as well. Compulsory policies have always been the worst for vaccine initiative and uptake in trust. Every time a compulsory policy comes forward, it's usually led to a large resistance movement and an expansion of hesitancy, almost exclusively every single time. So compulsion is usually not the way.

The best way that it's historically always worked, is working with community members, community leaders in different communities. So it's usually religious leaders or physicians of colour if you're working with a community of colour. And working with people they trust who will listen to their concerns and would not be coming from the establishment that has historically been an oppressing force for them. So working directly with communities is really key and important and listening to those individual concerns for hesitancy itself.

Because anti-vaccination movements and anti-vaccination narratives are only a small piece of why people actually are hesitant historically. That's the loudest piece we hear and they're very visible, but there's always a number of personal individual reasons as well. And so when that personal conversation happens is when hesitancy itself can really be addressed.