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What Lies Beneath

What Lies Beneath

Tackling Vaccine Hesitancy

Johnston, Michelle MBBS

doi: 10.1097/01.EEM.0000795760.41732.33
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    COVID-19, vaccines, pseudoscience
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    I have long been fascinated by conspiracy theories. Until now, I found them simply issues of amusing curiosity, academic side notes glancing off the serious world of evidentiary science. But then, as they say, things got real.

    The COVID-19 pandemic has only one exit door, and that is through the exhaustive vaccination of the humans on this planet; at least 80 percent of the population is the amount oft quoted. Leaving aside the thorny issue of global vaccine availability, one of the distressing reasons we are not reaching that sort of percentage is vaccine hesitancy, the term adopted by the World Health Organization.

    Vaccine hesitancy, of course, is nothing new. It has a long heritage, beginning from when immunizations were first introduced. But before we take a brief jog through history, it is important to distinguish those who are vaccine hesitant from antivaxxers, who are in a league of their own and are involved in dragging many others into their warped world view. They are also not a recent phenomenon, but they tend to fall into a fairly narrow category. Those leading antivaxxer movements, certainly in the past, have tended to be wealthy, middle class, and white, and they had something to gain by promulgating their ideas and influence. Alexander Ross, MD, fought against vaccination in 1885, for example, because it would heighten his own fame and professional standing. Andrew Wakefield, a former physician and the king of fraud and disinformation responsible for falsifying research published in the Lancet claiming a link between the MMR vaccine and autism, is another example of that.

    The White House publicized a report in July that said the current dissemination of antivaccination information could be traced back to just 12 influential online personalities. (Center for Countering Digital Hate. March 24, 2021; https://bit.ly/3xH23Nj.) Many of these people are seeking fame (infamy?) and financial gain, and they are merely peddling supplements, snake oil, and false cures.

    True vaccine hesitancy—where the individual is unwilling to get the vaccine or enable those close to be immunized—is different and encompasses a cornucopia of reasons. Like most complex societal memes, it is easier to understand the present if we look to the past, and it is interesting to see how these arguments repeat themselves through time.

    Some engage in disease minimization. It has been a common argument that the disease, or epidemic, does not exist or is a minor threat only, also seen initially with smallpox.

    Others believe that the vaccine will cause significant harm. Groups said in the 1800s that vaccines caused blood poisoning, in the 1920s cancer, and in the 1970s autism. Now we have interference with fertility, magnetism, and microchip control. (How far we have come!) This extends into the theory currently riding the airwaves that the vaccine is designed to cause harm.

    We know that we now reside in a misinformation ecosystem; this is the infodemic holding hands with the pandemic. The internet allows misinformation to spread to those vulnerable to antiscientific sentiment faster than the delta variant. And it's not only the “bad” influencers at fault, but the internet algorithms—these are designed to keep users engaged, continually scrolling for neurotransmitter hits, showing them more and more and more of the same things that caught their eye in the first place. It's extreme confirmation bias.

    More Reasons for Hesitancy

    These points might be on the more radical levels of misunderstanding, but many other reasons account for vaccine hesitancy, several of which are partly understandable. Promoting understanding is the point of this column, and education is a two-way street. To tackle vaccine hesitancy, we need to understand what is driving it for the individual in front of us. Other reasons for vaccine hesitancy, which have some basis in validity, are religious and spiritual beliefs, poor scientific communication to a population without a firm grasp on the scientific method, compulsory health mandates (we have bodily autonomy, after all), and distrust of the government.

    This last one is hardly surprising. If the government is putting out the edicts and in the same breath lying through its teeth about pretty much everything (and I'm looking at all world governments here, except maybe you, New Zealand), then there is understandable hesitation in taking up its messaging. This is particularly true for ethnic minority communities, which have good reason to believe that entrenched systemic racial inequities will work against them.

    People may be fearful or nervous about getting the COVID-19 vaccination for countless other reasons, and herein lies exactly the point: You can't tackle vaccine hesitancy without knowing the root cause that's driving hesitance in an individual. One thing we know does not work in combating misinformation is spewing forth facts, such as quoting percentage risks and statistics. Often it will make things worse and cause people to dig in their heels.

    The hardest thing you might have to do as a clinician, when you know the facts, you are exhausted and still scared by the pandemic, and know that vaccination is the only way to safeguard the patient, his family, your family, sheesh, the whole planet, is to ask gently, respectfully, with a true curiosity, why. Ask why the patient in front of you is vaccine hesitant, and then your response can be tailored to his specific concerns. We do know that the act of positive discussion with a caregiver who is genuinely concerned and one the patient respects is one of the safest ways to break down those barriers.

    Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novel Dustfall, available on her website, http://michellejohnston.com.au/. She also contributes regularly to the blog Life in the Fast Lane athttps://lifeinthefastlane.com. Follow her on Twitter@Eleytheriusand read her past columns athttp://bit.ly/EMN-WhatLiesBeneath.

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