Those who don’t support vaccination are often seen as irrational. Yet, on closer inspection, the issues are not so clear-cut. Condemning “anti-vaxxers” might even be counterproductive. Better is understanding resistance to vaccination.
Given the positive connotations of “resistance” — often thought of as valiant opposition to unfairness — it might seem wrong to give this label to anyone who does not fully support vaccination, the rationale being that they are being selfish and endangering public health. Whatever your view, it can be useful to better understand the psychology and politics of vaccination.
“Resistance to vaccination” can take many forms. It includes accepting some vaccines but not others, spacing out injections, openly questioning official vaccination policies, and publicly protesting vaccination mandates. Resistance can be individual or collective.
With the advent of Covid-19, vaccination has become a high-profile personal and political issue, with nearly every adult needing to make a personal decision about whether to be vaccinated and how to relate to others depending on their vaccination status. I address resistance to Covid vaccines later.
Personally, I do not have strong views about vaccination. My interest in the vaccination issue comes from supporting the free speech of Australian vaccination critics who came under severe attack over many years.
From the very first vaccine, for smallpox, there was resistance. In the 1800s in England, mandates triggered greater resistance, and even mass protests.
In the second half of the 1900s, vaccines were introduced for an increasing number of infectious diseases, including polio, measles, pertussis (whooping cough), mumps, chickenpox and others. Most of these vaccines are recommended for children rather than adults, thus introducing an extra consideration: parents need to make vaccination decisions for their children who are too young to give informed consent.
Governments and medical authorities throughout the world recommend vaccination against a range of diseases, though the number of vaccines and preferred ages differ somewhat. Some governments apply strong pressures for vaccination whereas others do not. The greater the official and social pressures, the more relevant is the concept of resistance.
For those who support vaccination, the arguments are pretty straightforward, summarised by the slogan “Vaccination saves lives.”
In particular, vaccines are designed to improve immunity against specific diseases, thus providing a benefit to the vaccinee (the person who is vaccinated). However, some people cannot be vaccinated or do not develop adequate immunity, for example cancer patients receiving chemotherapy who have a reduced immune function. These people are protected from infection when nearly everyone around them is immune. More generally, when nearly everyone is immune, infections have a hard time spreading. This sort of protection of those without immunity is a collective benefit.
Vaccination thus has two sorts of benefit, personal and collective. The collective benefit is often treated as generating a moral imperative that everyone should be vaccinated, to protect those with impaired immunity.
Before proceeding further, it’s necessary to say that nearly every important claim about vaccination is disputed by some partisans — that includes both individual and collective benefits.
Turning to arguments against vaccination, the most influential is the possibility of adverse reactions to vaccines, including illness, disability and death. Critics claim adverse reactions are far more common than normally recognised. Another argument follows the line of thinking that some diseases — for example mumps — are usually harmless in childhood and give better immunity than vaccines.
Most early vaccine developers — for example, the polio vaccine pioneers Jonas Salk and Albert Sabin — gifted their discoveries to the public: they did not try to commercialise their vaccines. Beginning in the 1980s, pharmaceutical companies sought to profit from vaccine development and sales. This fed into concerns felt by some parents that the profit motive might be compromising safety.
Decades ago, only a few vaccines were standardly available and recommended. More were added year by year, so in the US a child is now recommended to receive dozens of vaccine doses for numerous diseases. The great increase in the number of vaccines has contributed to parental reservations, especially for diseases that are rare or usually mild.
Sociologists have interviewed parents who have concerns about childhood vaccines. One of their findings is that parents with hesitations are usually well informed, well educated, and care a great deal about their children’s wellbeing. Few of them fit the caricature of being anti-rational or obsessed with conspiracy theories.
When a child seems to have an adverse reaction to a vaccine, the parents often report that doctors and health officials are sceptical, even contemptuous. These hostile attitudes can be counterproductive, causing parents to become alienated from mainstream medicine. Parents with reservations gravitate to places where they can share experiences without being shamed. When they discover vaccine-critical citizens groups, they may feel at home.
Numerous writers about vaccine hesitancy lay blame on “anti-vaccine” information on the Internet, promulgated by campaigners. Yet it may be the other way around: vaccine-critical groups may be driven more by common experiencesthan by winning recruits through fear-mongering. A study of members of the Australian Vaccination-risks Network found that most had concerns before they joined. The implication is that such groups are more the product than the cause of concerns about vaccination.
Forms of resistance
Many parents who decide not to follow official vaccination recommendations try to keep a low profile, especially in places where unvaccinated children are stigmatised. In these cases, resistance is individual and not publicised.
When pressures to vaccinate become stronger, the stakes are raised and resistance can have bigger effects on both children and parents. In some US states, to attend school the option of religious and conscientious objection has been removed and obtaining medical exemptions made more difficult. Parents can resist this sort of pressure by finding a sympathetic doctor, moving to a different state or home-schooling.
The stronger the pressures, arguably, the more likely some parents are to seek information and support from vaccine-critical groups. Strong pressures can sometimes foster the resistance they are supposed to overcome.
In Australia, rates of childhood vaccination have been high and stable for many years. Mainstream proponents of vaccination realised that only a few percent of parents were strongly opposed and that there were far more parents whose children were not fully vaccinated due to personal circumstances, including distance from doctors, travelling and inconvenient schedules. In this context, the most promising way to increase vaccination rates was to make it easier for parents who supported vaccination to have their children receive all their vaccines. These proponents argued for having respectful conversations with parents as the most productive way to increase vaccination rates.
However, other pro-vaccination campaigners — including Australia’s largest media organisation, News Corp — decided to target vaccine-critical groups and to get the government to remove welfare benefits from families whose children were not fully vaccinated. This campaign succeeded in stigmatising critics and increasing financial penalties but had little or no impact on vaccination rates. In this instance, resistance to vaccination was the rationale for financial penalties. It might be said that vaccine resistance became a political tool.
How should we think about resistance to vaccination?
If we think of slavery or the Nazis, it seems obvious that resistance is warranted, indeed praiseworthy. The same applies when resistance is to something that nearly everyone agrees is unjust or oppressive.
In the case of vaccination, the rights and wrongs of resistance are highly contested. From the point of view of supporters of vaccination, resistance is wrong: it is dangerous to public health. Furthermore, to publicly criticise vaccination is wrong because it may encourage refusal. Because vaccine hesitancy is such a danger, censorship and coercive measures are justified.
From the point of view of prominent critics of vaccination, resistance is valiant. They are campaigning for the right to choose, and pointing out information, unmentioned in official pronouncements, that they believe needs to be taken into account. Then there are parents, in particular those who want to learn enough to make their own informed decisions about their children’s health. Some of them decide to deviate from official recommendations. They become resisters.
Studying an issue like vaccination means being catapulted into a scientific controversy, a typical one in which most of the experts and groups with money and power are on one side and a few dissident experts and citizen groups are on the other. It’s possible to adopt a non-partisan position and just examine the methods of resistance, but more common is to decide one side is right and try to figure out how to help it overcome resistance. This is the path taken in numerous studies by supporters of vaccination.
The vaccination issue highlights the importance of the tactic of devaluation. Proponents stigmatise those who have reservations, calling them “anti-vaxxers.” Devaluation happens to resisters in a wide range of domains but is especially important in relation to vaccination, where the language of stigma has been taken up by many members of the public. In studying resistance, it is important to study the techniques used by authorities to subjugate resisters.
Note also that some critics put down those who are vaccinated as dupes or sheep, and send abuse and make threats against proponents. This is usually counterproductive.
Finally, it is important to note the enormous emphasis on vaccination as the solution to the problem of infectious disease and the consequent marginalisation of other methods of improving health, including exercise, good diet, sleep and avoidance of toxins. In a sense, the vaccination debate is a distraction: the focus should be on ways to protect and improve health. By putting so much attention on vaccination, and stigmatising and attacking critics, other contributors to ill-health are neglected. This includes cars and labour-saving devices that discourage physical activity, unhealthy foods, and the myriad chemicals that contaminate the environment. Companies that make great amounts of money from the way society is organised — from tech companies to town planners — avoid responsibility for associated harms. They are let off the hook by the focus on vaccination. The implication is to pay attention to issues that may be sidelined by the most prominent struggles.
The takeaway message is that the vaccination issue, including resistance, is not as simple and straightforward as often assumed. Learning more reveals complexities as well as insights for understanding resistance.
Covid vaccination: why is there resistance?
With the advent of the Covid-19 pandemic, governments introduced extraordinary measures to control the spread of the disease, including isolation orders, lockdowns, travel restrictions, contact tracing, testing, quarantining, distancing and mask-wearing. These were seen as temporary measures until Covid was brought under control. The hoped-for salvation was widespread vaccination.
Vaccines became available in record time. But that was not the end of the story. As in the case of other vaccines, there was resistance. The story of Covid-vaccine resistance repeats what happened with many earlier vaccines. But there are also important differences.
First, the similarities. Covid vaccines promise a benefit to individuals, reducing their susceptibility to disease and to serious impacts, and also promise a collective benefit because the infectious agent, the coronavirus SARS-CoV-2, has fewer people susceptible to infection. The argument for vaccination appeals both to self-interest, to protect your own health, and to social responsibility, to protect others.
As in the case of other vaccines, there have been critical voices, including among doctors and scientists, raising the same sorts of concerns, specifically that the benefits of the vaccines are oversold and that the risks are greater than acknowledged. As in the case of other vaccines, critics and vaccine-hesitant individuals have been stigmatised.
Thus in many ways the controversy over Covid vaccines is nothing new. It raises many of the same issues familiar to those involved in the politics of vaccination. But there are also quite a few differences that have made the issue far greater than anything before.
What’s different about Covid vaccines?
First, Covid vaccines have been introduced in the middle of a pandemic, furthermore one in a world interconnected as never before. The stakes are higher. The enormous alarm about Covid has meant that hopes and fears about vaccines have a correspondingly higher profile.
Second, the benefits and risks from Covid vaccines have an unusual profile. As is well known, the benefits from Covid vaccines are greatest for those most vulnerable, namely those who are old and have other health problems. This is like the pattern for influenza, except the flu also can be dangerous to the very young. The risks from Covid vaccines, due to adverse reactions, seem to be greatest for those who are young. So for children and young people, there is a curious combination of low personal benefit and higher personal risk. Adding to this, most studies show that having Covid gives longer-lasting immunity than being vaccinated, so for those young people with the lowest risk of contracting Covid, there seems to be less to gain from vaccination.
Third, Covid vaccines are the first ones imposed on the entire adult population. Most other vaccines are given in childhood. In the United States, flu vaccines are recommended throughout life but are widely recognised as being only partly effective, and are compulsory only for a few occupations such as healthcare. In the history of vaccination, compulsion is often met with widespread opposition, which is why most health policy leaders have advised against mandatory vaccination. For most adults, Covid vaccines are the first occasion in which they have experienced strong pressure to vaccinate and, in some cases, severe sanctions for not doing so.
Fourth, vaccination is seen as part of a wider package of Covid control measures, including isolation orders, lockdowns, distancing and mask-wearing. Some of the control measures, especially lockdowns, have had a severe psychological and financial impact on some individuals and sectors of the population. This has led some individuals and groups to challenge the narrative presented by political leaders that “We are all in this together,” when it is obvious that some groups are prospering while others are paying a high price. Also important are the serious psychological impacts of isolation. Although vaccination imperatives are not responsible for the effects of other Covid control measures, they can be seen as part of an apparatus of oppression, a sort of guilt by association.
Fifth, there has been extensive censorship of viewpoints contrary to official policy. For example, some critics have had their Facebook and YouTube accounts abruptly cancelled. However, because there are many alternative channels to obtain views contrary to orthodoxy, censorship may make critics, and anyone with reservations, feel unfairly treated. It can seem like there is not a free and open discussion.
Sixth, the call to be vaccinated for the good of the community comes after decades of neoliberal policies fostering individualism, using the rhetoric of personal freedom. People are encouraged to satisfy their desires through personal consumption of goods and services rather than through building shared activities with neighbours and friends. Employers have less loyalty to employees, who in turn treat jobs as stepping stones to personal advancement. Accepting a lower salary and status to serve the public has less attraction than before. In this context, suddenly people are called upon to make sacrifices for the common good. When they feel forced to make sacrifices, for example when their income is lowered, and they see elites with special privileges, this can make some want to push back against Covid controls — including vaccination.
Given these factors, resistance to Covid control measures is not surprising.
What to do
What are the implications? This depends to a great extent on one’s position concerning vaccination, so I will separately list some possibilities for different views.
For those who do not want to receive Covid vaccines, or who oppose mandates or coercive measures, what is the most effective way to resist? This is not easy to answer at an individual level, because people’s circumstances vary so much. At a collective level, in many countries there have been public protests with thousands of people joining marches and rallies.
It is well known that the mass media selectively report violence, so when ten thousand people protest peacefully, if ten of them break windows or clash with police, that will lead the news. This means that it is very hard to assess what is going on except by being there or talking to many who were.
Many of those involved are new to protest. To become more effective, one step would be to contact experienced nonviolent activists and develop a campaign strategy with clear goals and a variety of methods that will communicate concerns and mobilise greater support. Would silent vigils be effective? It’s hard to know but it would be worth trying to see whether a wider cross-section of the population would feel safe to participate. Clashes with police are likely to be counterproductive. Basically, protest organisers could learn a lot from experienced nonviolent campaigners. As well as protesting against, there could also be constructive actions that show what the desired future would be like.
Now consider implications for those who support Covid vaccinations and who are critical of or hostile towards those who refuse them. It is worthwhile to clarify goals. Is the goal greater levels of vaccination, or greater levels of immunity, or better health overall?
An initial suggestion is not to be so quick to condemn those who challenge or flout pressures to vaccinate. Although some refusers may be ill-informed, some have studied the issues, spent time weighing up options, and reached a considered decision. For such individuals, condemnation is unlikely to be helpful. Engaging in respectful conversations is more likely to be productive.
Vaccination mandates and censorship of Covid views contrary to orthodoxy may harden resistance. Some people oppose compulsory measures simply because they are compulsory. Another factor is that those who feel pressured to vaccinate are more likely to seek support from others with similar concerns. The result is that vaccination resistance transitions from individual to collective forms. In a sense, mandates create the very enemy — organised opposition — they are supposed to overcome.
Another implication is that resistance is about values, not just science. Talking about “following the science” is unlikely to be convincing to those who put a great priority on personal freedom, even at the expense of their own health. Furthermore, values can shape acceptance of medical authority, so it becomes a question of which authorities to invoke, mainstream or dissident.
Some supporters of vaccination become self-righteous, assuming they hold the one and only truth about Covid. Furthermore, if they recognise the role of values, in particular the values of individual rights versus public health, they assume their own values are superior. Presuming to hold the one and only truth and that one’s values are unquestionable is a poor basis for understanding resistance.
Some of the concerns of well-informed resisters may point to genuine issues, for example the lack of information about long-term consequences of Covid vaccines, the lack of comprehensive studies of adverse reactions, the role of vested interests and the relative neglect of preventatives and treatments, especially using nonpatentable substances such as vitamin D and ivermectin. It is possible to learn from resisters about ways to make vaccination more credible to at least some of its critics.
It may be possible to find common cause with some Covid vaccine critics. For example, agreement might be possible over non-vaccine ways to reduce the harms from Covid, such as encouraging exercise and protecting those who are most vulnerable.
When lives are at stake and some people seem to be flouting basic advice for the common good, it is tempting to attack, condemn and use coercive measures. It would be more productive to show respect, learn from critics and join together in whatever ways are possible.
Thanks to Bob Dildine, Kelly Gates, Julia LeMonde and Tom Weber for helpful comments on drafts, and to many others for stimulating discussions on vaccination issues.