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The need to look beyond the numbers when studying vaccine hesitancy

In this Following Up feature we reconnect with vaccine hesitancy researcher and author Maya Goldenberg to get her observations on the COVID-19 vaccine campaign one year later

It is easy, perhaps even popular, to focus on the failures of the national and international vaccination campaigns against the COVID 19 pandemic, but that would be ignoring the many successes of a global initiative unlike anything attempted in human history.

“Some things went better than you might have expected, and other things went worse,” said vaccine hesitancy researcher and author, Maya Goldenberg. 

“People always want to talk about the US situation where vaccination rates are low. It’s about 60 per cent and they made vaccines quite widely available. Look at Canada where we have very high rates of vaccination somewhere near 85 per cent for 12 and up. That’s a huge success and I think that’s a sign that there is a fair bit going well in Canada. There is general trust in the system that brought us vaccines.”

Goldenberg is associate professor of philosophy in the University of Gueph's College of Arts and author of Vaccine Hesitancy: Public Trust, Expertise, and the War on Science, that was published this time last year just as the vaccine campaign was kicking off.

Her research, as the title of her book suggests, examines resistance to vaccines by what has historically been a small but highly vocal segment of the population.

“We need only look at Ottawa a few weeks ago to see that even a minority, an extremist minority view, can be very disruptive and it wasn’t just the extremists that were supportive of this Freedom Convoy as they called it,” Goldenberg said. “There were a lot of regular Canadians too, who didn’t need to ascribe to everything that was being touted there, but they could at least say I have some sympathy for people that were hurt by the lockdown, people who feel isolated socially because they’re not vaccinated.”

The global response to the pandemic and resistance to protocols such as lockdowns, masking and vaccine mandates are unprecedented, but public protests have been part of vaccine campaigns since they were first developed at the end of the 18th Century.

“There have been times of great unrest like during smallpox vaccination when there were riots in the street,” said Goldenberg. “That happened in Montreal around vaccination. There has definitely, been public unrest, but we have never had a vaccine drive to this scale when we were trying to vaccinate the entire globe so, there are going to be problems.”   

The partisan political nature of the protests has complicated the process.

“That is something we haven’t seen before,” said Goldenberg. “I started researching vaccination in early 2015 and at that time, vaccines were a non-partisan issue. All politicians were in favour of vaccination. So, any kind of negative attitudes about vaccines were coming from the public not from politicians and that has shifted.”

Goldenberg worries what this political trend could further erode public trust in vaccines and make the existing, as well as future, campaigns even more challenging.

“I remember when I started this research, vaccine hesitancy researchers used to say, ‘hopefully, vaccines won’t get politicized the way climate science is because then we’re doomed,’ and, of course, we ended up exactly there,” she said.  “People on the right are far more reluctant about vaccines.  They frame it as a freedom of choice issue, but the freedom is the freedom not to vaccinate and the freedom to spread negative information about vaccines.”

The spread of disinformation and partisan division in the US is being blamed for the country’s low vaccination rates and high numbers of COVID deaths. In the first days of March, when this article was written, the number of COVID deaths in the US had surpassed 949,000 or 2,855.05 per million population.

At the same time Canada recorded 36,594 deaths or 961.28 per million population. That is little more than a third of the death rate per capita of the US.

Nevertheless, partisan resistance to vaccination and pandemic protocols is rising in Canada.

“Once the freedom messaging was established and they had gotten most of the Republican leadership and some Canadian Conservative leadership on board, there was a chance to really amplify that message,” said Goldenberg.  “They combined forces with anti-lockdown, anti-mask movements, and these newly formed groups, to make this general mantle of freedom that was not just against vaccines but against all public health intervention.”

They focus on the mistakes and failures of the vaccine campaign and cultivate mistrust in government, science, mainstream media, and accredited medical experts. 

“It is a curious thing that a lot of vaccine hesitators will point to unknowns and uncertainties about what we know about the COVID vaccines,” said Goldenberg. “In many ways they are right. We don’t know everything about it and a lot of these criticisms sound, in a lot of ways, like a sophisticated critique of science. We don’t have it all worked out. In fact, science is fallible and, especially, new science is far from secure.”

The uncertainty and mistrust have fuelled several conspiracy theories including that the government, Big Pharma and the mainstream media have been covering up evidence of the adverse side effects of vaccines.

Of course, many conspiracy theorists would claim mainstream sources can’t be trusted. They choose, instead, to place their trust and get much of their information from right-wing media personalities such as Tucker Carlson, and online sources such as Qanon and Infowars with its discredited conspiracy theorist host Alex Jones.

“Seems that if you are going to be consistent, you have to be skeptical of both sides and not just the side that claims majority view and what comes with that,” said Goldenberg. “There is a sophisticated understanding of the uncertainties of science and then a lot of certainty that Alex Jones knows. Why?  Why would Alex Jones know?  He will pretty much say anything. In fact, that is kind of what people love about him.”

Of course, not everyone who is vaccine hesitant, has fallen down the rabbit hole of conspiracy theories.  Some have sincere concerns and are looking for legitimate sources they can trust so, they can make informed decisions about their health and the health of their families.  

“I should say that that is kind of a core tenant of vaccine hesitancy research, that it is not just the rates of vaccine acceptance and refusal that we need to look at,” said Goldenberg.

“We need to look at the attitudes behind it. The attitudes can be about vaccines themselves. I don’t trust vaccines. I’m not sure that they are properly tested, but there is also the political ideology that has grown around vaccines that we need to be worried about. We don’t want to become divided socially like what we see in the US. So, we need to look at vaccine attitudes in particular, but also how they have been attached to political ideologies, right wing populist movements, because those things can grow significantly.”