More Americans are getting the Covid-19 vaccine, but a recent study in the Journal of the American Medical Association showed that 32 percent of people in the United States remain unlikely to get vaccinated against the virus. The newest group of vaccine doubters are parents of children who just received approval to get the shots. A poll in late October from the Kaiser Family Foundation shows that fewer than 1 in 3 American parents want to vaccinate their 5- to 11-year-olds.
Hesitancy about inoculations is nothing new. In fact, the sentiment is not only as old as the republic itself, but older.
While the issue of vaccine resistance has taken on new urgency and is receiving many more headlines because of the pandemic, hesitancy about inoculations is nothing new. In fact, the sentiment is not only as old as the republic itself, but older.
Vaccine hesitancy has always gone hand in hand with vaccines, meaning the scope of the problem is more deep-seated and intractable than many understand — even as social media is used to spread such sentiments further than ever before. That means the country almost certainly can’t rely on soft tools such as education and incentives alone to get sufficient numbers of people vaccinated.
The Chinese practiced smallpox inoculation as early as 1500 by inhaling powder made from the crusts of smallpox scabs in order to protect themselves from the disease. That was nearly 300 years before Edward Jenner founded vaccinology in the West in 1796 by taking the fluid from a cowpox blister and scratching it into the skin of a patient. There was such staunch resistance by individuals who were skeptical, given the many medical quacks of the day and their fears about endangering their children, that the English government made Jenner’s inoculation procedure mandatory for its citizens at the beginning of the next century.
When these innovations landed in the New World, they brought fears about the practice with them. "Since the founding of the American colonies, anti-vaccine sentiments have been widely expressed," notes Dr. Peter J. Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development.
As one early example, he pointed to an instance in which a Puritan minister and his physician were attacked in Boston for trying to use inoculation to combat the smallpox epidemic of the early 1720s. The Washington Post described the attack as sparked by “Fear of science, suspicion of the ruling elite, and a belief that medicine might meddle with God’s will.”
“Interestingly, the points anti-vaxxers made in the 1800s are not much different from points being made today,” notes Elizabeth Jacobs, a professor of epidemiology and biostatistics at the University of Arizona. Anti-vaxxers have always had to rely on confirmation bias outlier data to support their cause. To them, the focus can't ever be on the number of people who are dying or becoming hospitalized as a result of the disease that vaccines are known to prevent; today, for instance, they have to focus on the 1 in 200,000 people who have a serious adverse — even if nonlethal — reaction to a vaccine instead of the 1 in 150 people who die from Covid-19.
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Vaccine superstitions particularly track with a lack of trust in government, according to Janet Golden, an emeritus history professor at Rutgers University–Camden. Though these superstitions have been present in every American century, political trust has been in sharp decline in modern America.
The upheavals of the 1960s, the fiascos of the Vietnam War and Watergate in the 1970s, and the anti-government movement under President Ronald Reagan in the 1980s all fed this sentiment, which was then intensified by the tea party and Trumpism.
Into this brew dropped a television documentary that claimed the whooping cough vaccine caused permanent brain damage. Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, pinpoints the birth of the modern American anti-vaccine movement in 1982 with the release of the production, which he says led to a flood of lawsuits against pharmaceutical companies and advocacy groups spreading misinformation that vaccines do more harm than good.
The idea that the measles, mumps and rubella (MMR) vaccines cause autism was stoked by a discredited academic and former British physician who published a wildly controversial and since discredited study in The Lancet in 1998. Unfortunately, that motivated a growing group of parents to oppose vaccines, particularly those on the left who eschew Western science and embrace alternative medicine.
According to Hotez, the "anti-vaccine health freedom movement” attained more power and funding beginning in 2015 with the rise of the tea party on the right, which he blames for recent measles outbreaks and for perpetuating the myth that vaccines are connected to autism.
And of course, religious beliefs have continued to play a part in vaccine hesitancy as well, morphing as the science has changed. While many religious leaders have encouraged parishioners to become vaccinated against Covid-19, some today have objected on the grounds that certain vaccines have been developed using fetal cells. Previously, some ultra-Orthodox rabbis and other religious leaders have cited debunked information that vaccines are “experimental,” making them akin to “child sacrifice,”while in Nigeria, Muslim communities boycotted polio vaccination when religious leaders told their followers they may be contaminated with anti-fertility agents, HIV and cancerous agents.
The modern age has brought new reasons for vaccine hesitancy as well. Ironically, thanks to the success of vaccines, few people today have witnessed firsthand the consequences of the diseases vaccines are known to prevent. "The out-of-sight, out-of-mind principle applies to vaccine hesitancy," says Dr. Martin Myers, the former director of the National Vaccine Program Office of the U.S. Department of Health and Human Services.
Because vaccines work, Myers says, modern parents are no longer gripped by the terrible fears that were so common when parents recognized symptoms of meningitis, polio or rubella in their children. While these diseases have essentially been eradicated — leaving no devastating examples to imprint on parents’ minds — the number of children with developmental and autoimmune disorders, such as autism and asthma, have risen in visibility.
Then, of course, there’s social media. "Social media is the single greatest contributor to anti-science attitudes and the anti-vaccine movement," Jacobs calculates. She explains that such platforms amplify the problem by acting as echo chambers, by creating a financial model that rewards posts that are widely shared (even if they're false or misleading) and by creating spaces and groups for anti-vaxxers to gather around misinformation.
Of course, some vaccine hesitancy is understandable. Offit says even he’s a skeptic until he sees the data (in the case of Covid vaccines, the data “couldn’t be more encouraging”). He says what’s important is to keep the rare vaccine side effects in proper perspective with the deadly diseases they protect against. As the centuries-long resistance to vaccines makes clear, however, this compelling logic still isn’t enough to persuade everyone to get the shots.
Offit says the only option that remains for today’s holdouts are government mandates at the federal level or requiring proof of entry into stores and events by local businesses. "When logic and reason don't matter to someone," he said, "you have to find something they do care about."