Vaccine Hesitancy Is Nothing New But It Can Be Overcome

By: Alia Hoyt  | 
smallpox cartoon
This cartoon "Cow-Pock, or, The Wonderful Effects of the New Inoculation" by James Gillray depicts some of the fears people had about the smallpox vaccine causing them to grow cow-like parts. Library of Congress/Corbis/VCG via Getty Images

Nobody likes to be sick, but it seems there are plenty of people who are willing to take a chance on a disease like COVID-19, instead of getting a vaccine. Why is that? And is this a new phenomenon? First, we have to understand the difference between vaccine hesitancy and anti-vaccine activism (or vaccine resistance).

"Vaccine hesitancy and anti-vaccine activism are distinct and largely unrelated," explains Noel Brewer, Ph.D., professor of health behavior at the University of North Carolina in an email. "Only around 2 percent of Americans will never get a vaccine, and among these hard refusers only a handful attempt to recruit others to their views."


By comparison, he says, most people have at least some questions about vaccines, which is not a bad thing. "Vaccine hesitancy is normal and healthy and should be encouraged. It's good to have questions, ask them and get high-quality, trustworthy answers," he says.

The vocal anti-vaccination movement is fairly recent and was really kicked into gear in 1998 by a now-discredited paper that appeared in the medical journal Lancet linking vaccines and autism, says Brewer. However, vaccine hesitancy is as old as vaccines themselves.


Vaccine Hesitation Through History

"This has been going on for centuries," says Dr. Kathryn Edwards, author of an American Academy of Pediatrics clinical report "Countering Vaccine Hesitancy." She points out that there was a cartoon published back in 1802 that depicts people growing cow-like parts. This was because Edward Jenner pioneered the smallpox vaccine first using material from cowpox.

The first smallpox vaccine "was met with enthusiasm but also dread," wrote medical historian Elena Conis in a 2015 article. "While many patients and physicians were eager to fend off one of that era's most feared diseases, many others balked at the prospect of contaminating their healthy bodies with disease matter from an animal." And when European countries began making smallpox vaccines mandatory in the early 1800s, "societies of anti-vaccinationists formed to protest what they saw as unequal treatment and undue infringement of individual liberty."


But they didn't get much traction. There was also little protest against the polio vaccine, released in 1954 to "wild enthusiasm" in America, according to Conis. "Parents so dreaded polio that they were quick to seek the vaccine for their children, and coercive policies never became necessary," she wrote.

polio vaccine
A nurse prepares children for a polio vaccine shot as part of a city-wide testing of the vaccine on elementary school students in 1954.
Bettmann/Getty Images

But as the decades went on, American parents were not so excited about vaccinations for measles, mumps and other diseases, she noted. "Families long accustomed to living with measles, for example, shrugged off the new vaccine against the disease." Health officials often had to make vaccinations mandatory for school registration to get compliance.

In 1982, a TV documentary called "DPT: Vaccine Roulette" aired, featuring profiles of children whose mothers believed they were harmed by the vaccine for diphtheria, whooping cough and tetanus, one of the first media coverages critical of vaccines. Then, the 1998 Lancet article linking the MMR (measles, mumps and rubella) vaccine and autism sparked the "anti-vaxxer" movement.

Fast forward to 2021 and the new vaccination against COVID-19. A whopping one-third of American adults are skeptical of getting it, according to the Associated Press, a pretty big problem for those trying to slow or stop the pandemic.


Why Vaccine Hesitation?

We've already established that vaccine hesitancy is normal, even healthy. But why does it happen? The reasons are threefold, according to Edwards.

1. People don't think the disease is that bad, therefore it doesn't need to be prevented. "One of the issues that make vaccine hesitancy more common prior to COVID is that many of the infectious diseases that parents dreaded for their children have been eliminated," Edwards explains, noting that severe chickenpox, mumps and other once-devastating illnesses are far rarer than they used to be, thanks to vaccines. In terms of COVID, fear levels tend to run a wide range of normal, with some people petrified of the virus and others totally unconcerned. "Many people who don't want to get the vaccine are less afraid of getting COVID than those who get [the vaccine]," she explains.


Of particular influence to this aspect of vaccine hesitancy is the media, says Edwards. "Some is very science-based, others are not," she notes. "An internet site doesn't come with a rating of whether it's based on fact or not."

2. They're worried about the safety of the vaccine. This is a big one for the COVID-19 vaccine; since it was developed so quickly, a lot of people think that it can't possibly be safe enough to use. (In reality, scientists had been dealing with other coronaviruses like SARS and MERS for decades which gave them a head start in vaccine development.) Although vaccine hesitancy is common among people of all demographics, minority populations are especially skeptical because many distrust the medical system. Think of the infamous Tuskegee Syphilis Study.

3. Individualism is important. Most people don't like to be told what to do, even if it's in their best interests. They want to "decide for myself if I get vaccinated, whether I wear masks, if I go out or quarantine," Dr. Edwards says. "It's the sense of wanting to be an individual and having individual rights."


How to Handle Vaccine Hesitancy

For what it's worth, vaccination rates are still high in the U.S., with 91.5 percent of children aged 19-35 months fully vaccinated against measles, mumps and rubella as of 2017. This is an all-time high, with the lowest rate since 1994, occurring not-so-coincidentally in 1998 (86 percent) when the fraudulent MMR vaccine/autism study was released.

Still, there's not likely to be a magic cure to eliminate vaccine hesitancy anytime soon. "We don't have much evidence that interventions to decrease hesitancy can increase vaccine uptake. Such interventions have been unreliably effective," Brewer says. "That said, the best way to address hesitancy is to have a person talk with their healthcare provider. A provider recommendation is the single biggest motivator of vaccination."


kid getting COVID-19
Joseph Galdamez, 14, receives a first dose of the Pfizer COVID-19 vaccine at a Los Angeles County mobile vaccination clinic on May 14, 2021. Polls have shown just 30 percent of parents plan to vaccinate their kids right away, now that the vaccine has been approved for children 12 and over.
PATRICK T. FALLON/AFP via Getty Images

So, let's say a friend mentions that they're scared to get a certain vaccine, whether for themself or a child. The worst thing you can do is tell them they're stupid or unilaterally discredit their concerns. Instead, find out why they're concerned. Is it due to side effects? Fears about big pharma? Potential long-term problems?

Validate their feelings by listening and taking them seriously. Then suggest that they visit some reputable sites (with you or on their own) to get credible answers to their questions. A few that Edwards suggests are the CDC, AAP and the National Institutes of Health vaccine information portals. "There's a wealth of information to look at that can answer questions, as long as it's a source that is linked to science," she says. (The American Academy of Family Physicians website also has an extensive explanation of COVID-19 vaccine myths and facts.)

Finally, as Brewer says, suggest a frank conversation with their doctor to find out why the vaccine is recommended, if there are any risks and what the side effects might be. Most of the time, a simple conversation with a knowledgeable person will allay fears. "Certainly, I want my patients to understand what they're receiving and how it works. I also want them to know that they may experience side effects that I can tell them about," Edwards says.