Heidi Larson on Vaccine Skepticism

As the toll from the COVID-19 pandemic increased, polling suggests counterintuitively that resistance to a future vaccine has also risen. Anthropologist Heidi J. Larson identified several likely drivers of this, including political polarization, a focus on being ‘natural,’ the undercurrent of mistrusting the so-called elite. But in this Social Science Bites podcast, she tells interviewer Dave Edmonds that there’s another driver.

Scientists themselves.

Families who have some expertise in running their own affairs can come to resent “the elitism of science, the language of science, the ‘we know better’” which dismisses their experiences and more importantly, their questions. “A lot of parents feel very strongly feel that they have their own evidence of vaccine problems,” she notes, and the medical establishment has often not invested a lot into bringing the public along – even as the number of vaccines and the expectation of being vaccinated grows.

“[The public is] saying, wait a minute – we want to have say in this, we want to be able to ask some questions … [W]hen they feel like the door in closed on the questions, that shuts down the conversation. I think in order to become unstuck, we need to have more dialog and be open.”

Stuck is the name of Larson’s new book. Besides the obvious pun in the title, Larson explains Stuck: How Vaccine Rumors Start -- and Why They Don't Go Away also refers to being “stuck in the conversation, why the public health community has been losing some of the public enthusiasm for vaccines.”

These are questions and concerns Larson routinely addresses in her role as director of the Vaccine Confidence Project, a World Health Organization (WHO) Centre of Excellence that addresses vaccine hesitancy, and as a professor of anthropology, risk and decision science at the London School of Hygiene & Tropical Medicine’s Department of Infectious Disease Epidemiology.

The first organized opposition to compulsory vaccination arose in the United Kingdom in the late 1800s, she explains, as a reaction to mandatory smallpox vaccinations. “To this day that is one of the persistent themes that has fueled some of this resistance.”

Nonetheless, as vaccinations remain one of the most remarkable health interventions available, the resistance that might be expected to erode in the face of a global health emergency hasn’t faded.

“Strangely, in the context of the pandemic, the already amplified skepticism has taken another level of resistance, which is surprising to many of us. You’d think with such a serious disease and a pandemic it would be a time where people would say, ‘Wow, this is really an example of why we really need a vaccine.’”

And the resistance, whether to a coronavirus vaccine or to vaccine in general, can be seen globally. In fact, Larson is seeing resistance groups linking up across borders – and an a most inopportune time.  “I see the whole increase in the anti- and skepticism as being kind of a tipping point … We’ve always had all these other issues that have been challenging in getting enough people vaccinated, both from the supply of the vaccine and the access, logistics and all the rest. But this additional factor – we’ve stagnated in our global vaccination coverage and just can’t seem to get above a certain amount.” And those coverage levels in some cases fall below the thresholds needed for “herd immunity,” which in turn means we can expect more cases, whether or COVID, measles or even polio.

Social media has helped skeptics get their messages disseminated, and Larson notes that the Wakefield autism scare arose the same year as the start of Google. “The sentiments are not new,” she says, “but the scale and intensity of them is.”

In addition to her position in London, Larson is also a clinical professor in the Department of Global Health at the University of Washington and a guest professor at the University of Antwerp. She previously headed global immunization communication at UNICEF, chaired the Advocacy Task Force for the Gates Foundation-sponsored Gavi, the Vaccine Alliance, and served on the WHO Strategic Advisory Group of Experts Working Group on vaccine hesitancy.