Global vaccination trends are telling us both good news and bad news stories, nearly four years after the start of a global pandemic. On the plus side, some childhood immunizations have begun recovering to pre-COVID rates. Against that, almost half of the 73 countries that reported pandemic-related declines in vaccine rates have either flatlined or continue to drop. Also on the downside, UNICEF reported earlier this year that public trust in vaccinations had eroded worldwide. And that includes the U.S., where one new pandemic documentary aims to probe (and show ways to ease) this distrust.
The film, called A Shot in the Arm, couldn’t be more timely. Confidence in vaccine safety has dropped for two years in the U.S., according to a recent survey, while belief in misinformation has grown. A new report from the Centers for Disease Control (CDC) meanwhile recorded the highest-ever vaccine exemption rate for children entering kindergarten, in the 2022–23 school year.
Public health and policy experts are alarmed, but not all point to the same culprits. Some, such as health law expert Timothy Caulfield of the University of Alberta, blame misinformation and conspiracy theories spewed by antivaccine crusaders for the decline. So does the prominent vaccine scientist Peter Hotez, who, in a recent interview with Scientific American, argued that a “well-oiled, well financed antiscience ecosystem” is undermining public trust in vaccines.
However, other experts, such as Julie Leask, an Australian social scientist who studies all the different reasons that cause people not to vaccinate, point to a more complicated mix of psychological, socioeconomic and ideological factors that, yes, does include the influence of crusading antivaccine activists. “In our postpandemic world, trust in public health and government has been severely tested, and bad actors are having their day,” Leask said, in an e-mail. At the same time, she also urges science communicators to wrestle with the appeal of high-profile vaccine opponents like Robert F. Kennedy, Jr. “I do think people need to engage with the anxieties beneath what he says, rather than attack it on a manifest level or just attack him,” she added.
The new documentary premiering this month evocatively captures those deep-seated anxieties. A Shot in the Arm unfolds at the onset of the pandemic, when fear and confusion paralyzed society. The film then chronicles the rhetorical battlefield that pitted earnest public health professionals, who preached cautionary social measures and the science of immunization, against the blustery, self-appointed watchdogs of “medical freedom” who inveighed against masks, lockdowns and the COVID vaccine.
“Who should we listen to, who should we trust?” the documentary asks, in its exploration of denialism. It seems like a no-brainer. During an interview in the film, Kennedy is challenged to name “any vaccines in history” he thought were “a benefit to mankind.” I was sure that, if nothing else, Jonas Salk and polio would roll off his tongue. Instead, Kennedy demurred: “Um, I don’t know the answer to that.”
As The New Yorker put it in July, this scion of a famous political family is “roiling with conspiracy theories”—about everything from the CIA and Wi-Fi, to the COVID vaccines and the cause of AIDS. Despite such a mindset, or perhaps because of it, Kennedy is surging as a third-party presidential candidate. Comedians have mocked him, and family members have deplored and condemned his views. It hasn’t mattered. (Like Donald Trump, Kennedy’s superpower is shamelessness.) So perhaps it is time, as Leask suggests, to engage with whatever is roiling the people who seem drawn to his message.
In a 2022 Nature Medicine paper, scientists with the London School of Hygiene and Tropical Medicine write that “some of the factors fueling vaccine hesitancy, such as anxieties around the pace of technological change or feelings of political disempowerment, are not within the control of the medical community.” The authors acknowledge that rampant misinformation plays a significant role in undermining confidence in public health authorities, but “focusing only on the information ecosystem can obscure the wider sociocultural, historical, institutional and political context.”
That context is essential to an understanding of vaccine hesitancy in some communities, such as Black Americans, who have long faced inequities in health care and also carry a historical memory of immoral medical experiments. (A Shot in the Arm, addresses this issue with its attention to the notoriously unethical Tuskegee syphilis study.)
On that broader note, the 2022 paper argued that acute public anxieties during the pandemic became intertwined with a legacy of distrust in medical and government institutions. Opportunistic misinformation peddlers exploited this legacy. The authors concluded: “Like the virus that gave rise to them, it seems probable that myths and conspiracies around COVID-19 and vaccines will be things that we all need to learn to live with and manage for some time to come.”
This seems prescient, given Kennedy’s recent ascendance in a political sphere already filled with demagogues, some in Congress who are politicizing dangerous nonsense about vaccines. That’s a recipe for disaster, which we already got a bitter taste of from the infamous January 6 Capitol riot. A Shot in the Arm shows the jarring scene of the “MAGA Health Freedom” rally, when leading anti-vaxxers joined with “Stop the Steal” organizers, a confederation of conspiracy mongers, to rile up the angry mob in Washington, D.C. “I wish I could tell you that this pandemic is really dangerous,” antivaccine leader Del Bigtree shouted from a lectern. “I wish I could believe that voting machines worked and that people cared. You’ve been sold a lie!”
Since then, the MAGA and antivaccine movements have continued to merge into a potent Frankenstein ideology, stitched together out of mistrust for experts, that threatens to further erode trust in government institutions as well as scientists—at least among Republican voters.
Against this worry, the bigger picture offers encouragement on the vaccine front. A new and comprehensive Texas A & M University survey found that Americans “are overwhelmingly supportive of all vaccination mandates.” This tracks with findings from a survey published earlier this year by the Pew Research Center.
This also suggests that conspiracy theories and “alternative facts” are not poisoning the minds of most Americans about childhood immunizations. That’s a relief. As the science writer Michael Specter wrote in his 2009 book, Denialism: “Choosing to vaccinate an infant requires faith–in pharmaceutical companies, in public health officials, in doctors, and, above all, in science.”
It’s true that a good number of vaccine-hesitant people have lost such faith. But they are not a monolith, cautions Leask, and shouldn’t be broadly labeled as “antiscience” if we have any hope of restoring their trust in the scientific establishment. Field studies and the literature on science communication suggest approaching vaccine reluctant individuals respectfully and from a position of empathy.
There’s a scene towards the end of A Shot in the Arm that reflects empathy’s effectiveness. It comes when the noted vaccine expert Paul Offit of the University of Pennsylvania appears on a podcast hosted by a vaccine-refusing parent. “You’ve been saying a lot of things that make a whole lot of sense,” she acknowledges to him at one point, before imploring her audience to engage in a respectful dialogue on vaccines. People need “to stop treating each other so mean and so badly,” the parent activist urges her listeners, “so we can get somewhere.”
That sounds like a worthy prescription for our polarized times, in general; it’s also an Rx that would surely help build long-standing trust in the vaccines that protect us and our loved ones from infectious diseases.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.