Does the Public Trust the COVID-19 Vaccine?

As we know, the year 2020 has been disrupted by the current global pandemic, which is highly contagious and has led to a heavy burden on hospitals, healthcare workers, and emergency responders as well as had a sharp economic impact with shutdowns of businesses and entire countries. With this in mind, if a COVID-19 vaccine became available today, would you take it?

According to a BBC News article, multiple companies have been working to develop a COVID-19 vaccine and have reported preliminary results suggesting competitive efficacy results, including AstraZeneca (62-90% effective), Moderna (95% effective), Pfizer-BioNTech (95% effective), and Gamaleya (Sputnik V) (92% effective). With the race to the vaccine nearing a potential end, many are questioning when exactly a vaccine will be available and which groups of people the vaccine will be available to first. As reported throughout the year, conspiracy theories and misinformation have been continuously spread around the pandemic, and as the vaccine becomes available, experts expect resistance from the anti-vaccination movement. This begs the question: will the public take the vaccine?

A CNN article describes what anti-vaccination arguments have entailed historically:  

• Minimizing the Disease’s Threat: Individuals may purport that the disease is not as great a threat or as widespread as reported, or that the concern around a disease is a “senseless panic” such as the case of the anti-vaccinationists in response to the smallpox vaccination in 1885.
• Casting Doubt on the Vaccine’s Safety or Effectiveness: This can include claims that the vaccine causes an illness or does not work at all.
• Making Claims About a Vaccine Conspiracy: One argument is that vaccines are a simply a tool used by the government to gain a profit and exert control over personal freedoms
• Using “Experts” That Support the Argument: This method utilizes the support of an “expert” who supports the narrative (e.g. Andrew Wakefield, a former physician who published a discredited study linking the MMR vaccine to autism.)

Understanding the importance of this topic to public discourse regarding vaccinations and the importance of being able to identify misinformation online, especially with the impending availability of COVID-19 vaccines, Prof. Melodie Yunju Song, from Ted Rogers School of Management, Ryerson University, Canada, provides an overview of the cyclical discourse of anti-vaccination movements on the online public sphere in contemporary society in her chapter “Public Engagement and Policy Entrepreneurship on Social Media in the Time of Anti-Vaccination Movements”, sourced from Using New Media for Citizen Engagement and Participation (IGI Global).

Using New Media for Citizen Engagement and Participation Prof. Marco Adria (University of Alberta, Canada) Copyright: 2020 | Pages: 347 | ISBN: 9781799818281 | EISBN: 9781799818298 This publication provides emerging research exploring the theoretical and practical aspects of how social media should be added to public-involvement activities such as citizen juries, public deliberation, and citizen panels...Learn More.

A highly contagious disease, measles deaths claimed 110,000 lives in 2017, with children under the age of 5 taking the hardest toll (World Health Organization, 2019c). In most Organization for Economic Co-operation and Development (OECD) countries, MMR vaccine is highly accessible, provided for free by the state or provincial government. Despite so, the rate of unvaccinated children are rising (Larson, Jarrett, Eckersberg, Smith, & Patterson, 2014). According to the World Health Organization (WHO), reported cases of measles in 2019 increase by 300% (n=112,163) compared to 2018 in the first three months alone (World Health Organization, 2019b). Since reported cases makes up 10% of the actual cases, and global MMR immunization coverage is currently at merely 67%, it is projected that measles outbreaks will continue an upwards trajectory if immunization rates remain below the targeted global coverage rate of 95% (ibid).

WHO has declared vaccine hesitancy as one of the top 10 threats to global health in 2019 (World Health Organization, 2019a). Research shows that decreased immunization coverage rates due to vaccine hesitancy leads to periodic and sustained vaccine-preventable outbreaks in the US (Bolton, Memory, & McMillan, 2015), France (Ward, 2016), Croatia (Repalust, Šević, Rihtar, & Štulhofer, 2016), China (Wagner et al., 2017), Japan (Okuhara, Ishikawa, Okada, Kato, & Kiuchi, 2017), Malaysia (Mohd, Kew, & Moy, 2017), Italy (Aquino et al., 2017), Ukraine (The Lancet Editorial, 2018), and Brasil (Sato, 2018).

One of the most common reasons for vaccine hesitancy relates to the concern that MMR vaccines cause autism, an erroneous claim that first appeared in a false publication in a reputable journal - The Lancet – in 1998 (Wakefield et al., 1998). Wakefield’s fraudulent paper was the match that ignited the fiery skepticism to MMR vaccination. Powerful international and national advocacy groups such as the National Vaccine Information Center Advocacy Portal (NVICAC), the Californian Coalition for Vaccination Choice (CCVC) uses social media and websites to actively disseminate and sign petitions against all types of vaccines, calling for vaccine exemption for their children based on philosophical grounds (CCVC, 2015). Although the Lancet retracted the article in 2010, the damage was done. The paper was circulated for 12 years, the false results were reported by the media, discussed in press, and on the internet, and had been cited by thousands.

Researchers in medicine, public health, communication, mass media, computer science and informatics are boggled by the resistance to one of the safest medical interventions in humanity. These researchers ask the same question from various angles in hopes of finding out ‘What drives some segments of society to accept the MMR vaccine while others are reject the vaccine?’

We use the case of vaccine hesitancy to explore public health discourse using online media to answer our question of interest. Typologies of online public engagement will be examined to illustrate the different approaches used by pro- and anti-vaccine groups to inform, consult with and engage with the public on public health issues that has been the subject of long-standing debate and confusion. The parallel narratives of two existing paradigms (modernism and post-modernism) are used to explain how different perceptions of vaccination have been shaped by vaccination proponents and opponents. In the first section, we provide a brief account of anti-vaccination movements in the West starting with resistance of the smallpox vaccine in the UK in the 19^th century. In the second section, we propose that an ideo- logical clash between practitioners of modernism and the postmodernists is the overarching reason for anti-vaccination movements to persist. The third section touches on the typologies of public engagement online and compare and contrast the different methods of online engagement tactics employed by pro- and anti-vaccine agencies. Finally, we draw on the psychological and political frameworks on issue framing to discuss the plausible reasons for the persistence of anti-vaccination movements on a micro-level.

Background

The Cyclical Discourse of Anti-Vaccination Movements in the West

Since the first commercially available vaccination was developed in 1796 by Edward Jenner to create immunity to smallpox, vaccine hesitancy has been a prevailing conversation in the public sphere. Hesi- tancy towards new technology – in this case, a procedure that eliminates the possibility of getting deadly diseases such as the chicken pox, exists as long as technocultural strife in the public sphere continues to be regurgitated and discussed.

The First Wave: Late 1850’s - 1900’s

The first wave of anti-vaccination movements was targeted at mandatory vaccines such as smallpox vac- cines and the polio vaccine. The first national anti-vaccination organization recorded in history was the National Anti-vaccination league (NAVL) (Durbach, 2004; The Cincinnati DailyGazette, 1879;Wolfe & Sharp, 2002). The NAVL impressively repealed the British Vaccination Acts of 1853, 1867, and 1871 in Britain due to the coalitions’ claim that there was inconclusive evidence as to whether smallpox vaccine caused leprosy (Kakar, 1996;Porter & Porter, 1988). The Royal Commission conducted 11 enquiries from 1898-1907 on vaccine safety. The result was ‘The Act of 1898’, a law that allows parents to request exemption for their children under ‘conscientious objection’ in the UK (Salmon et al., 2006).

The NAVL excelled at communicating their agenda. They had their own monthly newspaper, regular town hall meetings, and they had enough donors to support holding the first International Congress of Anti-Vaccinators in 1883 (Sacramento Daily Union, 1983). NAVL also visited Canada and the US to help establish the Anti-Vaccination League of Canada in 1900 and the Anti-Vaccination Society of America in 1908 (Arnup, 1992; Poland & Jacobson, 2011). These movements were a by-product of resistance to the growing acceptance of mechanical and technological advancement in the late 19^th century.

Around this time, public health first came into recognition in North America, representative of this was the Jacobson vs. Massachusetts law (1902) – the first landmark public health law that established a government’s legal responsibility in protecting others’ health by way of requesting mandatory vaccina- tion (Mariner, Annas, & Glantz, 2005; Parmet et al, 2005). The Jacobson vs. Massachusetts Law marked the end of the first anti-vaccination movement.

The Second Wave: Post World War II

Post-WWII marked the height of success in vaccination delivery with little anti-vaccination resistance from the public (Omer, Salmon, Orenstein, deHart, & Halsey, 2009). Opponents of universal vaccines came from within the scientific community. In the 1960’s onwards, several groups of physicians published in medical journals questioning the rationality of the Diphtheria, Pertussis, and Tetanus (DPT) vaccine because of observed correlation between DPT vaccine inoculation and neurological complications, en- cephalitis, and its lack of efficacy (Baker, 2003, 2008; Gangarosa et al., 1998; Poland & Jacobson, 2001; Stewart, 1980; Stewart & Wilson, 1981; Strom, 1960), whooping coughs rarely kills (Gangarosa et al., 1998; Poland & Jacobson, 2011). Within this group of anti-DPT physicians, Professor Greg Stewart was considered the de facto spokesperson in the press and on the radio and television (Baker, 2003, 2008; Stewart, 1980; Stewart & Wilson, 1981).

Stewart’s claim drew enough attention that the British Joint Committee on Vaccination and Immuni- zation (JCVI) launched the National Childhood Encephalitis Study (NCES) based on cases submitted by the Association of Parents of Vaccine-Damaged Children, a UK-based, parent-led non-profit association (Baker, 2003). Subsequently, uptake of DPT decreased to 50% in 1980’s compared to 91% in the early 70’s, and pertussis endemic swept the UK, Sweden, Russia, Italy, and Australia (Baker, 2003). Where anti-vaccination movements were most vocal in printed press, many were highly educated and demanded justice for their children, they provided pamphlets and taught parents to write to local legislators to call for investigation (Fox, 2006). Although all cases pointed towards null correlation to neurological dam- age nor encephalitis with DPT vaccine, the public has lost its trust for DPT for a whole decade starting in the mid-70’s (Baker, 2003).

The Third Wave: 1998 to Present

All medical interventions come with a risk, but the MMR vaccine is considered one of the safest and most cost-effective medical interventions in human history (Bloom, Marcuse, & Mnookin, 2014). In the 80’s, vaccine production was thought to be a low return-rate, one-time only procedure that pharmaceutical companies had little interest in manufacturing; coupled with previous anti-vaccination safety concerns, willingness to produce vaccines was lukewarm (Offit, 2005).

The third wave of anti-vaccination movement began after a now-retracted fraudulent article on the linkage of autism and MMR vaccination was published on the Lancet (Wakefield et al., 1998). In the UK, media widely reported the study findings and English-speaking countries soon picked up on the report, attracting international attention from concerned parents, curious physicians, and skeptical im- munologists and virologists. Amidst floating rumors that the vaccine’s thiomersal content causes autism, some parties were more vocal than others, thus leading to the third wave of anti-vaccination movement and the most recent MMR outbreaks that are the focus of our case study.

Understanding the need for research around this topic, this research is featured in the publication Using New Media for Citizen Engagement and Participation (IGI Global). This title provides emerging research exploring the theoretical and practical aspects of how social media should be added to public-involvement activities such as citizen juries, public deliberation, and citizen panels. Readers will be offered insights into the critical design considerations for planning, carrying out, and assessing public-involvement initiatives. Featuring coverage on a broad range of topics such as citizen journalism, online activism, and public discourse, this book is ideally designed for corporate professionals, broadcasters, news writers, column editors, politicians, policy managers, government administrators, academicians, researchers, practitioners, and students in the fields of political science, communications, sociology, mass media and broadcasting, public administration, and community-service learning.

It is currently available in print and electronic format (ISBN: 9781799818281, EISBN: 9781799818298) through IGI Global’s Online Bookstore at a 20% discount. Additionally, to ensure that the research community can easily and affordably access this content, this publication and all IGI Global titles are available on the individual article and chapter level (pay-per-view) for US$ 37.50 through IGI Global's InfoSci-Ondemand. Recommend this publication and view all of the chapters featured in this title on the book webpage here. Additionally, this research and IGI Global’s full list of related titles is featured in the InfoSci-Books database. Request a free trial or recommend the InfoSci-Books database to your library to have access to this critical research.

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