Vaccine hesitancy has been a major cause for concern throughout the COVID-19 pandemic. The World Health Organization have previously addressed vaccine hesitancy via the ‘3C model’ (Convenience, Complacency, and Confidence). Recent scholarship has added two more ‘Cs’ (Context and Communication) to formulate a ‘5C model’ that is more equipped to adapt to the uncertainties of the pandemic. This paper focuses on the four ‘Cs’ that explicitly concerns trust (Complacency, Confidence, Context, and Communication) and phenomenologically distinguishes confidence from trust. (...) Experts view vaccines in terms of confidence, where the prospect of an undesirable outcome is extremely rare. Hence, not vaccinating and compromising herd immunity is seen to be unreasonable. Hesitant individuals contest the expert perspective and view vaccines in terms of trust, where the prospect of disappointment is likely. From this perspective, to vaccinate is to take a risk, and it is within reason to have the freedom to choose otherwise. This paper focuses on the hesitant perspective to identify the two social indicators of trust in vaccines most prominently shown during the COVID-19 pandemic in the Global North: (i) the expert reaction to hesitant concerns and (ii) the loss of freedom in relation to vaccine requirements. (shrink)

This paper argues that vice-charging, the practice of charging other persons with epistemic vice, can itself be epistemically vicious. It identifies some potential vices of vice-charging and identifies knowledge of other people as a type of knowledge that is obstructed by epistemically vicious attributions of epistemic vice. The hazards of vice-charging are illustrated by reference to the accusation that parents who hesitate to give their children the MMR triple vaccine are guilty of gullibility and dogmatism. Ethnographic and sociological research is (...) used to make the case that this charge is, in a significant range of cases, epistemically unjust and hinders attempts to make sense of vaccine hesitancy. This epistemic injustice consists in the representation of vaccine hesitant parents as less than full epistemic agents. A case is made for a more tolerant and inclusive approach, not only to vaccine hesitancy but also to other forms of unorthodoxy or non-compliance. The primary objective in these cases should be to achieve Verstehen of seemingly alien outlooks and practices so that policy makers and practitioners in public services can more effectively educate a sceptical public about the risks of vaccine hesitancy. (shrink)

This paper examines the trust relations involved in Israel’s COVID-19 vaccination campaign, focusing on vaccine hesitancy and the concept of ‘trust’. The first section offers a conceptual analysis of ‘trust’. Instead of analyzing trust in the vaccination campaign as a whole, a few objects of trust are identified and examined. In section two, the Israeli vaccination campaign is presented, and the focus is placed on vaccine hesitancy. In section three, different trust relations are examined: public (...) trust in the Israeli government and health institutions, interpersonal trust in healthcare professionals and experts, trust in the pharmaceutical companies that make the COVID-19 vaccine, the US FDA, and trust in the new vaccine and the new technology. Through this complexity of trust relations, I argue that it is impossible to completely separate the trust that the vaccine is safe and effective from social aspects of mistrust. Additionally, practices of silencing and censoring the concerns of vaccine hesitaters – both experts and among the public, are pointed out. I contend that these cases further minimize vaccine hesitaters' trust in vaccine-related entities. In contrast, in section four, I suggest the ‘trust-based approach’: since vaccine hesitancy is not solely the result of knowledge deficiency but also a lack of trust relations, any campaign that addresses vaccine hesitancy should also focus on trust. The advantages of this approach are spelled out. For governments, a discussion based on trust is, ultimately, the best democratic way to encourage hesitaters to take the plunge and get vaccinated. (shrink)

Vaccine hesitancy is a growing threat to public health. The reasons are complex but linked inextricably to a lack of trust in vaccines, expertise and traditional sources of authority. Efforts to increase immunization uptake in children in many countries that have seen a fall in vaccination rates are two-fold: addressing hesitancy by improving healthcare professional-parent exchange and information provision in the clinic; and, secondly, public health strategies that can override parental concerns and values with coercive measures such (...) as mandatory and presumptive vaccination. It is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity. Although public health strategies can be ethically justified in limiting freedoms, a parent-centered approach seldom acknowledges how it is impacted by contemporaneous coercive measures. In addition, the clinical encounter is not well suited to helping parents consider the public dimensions of vaccination, despite these being important for trust formation and informed decision-making. Efforts to address vaccine hesitancy require more consistent engagement of parental and citizen views. Along with evidence-based information, debates need to be informed by ethical support that equips parents and professionals to respond to the private and public dimensions of vaccination in a more even-handed, transparent manner. Efforts to address vaccine hesitancy need to avoid simple reliance on either parental values or coercive public policies. To do this effectively requires increasing citizen engagement on vaccination to help inform a parent-centered approach and legitimize public policy measures. In addition, cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics. (shrink)

Increasing vaccine hesitancy among parents in high income countries and the resulting drop in early childhood immunisation constitute an important public health problem, and raise the issue of what policies might be taken to promote higher rates of vaccination. This article first outlines the background of the problem of increasing vaccine hesitancy. It then explores the pros and cons of three types of policy: 1) Interventions focused on increasing awareness of the benefits of vaccination while eliminating (...) mistaken perceptions of risks. 2) “Nudges”, which make certain choices more likely to be voluntarily chosen by manipulating the decision environment. 3) Policies that impose costs to make non-vaccination undesirable even for parents who are hesitant. It argues that a wide range of policies, including coercive policies, is desirable from a public health perspective, as the least intrusive policies alone are unlikely to achieve and sustain the important public good of herd immunity. (shrink)

Addressing vaccination hesitancy is a major challenge in the fight against infectious disease. Vaccine hesitancy has given rise to recent outbreaks of vaccine preventable diseases (e.g., measles) in developed countries. In developed regions, particularly Europe and North America non-structural barriers to vaccination such as risk perceptions and philosophical beliefs seem to play a crucial role in vaccination uptake (Larson et al. 2014), and also contribute to current vaccine hesitancy with regard to COVID-19. To combat (...) these developments, understanding psychological factors in vaccination hesitancy is increasingly important. A better understanding of these psychological factors in turn points to communication strategies that can reduce vaccine hesitancy. These strategies depend upon individuals’ possession of capacities that are required for morally responsible agency (“responsibility-level capacities”), and in particular the capacities to recognize and respond to reasons. Strategic communication concerning vaccines can improve the exercise of individuals’ responsibility-level capacities as they pertain to risk perception and outcome expectancies. We begin by introducing cutting-edge work from the philosophical literature on agency and responsibility, with a special focus on the responsibility-level capacities at work in the practical context of deciding whether to vaccinate. We then summarize lessons drawn from a variety of studies in psychology and behavioural economics on how individuals reason, decide, and behave in these practical contexts. These lessons help illuminate the extent to which individuals exercise responsibility-level capacities in such contexts while also pointing to strategies that can improve the exercise of those capacities. (shrink)

This project explores vaccine hesitancy through an artist–scientist collaboration. It aims to create better understanding of vaccine hesitant parents’ health beliefs and how these influence their vaccine-critical decisions. The project interviews vaccine-hesitant parents in the Netherlands and Finland and develops experimental visual-narrative means to analyse the interview data. Vaccine-hesitant parents’ health beliefs are, in this study, expressed through stories, and they are paralleled with so-called illness narratives. The study explores the following four main health beliefs originating from the parents’ (...) interviews: perceived benefits of illness, belief in the body’s intelligence and self-healing capacity, beliefs about the “inside–outside” flow of substances in the body, and view of death as a natural part of life. These beliefs are interpreted through arts-based diagrammatic representations. These diagrams, merging multiple aspects of the parents’ narratives, are subsequently used in a collaborative meaning-making dialogue between the artist and the scientist. The resulting dialogue contrasts the health beliefs behind vaccine hesitancy with scientific knowledge, as well as the authors’ personal, and differing, attitudes toward these. (shrink)

This paper argues that vice-charging, the practice of charging other persons with epistemic vice, can itself be epistemically vicious. It identifies some potential vices of vice-charging and identifies knowledge of other people as a type of knowledge that is obstructed by epistemically vicious attributions of epistemic vice. The hazards of vice-charging are illustrated by reference to the accusation that parents who hesitate to give their children the MMR triple vaccine are guilty of gullibility and dogmatism. Ethnographic and sociological research is (...) used to make the case that this charge is, in a significant range of cases, epistemically unjust and hinders attempts to make sense of vaccine hesitancy. This epistemic injustice consists in the representation of vaccine hesitant parents as less than full epistemic agents. A case is made for a more tolerant and inclusive approach, not only to vaccine hesitancy but also to other forms of unorthodoxy or non-compliance. The primary objective in these cases should be to achieve Verstehen of seemingly alien outlooks and practices so that policy makers and practitioners in public services can more effectively educate a sceptical public about the risks of vaccine hesitancy. (shrink)

We ask whether it is reasonable to delay or refuse to take COVID-19 vaccines that have been shown in clinical trials to be safe and effective against infectious diseases. We consider two kinds of vaccine hesitancy. The first is geared to scientifically informed open questions about vaccines. We argue that in cases where the data is not representative of relevant groups, such as pregnant women and ethnic minorities, hesitancy can be reasonable on epistemic grounds. However, we argue that (...) hesitancy is not reasonable if a vaccine has passed well-conducted clinical trials. The second kind of hesitancy is to do with beliefs about the institutions offering a successfully trialled vaccine and the justifiability of cooperating with those institutions. For example, in the UK, distrust of the UK Government or the National Health Service is identified as a factor in the vaccine hesitancy of minority ethnic populations. We ask whether this sort of hesitation is reasonable given normative requirements of fair co-operation, both with those institutions and the wider population. We suggest that the answer is not straightforward. Sometimes the hesitation is unreasonable but understandable. (shrink)

This paper offers an explanation for subjects’ lack of confidence in vaccines’ safety, which in turn is widely recognized as one of the main determinants of vaccine hesitancy. I argue that among the psychological roots of this lack of confidence there is a kind of intuitive thinking that can be traced back to a specific superstitious belief: the belief that “it is bad luck to tempt fate”. Under certain conditions, subjects perceive the choice to undergo vaccinations as an action (...) that “tempts fate”, and this leads them to overestimate its risks. When an action is perceived as “tempting fate”, indeed, its possible negative outcomes are anticipated as highly aversive, and as such they capture subjects’ imagination, thereby feeling more subjectively probable. This has important consequences for practical pro-vaccine interventions. Part of what makes an action perceived as “tempting fate” is its being free, arbitrary, and departing from one’s typical behavior: insofar as vaccine hesitancy is driven by beliefs about tempting fate, then, we can predict the success of interventions that make vaccinations nearly mandatory, or build vaccination opportunities into health care routines as opt-out, rather than opt-in options, making them closer to something that subjects passively accept rather actively seek. (shrink)

We ask whether it is reasonable to delay or refuse to take COVID-19 vaccines that have been shown in clinical trials to be safe and effective against infectious diseases. We consider two kinds of vaccine hesitancy. The first is geared to scientifically informed open questions about vaccines. We argue that in cases where the data is not representative of relevant groups, such as pregnant women and ethnic minorities, hesitancy can be reasonable on epistemic grounds. However, we argue that (...) hesitancy is not reasonable if a vaccine has passed well-conducted clinical trials. The second kind of hesitancy is to do with beliefs about the institutions offering a successfully trialled vaccine and the justifiability of cooperating with those institutions. For example, in the UK, distrust of the UK Government or the National Health Service is identified as a factor in the vaccine hesitancy of minority ethnic populations. We ask whether this sort of hesitation is reasonable given normative requirements of fair co-operation, both with those institutions and the wider population. We suggest that the answer is not straightforward. Sometimes the hesitation is unreasonable but understandable. -/- . (shrink)

Churches have always been regarded as a safe haven during calamities. This changed during COVID-19 lockdown when churches were forced to shut down. The COVID-19 pandemic has posed a new normal to the world at large, calling for immediate action from authorities and introducing vaccination as an antidote. However, some religious practitioners as a vehicle of change through the institution of the church have been acting on the contrary because it discourages the uptake of vaccines, leading to vaccine (...) class='Hi'>hesitancy. COVID-19 vaccine hesitancy has been observed in the Christian community because Christians use Bible verses as a scapegoat for not getting a jab. There is a chasm that exists between faith and science, and it perpetuates the discourse of vaccine hesitancy. CONTRIBUTIONS: This article applies a qualitative descriptive phenomenological approach and seeks to address the conspiracy theories and the use of Bible verses as discourse on vaccine uptake. (shrink)

A significant amount of scientific evidence shows that childhood vaccination constitutes one of the most successful and cost-effective public health interventions of the last century. It has saved millions of lives. Nonetheless, many parents are reluctant or outright hostile to having their children vaccinated. Similarly, in spite of the fact that vaccines against SARS-CoV-2, the virus that causes COVID-19, are highly effective in protecting people against death and serious illness, about a third of adults in the United States are (...) still unvaccinated as of July 2022. What leads people to be skeptical of vaccines or to refuse them altogether?The dominant narrative answering this... (shrink)

Abstractabstract:Vaccine hesitancy continues to pose a formidable obstacle to increasing national COVID-19 vaccination rates in the US, but this is not the first time that American vaccination efforts have confronted resistance and apathy. This study examines the history of US vaccination efforts against smallpox, polio, and measles, highlighting persistent drivers of vaccine hesitancy as well as factors that helped overcome it. The research reveals that logistical barriers, negative portrayals in the media, and fears about safety (...) stymied inoculation efforts as early as the 18th century and continue to do so. However, vaccine hesitancy has been markedly diminished when trusted community leaders have guided efforts, when ordinary citizens have felt personally invested in the success of the vaccine, and when vaccination efforts have been tied to broader projects to improve public health and social cohesion. Deliberately cultivating such factors could be an effective strategy for lessening opposition today, when COVID-19's distinctive characteristics make addressing vaccine hesitancy more urgent than it has ever been. (shrink)

At a book event in March last year—one year into the pandemic and four months after mass immunization programs began—Goldenberg voiced her concerns about the timing of her book's launch into the world. This anxiety is echoed in the preface of the book itself, where she notes that the emergence of a global pandemic as she completed five years of work threatened to introduce a whole new set of issues that might fundamentally alter the book's arguments. Goldenberg's concern is understandable: (...) since the publication of her book, it is undeniable that public trust in vaccines and the experts who advocate for them have been constant topics of debate.This engagingly... (shrink)

Churches have always been regarded as a safe haven during calamities. This changed during COVID-19 lockdown when churches were forced to shut down. The COVID-19 pandemic has posed a new normal to the world at large, calling for immediate action from authorities and introducing vaccination as an antidote. However, some religious practitioners as a vehicle of change through the institution of the church have been acting on the contrary because it discourages the uptake of vaccines, leading to vaccine (...) class='Hi'>hesitancy. COVID-19 vaccine hesitancy has been observed in the Christian community because Christians use Bible verses as a scapegoat for not getting a jab. There is a chasm that exists between faith and science, and it perpetuates the discourse of vaccine hesitancy. Contributions: This article applies a qualitative descriptive phenomenological approach and seeks to address the conspiracy theories and the use of Bible verses as discourse on vaccine uptake. (shrink)

This is an excellent book. It is written at the intersection of philosophy of medicine, social epistemology, science and technology studies, and public policy. It conceptualizes the phenomenon of vaccine hesitancy as an understandable attitude that, when sizeable enough, causes vaccine refusal. Its focus is on pre-COVID-19 vaccine hesitancy and primarily on parental decisions about childhood vaccinations. Its publication, one year into the COVID-19 pandemic, comes at a fortuitous time because it can help us view our urgent concerns (...) about the sorry state of vaccine uptake in the industrialized North in a broader context. It is an optimistic book with faith in the reasonableness of human beings, sympathy for the... (shrink)

With unexpectedly good timing, I published a monograph on vaccine hesitancy in March 2021, just as COVID vaccine rollouts were reaching full steam in high income countries, including my own. My years of research and writing were near completion when the SARS-CoV-2 virus was first identified; my focus was on parents' hesitancy over routine childhood vaccinations. Vaccine hesitancy in industrialized nations has been intensely studied by social and behavioral scientists and was the subject of considerable media commentary (...) and popular science writing up until COVID vaccine hesitancy redirected that energy. Past knowledge informs current understanding, and I proposed a shift in characterizing... (shrink)

This article starts with a case outlining ethical challenges encountered in participatory action research (PAR) on vaccine hesitancy in rural India during Covid-19. Community researchers were recruited by a not-for-profit organisation, with the aim of both discovering the reasons for vaccine hesitancy and encouraging take-up. This raised issues about the roles and responsibilities of local researchers in their own communities, where they might be blamed for adverse reactions to vaccination. They and their mentor struggled with balancing societal (...) protection against individual rights to make choices. These themes are explored in two commentaries discussing the difficulties in balancing ethics in public health (prioritising societal benefits), social research (protecting participants from harm and respecting their rights not to be involved) and participatory research practices (maximising democratic participation and decision-making). As discussed in the first commentary, often these cohere, but tensions can arise. The second commentary also raises the issue of epistemic justice, questioning the extent to which the villagers could have a say in the design, implementation and interpretation of the research, and the dangers of not hearing the voices and arguments of people who reject vaccination. The case and commentaries highlight the complexities of PAR and additional challenges in a public health context. (shrink)

Although vaccines are considered an efficient public health tool by medical experts, in different countries, people’s confidence in them has been decreasing. COVID-19 has elevated medical scientists’ and practitioners’ social reputation, and it may have reduced global vaccination hesitancy. Still, this alone will not altogether remove the existent frictions that prevent people from complying with vaccination schedules. This paper will review the common causes behind vaccination hesitancy. It will also explore different types of public policy (...) interventions that health experts in governments and institutions employ to fight vaccine hesitancy and non-compliance. The main objective of this article is to argue that, considering the nature of the issue (vaccine hesitancy and its causes), among the various possibilities, policies based on behavioral insights can provide an effective instrument to remove those frictions. Among them, special attention will be devoted to nudges which promise efficiency while avoiding some of the ethical and political costs of other interventions, thanks to their libertarian paternalistic frame. The article concludes by suggesting that public health policymakers should consider the libertarian paternalistic approach of nudges when deploying interventions that aim at changing people’s attitudes and behavior. (shrink)

Japan has been reported as a country with high levels of vaccine hesitancy. However, a lack of comprehensive reviews studying factors for vaccine hesitancy for the COVID-19 vaccines in the Japanese context from the perspective of ethical controversy exists. Using a narrative review method, we reviewed factors associated with vaccine hesitancy to the COVID-19 vaccines and examined issues related to ethical controversy among the Japanese population. Factors associated with vaccine hesitancy include concerns about vaccine safety, suspicion (...) of vaccine inefficacy, mistrust of the government, and low perceived threat. Factors associated with vaccine acceptance include environmental factors, factors related to Japanese cultural values, including collectivism and social norms, and positive attitudes toward information provided by authorities. Unique backgrounds in Japan are historical events such as the anti-HPV vaccine campaigns, the accessible medical system fostering high expectations of zero risk, and cultural factors of caring social norms influencing vaccine acceptance. Ethical controversies arise from preferences and practices at the individual or national level around individual rights versus public health benefits. Healthcare professionals and public health experts should continue dialoguing with the critical mass, practitioners, and policymakers, considering the ethical dilemmas surrounding individual rights and public health benefits. Insights obtained from this study indicate the need to develop tailored strategies to enhance vaccine acceptance while respecting individual autonomy within the Japanese context. (shrink)

Because inappropriate built-in or managed vaccination campaigns, regardless of the causes of vaccine hesitation, can have side effects, the most important being the opposition to vaccination, the understanding of vaccination hesitation can have an influence on specific public policies. In this article we identify a set of possible explanations for vaccine hesitation, which can be used to assess situations, identify problems and adopt appropriate solutions. We highlight the fact that the vaccination hesitation is not just about (...) vaccination, the approach of identifying explanatory hypotheses involves identifying all relevant frames of reference, all social areas that participate in establishing the appropriate interpretation context. The level of compliance with the rules could be an important explanatory hypothesis for the differences between different states in the share of vaccinated citizens. Other explanatory hypotheses: the structure of epistemic communities, community and individual cognitive resources on strategies facing the uncertainty and risk, distrust. We also assess the limits of using the deficit model. We keep in mind two cognitive asymmetries: inaction is perceived as less risky or responsible than action; the indecision is in a similar situation to the decision. Because the values that people adhere reflect their personal beliefs and convictions, and they guide the way they seek, receive, and interpret information, strategies to reduce vaccine hesitation should be based on verifying the compatibility of the intended outcome with individual values and to continue testing the various solutions to change the beliefs that contribute to the determination of vaccine hesitation or refusal. (shrink)

BackgroundThe experiences of UK ethnic minority healthcare workers are crucial to ameliorating the disproportionate COVID-19 infection rate and outcomes in the UKEM community. We conducted a qualitative study on UKEM healthcare workers’ perspectives on COVID-19 vaccine hesitancy in the UKEM community.MethodsParticipants were 15 UKEM healthcare workers. Data were collected using individual and joint interviews, and a focus group, and analyzed using thematic analysis.ResultsWe generated three themes: heterogeneity, mistrust, and mitigating. Therein, participants distinguished CVH in the UKEM community in educational (...) attainment and ethnicity. They pointed to the role of mistrust in CVH in the UKEM community. They opined that the mistrust underlying CVH in the UKEM community is rooted in history and religion, conspiracy theories, the speedy development and novelty of the vaccines, post-vaccination complications/side effects, false positive test results, and social media and social support/influence. Participants recommended that interventions targeted at mitigating CVH in the UKEM community need to, in a non-judgmental way, tackle dis/misinformation and provide education, and incorporate UKEM healthcare worker endorsement. They also suggested such interventions be community-oriented, enhance the convenience of vaccination centers and the possibility of vaccine choice, and appreciate that overcoming CVH and accepting vaccination is a gradual process involving personal assessment of risks and benefits.ConclusionCVH in the UKEM community is a multifaceted phenomenon requiring multicomponent interventions. (shrink)

This article aimed to show the analytical potential of the life-world concept in the field of public health, which has not received much attention in the phenomenological literature. Specifically, based on phenomenologically grounded qualitative research, we aimed to show how the life-world concept, as worked out in Edmund Husserl’s philosophy, can offer new insights on COVID-19 vaccine hesitancy. Although there are many ways in which the life-world can motivate vaccine hesitancy, we have narrowed our focus to one of (...) them. Our aim is to argue that COVID-19 vaccine hesitancy is motivated by discrepancies and conflicts between the perceptual life-world and the scientific knowledge. If the scientific knowledge about the pandemic and the vaccine is not integrated in the life-world—which in its core is an embodied, perceptual world—and instead conflicts with it, people are more likely to become disinclined to get vaccinated rather than motivated to pursue vaccination. We conclude the discussion by outlining ideas on how the insights offered by our analysis could be potentially used in devising management and communication strategies in public health crises, such as a pandemic outbreak. (shrink)

Bioethics, Volume 36, Issue 4, Page 453-460, May 2022.

Background: Pediatric COVID-19 vaccine hesitancy hinders the establishment of immune barrier in children. Psychological flexibility may be a key contributing factor to pediatric COVID-19 vaccine hesitancy, and self-efficacy and coping style play an important role in the relationship, but the underlying mechanisms remain unknown.Methods: A cross-sectional study was conducted on parents from June 2021 to July 2021. A total of 382 parents were recruited for an online-investigation. Serial mediation models were used to examine whether self-efficacy and coping style (...) mediated in the psychological flexibility-pediatric COVID-19 vaccine hesitancy linkage.Result: Psychological flexibility was negatively related to pediatric COVID-19 vaccine hesitancy. Coping styles rather than self-efficacy played a mediating role independently. Serial mediation analyses indicated that self-efficacy and coping style co-play a serial mediating role in the association of psychological flexibility and pediatric COVID-19 vaccine hesitancy.Conclusion: The present study showed that high psychological flexibility, high self-efficacy, and positive coping style were conducive to the lower pediatric COVID-19 vaccine hesitancy. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S12-S17, March‐April 2022.

The year 2020 has yielded twin crises in the United States: a global pandemic and a public reckoning with racism brought about by a series of publicized instances of police violence toward Black men and women. Current data indicate that nationally, Black Americans are three times more likely than White Americans to contract Covid-19, a pattern that underscores the more general phenomenon of health disparity among Black and White Americans. Once exposed, Black Americans are twice as likely to die of (...) the virus. Unsurprisingly, Black Americans report higher levels of fear of Covid-19 than their White peers, but they also report higher levels of hesitancy toward a Covid-19 vaccine. This paper explores why this apparent discrepancy exists. It also provides practical recommendations for how government and public health leaders might address vaccine hesitancy in the context of the twin crises of 2020. (shrink)

Using 2021 data and information related to COVID‐19, this paper discusses the contribution of colonization, medical mistrust and racism to vaccine hesitancy. Vaccine hesitancy is defined as ‘delay in acceptance or refusal of vaccines despite availability’. Colonization is described as the ‘way the extractive economic system of capitalism came to the United States, supported by systems of supremacy and domination, which are a necessary part of keeping the wealth and power accumulated in the hands of the colonizers and (...) ultimately their financiers’. The system of colonization results in policies and practices, including those related to health, that continue to create oppression and support racism. Persons experience trauma as the byproduct of colonization. Chronic stress and trauma create chronic inflammation and all diseases, whether genetic or lifestyle, have a common pathogenesis that is a component of inflammation. Medical mistrust is the absence of trust that healthcare providers and organizations genuinely care for patients' interests, are honest, practice confidentiality and have the competence to produce the best possible results. Finally, racism is described as everyday racism and perceived racism in healthcare. (shrink)

Health care systems can positively influence our personal decision-making and health-related behavior only if we trust them. I propose a conceptual analysis of the trust relation between the public and a healthcare system, drawing from healthcare studies and philosophical proposals. In my account, the trust relation is based on an epistemic component, epistemic authority, and on a value component, the benevolence of the healthcare system. I argue that it is also modified by the vulnerability of the public on healthcare matters, (...) and by the system’s credibility. I apply my proposed analysis of public trust in health care systems to the phenomenon of vaccine hesitancy, a tendency to question vaccine policies, and to seek alternative vaccine schedules or to refuse vaccination. Understanding the role of trust and its components can be key to understanding the phenomenon. (shrink)

Some vaccine-hesitant people lack epistemic trust in the COVID-19 vaccine recommendation that because vaccines have been shown to be medically safe and effective, one ought to get vaccinated. Citing what I call exception information, they claim that whatever the general safety and efficacy of vaccines, the vaccines may not be safe and effective for them. Examples include parents citing information about their children's health, pregnant women's concerns about the potential adverse effects of treatment on pregnant women, young people citing their (...) relative invulnerability to extreme COVID-19 symptoms, or members of vulnerable racial groups citing epistemic injustice, such as a lack of representation in COVID-19 vaccine trials. This paper examines the extent to which a lack of epistemic trust in vaccine recommendations, based on such exemption information, is rational. (shrink)

As we journey into the fourth year of the COVID-19 pandemic, a majority of Americans express relief at a “return to normal,” experience pandemic fatigue, or embrace the idea of living with COVID-19 in much the same way we live with the seasonal flu. But transition to a new phase of life with SARS-CoV-2 does not diminish the importance of vaccination. The US Centers for Disease Control and the Food and Drug Administration recently recommended another round of booster dose (...) for persons age 5 and up, or an initial series for those not previously vaccinated, with an updated bivalent formula that protects against both the original virus strain and Omicron subvariants that are now the dominant source of infection. By most accounts most of the population has been or will become infected with SARS-CoV-2. Suboptimal uptake of the COVID-19 vaccines among the approximately 25 million adolescents in the United States is a significant obstacle to population coverage, public health, and the health and well-being of adolescents. A major cause of low adolescent uptake is parental vaccine hesitancy. This article discusses parental vaccine hesitancy and argues that permitting independent adolescent consent to COVID-19 vaccination should be an ethical and policy priority as we continue to confront the threat of Omicron and other variants of the coronavirus. We discuss the central role of the pediatric healthcare team in caring for adolescent patients who disagree with their parents about vaccination. (shrink)

The public rejection of scientific claims is widely recognized by scientific and governmental institutions to be threatening to modern democratic societies. Intense conflict between science and the public over diverse health and environmental issues have invited speculation by concerned officials regarding both the source of and the solution to the problem of public resistance towards scientific and policy positions on such hot-button issues as global warming, genetically modified crops, environmental toxins, and nuclear waste disposal. The London Royal Society’s influential report (...) “Public Understanding of Science”, which spearheaded the now-thriving area of science... (shrink)

In the original publication, the sentence “Most notable and famous are the Tuskegee syphilis experiments that occurred from 1932–1972, in which Black men in Macon County, AL were infected with syphilis under the guise of free health care.” under the section “Drivers of Mistrust of Motives” was published incorrectly. The correct one is “Most notable and famous are the Tuskegee syphilis experiments that occurred from 1932–1972, in which Black men in Macon County, AL many of whom had latent syphilis, were (...) misled into believing that they would receive free health care in exchange for their participation. (shrink)

AbstractWe propose an emerging conceptualization of “intervention hesitancy” to address a broad spectrum of hesitancy to disease prevention interventions among healthcare personnel (HCP) beyond vaccine hesitancy. To demonstrate this concept and its analytical benefits, we used a qualitative case-study methodology, identifying a “spectrum” of disease prevention interventions based on (1) the intervention’s effectiveness, (2) how the intervention is regulated among HCP in the Israeli healthcare system, and (3) uptake among HCP in the Israeli healthcare system. Our cases (...) ultimately contribute to a more nuanced conceptualization of hesitancy that HCP express towards disease prevention interventions. Our case interventions included the seasonal influenza vaccine, the Mantoux test, and the hepatitis B (HBV) vaccine. Influenza and HBV are vaccine-preventable diseases, though their respective vaccines vary significantly in effectiveness and uptake among HCP. The Mantoux test is a tuberculin skin test which provides a prevention benchmark for tuberculosis (TB), a non-vaccine preventable disease. We conducted semi-structured interviews with relevant stakeholders and analyzed them within Israeli and international policy context between 2016 and 2019, a period just prior to the COVID-19 pandemic. We propose the conceptualization of “intervention hesitancy”—beyond “vaccine hesitancy”—as “hesitancy towards a wide range of public health interventions, including but not limited to vaccines”. Results suggested that intervention hesitancy among HCP is rooted in weak trust in their employer, poor employment conditions, as well as mixed institutional guidelines and culture. Conceptualizing intervention hesitancy expands the ability of healthcare systems to understand the root of hesitancy and foster a supportive institutional culture and trust, cognizant of diverse disease prevention interventions beyond vaccination. (shrink)

At this point, I think it is fair to say that most of us know someone—a family member, a coworker, a friend, a student—who is resisting getting a vaccine against COVID-19. Frankly, this amazes me. I was recently discussing this with a friend—"Rebecca"—when to my utter shock, she confessed to me that she "does not trust the vaccine" and is not planning to get one until there is more certainty of its efficacy and safety. While there are many things that (...) stood out to be in this conversation, what stood out to me was a particular comment she made; she said to me: "The thing is, I'm a skeptic, and you're not."I admit, this comment threw me for a loop. How could I, a feminist bioethicist who has dedicated a good chunk of... (shrink)

The use of language and images in the media may have a strong effect on people’s political cognition. In this regard, conspiracy theories and misinformation about the COVID-19 vaccine can lead to reluctant uptake of the vaccine even among medical staff. In two experiments, this article tests the hypothesis that the public’s willingness to get vaccinated against the novel coronavirus depends on the framings they are presented with. Two hundred thirty-two female Saudi students are exposed to either pro- or anti- (...) class='Hi'>vaccination messages. In Experiment 1, they are asked to read semi-artificial news stories, and in Experiment 2 political cartoons. The results show that readers of the news articles, but not of the cartoons, are susceptible to framing effects. We consider the implications of how issues are framed for journalists and health professionals. (shrink)