Where does vaccine hesitancy come from?
Vaccine hesitancy is impacted by the ‘3 Cs’: confidence, convenience and complacency. Many people are taking a ‘wait and see’ approach because of doubts surrounding vaccine effectiveness and safety. Concerns include short development timelines, perception of vaccine-related risk and impact on long-term health, as well as a lack of communication and endorsement from trusted healthcare providers and community leaders. Vaccine hesitancy has been exacerbated by the COVID-19 ‘infodemic’ (the spread of inaccurate information on the pandemic and vaccines), leading to conspiracy theories and feelings of confusion and anxiety among the general public. Structural factors, including barriers to access, socioeconomic disadvantages and systemic racism, are also known to drive low vaccine confidence and uptake.
People who distrust doctors or medical and governmental institutions are more likely to be vaccine hesitant. In Black populations, a history of systemic racism, unethical healthcare research, negative healthcare experiences and biomedical abuses has led to a suspicion of institutions, amplifying feelings of mistrust. For example, a syphilis study led by the Tuskegee Institute in 1932–1972 was carried out on Black men without informed consent. A high number of participants died because penicillin, which became ‘the treatment of choice’ for syphilis in the early 1940s, was withheld from them. In 1979, the administering physician in the Depo-Provera study stated that it was his ‘moral duty’ to give a 14-year-old Black girl contraception, without her consent, while she was under general anaesthesia.
For people with breast cancer, vaccine hesitancy is reportedly driven by the fear of experiencing adverse reactions and a distrust of healthcare systems. Confidence in vaccine effectiveness has also been shaken by the fact that trials included only a small number of cancer patients.