Stuck: How Vaccine Rumors Start—and Why They Won’t Go Away

In Stuck: How Vaccine Rumors Start—and Why They Don’t Go Away, Heidi J. Larson, Ph.D., imparts insights into the phenomena of vaccine hesitancy and vaccine resistance. A noted authority on vaccine confidence, Dr. Larson is Professor of Anthropology, Risk, and Decision Science and Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine. She holds a concurrent appointment as Clinical Professor of Health Metrics Sciences at the University of Washington in Seattle. Relevantly, the hardcover edition of Stuck was introduced in early 2020, while COVID-19 was attaining pandemic status, and the paperback version appeared during the first half of 2022, after COVID-19 vaccination had emerged. The 2022 edition includes the earlier content and updates the material to incorporate information about the public’s reaction to the COVID-19 vaccines. Notably, Dr. Larson writes, “…I did not expect to come back to the United States and Europe to witness an emerging tsunami of skepticism around one of the most tried-and-true, life-saving health interventions in modern history.”

The author approaches the issue of vaccine rejection through the wide-angle lens of an anthropologist in a balanced, nonjudgmental, and contextual manner, avoiding words like “ignorant,” “pernicious,” “perplexing,” or “marginal.” She emphasizes that a confluence of many ecologic and cultural processes underlies the immunization hesitancy and resistance that are so prevalent in contemporary society. Today, the antivaccine movement and the rumors that perpetuate it are burgeoning, highly politicized, and driven by deep grievances. Vaccine reluctance and refusal have gone mainstream, no longer confined to the margins of society. Importantly, the debates about vaccines are seldom, if ever, solely about the vaccines themselves. Rather, the uproar has become entwined with geopolitical, moral, ethical, autonomy/privacy, and cultural issues, including underlying distrust of government, regulatory agencies, multinational corporations, and the medical establishment, which is perceived to have an unprincipled relationship with the pharmaceutical industry.

Vaccine hesitancy and refusal are not new. Dr. Larson reminds us that the first “anti-vaccine league” was established in the mid-1850s when emotions erupted in the United Kingdom against an 1853 law making smallpox vaccination compulsory. Leicester, England, became the epicenter of one of the most vibrant anti-vaccine movements in history, when the expansion of the mandate in 1867 to include individuals up to 14 yr of age sparked a tipping point. Vaccine rates dropped precipitously to 3%. The United Kingdom movement grew to encompass several other European nations. What is new, however, is that the viral spread of doubt, misinformation, and disinformation today travels at unprecedented speed and distance due to the Internet and social media platforms, and the availability of vaccines and combinations of vaccines to question has grown enormously.

Derived from a Latin word meaning noise, gossip, or clamor, rumors thrive in situations of uncertainty, anxiety, and fear. Ferment fuels rumors. Distrust of governmental motives, for example, led to the boycotting of a campaign against neonatal tetanus by vaccinating young women in Cameroon in 1990. Rumors spread that the vaccine caused sterility. Interestingly, in the history of vaccines, one of the predominant recurrent rumors—interrupted by sporadic interludes of dormancy—is the fear of vaccines being used to sterilize populations. Not only did the tetanus vaccine rumors negatively affect tetanus vaccination, they also triggered a domino effect of waning confidence in several other vaccines.

Suspicions and distrust of governmental and international initiatives became more entrenched by the U.S. Central Intelligence Agency initiative in Pakistan in 2011. In an attempt to establish the hiding place of Osama bin Laden, the U.S. Central Intelligence Agency created a fake hepatitis vaccination program as a cover for a physician to enter the suspected hiding place of bin Laden to confirm his presence. Dr. Larson underscores that the sham door-to-door “vaccination” plan coincided with an especially fragile time in the polio eradication efforts in Pakistan. When the deception was exposed, heightened suspicions exacerbated the militants’ resistance to polio vaccination and no doubt contributed to violence against polio workers, culminating in the death of several workers and their guards. This debacle prompted the deans of 12 public health schools across the country to write President Obama, appealing to him to never again allow covert action to be embedded in a public health initiative.

Incorrect or misunderstood “scientific” information can also be tenacious, taking on a life of its own, as reflected by the claim that the measles-mumps-rubella vaccine causes autism. Dr. Andrew Wakefield planted the suggestion of the vaccine-autism link with his 1998 publication in Lancet.¹  Although the information was debunked and the article was retracted in 2010, with Wakefield’s medical license withdrawn by the United Kingdom General Medical Council, he continues his outspoken crusade concerning vaccine risks and remains a hero to countless followers. As J.B. Handley of the autism and anti-vaccine advocacy group Generation Rescue asserted, “To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one.”²  Notably, Andrew Wakefield’s provocative publication appeared on the eve of the digital revolution.

Episodes of mass psychogenic illness, a form of mass hysteria, among vaccine recipients can also promote anti-vaccination rumors. This spectacle of “emotional contagion” was prevalent internationally in 2014, after young girls who were given human papillomavirus vaccine developed a constellation of symptoms, including dizziness, headaches, fainting, and dyspnea, that were erroneously attributed to the vaccine. The World Health Organization subsequently renamed the syndrome immunization stress-related response, which underscores the importance of biopsychosocial context. Although these symptoms are not caused by the vaccine, they are related to the vaccine experience.

Misperception of risk is also a huge problem, because the online ecosphere has efficiently led to the social amplification of risk. Moreover, many vaccine-hesitant individuals have never seen first-hand the deadly devastation that several diseases for which vaccines are available can wreak. Although physicians assess risk and benefit, many young people today tend to focus primarily, if not exclusively, on the perceived risks of vaccines rather than on the benefits that accrue when a serious, potentially fatal disease is prevented.

With specific reference to COVID-19 vaccines, many people mistakenly believe that messenger RNA technology is new, although it has existed for nearly two decades. The genetic sequence of the new coronavirus, which was needed for vaccine development, only became available on January 10, 2020, and the usual timeline for vaccine development to approval typically is 5 to 10 yr. Nonetheless, scientists and companies entered a marathon to deliver the first COVID-19 vaccine. Unfortunately, the speed of the sprint became a point of contention for the vaccine hesitants and resistors; an experience akin to performance punishment has ensued. Since the timely arrival of safe and effective vaccines in late 2021, many skeptics have become quick to point out that the vaccine is not “really” approved by the Food and Drug Administration because it has emergency use authorization only. “It is too new…too experimental.” (Does this strike a familiar chord?)

Dr. Larson does an admirable job of describing the multifactorial root causes and technological amplifiers that have contributed to the extensive and expanding problems of vaccine hesitancy and resistance. Unfortunately, however, concrete examples of practical solutions to this vexing public health crisis remain elusive. How does one strike an appropriate balance between individual freedom and social responsibility? How can privacy be preserved in the context of community obligations? Clearly, education alone is insufficient. Vaccine skeptics need to feel heard and respected. Trust, the glue that holds all relationships together, is essential, and trust is based on integrity.

Lack of trust in the medical establishment and some of society’s major institutions is understandable and is not confined to vaccination issues. Although not discussed by Dr. Larson, I would argue that one has only to reflect on the disgraceful Tuskegee syphilis experiments,³  the immortalized cell line of Henrietta Lacks whose cancer cells were cultured at Johns Hopkins without her knowledge or consent,⁴  and the human radiation experiments conducted from the late 1940s into the early 1970s,⁵  to offer but a few historical examples of deplorable ethical breaches that particularly affected minority and disadvantaged communities. Is it surprising in today’s hyperpolarized environment that a legacy of suspicion directed at the scientific establishment has resulted?

The erosion of public trust that has characterized recent decades will be difficult to re-establish and will take time. A proactive, trust-building effort is sorely needed to create a dialogue—and a bridge—between citizens and scientists, engaging resistors as part of the solution rather than denigrating them as a major part of the problem. More sensitive, empathic, engaging, and creative messaging by public health officials has begun to emerge, but the goal post remains distant.