Readings & Audiovisual

Healthcare workers are a priority target population in current COVID-19 vaccination strategies because of their increased workplace exposure and contacts with potentially at-risk patients.1 In some European countries such as Belgium, Greece, and France,2 COVID-19 vaccination is now required for this group. However, studies show that a varying but often substantial proportion of healthcare workers are hesitant about receiving these vaccinations.3 This is extremely relevant for vaccination campaigns, as healthcare workers are among the most trusted sources of vaccine information and have a direct influence on the vaccination decisions of their patients and social contacts.4 Furthermore, insufficient vaccination uptake risks increasing COVID-19 infections, most likely leading to more hospitalizations and less available health staff, increasing the workload in hospitals, and thus reducing health system capacities to adequately respond to the epidemic. Health professionals often do not voice their vaccine-related concerns, particularly to colleagues, due to the institutional and societal pressures to vaccinate. We may frame this phenomenon as unspoken vaccine hesitancy.

Vaccines are in the news every day as some countries struggle to improve vaccination rates and others struggle to access vaccines. A social science approach is needed to further explore what actions can be taken to optimize vaccine acceptance during a disease outbreak, with immediate lessons for the COVID-19 pandemic. Social science can highlight histories of oppression, political-economic contexts that exacerbate inequality, and how communities experience injustice with implications for how individuals view, trust, and take up vaccines. In this Epicast, we explore social science perspectives on vaccine deployment through the lens of Project AViD: Anthropological Exploration of Facilitators and Barriers to Vaccine Deployment and Administration During Disease Outbreaks.

On 15 October 2020, the WHO Technical Advisory Group (TAG) on Behavioural Insights and Sciences for Health held a special meeting with the WHO Department of Immunization, Vaccines and Biologicals to discuss behavioural considerations in relation to COVID-19 vaccine acceptance and uptake. The discussion focused on a series of key questions around achieving high and equitable uptake of vaccines through evidence-based and behaviourally informed strategies.

In attempting to provide protection to individuals and communities, childhood immunization has benefits that far outweigh disease risks. However, some parents decide not to immunize their children with some or all vaccines for reasons including lack of trust in governments, health professionals, and vaccine manufacturers. This article employs a theoretical analysis of trust and distrust to explore how twenty-seven parents with a history of vaccine rejection in two Australian cities view the expert systems central to vaccination policy and practice. Our data show how perceptions of the profit motive generate distrust in the expert systems pertaining to vaccination. Our participants perceived that pharmaceutical companies had a pernicious influence over the systems driving vaccination: research, health professionals, and government. Accordingly, they saw vaccine recommendations in conflict with the interests of their child and “the system” underscored by malign intent, even if individual representatives of this system were not equally tainted. This perspective was common to parents who declined all vaccines and those who accepted some. We regard the differences between these parents—and indeed the differences between vaccine decliners and those whose Western medical epistemology informs reflexive trust—as arising from the internalization of countering views, which facilitates nuance.

This comparative study explores incertitude about hepatitis B (HBV) and its implications for childhood vaccination in Bangui, Central African Republic, and the Cascades region, Burkina Faso. Anthropological approaches to vaccination, which counter stereotypes of “ignorant” publics needing education to accept vaccination, excavate alternative ways of knowing about illness and vaccination. We build on these approaches, evaluating different kinds of incertitude (ambiguity, uncertainty, ignorance) about infancy, HBV, health protection, and vaccination. Using interviews and participant observation, we find that Bangui and Cascades publics framed their incertitude differently through stories of infancy, illness, and protection. We locate different forms of incertitude within their historical contexts to illuminate why vaccination practices differ in the Cascades region and Bangui. A more nuanced approach to incomplete knowledge, situated in political, economic, and social histories of the state and vaccination, can contribute to more appropriate global health strategies to improve HBV prevention.

Parents’ decision to use vaccination services is complex and multi-factorial. Of particular interest are “vaccine-hesitant” parents who are in the middle of the continuum between vaccine acceptance and refusal. The objective of this qualitative longitudinal study was to better understand why mothers choose to vaccinate—or not—their newborns. Fifty-six pregnant mothers living in different areas of Quebec (Canada) were interviewed. These interviews gathered information on mothers’ views about health and vaccination. Almost half of the mothers were categorized as vaccine-hesitant. A second interview was conducted with these mothers 3 to 11 months after birth to look at their actual decision and behavior concerning vaccination. Our results show the heterogeneity of factors influencing vaccine decision making. Although the majority of vaccine-hesitant mothers finally chose to follow the recommended vaccine schedule for their child, they were still ambivalent and they continued to question their decision

Vaccination anxieties grew into a public health issue during the 2008 failed measles and rubella immunization campaign in Ukraine. Here I explore how health care providers bend official immunization policies as they navigate media scares about vaccines, parents’ anxieties, public health officials’ insistence on the need for vaccination, and their own sense of expertise and authority. New hierarchies are currently being renegotiated, and I follow health care providers as they attempt to parcel out their new position in the Ukrainian society and beyond. Public health control is reframed in a postsocialist context as a condition of acceptance into the European community as a sanitary democracy, and a contestation point between citizens and state. I untangle how relationships between citizens and states shape the construction of medical risk. [vaccination anxieties; health care providers; postsocialism; Ukraine]