Political dimensions of misinformation, trust, and vaccine confidence in a digital age

Vaccine confidence in the digital age

The worldwide decline in vaccine confidence in recent years can be partly associated with the rapid expansion of social media.6 Delays in and refusals of vaccination have been shown to be “more frequent in people who reported the internet as their main source of information,” and negative information about vaccines spreads faster online than positive information.7 These trends are concerning, but assuming that misinformation is the sole explanation for vaccine refusal can be risky. Although evidence shows that online misinformation correlates with reduced vaccination intention,8 intentions do not always predict behaviour.9 Most importantly, focusing on misinformation may lead to characterisations of vaccine hesitancy as primarily a problem of insufficient or incorrect information.10 Social science research has shown that hesitancy rarely reflects knowledge deficits and often even has little to do with the vaccine itself, rather reflecting problems of mistrust in experts, institutions, and authorities.1112 A contextual understanding of people’s offline experiences can offer insights into how people engage with online (mis)information and how this in turn shapes their views on vaccination.

Vaccine hesitancy as a commentary on mistrust

A political analysis helps to situate vaccines in this broader context, considering indirect political factors such as citizens’ relationships to their governments and how vaccination becomes implicated in wider contestations of political authority. Studies have consistently shown that lower trust in government is linked to lower vaccination intentions.1314 This has been the case since the introduction of the first vaccines in 19th century Britain, which sparked widespread working class protests around poor working and living conditions.15 Similarly, refusals of smallpox vaccination became part of challenges to colonial rule in India.16

Content analyses of concerns around vaccines similarly show that they often reflect anxieties about the motives of government and public health officials. During the Ebola vaccine trials in Sierra Leone, for example, fears circulated that the novel vaccine may be a ploy to decimate the population and steal blood for westerners’ use, echoing violent and extractive colonial pasts.17 Similar narratives re-emerged and spread rapidly through social media that the covid-19 vaccine was intended to “kill people slowly in Africa.”18 Concerns surrounding vaccination can, in other words, be read as commentaries of mistrust that go far beyond immunisation.

Such mistrust is also rarely unjustified. In 2003 boycotts of the polio vaccine in northern Nigeria were linked, among other factors, to memories of the 1996 Pfizer trial of a meningitis drug that resulted in high profile lawsuits around the company’s failure to obtain informed consent.19 Mistrust in the federal government’s collaboration with western pharmaceutical companies was cited in subsequent vaccination campaigns as a reason for refusal.20 Similarly, in the US, lower rates of vaccine confidence among Black, indigenous, and other communities have been connected to mistrust in the government and experiences of structural racism and state violence. Black American participants in a study about the flu vaccine cited the historical legacy of racist scientific experiments for not trusting a “government vaccine.”21 For many Black Americans, medical encounters continue to be marked by experiences of disrespect and discrimination.22 Such experiences affect vaccine uptake. In Sierra Leone, rural mothers reflected on humiliating previous experiences at health centres, inadequate care, and excessive costs as reasons why they were discouraged from taking their children to be vaccinated.23 This kind of structural violence poses significant barriers to accessing vaccination and makes translating health information into action difficult. Simply classifying these groups as vaccine hesitant can hide the broader processes of marginalisation that erode trust in government and health providers, giving legitimate reasons for being apprehensive.

Labelling minoritised groups as “vaccine hesitant” has been shown to reinforce exclusion. Research on ultra-orthodox Jewish communities shows that decisions about vaccination are complex and rarely lead to blanket refusal but that official discourses focused on hesitancy served to bolster “antisemitic representations of Jews as public (health) risks,” paying little attention to the ongoing “crisis of confidence” in these long neglected communities.24

Experiences of exclusion, memories of historical oppression, and contemporary experiences of structural violence, underfunding of healthcare, and rising inequality therefore shape attitudes to vaccines and filter how people engage with information they receive about them. Whereas misinformation is increasingly global, how people make sense of the information they receive remains local.

Direct mobilisation around vaccines

In recent years we have also seen more direct efforts to bring vaccination into political discourse, as politicians and interest groups increasingly explicitly mobilise their electorates and membership around the topic of vaccines. Doubts around vaccination have been central to the political campaigns of “populist” parties and politicians. Gaining momentum with the rise in social media, populist politics, broadly defined, relies on a contrast between “the people” and “the political establishment,” as these movements capitalise on feelings of mistrust and disenfranchisement.25 Parties such as Italy’s Five Star Movement explicitly expressed concerns about the posited connection between measles, mumps, and rubella vaccines and autism,26 before changing their position during the covid-19 pandemic. Similarly, former President Magufuli of Tanzania stated that he would not acquire covid-19 vaccines as these may have been “manipulated by imperialists to harm Tanzanians” as a key component of his political platform.27

The rising appeal of populist politics has been accompanied by increased polarisation. Affiliation to political parties has been shown to be a predictor of vaccination intention, as has exposure to different kinds of media.2829 A study in 2019 showed that the percentage of people who voted for a populist party in the 2014 European elections was positively associated with the number of people who believed that “vaccines are not safe or important.”26 Vaccines can therefore be a polarising topic, but how they become polarising depends on context. In western Europe, for example, leaning to the political left or right did not matter as much in determining attitudes to vaccines as did holding an “anti-elitist worldview.”30

Another example of direct political mobilisation around vaccination is the anti-vaccination (anti-vax) movement. This movement represents a minority opinion, yet it has been shown to fuel misinformation online, with the potential to influence a broader constituency of people who may have legitimate concerns or be undecided. Prominent anti-vaxxers have also openly supported political campaigns and received support from politicians, gaining power and visibility.31

Rebuilding trust in the digital age

The challenge of vaccine hesitancy has given rise to a range of efforts to tackle it. Efforts that focus solely on debunking misinformation or on providing more information to individuals have been shown to be ineffective in tackling the underlying causes of mistrust. During the west African Ebola epidemic, researchers highlighted that interventions aimed at correcting “misconceptions” around the disease failed to engage with the plethora of reasons why many people feared reporting loved ones to the hospital.32 Conversely, community engagement approaches that focus on two way dialogue and directly engage with the diversity of people’s experiences and opinions have been shown to increase trust and participation, including in the context of vaccination.3334 A political analysis can contribute to the efforts of people involved in combating mistrust in vaccines in several ways.