EDITORIAL: What We Get Wrong About America’s Unvaccinated
Cases are rising again as a new variant spreads around the world. (Florida Health)
The views expressed herein represent the views of a majority of the members of the Caravel’s Editorial Board and are not reflective of the position of any individual member, the newsroom staff, or Georgetown University.
The New York Times published the names, ages, and brief descriptions of 1,000 people who had died from COVID-19 on its front page on May 24, 2020. The piece was titled, “U.S. Deaths Near 100,000, An Incalculable Loss.” A year and a half later, the COVID-19 pandemic, the death count of which now exceeds three-quarters of a million deaths, officially surpassed the 1918 flu pandemic as the deadliest in U.S. history.
These grim milestones stand in stark contrast to the United States’ various advantages for a proper pandemic response: despite a nation-wide campaign that distributed more than 500 million free vaccine doses and fully vaccinated nearly 200 million people, COVID-19 cases and deaths reached their highest levels since February 2021 in mid-September. What explains this disconnect between the extent of U.S. COVID-19 responses and the pandemic’s catastrophic toll on the country?
Many people blame the “anti-vaxxers,” often imagined as conspiracy theorists more invested in Facebook ideological bubbles than any semblance of reality as solely responsible for this dilemma. Howard Stern’s gruff diatribe against anti-vaxxers likely reflects the frustration of many U.S. citizens—millions of doses are thrown away while thousands of the unvaccinated are hospitalized, and foreign countries face severe vaccine shortages. But too often this frustration begins and ends with indignancy, confusion, and ridicule of anti-vaxxers. It also misrepresents the actual composition of the unvaccinated and refuses to explain why they exist beyond individual selfishness or paranoia.
But, even more dangerously, this cynicism overlooks the deeper structural reasons why vaccine refusal is so widespread in the U.S. The sheer prevalence of vaccine hesitancy reveals severe failings within the country’s institutions. This phenomenon did not appear in a vacuum—misinformation that encourages mistrust of public health officials abounds within U.S. politics and media. Any comprehensive attempt to address vaccine hesitancy cannot ignore structural causes. Performative outrage against anti-vaxxers muddles the realities of the COVID-19 pandemic and obscures the policies that could address and assist unvaccinated people.
Anti-Vaxxer? I hardly know ‘er!
Among center-to-left, politically engaged Americans, the phrase “anti-vaxxer” typically conjures caricatures inspired by Donald Trump’s most vocal supporters: older, white, wealthy MAGA Republicans, spewing nonsense about Bill Gates, microchips, and mind control. This image is convenient; it transfers the blame for the pandemic onto one group of people, absolving onlookers of empathy over the deaths of unvaccinated people. It’s certainly the idea behind innovations like the subreddit r/HermanCainAwards, in which users mock accused anti-vaxxers who have since died of COVID-19. And it’s almost entirely false.
Indeed, true anti-vaxxers—those who propound disproven claims that all vaccines are harmful, cause death or disability, and should be avoided at all costs—make up a relatively small proportion of U.S. citizens. In the most recent psychological study on vaccine hesitancy in the U.S., 8 percent of poll respondents claimed to always oppose vaccines. Only 22 percent of respondents self-identified as “anti-vaxxers.” While the fact that around one in five people in the U.S. embraces this label is concerning in and of itself, 42 percent of U.S. citizens have not been vaccinated, indicating that it’s not necessarily anti-vaxxers who are keeping the U.S. from herd immunity.
A common argument is that all those who want to be vaccinated, have been, but that is not necessarily the case. This is largely the result of conflating vaccines availability—i.e., the U.S.’s massive vaccine stockpile and bankrolling of vaccination at pharmacies across the country—and vaccine access, which is predicated on a plethora of factors both individual and societal, from late work schedules to city layouts to child care. 44 percent of unvaccinated people in the U.S. are willing to get vaccinated. Were this population to be vaccinated, more than three-quarters of the U.S. would have protection against COVID-19.
The false dichotomy between vaccinated and unvaccinated people is further eroded by the fact that many vaccinated people question the safety and efficacy of the vaccine that they willingly chose to receive. Lack of information and misinformation have pervaded all aspects of the vaccination campaign, and individual risk and opportunity calculations are vastly more complex and nuanced than they first appear. Despite this, there’s precious little research into the real reasons behind vaccine hesitancy and lack thereof, contributing to the stereotype of the anti-vaxxer.
And even among anti-vaxxers themselves, only a tiny fraction of these are the virulent, vocal activist types that seem so common in mommy blogs and Twitter feuds. This very same caricature so loved by liberals, in fact, has demonized vaccine-hesitant people in the U.S., alienating them further and cultivating vast divides of mistrust that drive them toward misinformation and anti-vaccine sentiment.
That’s not even taking into account the sociopolitical factors that may drive people to identify as anti-vaccine in the first place—from sour experiences with disdainful or paternalistic doctors to a desire to be part of a tight-knit community of anti-vaxxers to historical trends of medical racism and sexism. Anti-vaxxers are not a monolith; the unvaccinated U.S. citizens are diverse, both in identity and in decision-making, and to treat them as a single entity undermines any attempt to support higher vaccination rates.
Hating the Messenger, not the Message?
It’s fruitless to ridicule such a diverse group of vaccine-hesitant people. When many anti-vaxxers live in echo chambers prone to spreading conspiracy theories and dangerous strains of nationalist populism, mocking anyone apparently not smart enough to “follow the science” will only push them farther into those bubbles, wherever they are.
The Editorial Board of the Dallas Morning News reviewed government policy dealing with anti-vaxxers in September and concluded, “We appreciate officials’ unrelenting efforts to expand access to the vaccine, but their main hurdle now is resistance to the science and to the messengers. The tone of the message matters greatly.”
At least in Dallas, the main obstacles to higher vaccination rates were concerns about vaccine side effects and distrust in the government. In this case, the character of the messengers—government officials—matters. Indeed, when a community thinks that the people or officials they distrust are mocking them or not taking them seriously, that community can become recalcitrant toward engagement.
The executive director of a community development center in South Dallas suggested to the Dallas Morning News that the best way to prompt anti-vaxxers to engage with the government and reconsider their stances would be to involve “demographic groups that government officials are targeting for vaccination… in crafting the message.”
When anti-vaxxers and political polarization stem from similar places, their solutions fit the same mold—governments at all levels have a responsibility to engage with and include as many communities as they can in their outreach and in policy planning processes.
MISINFORMATION-19
However, vaccine hesitancy has deep roots in the misinformation movement, which stems from underlying flaws in the way people understand social media, lack of trust in governmental institutions, and general inequality in terms of U.S. public education.
The general inequality of public education in the U.S. is the earliest creator of susceptibility to misinformation. The quality of education varies greatly from state to state. Overwhelmingly, the South displays much lower levels of quality education in comparison to the other states (with the partial exception of Texas, which lands solidly in the middle).
This map from WalletHub shows the top-performing public schools in the U.S. (WalletHub)
The research presented in this Wallethub article found immense discrepancies from state to state--for example, Alabama, the state with the highest dropout rate, has four times more dropouts than D.C., the territory with the lowest dropout rate. This disparity is mirrored in other aspects of education, such as teacher-student ratios.
This is most likely because public education comes mostly from wildly unequal local and state funds; federal funds provide little for most childrens’ educations. In addition, studies have found that those in areas that give the most to education in taxes perform the best—exacerbating the economic and educational inequalities prevalent in the U.S.
In addition, a distrust of government institutions abounds in the United States. Faith that one’s government will do “what is right” has decreased significantly, starting from 1965 to current day. Currently, 2 percent of U.S. citizens reported that they trust the U.S. government to do what is right “just about always,” and 22 percent report that they will trust the government “most of the time.” Levels of government trust do differ when a new president comes into power—36 percent of Democrats and Democrat-leaning independents trust Biden’s government, while only 9 percent of Republicans do. Nevertheless, even 36 percent is well under half the population, and therefore this lack of trust is certainly part of vaccine hesitancy calculations: how can you trust a vaccine given to you by a government that you think does not have your best interests at heart?
This chart tracks the decreasing trust in the U.S. government. (Pew Research Center)
Social media and a rise in “fake news” also contribute to an increase in the spread of and belief in misinformation. As of March 2020, almost 30 percent of U.S. adults thought China had created COVID-19 as a bioweapon, and in June, about 25 percent believed that COVID-19 was created by people in positions of power.
Psychologists have identified a few causes of misinformation. Norbert Schwartz, a professor of psychology at the University of Southern California, determined that if misinformation is presented in an easily digestible format, people are much more likely to accept it as truth. In addition, people are skeptical of new information very selectively, often only doubting information that goes against their political beliefs.
There has been such an increase in misinformation surrounding COVID-19 that the World Health Organization published a joint statement with the UN, claiming that misinformation had contributed to a COVID-19 “infodemic.” It argued that the overabundance of information about COVID-19 included deliberate attempts to spread misinformation. According to the article, “There’s often a lot of uncertainty in crisis situations, so people come together and start sharing information in a sort of collective sense-making process.”
Looking forward, how can the U.S. government and other groups work to stop the spread of misinformation? On an institutional level, there are of course issues that warrant addressing. In the more immediate future, there are a few possible solutions to misinformation. One strategy, known as “prebunking,” focuses on teaching people about a new particular piece of fake news and how to understand why it is false, in contrast to “debunking” fake news after the fact. Interestingly, several psychologists have also been creating games, such as called “Bad News” that focus on teaching people about the spread of misinformation through interactive games.
Media literacy classes are a good way to spread prebunking, games, and other forms of identifying misinformation. Classes targeting older populations might be a step in the right direction, although they would serve as a temporary response rather than addressing structural issues.
Vaccinating Against Mistrust
COVID-19 killed 5 million people and left political unrest and economic uncertainty in its wake. It also thrust into the spotlight, and therefore into public scrutiny, processes that are often hidden behind doors for years and usually only introduced to people in doctors’ offices. The process of vaccine development was highly discussed in news outlets, and while medical communities rightfully call the relatively quick development of the COVID-19 vaccine a miracle of modern medicine, critical misunderstandings and misinformation campaigns sowed doubt in healthcare institutions.
Misinformation thrives in uncertainty, and political polarization makes it difficult for facts alone to disprove misinformation. The politically charged debates around COVID-19’s existence and severity have misled people in the U.S. from the pandemic’s beginning. Individual citizens, stuck in their homes throughout quarantines, absorbed conflicting information about the pandemic from its very beginning. People now have questions about their personal health and the safety of their loved ones—this is not something to ridicule; it means the media, public health officials, and the U.S. government should work toward answering those questions with empathy and better information delivery.
In the long run, however, the U.S. has to systematically address both the causes of misinformation and the educational gaps that make spotting misinformation more difficult. When social media is so intertwined with the dissemination of news, it is more important than ever to introduce media literacy into curricula in schools and beyond. Not everyone must possess the scientific expertise necessary to understand the technology behind vaccine development, but they should all have access to an education that allows them to make well-informed decisions about the information they consume and a government they can trust.
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