Now Thomas, one of the twelve, called the Twin, was not with them when Jesus came. So the other disciples told him, “We have seen the Lord.” But he said to them, “Unless I see in his hands the mark of the nails, and place my finger into the mark of the nails, and place my hand into his side, I will never believe.”
Eight days later, his disciples were inside again, and Thomas was with them. Although the doors were locked, Jesus came and stood among them and said, “Peace be with you.” Then he said to Thomas, “Put your finger here, and see my hands; and put out your hand, and place it in my side. Do not disbelieve, but believe.” Thomas answered him, “My Lord and my God!”
— John 20: 24-28 (NIVUK)
When the risen Christ encountered ‘Doubting Thomas’, He empathetically called to Thomas and presented evidence that cleared all Thomas’s doubts. In this story Jesus models trust-building wherein a specific doubt was met with the only information that could clear it in that moment; any other broad and blanket information might not have sufficiently accomplished this.
In an ideal scenario, the specific fears and doubts of those questioning the common practice of vaccination would be cleared with rigorous and accessible information. Everyday life is less than ideal, however, and we know that evidence does not always elicit a change in mind.
In the twenty-first century vaccines are a healthcare staple in most countries. In spite of the significant positive impact on global healthcare that vaccines have had, the concept of vaccination is still often accompanied by mistrust, spawning the so-called “anti-vaxxer” movement. It is important to note that vaccine hesitancy, which involves delayed acceptance of vaccines, is different from vaccine refusal in which there is total non-acceptance of receiving vaccination. Both of these schools of thought still physically affect healthcare dynamics. Because individuals who are vaccine hesitant far outweigh those who outrightly refuse vaccines, hesitant individuals will have more of an effect on herd immunity. Measles has resurged in the UK and USA because of decreasing vaccination rates, mainly due to this reluctance, complacency, and anti-vaccine sentiment. This trend may lead to avoidable large-scale measles epidemics in the future.
UK-based research charity, The Wellcome Trust, conducted a global survey in 140 countries with responses from 140,000 people to gain insight into global attitudes towards vaccines. They published their findings in a 2019 global monitor which showed that France has the highest vaccine mistrust in the world whilst the highest vaccine confidence can be found in Rwanda and Bangladesh. Rwanda’s roll-out of vaccines has reached at least 90% of children, whilst after carrying out the largest measles campaign in history Bangladesh recorded an 84% decrease in measles between 2000 and 2016. It is important to note the strategies, tools, and interventions that have led to these successes in Rwanda and Bangladesh in order to echo them in other parts of the world. Acknowledging that these two countries, primarily made up of Black and Brown people, have achieved a level of vaccine confidence now lacking in the West is also important to socio-political considerations of healthcare in terms of challenging racialized thinking patterns.
There have been many cases built against anti-vaccine rhetoric that rightfully point out the good vaccines do, the phenomenon of herd immunity, the need to protect immunocompromised individuals within our communities, and the resurgence of vaccine-preventable disease. The thought process behind these conversations has indeed been to encourage an uptake in vaccines by quashing “anti-vaxx” fears. However, uprooting a fear without replacing it with helpful information is redundant. Therefore, it is time to shift focus from merely quashing anti-vaccine sentiment to intentionally building vaccine confidence. Nigeria provides a heartening case study on how this can be achieved.
In 2007, in PLOS Medicine, Dr. Ayodele Jegede outlined strategies used in Northern Nigeria to overcome the Polio boycott in 2003, showing how effective community interventions can be in building peoples’ trust in vaccines. The Nigerian government liaised with political and religious leaders, who had previously expressed anti-vaccine sentiment, and in an effort of teamwork were able to provide a solution specifically for the northern Nigerian context: state and religious representatives were allowed access to observe how the polio vaccine was tested in South Africa, Indonesia, and India. A satisfactory action plan was put in place where a specific manufacturer was chosen by these envoys. Shortly thereafter, a meeting organised by the World Health Organisation (WHO) and UNICEF was held in Northern Nigeria with envoys from other countries in the West African region in order to further advance the polio vaccine campaign. This meeting was held on the 22nd of September, 2004, showing that within the space of two years there was significant growth in vaccine trust in the region. This case study provides a model for two-way communication between grassroots healthcare workers and health ministries, wherein concerns from the general public were directly and thoroughly addressed without merely imposing mandatory vaccination, which studies have shown, is not effective.
The Nigerian vaccine confidence-building case study highlights the importance of religious leaders in community healthcare interventions. Religious institutions getting involved in the politics of vaccination is important also in light of instances where religion is used to reinforce vaccine refusal. For example, in the USA people can presently use religion as a basis to exempt their children from vaccination.
In the noughties we have also seen religious organisations categorically backing vaccinations: African Muslim scholars and medical professionals produced the 2014 Dakar Declaration on Vaccination, which explicitly encourages vaccination. Further, in 2018 the Orthodox Union (OU) and the Rabbinical Council of America (RCA) produced a statement strongly urging parents to vaccinate healthy children, based on paediatrician recommendations. In 2005 the Catholic Church’s Pontifical Academy for Life outlined that while cells from two aborted foetuses were used in 1964 and 1970 in the preparation of some vaccines, in the absence of alternatives it is morally justified to use those vaccines. The National Catholic Bioethics Centre (NCBC) acknowledge that present-day vaccines are prepared in descendent cells from these two foetuses, meaning they are far-removed from the aborted cells. Presently, The Catholic Church encourage vaccination.
Physician Dr. Rahul Parikh makes a case for “community storytellers” – not just religious leaders, but also family members, and friends, who use word of mouth to change minds within their circle of influence. Because vaccine misinformation is so easily spread online, online messaging and word of mouth are powerful tools for countering misinformation with accuracy. There is evidence that community storytellers in the form of religious and community leaders, and people with first-hand experience of a vaccine-preventable disease, have built vaccine confidence – it is imperative to keep this momentum going. It is also critical that those of us who position ourselves as community storytellers remain open and empathetic towards identifying targeted interventions for those who still harbour doubts.
Community storytellers will also be made up of scientists, medical practitioners, healthcare workers, and science and medical communicators, whose words around healthcare can often be revered: we thus have an added responsibility not to give up on plugging doubts with helpful information. We need to parse through the anti-vaccine rhetoric in different parts of the world in order to identify the roots of vaccine mistrust: only in this way can strategies to appropriately deal with this mistrust be outlined and specifically targeted.