As a doctor, I can’t understand anti-vaxxers, certainly not the vociferous sort who campaign aganist vaccination outside schools, or just refuse without giving a reason. Vaccinations have always been an incredible scientific advance. In the 1960’s, I was so relieved myself to get the polio vaccine when it came, because people and especially children were terrified of it. Every school had at least one child who died, or came back in a wheelchair. Then smallpox, measles, whooping cough, and a host of others greatly reduced the threat of illness at all ages. Vaccination was a miracle. Only cranks refused it.

But now the world’s recovery from Covid-19 is being threatened because many people are refusing the vaccine. Despite the undoubted fact that vaccines work, and that most people dying from covid in rich countries are unvaccinated, people are still refusing.  Only a minority  are anti-science or staunch anti-vaxxers with bizarre theories. The majority are just not convinced. So why?  

Firstly, trust, in the government’s policy makers; the health service and in the vaccine itself.  In some countries (Russia, USA, Albania, many African countries), people just don’t trust the vaccines, and think they do more harm than good. They may particularly distrust Big Pharma, often for good reason, especially in the USA after the Oxycontin debacle, and in Africa where there have been many clinical trials which have harmed patients.  They may distrust doctors who they may perceive as only in it for money, or when they or a close relative have been damaged by medical treatment or a procedure. Or they just distrust their governments for political reasons as in Russia. They therefore gravitate to treatments which are seen as more natural and therefore safer. They tend to discard scientific  research, preferring to do their own “research” through Google. 

Other reasons centre on whether or not the person thinks the disease to be a serious risk to their health, and in the case of Covid it is well known that younger fit people are unlikely to get seriously ill. Some such people don’t think it is very important, even though people in this category do get very ill and can die.  Whether the vaccine is easily available as well is an important determinant, especially in poorer environments.  

But a very important determinant is the willingness to protect others from infection, through getting the vaccine oneself, and this varies greatly with a person’s world-view. It requires an understanding of how good health can be a lottery, and that you can get seriously ill  very suddenly despite having taken every precaution, and being basically fit. Illness can strike anyone at anytime.

People who distrust healthcare and the science associated with it, often want to be in control, rather than consult professionals,  and can be  reluctant to use it.  They  prefer to go for over-the-counter  treatment, or advertised procedures without scientific rigour, and other home or traditional remedies. They assume that if they treat their bodies properly – healthy diet, plenty of exercise, knowledge of how the body works – they will never get ill. I admire these people in a way. But  such people can fail to get medical care soon enough, if they are unlucky enough to get a sudden severe illness.  In contrast, a few people (who are have access to free scientific medical care  and good education) can tend to rely entirely on the medical system for all their needs and can overuse it, not realising that the body is indeed very good at healing itself. They may therefore demand medical care early without being prepared to wait and see. This takes away their “agency” and they can become very dependent and passive. When they become ill they say “you can’t be too careful”, and are very risk-averse, which itseff may have negative consequences for their health. So it is important to strike a balance between consuming every kind of recomended medical care, and treating oneself with no regard for science.

Fortunately, in the UK  not so many people are as sceptical of vaccination as in the USA. This is because in general people really do trust their NHS, and o think that there is bound to be  a pill for every ill, or that there is a treatment that will magically make you better regardless, and that you have a right to every treatment at very little personal financial cost. I saw this a lot when I was working in general  practice in the UK. 

 This dichotomy between different world views of healthcare was manageable in a less interconnected world, when there was a spectrum of beliefs but the extreme ends being held by a small proportion of people. But now, with social media amplifying such world views, and applying  algorithms which are geared  towards making  money for themselves, more and more people are being pushed into the category that distrusts medical care and emphasises their own ability to keep themselves fit, such as the “wellness” movement.  Refusing vaccination, which has very little to do with personal autonomy and everything to do with health of populations is a very dangerous strategy, both for themselves and the communitioes they are part of. 

Personally, I have a lot of common ground with people who want to use mainstream medical services as little as possible.   I spent 35 years in general practice, and I found it was essential to treat each person as an individual, and find out what  each person really wanted out of the consultation, as people varied so much in their ideas.  If they follow quack theories and  mad gurus, so long as they keep it in perspective, so what?  I am very aware from my medical work that the body is indeed very good indeed at healing itself.  95% of symptoms get better entirely on their own.  And it is refreshing to find people  who are determined to maximize their health  and are convinced that they will succeed. It contrasts with the people who thronged into my surgery with every cough and cold, who were chronically anxious and never took responsibilty for their own health, prefering to rely on the doctor’s prescriptions every time. They could be  utterly dependant on their doctor, sometimes because they were lonely, and were underconfident.  Some  even wanted to be diagnosed with an illness as that would either  get them out of work they didn’t like,  or get them more money; some who were disorganised and  lacking in drive.  Some had very high expectations and could be very demanding. 

But mostly I saw many who were just  very unlucky in the  lottery of health, and suffered a lifetime of bad health, yet tried their best to conform to medical advice in order to make  their health as good as possible. There were people who drew the short straw and developed type I diabetes in childhood, or had rheumatoid arthritis, in other words diseases they could not possibly have caused themselves. Then there were the many people who were poor, weren’t able to afford a good healthy food, having to buy ultra processed poor quality food because it was cheap, had jobs which were hard on their backs and joints. Their bodies tended it wear out more quickly because  of the stresses and strains of their lifestyles. These people could be helped by modern medicine and it was my job to do just that.

Of course, in the modern “wellness” culture, where bloggers, health gurus, and health influencers thrive,  it isn’t only well-trained dieticians, or physios from whom that people get their information, it is also websites that promise immediate cures and therapy which have no validity in scientific terms at all. “Dieticians” and “Physios” with no qualifications can treat patients  and charge a lot of money with no oversight.  It is all about control and money. It is often relatively young people, usually basically fit, with jobs and a reasonable amount of money,  who are starting to think about “wellness”, and looking up on-line to find how they can stay fit. More often women than men, they are willing to learn about the human body and how it works, and want to follow a lifestyle that suits them.  All very good,but many do not want to involve medical professionals at all, especially where there is a high cost in doing so such as in USA.  If the internet provided a balanced view of scientifically accurate information then that would not be a problem. But the algorithms that govern the websites they see quickly pull them towards more extreme  content, and misinfornmation is rife, and soon they may be reading  stuff that tends towards QAnon,and very right wing ideas. One trope that gets traction is that you can control your health by following these arcane rules, and if you do you will never get ill. They look at Covid, and see that the worst effects of the virus are on those who are already ill, and feel that they won’t get ill because they are following the right rules. 

More than that, people can  come to believe that those who do get ill are in some way at fault – they eat unhealthily and take harmful medications  or foods, and  they  may regard the lives of those less fortunate than themselves as having scant value. One writer says “Some of the most strikingly nasty stuff I’ve seen with Covid misinformation has come from wellness influencers.” All this works against the fundamentals to do with vaccination – that you don’t only do it to protect yourself, but you do it to protect everybody else, including those you love who may be unluckier than you in their health. This outlook is a world apart from the disdainfulness that I refer to above in which they don’t see why they should take any risk at all for the common good.  Modern vaccines are extremely safe, but bad events can happen to the detriment of a very few individuals. But when, as in this case, the virus is so infectious that you are very likely indeed to get it, and  can get seriously ill with it, then the risk is very much worth taking on an individual level, aside from helping the whole community. 

It is likely that some anti-vaxxers cannot now be persuaded to get vaccinated – their views are too entrenched.  But htere are many who are vaccine-hesitant who might be persuaded. So what can health professionals and governments do to help these people come forward? There are reasons such as needle phobia  for instance where the underlying anxiety can be treated, and there are now vaccines that can be given viaskin  patches. Vaccines should be readily available – vaccines can be given in drop in clinics, people shouldn’t have to wait in long queues,  there should be an unhurried atmosphere to calm nerves and so on. Huge vaccination camaigns can help. In some difficult neighborhoods, rewards could be offered. 

Then there is the question of sanctions for those who won’t get vaccinated. These have to be carefully titrated against people’s freedoms. Vaccine passorts for certain venues or travel, can work well, as in France,   On the whole I am against compulsion, and against forcing people out of a job unless it is really dangerous for an unvaccinated person to be in that situation – hospital ward or care homes for instance. In the end it will be a decision made by the individual, and although it is heartrending to see people dying of covid pleading to be vaccinated when it is too late. 

More importantly online platforms should be held accountable forn the harmful and incorrect information they publish, as any other publishingt company would have to be. It is a scandal that they can get away with it.