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Vaccination and the Anti-Vax Movement in the US and Internationally Throughout Time

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Vaccination and the Anti-Vax Movement in the US and Internationally Throughout Time

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Higher amounts of Anti-Vaxxers Live in Certain States and Regions within the US 

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Higher amounts of Anti-Vaxxers Live in Certain States and Regions within the US 

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Elevated Prominence of Anti-Vaxxers in Communities That Have Suffered From Mistreatment 

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Elevated Prominence of Anti-Vaxxers in Communities That Have Suffered From Mistreatment 

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People Living Prior to Modern Vaccine Standards and Safety 

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People Living Prior to Modern Vaccine Standards and Safety 

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Communities Across The World Throughout History

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Communities Across The World Throughout History

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People in Countries Across the World with Both High and Low GDPs 

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People in Countries Across the World with Both High and Low GDPs 

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“A 2015 Pew Research study in the USA found that people who distrust vaccines are more likely to be earning less than $25,000 a year, live in the Midwest rather than more affluent California, and lack college-level education.”(https://wellcomecollection.org/articles/Whf_BSkAACsAgwil)

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Smallpox

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TB

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In 1932, the USPHS, working with the Tuskegee Institute, began a study to record the natural history of syphilis. It was originally called the "Tuskegee Study of Untreated Syphilis in the Negro Male" (now referred to as the "USPHS Untreated Syphilis Study at Tuskegee"). The study initially involved 600 Black men - 399 with syphilis, 201 who did not have the disease. Participants' informed consent was not collected. Researchers told the men they were being treated for "bad blood," a local term used to describe several ailments, including syphilis, anemia, and fatigue. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance.

By 1943, penicillin was the treatment of choice for syphilis and becoming widely available, but the participants in the study were not offered treatment.

In 1972, an Associated Press story about the study was published. As a result, the Assistant Secretary for Health and Scientific Affairs appointed an Ad Hoc Advisory Panel to review the study. The advisory panel concluded that the study was "ethically unjustified"; that is, the "results [were] disproportionately meager compared with known risks to human subjects involved." In October 1972, the panel advised stopping the study. A month later, the Assistant Secretary for Health and Scientific Affairs announced the end of the study. In March 1973, the panel also advised the Secretary of the Department of Health, Education, and Welfare (HEW) (now known as the Department of Health and Human Services) to instruct the USPHS to provide all necessary medical care for the survivors of the study. ¹ The Tuskegee Health Benefit Program (THBP) was established to provide these services. In 1975, participants' wives, widows and children were added to the program. In 1995, the program was expanded to include health, as well as medical, benefits. The last study participant died in January 2004. The last widow receiving THBP benefits died in January 2009. Participants' children (10 at present) continue to receive medical and health benefits.

Later in 1973, a class-action lawsuit was filed on behalf of the study participants and their families, resulting in a $10 million, out-of-court settlement in 1974.

On May 16, 1997, President Bill Clinton issued a formal Presidential Apology for the study.

References

1 "HEW News" Office of the Secretary, March 5, 1973; Memorandum "USPHS Study of Untreated Syphilis (the Tuskegee Study; Authority to Treat Participants Upon Termination of the Study," from Wilmot R Hastings to the secretary, March 5, 1973.

2 Vonderlehr, R.A., Clark, T., Wenger, O.C., Heller, J.R., Untreated Syphilis in the Male Negro, Journal of Venereal Disease Information. 17:260-265, (1936).

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Statistics about Modern Day Vaccination Rates in Black Community 

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Statistics about Modern Day Vaccination Rates in Black Community 

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Key Findings

Vaccine confidence has improved among Black Americans, but mistrust plays a role in holding down vaccination rates.

The authors found that vaccine-related mistrust is a multifaceted construct that includes distrust of health care and health care providers (to be equitable), the government (to provide truthful information), and the vaccine itself (to be safe and effective).

The national discussion of confidence issues has masked access problems.

Access issues include distance to vaccine site or insufficient vaccination sites in one's community; lack of transportation to available vaccination sites; lack of high-speed internet access and/or internet literacy or lack of English literacy required to locate and schedule appointments; and work- and child care-related issues as well as other scheduling challenges.

Following the development and rollout of COVID-19 vaccines in late 2020, researchers, policymakers, and community leaders expressed concern about the low levels of confidence in COVID-19 vaccines among Black Americans across the United States. Although vaccination rates have increased over time, Black Americans are still being vaccinated at lower rates compared with other racial or ethnic groups (Figure 1).

This Study

To identify approaches to increase vaccine confidence and uptake among Black Americans, RAND Corporation researchers conducted a national survey of 207 Black participants in November 2020. The team also conducted in-depth interviews with 28 Black participants from December 2020 to March 2021. The in-depth interviewees comprised 23 participants who responded on the survey that they would not get the vaccine when it became available and five community stakeholders who represent different Black organizations and subcommunities, including people living with HIV, sexual and gender groups, and immigrants. In the interviews, participants gave their perspectives about how to encourage vaccine confidence and increase vaccination among people in Black communities. The study was conducted in partnership with a national advisory board of eight community stakeholders.

Figure 1. COVID-19 Vaccination Inequities, as of June 9, 2021

Black Americans

U.S. population

Received one dose

23.3%

51.7%

Fully vaccinated

19.7%

42.3%

SOURCE: Centers for Disease Control and Prevention, "COVID Data Tracker," webpage, 2021.

Main Findings

The study produced two overarching findings that speak to the current crisis and may offer lessons to inform a proactive response to future public health crises.

Vaccine confidence has improved among Black Americans, but mistrust plays a role in holding down vaccination rates. Mistrust of the vaccine stems directly from historical and ongoing discrimination and racism experienced by Black communities and can be conceptualized as an adaptive coping response to such experiences. The authors found that vaccine-related mistrust is a multifaceted construct that includes distrust of health care and health care providers (to be equitable), the government (to provide truthful information), and the vaccine itself (to be safe and effective). Table 1 provides details on key areas of mistrust expressed by survey participants.

Table 1. Survey Responses from the Beginning of the Vaccine Rollout (November-December 2020)

I am worried the vaccine could be harmful.

64%

15%

20%

People who take a COVID-19 vaccine will be like human guinea pigs.

59%

18%

23%

Black people should be suspicious of information from the government about COVID-19.

34%

35%

31%

Within the health care system, people from my racial/ethnic group are treated differently than people from other groups.

62%

21%

26%

The national discussion of confidence issues has masked access problems. Although there has been considerable attention paid to the issue of mistrust and vaccine confidence among Black Americans, increasing confidence has shifted the spotlight to barriers to access as a reason for persistently lower vaccination rates. Specific access challenges noted by study participants at the beginning of the vaccination rollout included the following:

the distance to vaccine site was too far or there were insufficient vaccination sites in one's community

lack of transportation to available vaccination sites (e.g., poor public transportation infrastructure or lack of access to private transportation)

lack of high-speed internet access and/or internet literacy or lack of English literacy required to locate and schedule appointments

work- and child care-related issues and other scheduling challenges, particularly in the case of a two-dose vaccine and when managing side effects.

Recommendations

The authors made several recommendations based on their own survey and interview data and discussions with the study's national advisory board. At the outset of the vaccine rollout, when issues of low confidence and limited access became apparent, community stakeholders across the country took the lead to develop their own tailored solutions. Later, as vaccination rates leveled off, national initiatives further aimed to reduce access barriers. It is perhaps not surprising then that the recommendations developed by the authors to increase vaccine confidence and access overlap with those that are already being implemented in communities across the United States.

Solutions for increasing vaccine confidence include the following:

Acknowledge that systemic racism has contributed to an understandable and justified response of mistrust before providing information about the vaccine.

Develop clear, layperson-oriented, transparent messaging that (1) is tailored to specific subcommunities within the broader Black American community and (2) acknowledges both what we know and what we do not know about the vaccine, particularly when conducting outreach to marginalized subcommunities, such as people living with HIV, sexual and gender minorities, and immigrant communities.

Provide opportunities for open dialogue with scientists and health care providers who can answer questions.

Identify trusted messengers by community, including trusted public health officials and Black doctors, who can work with local leaders to disseminate information together.

Leverage the power of social networks, including friends and family who have been vaccinated, who can discuss their vaccination experiences and reasons for getting vaccinated with their peers.

Solutions for increasing vaccine access include the following:

Add medical (e.g., clinics, primary care providers) and nonmedical (i.e., community-based) vaccination sites in underserved communities.

Build on existing resources in communities, such as trusted community-based organizations that already provide resources and human resources who are already trained in health-related fields.

Simplify and streamline access (e.g., provide transportation, do not require appointments, allow appointments to be made by phone, meet people where they live and work).

Collect and publicly release good data on COVID-19 risk, vaccination, and vaccine efficacy by subgroup, including by race or ethnicity and by other vulnerable groups (e.g., sexual and gender minority groups, immigrant communities, those without English proficiency, people with insecure housing status)-recognizing that there is great diversity in Black communities and that cultural norms, experiences, and beliefs about health care may differ by subcommunity.

Use vaccination (and the 15-minute waiting period following vaccine administration) as an opportunity to screen for health conditions and increase health care and social service access.

Create authentic partnerships between communities and public and medical officials.

It is worth noting that, as with the challenges noted in the findings, these solutions will need to be multifaceted and focus on building long-term capacity and engagement.

Key Takeaway

To improve Black Americans' confidence in COVID-19 vaccines, and in public health initiatives more generally, health care organizations and the U.S. public health system need to undertake efforts to become more trustworthy. Being honest about historical and ongoing discrimination and working with communities to provide equitable, accessible care can significantly contribute to such efforts. These steps will improve the health care system's response not only to the current public health crisis but also to future crises.

This report is part of the RAND Corporation Research brief series. RAND research briefs present policy-oriented summaries of individual published, peer-reviewed documents or of a body of published work.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.

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Removing Barriers to Vaccination for Black Americans

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To improve Black Americans' confidence in COVID-19 vaccines, health care organizations and the public health system need to become more trustworthy. Honesty about historical and ongoing discrimination and working with communities to provide equitable, accessible care could help.

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Reported Cases of Vaccine Preventable Diseases

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Reported Cases of Vaccine Preventable Diseases

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From Smallpox-Covid-19, More History (and how vaccines have gotten safer over time)

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From Smallpox-Covid-19, More History (and how vaccines have gotten safer over time)

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For centuries, humans have looked for ways to protect each other against deadly diseases. From experiments and taking chances to a global vaccine roll-out in the midst of an unprecedented pandemic, immunization has a long history.

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When I first began thinking about vaccines and hesitation around vaccines, I found myself thinking through a very bias lens. From my point of view, there is no clear reason that I would not take precautions to keep myself safe using a tool that I trust. However, after learning more about the reasons people choose to get vaccines or choose not to, it is not always an easy answer for some people.

At first, what came to mind was the ties between nationalists or far rights and anti-vaxers. I thought about the fact that historically they have not trusted the government as much as the general population. However, this stereotype in my head does not hold the full truth (although it might be partially spot-on). They are not the only group who have been hesitant (or not hesitant) to get their shots, especially when you consider history and how far the vaccine technology has come. So, I realized, more ideas needed to be represented and more time periods. Who thought what?

I like the idea that politics and people’s characteristics define what they chose to do about their health. However, I also know that so many other factors contribute to this choice--generational racial trauma, governmental mistrust, fear of safety--and much more. I aim to provide an interactive way to compare pro-vax, vaccine hesitant, and anti-vax points of view.

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Both of these posters were released by governments.

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Anti-Vax in Right-Winged Political Parties 

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Anti-Vax in Right-Winged Political Parties 

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Andrew Wakefield, who wrote the notoriously famous paper on the link between vaccines and autism, despite being disproved is still a prominent figure in American and English politics.

https://www.theguardian.com/society/2018/jul/18/how-disgraced-anti-vaxxer-andrew-wakefield-was-embraced-by-trumps-america

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Have you ever met someone vaccine-hesitant? What were their reasons, did they share? Were these reasons due to an underlying distrust or fear that they had?