In Communities We Trust Institutional Failures and Sustained Solutions for Vaccine Hesitancy

Abstract

In winter 2020, a novel coronavirus (SARS- CoV-2) that caused COVID-19 started its spread across the globe, and by July 2020, over 500,000 people worldwide had died of the disease. By March 2021, there were over 120 million cases and over 2.8 million deaths. To combat the pandemic and return to “normalcy”, experts estimate that at least 80% of the world’s population needs to be resistant to the virus, and most of the world’s population will require vaccination. This will be a challenge. In addition to facilitating widespread distribution, governments will need to combat “vaccine hesitancy”: an individual’s reluctance to get vaccinated or vaccinate their children. In the United States, 71% of the adult population says it is willing to get vaccinated, and the numbers are much lower in Europe (Ipsos & World Economic Forum, 2020; Summers, 2021). Contrary to popular belief, not all vaccine hesitancy is the same. Nor is it simply the result of ignorance or antipathy towards science. At its root, vaccine hesitancy is about institutional mistrust. Communities question whether their governments, and scientific, technological, and medical institutions, really represent their needs and priorities. Long legacies of mistreatment of marginalized communities further fuels this mistrust. In this report, we examine analogical case studies that help us understand the roots of institutional distrust and ultimately, vaccine hesitancy. This method allows us to systematically analyze previous examples of the relationships between science, technology, policy, and society to understand the consequences and challenges of new technology. Our analysis identifies sources of public mistrust and anticipates better approaches for establishing community trust, especially for those from marginalized or disadvantaged backgrounds. We reveal two main causes of public mistrust: 1. limitations and failures in scientific and technical institutions, and 2. institutionalized mistreatment of marginalized communities. Both, we argue, ultimately help to legitimate the circulation of false information and sow vaccine hesitancy. On the basis of this analysis, we provide recommendations to help restore public trust, and use additional model cases to describe how they might be implemented.