Vaccine hesitancy is a symptom of people’s broken relationship with the state
Nesrine Malik The Guardian
It’s hard to
explain what it feels like when someone you thought you knew intimately starts
to repeat conspiracy theories about the pandemic and vaccines. You don’t really
grasp what’s happening immediately: it’s too vast and jarring a realization to
gulp down in one go. So you go through phases. First you clutch at straws.
Perhaps it’s a bad joke, or they didn’t really mean it, or they’re just
misinformed. Then you enter a stage of hot, disorienting rage and frustrated
remonstration. Once that is spent, finally you cool off. But inside you is a
leaden realisation that not only is this person you love putting their life at
risk: perhaps you never really knew them at all.
People with the
wildest theories about the pandemic can be found in countries even where most
people don’t have access to the internet, cable TV or the shock jocks of
commercial radio. A common impulse is to write off those espousing conspiracies,
consigning them to the casualties claimed by WhatsApp groups, disinformation or
silent mental health issues. These things may be true – but vaccine hesitancy
is a symptom of broader failures. What all people wary of vaccines have in
common, from Khartoum to Kansas, is their trust in the state has
been eroded. Without understanding this, we will be fated to keep channelling
our frustrations towards individuals without grasping why they have lost trust
in the first place.
This mistrust can
run so deep that people will trust almost any source of information other than
the government. In my birthplace of Sudan, fewer than 1% of the
population have been fully vaccinated and ventilators are even rarer than
vaccines. The story is much the same in several other African countries, where
vaccine availability is so poor that people will drop everything and head to a
hospital based on nothing but a rumour that free shots are available that day.
But for many other people, those rare lifesaving vaccines sound suspiciously
like too much of a good thing.
When the first
batch of donated vaccines was sent to Sudan earlier this year, two vulnerable
members of my family rejected them because someone had started a rumour that an
electrical power shortage in the country meant vaccines couldn’t be properly
stored, and thus they would certainly have “gone off” and be harmful. I and
others tried to convince them that, even if that were the case, the worst case
scenario was the shots would be ineffective rather than actually harmful. Our
efforts were futile. Still, I clutched at those straws, hoping that once the
first shots were administered and no harm was reported, my relatives would come
round. But their excuses were ready. The new batch was a “reject”, I was told,
donated by western countries that sent the vaccines to Africa for
some good PR rather than throwing them away.
This sounds like
completely irrational behaviour, but in fact it is the opposite. In countries
such as Sudan, nothing good, and certainly nothing free, comes from the state.
The government is an extractive body that exists not to serve citizens, but to
rifle through their pockets and charge them for going about their daily
business. Corruption is endemic – from bribing one’s way through traffic
violations, to being forced to use private hospitals because government cronies
have hoarded medical technology. The state is something that you thrive in
spite of. The government’s communication reflects this uneasy relationship.
Officials speak to the public either to scold them or spread propaganda, and
dissent is banned; in Egypt, doctors who contradicted the government’s account
of the pandemic were arrested, while oxygen tanks ran out in
intensive care units in Cairo.
How do you try to
convince someone that the provision of free and effective Covid vaccines is the
exception to the rules they have lived under their whole life? That vaccines
are a sudden outbreak of generosity and competence? Suspicion is
easily sown, because political systems don’t need to be fully authoritarian to
sustain exploitative and dishonest regimes that breed mistrust. You might think
there is a dodgy hidden profit motive behind Covid vaccines if you live in the
US, for example, where there is extreme political resistance to publicly funded
healthcare, an outrageously profitable healthcare and pharmaceutical industry
that spends $306m (£221m) on lobbying a year, and exorbitant,
unregulated pricing of everything from flu shots to holding your
baby after birth. You might, if you lived in the UK, doubt the
government’s assurances that the vaccine had been rigorously tested, after
seeing senior officials appear to make up pandemic policies as they went along,
dragging the nation with them through U-turns and lockdowns whose
rules they did not follow themselves.
State failure
breeds paranoia. And when trust in government breaks down, people turn to
personal vigilance. This climate of hesitancy and wariness is heightened by
poorly regulated media that trade in falsehoods. In the UK, for example, a misleading
report about ethnic minority people being excluded from vaccine trials was
resolved only with a short correction in a footnote.
Vaccine rejection
doesn’t happen in a vacuum. It’s easier to dismiss hesitancy and conspiracies
as unhinged behaviour; it makes us feel less unnerved by displays of unreason
from those who we think are, or should be, rational people. Sure, among
vaccine-hesitant people are those who are simply stubborn, misanthropic or
selfish. But, just as the pandemic exploited the weaknesses of our economic and
public health systems, vaccine hesitancy has exposed the weaknesses of states’
bond with their citizens. There are no easy answers for how to deal with those
who repeat conspiracy theories and falsehoods, but scrutinizing the systems
that lost their trust is perhaps a good place to start.
Nesrine Malik is
a Guardian columnist