Most people have welcomed the possibility of getting vaccinated against COVID-19[feminine], but a sizable minority did not. Vaccine-resistant people tend to hold strong opinions and confidently reject conventional medical or public health recommendations. This is confusing to many, and the issue has become a flashpoint in several countries.
This has led to strained relationships, even within families, and at the macro level has threatened social cohesion, such as during the month-long protest on the grounds of parliament in Wellington, New Zealand.
This begs the question: where do these strong, often visceral anti-vaccination feelings come from? As life course researchers, we know that many adult attitudes, traits and behaviors have their roots in childhood. This idea prompted us to learn about vaccine resistance among long-time group members. Dunedin Studywhich turns 50 this month.
Specifically, we asked study members about their vaccination intentions between April and July 2021, just before the nationwide rollout of the vaccine that began in New Zealand in August 2021. Our results support the idea that opinions anti-vaccination stem from childhood experiences.
The Dunedin study, which followed a birth cohort from 1972 to 1973, amassed a wealth of information about many aspects of the lives of its 1,037 participants, including their physical health and personal experiences as well as their values, motivations, lifestyles, information processing skills and emotional tendencies, dating back to childhood.
Almost 90% of Dunedin Study members responded to our 2021 Vaccination Intent Survey. We found that 13% of our cohort had not planned to get vaccinated (with a similar number of men and women).
When we compared the early life histories of those who were vaccine-resistant to those who were not, we found that many vaccine-resistant adults had histories of adverse childhood experiences, including abuse. , abuse, deprivation or neglect, or having an alcoholic parent.
These experiences are said to have made their childhoods unpredictable and contributed to a lifelong legacy of distrust of authority, while seeding the belief that “when the proverb hits the fan, you’re on your own.” Our findings are summarized in this figure.
Personality tests at age 18 showed that people in the vaccine-resistant group were vulnerable to frequent extreme emotions of fear and anger. They tended to shut down mentally when stressed.
They also felt fatalistic about health issues, reporting at age 15 on a scale called “health locus of control” that there is nothing people can do to improve their health. As teenagers, they often misinterpreted situations by needlessly jumping to the conclusion that they were threatened.
The resistance group also described themselves as non-conformists who valued personal freedom and autonomy over following social norms. As they grew older, many experienced mental health issues characterized by apathy, faulty decision-making, and susceptibility to conspiracy theories.
Negative emotions combine with cognitive difficulties
To make matters worse, some vaccine-resistant study members had cognitive difficulties since childhood, as well as their early adversities and emotional vulnerabilities. They had been poor readers in high school and had performed poorly on the study’s verbal comprehension and processing speed tests. These tests measure the amount of effort and time a person needs to decode incoming information.
These long-standing cognitive difficulties would certainly make it difficult for anyone to understand complex health information in the calmest of conditions. But when the difficulties of understanding combine with the extreme negative emotions more common among vaccine-resistant people, it can lead to vaccination decisions that seem inexplicable to medical professionals.
Today, New Zealand has achieved a very high vaccination rate (95% of eligible people over the age of 12), which is about 10% higher than in England, Wales, Scotland or Ireland and 20% higher than in the United States.
Most strikingly, New Zealand’s death rate per million population is currently at 71. This compares favorably to other democracies such as the United States with 2,949 deaths per million (40 times the New Zealand rate). Zealand), the UK at 2,423 per million (34 times) and Canada at 991 per million (14 times).
How to overcome vaccine resistance
How then do we reconcile our finding that 13% of our cohort were vaccine resistant and the national vaccination rate now stands at 95%? There are a number of factors that contributed to driving the rate so high.
Good leadership and clear communication from the Prime Minister and the Director General of Health
taking advantage of the initial fear regarding the arrival of new variants, Delta and Omicron
the widespread implementation of vaccination mandates and border closures, both of which have become increasingly controversial
government delegation of vaccination responsibilities to community groups, especially those most at risk such as Maori, Pasifika and those with mental health issues.
A distinct advantage of the community-driven approach is that it taps into more intimate knowledge about people and their needs, thereby creating (higher) trust for decision-making around vaccination.
This is consistent with our findings which highlight the importance of understanding individual life histories and different ways of thinking about the world – both of which are attributable to the adversities some people experience early in life. This has the added benefit of encouraging a more compassionate view of vaccine resistance, which could ultimately translate into higher rates of vaccine readiness.
For many, the move from a one-size-fits-all approach has been too slow and this is an important lesson for the future. Another lesson is that achieving high immunization rates has not been without “cost” to individuals, families and communities. It has been difficult to persuade many citizens to get vaccinated, and it would be unrealistic not to expect residual resentment or anger among those most affected by these decisions.
Preparing for the next pandemic
COVID-19 is unlikely to be the last pandemic. Recommendations for how governments should prepare for future pandemics often involve medical technology solutions such as improvements in testing, vaccine distribution and treatment, as well as better prepared hospitals.
Other recommendations emphasize cost-effective solutions such as a global pandemic fund, more resilient supply chains and global coordination of vaccine distribution. The contribution of our research is the appreciation that citizen vaccine resistance is a lifelong psychological style of misinterpreting information during crisis situations that is established before high school age.
We recommend that national preparedness for future pandemics include preventive education to teach schoolchildren about the epidemiology of the virus, mechanisms of infection, infection mitigation behaviors and vaccines. Early education can prepare the public to appreciate the need for handwashing, mask-wearing, social distancing, and vaccinations.
Early education about virus and vaccines could provide citizens with a pre-existing framework of knowledge, reduce the level of citizen uncertainty in a future pandemic, prevent emotional stress reactions, and improve openness to health messages. Technology and money are two key tools in a pandemic preparedness strategy, but the third vital tool should be a prepared population.
The take-home messages are two-fold. First, don’t despise or underestimate vaccine resistant people, but rather try to better understand “where they came from” and try to address their concerns without judgment. The best way to do this is to empower local communities that vaccine resisters are most likely to trust.
The second key idea points to a longer-term strategy that involves education about pandemics and the value of vaccinations in protecting the community. It has to start when the children are young and, of course, it has to be delivered in an age-appropriate way. That would be wise simply because when it comes to future pandemics, it’s not a question of if, but when.
Richie PoultonCNZM FRSNZ, Director: Dunedin Multidisciplinary Health and Development Research Unit (DMHDRU), University of Otago; Avshalom CaspiTeacher, duke universityand Terrie MoffitNannerl O. Keohane University Psychology Professor, duke university.