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Fintan O’Toole: To counter vaccine sceptics, we must understand them

Vaccine suspicion has a long-standing imaginative power that’s hard to overcome

In 1944, a somewhat cranky old man wrote a long letter to The Irish Times in which he gave out about “the dangerous and grossly unscientific operation called vaccination”. He maintained that “at present, intelligent and instructed people do not have their children vaccinated” and that “more people are now killed by vaccination than by smallpox”.

Unfortunately, the crank in question was not just some eccentric buffer or golf club bore. He had both a Nobel Prize and an Oscar and was widely regarded as one of the world's great minds. He was by far the most influential Irishman of the previous half-century. His name was George Bernard Shaw.

This week we had more reasons to be hopeful about the possible end of the pandemic when trials of another Covid-19 vaccine, this one being developed by Oxford University and Astra Zeneca, showed very promising results.

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An astonishing 42 per cent of Americans in a survey published last week said they would refuse to be vaccinated

Science and the Irish scientists on the forefront of this project are doing their job magnificently. Vaccines have been developed from scratch with astonishing rapidity.


Yet the challenge the world now has to face is not just scientific. It is also imaginative. If the authorities don’t grasp this, the promise of this moment may not be fulfilled.

For a vaccine to be effective, most of the population has to get it. Last month, in a survey for the Irish Pharmaceutical Healthcare Association, only 55 per cent of people said they would take a Covid vaccine. Thirty-three per cent were unsure and 12 per cent said they would not take it.

This is not a case of older and less well-educated people being troglodytes. A fifth of those aged between 18 and 34 were opposed to taking the vaccine – a much higher proportion than among their elders.

Nor is this just an Irish problem. An astonishing 42 per cent of Americans in a survey published last week said they would refuse to be vaccinated.

To put it mildly, this requires explanation. Vaccination works. It has saved hundreds of millions of lives, eliminated the scourge of smallpox and, in developed countries, banished the terror of polio.

It has exorcised the ghost of tuberculosis that has haunted so many families. Very few of our children now die of rubella or diphtheria. The HPV vaccine is preventing cervical cancers. Time after time, we have seen grief and misery and death held at bay.

The Bernard Shaw of 1944 may be a dangerous crank but when he formed his views half a century earlier, they were not merely silly

Yet the very success of vaccination may be one of the reasons for the flourishing of anti-vaccine sentiment among the young – they haven’t had to watch loved ones die from terrible diseases.

It’s tempting to just scream at such people and condemn them as ignorant, self-indulgent dupes of idiotic conspiracy theories – not least because some of them are. But that won’t help. Instead, we have to understand anti-vaccination sentiment as a cultural phenomenon with its own history and a specific imaginative power.

The first thing to grasp is that scepticism wasn’t always foolish. The Bernard Shaw of 1944 may be a dangerous crank but when he formed his views half a century earlier, they were not merely silly.

Shaw’s doubts were rooted in personal and political experience. He had been vaccinated against smallpox after a deadly outbreak in 1871. But in 1881, he nonetheless contracted smallpox (his famous red beard was grown to hide the marks). It was not unreasonable to conclude that the vaccine didn’t work.

The political experience came from his time as a borough councillor for the St Pancras district of London. He served on its health committee and took his duties very seriously.

What he realised was that the great killers were poverty, overcrowding and lack of sanitation. His concern was that vaccination was being used as a cheap and dubiously effective alternative to real action against these social evils: give them a jab but leave them to live in filth.

A lot of the great 19th-century liberals and radicals thought along similar lines. William Gladstone was an anti-vaxxer. So were Frederick Douglass and Leo Tolstoy.

The success of vaccines is counted in the hundreds of millions. Their failures – the bad reactions that do occur – are individual and often tragic

We also have to get our heads around a paradox: the sceptics played a very important part in making vaccines safe. Without them, we might not have the rigorous multi-stage trials we are now seeing in relation to Covid-19.

Shaw’s allegation that vaccines killed people was wildly exaggerated but not entirely wrong. Early vaccination programmes were a free-for-all. Some of them were deadly. In the United States, children died of tetanus after being given a vaccine for diphtheria.

By highlighting such scandals, anti-vaxxers did science a real service. Vaccines were regulated and tested, becoming steadily safer.

The problem is these legitimate concerns became cultural memes. Justified anxiety became paranoia. Legitimate worries about the arrogance of experts became conspiracist fantasies.

Most of all, though, the scientific imagination is in competition with the aesthetic imagination. It is a contest of big numbers versus intimate details.

It is vital that confidence is not assumed but earned. 'Trust me, I'm a doctor' will not cut it with those who are already mistrustful

The success of vaccines is counted in the hundreds of millions. Their failures – the bad reactions that do occur – are individual and often tragic.

The way our imaginations work gives the anti-vax story an inbuilt advantage. The epidemiologist has to point to an abstraction: the masses of people who didn’t get sick. The teller of scare stories can point to flesh-and-blood examples of specific individuals who suffered terrible side effects. It’s the difference between a dry statistical report and a riveting novel.

Equally, there’s a problem with the way we think about cause and effect. We are not naturally interested in the “cause” of what was prevented from happening. It’s a nebulous and negative concept.

But, on the other hand, we are prone to look for causes of complex effects we do not understand. The idea that a child did not die from measles because of the MMR vaccine is much less gripping than the spurious idea that a child became autistic because of the MMR vaccine.

Only if we understand the social resistance to vaccines, not just as individual selfishness or stupidity but as a historical and cultural phenomenon, can we think about how to counter it.

First, since it is rooted in a history of sometimes justified suspicion, it is vital that confidence is not assumed but earned. Everything must be laid out in the open – the risks as well as the benefits. “Trust me, I’m a doctor” will not cut it with those who are already mistrustful.

Second, the authorities must counter the anti-vaxxers’ inherent advantage in story-telling. There has to be a kind of messaging that gives the lives that are being saved the same dramatic presence as the bad reactions will always have. Make them real, vivid, personal and intimate.

The science and logistics of conquering Covid-19 will unfold on a gigantic scale – billions of doses delivered to billions of people. But the dramatic story will have to be immediate and personal: your granny, your friend, your neighbour, your job.

What is not going to happen – all those deaths prevented – must be made to radiate in the collective imagination as powerfully as any epic tale of rescue.