Speaking to the Unvaccinated: Part 2 — Ideology

Speaking to the Unvaccinated People at Work

Approved COVID-19 vaccines have strong evidence that they are both safe and highly effective at preventing COVID-19 infection. Meanwhile, Canada has a vocal minority of citizens with strong anti-vaccine sentiments. What would drive people to openly critique and dispute scientific evidence during a public health emergency? To many people, it doesn’t seem rational and they would be correct. Emotional reasoning is almost invariably behind most anti-vaccine sentiment. In this mini-blog post, Adam Henley explains how political ideology can shape perspectives on vaccination.

‘Protective Mothering’ and the Motivated Refusal of Vaccines

Long before the global fight against COVID-19, researchers knew that mandatory vaccination was an emotionally charged issue. Parents of children who refused vaccination for their child often voiced concerns about the safety of vaccines, even when this conflicted with scientific evidence. Interestingly, these parents were often engaged in other health-promoting behaviours (e.g. breastfeeding, increased fresh fruit and vegetable intake, exercise, etc.) outside of their choice to forego vaccination for their child. After much study of the phenomena, Attwell and Smith (2017) ultimately determined that parenting was a political act. Mothers who were vaccine hesitant held specific political viewpoints which sustained their anti-vaccine perspectives… even after presented with scientific evidence.

Social Categorization Theory suggests that people take action to protect and maintain group affiliations in order to bolster a positive view of themselves. In the case of vaccine hesitant mothers, the choice to not vaccinate their child was often enabled by their social capital (group affiliations) and socio-economic status. Researchers were shocked when a study designed to improve self-esteem and confidence among vaccine hesitant mothers actually resulted in greater vaccine hesitancy. As this intervention would be unethical to study further, it was not pursued further by the team.

Traditionally, strong anti-vaccine viewpoints were associated with alternative health and naturalistic paradigms. What we see now is a different set of political ideologies around vaccination.

Ableism: Putting Work before Health

When it comes to COVID-19 vaccine hesitancy, public health leaders are likely paying the price for protracted periods of lock-downs. Some people were comfortable with the economic impacts, while other people were deeply offended by putting health ahead of the economic outputs in the short-term. Why?

Among professions and groups where hard work is a key expectation, government regulations that mandated quarantine or specific precautions were inconsistent with group incentives and norms. Many adults place their career identity (a.k.a. work) ahead of other commitments, especially health. Imagine for a second the shift worker working overtime in the oil sands. Why would this shift worker care about vaccination when they already work long hours in a cold, desolate environment with poor air quality? They’ve already taken on inordinate risks for their health to make an above average income. This worker is likely to accept the risk of COVID-19 just as they previously accepted the risk of heart attack, stroke, diabetes, obesity and chronic pain.

Healthism & Rugged Individualism

Healthism is a political doctrine whereby people assume they have full control over their own health outcomes, creating a moral expectation they they are personally responsible for their own health. Under this rugged individualism, it is hard to imagine becoming vulnerable to the actions of other people in your community. It is also difficult to imagine how your health behaviours will affect others.

We have several examples of healthism in public health settings. For over thirty years, public health experts have tried to convince people they are responsible for protecting their health. From Canada’s Food Guide to ParticipACTION to anti-smoking campaigns, we have impressed on all Canadians the importance of focusing on your own health behaviours. Unfortunately, it is very difficult to control COVID-19 spread with just health-promoting behaviours. No single intervention is highly effective in containing the spread. You can socially distance, use face masks and wash your hands … but, your risk of contracting COVID-19 cannot be entirely prevented within settings where the community faces a high burden of disease.

Uselessness as a Moral Failure

The idea of overcoming COVID-19 speaks to self-management of disease as a form of virtue. One common thought among the unvaccinated is: “I can work harder than others, so I am healthy… COVID-19 would never kill me.” Logically, there are some errors in this type of reasoning. However, emotionally, it makes perfect sense. The person who works hard can do so because they are ‘able bodied’ (their self-selected indicator of health). Therefore, the unvaccinated feel little motivation to take preventative actions against a disease that only affects the fat, lazy, unemployed and extremely old (in their mind).

Most health-promoting behaviours that prevent COVID-19 transmission interfere with perceptions of ‘usefulness’. For example:

  • Taking 1-2 days off work after getting a vaccine, or feeling tired for a couple days after vaccination.
  • Self-isolating for 14 days after exposure to a confirmed case of COVID-19
  • Self-isolating when you are pretty sure you just have a cold or a sore throat
  • Working from home when your employment setting has an on-site office with productivity tools (e.g. photocopier, conference room, etc.)

For the reasons described above, the unvaccinated person is ‘good’ simply because they avoid burdening society with their own `uselessness’. Their willingness to work in spite of costs to their own health (toxic productivity) is what makes them a valuable worker. This person fears becoming useless more than they fear dying. And, this then shapes their relationship with their body. Unvaccinated workers often believe their body remains healthy solely because of their strong will. They have distorted health beliefs which then shape their ability to take action should they become sick.


References 

Attwell, K., Meyer, S. B., & Ward, P. R. (2018). The social basis of vaccine questioning and refusal: A qualitative study employing Bourdieu’s concepts of ‘capitals’ and ‘habitus’. International Journal of Environmental Research and Public Health15(5), 1044–1061. doi:10.3390/ijerph15051044 

Attwell, K., & Smith, D. T. (2017). Parenting as politics: Social Identity Theory and vaccine hesitant communities. International Journal of Health Governance22(3), 183–198. doi:10.1108/IJHG-03-2017-0008 

Attwell, K., Smith, D. T., & Ward, P. R. (2018). ‘The Unhealthy Other’: How vaccine rejecting parents construct the vaccinating mainstream. Vaccine36(12), 1621–1626. doi:10.1016/j.vaccine.2018.01.076 

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Published by Adam Henley

Adam is a Registered Nurse with experience in chronic disease management, symptom measurement, hematology/oncology, primary care behavioural health and geriatrics. He combines counselling, nutrition & exercise with traditional home nursing care. Adam cares to live health together with clients in a manner consistent with Parse’s Theory of Human Becoming. At the heart of his care, Adam offers evidence-based strategies to transform health together.

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