vaccine politics essay

The Anti-Vax Movement Isn’t Going Away. We Must Adapt to It

A merica’s immunization policies are facing a bleak future. Political polarization about vaccine policies is likely to cause outbreaks of previously controlled infectious diseases. If we cannot prevent these disasters, we should pivot our focus towards managing them.

Resistance to vaccination is not a new problem , but the COVID-19 pandemic exacerbated it. It should be clear by now that neither persuasion nor coercion is sufficient to change the minds or the behavior of people who are determined to refuse vaccines. Education and research cannot defeat coordinated misinformation. And government efforts—at federal, state, and local levels—are stymied by a combination of inadequate power, insufficient political will, and a lack of perceived legitimacy by vaccine refusers. One of America’s core lessons from the COVID-19 pandemic is that a heavy-handed response to vaccine refusal can make things worse.

Many U.S. states have ended their COVID-19 vaccine mandates. But America’s childhood vaccine mandates for school entry are also vulnerable. As researchers of vaccination social science, ethics, and policy, we have sometimes encountered an optimistic view that immunization in America will soon snap back to a pre-pandemic “normal.” But this hope ignores the cracks that were already present in America’s immunization social order before the pandemic, cracks that COVID-19 only widened. State-based conflicts over school enrollment vaccine mandates became increasingly political and contentious during the 2010s. Continued political polarization about vaccine mandates is likely to reduce immunization rates and precipitate the return of previously controlled diseases. That’s why it’s time to adapt to vaccine refusal and prepare to manage these outbreaks, rather than hope they can be prevented.

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All American states require vaccines for school enrollment, but most permit parents to opt out of vaccinating by obtaining a nonmedical exemption. Nonmedical exemptions may be available based upon religious or personal beliefs, depending on the state. Attempts to change these exemption policies have emerged as polarizing flashpoints for Democrats and Republicans. In 2015, California took the unprecedented first step of eliminating nonmedical exemptions to its vaccine requirements to reduce rates of vaccine refusal. Since 2015, Democrats, major physician organizations like the American Medical Association, and pro-vaccine parent activists have tried to remove nonmedical exemptions in many other states.

Democratic lawmakers have now eliminated nonmedical exemptions in California, New York , Washington State (for measles vaccine), Maine, and Connecticut. New national organizations, like the Safe Families Coalition, are pushing for similar changes in many other states. Where Democrats organized to abolish vaccine opt-outs, Republicans fought to protect or expand them. The fight continues, as Republicans look for ways to further weaken childhood vaccine mandates. A case in point: on 17 April this year a Republican judge in Mississippi reinstated a religious exemption to that state’s vaccine mandates that courts had overturned in 1979. 

Attempts to scrap nonmedical exemptions inject new kinds of coercion into a fracturing immunization social order. This intensifies the politicization of school vaccine mandates and erodes public support for these critical policies. Conflicts about COVID-19 pandemic control measures were not outliers, but instead signs of a crumbling immunization consensus. The bitter truth is that nonpartisan vaccine policy was dead before the world had heard of COVID-19.  

Removing nonmedical vaccine exemptions will not overcome vaccine refusal or prevent outbreaks. Only in states where Democrats control all levers of state power can such bills pass, given unified Republican opposition. These policies can deliver local increases in immunization rates. However, even in Democrat-led states, enforcement is likely to be uneven at best, and to be worse in communities where immunization rates are already low. For example, the leadership of private schools is unlikely to enforce strict vaccine mandates that they believe are inconsistent with their values, or that will cause them to lose substantial tuition revenue.

Local successes in Democrat-led states are likely to be overshadowed by immunization policy failures in Republican-led states. In the current political climate, Democrats own the issue of eliminating nonmedical exemptions. In contrast, Republicans have emerged as champions of preserving and expanding them, or even of eliminating mandates altogether. Republicans will weaken existing mandates in the states that they control, and this will lead to lower immunization rates in those places, and perhaps beyond, as vaccination policy embeds more deeply in America’s culture wars.

Read More : How the Anti-Vax Movement Is Taking Over the Right

The implications are significant. The near future likely portends escalating disputes about immunization policy, lower vaccination rates, and a resurgence of diseases once tamed by vaccines. Our response should be to adapt to widespread vaccine refusal rather than to nurture naïve hopes of overcoming it. If we can’t prevent outbreaks, we will need to learn to live with them.

Public health institutions have a crucial role in this shift towards adaptation. They must enhance their capacities, extending COVID-19 surveillance techniques like sewage sampling to encompass other diseases. This method helped New York State Department of Health detect polio virus in wastewater samples in 2022. There is also an urgent need to train medical professionals in diagnosing and treating vaccine-preventable diseases that were once thought to be controlled or eliminated. And governments should prepare to rapidly deploy mobile clinics and response teams to areas hit by outbreaks.

Community-level planning is essential for adapting to more frequent outbreaks in schools and other institutions. Strategies should include the ability to move between in-person and online schooling and the provision of daycare services for essential workers’ children, especially to safeguard the capacities of health care institutions.

Private institutions, from businesses to cultural organizations, must plan their own disease control measures. These may include private vaccine mandates, although state legislatures may outlaw such policies, as some did for COVID-19. However, businesses will be able to keep the assembly lines going and the service counters staffed only if they can reduce the impact of disease on their workforce.

Given the prospect of uneven state and institutional support for vaccination, individuals and families must also brace themselves for more frequent disease outbreaks. Some new parents already prevent unvaccinated relatives from visiting their babies. Families will need to consider extending these forms of private immunization governance when states can no longer protect them.

We are not talking about “giving up.” Governments should continue to promote vaccine acceptance and enforce vaccine mandates. The right kinds of outreach can sway some people who are on the fence about vaccinating. But these efforts alone are unlikely to be sufficient to prevent future outbreaks. Adapting to the times we live in is the only way forward.     

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This Is the Moment the Anti-Vaccine Movement Has Been Waiting For

By Tara Haelle

Ms. Haelle is a science journalist who covers vaccine hesitancy and the anti-vaccine movement. She is the author of “Vaccination Investigation: The History and Science of Vaccines.”

As the coronavirus began pushing the nation into lockdown in March 2020, Joshua Coleman, an anti-vaccine campaigner who organizes anti-vaccine rallies , went on Facebook Live to give his followers a rallying speech. He laid out what he thought the pandemic really was: an opportunity.

“This is the one time in human history where every single human being across this country, possibly across the planet, but especially in this country, are all going to have an interest in vaccination and vaccines,” he said. “So it’s time for us to educate.”

By “educate,” he meant to spread misinformation about vaccines.

The approach that Mr. Coleman displayed in his nearly 10-minute-long appearance — turning any negative event into a marketing opportunity — is characteristic of anti-vaccine activists. Their versatility and ability to read and assimilate the language and culture of different social groups have been key to their success. But Mr. Coleman’s speech also encapsulated a yearslong campaign during which the anti-vaccine movement has maneuvered itself to exploit what Mr. Coleman called “a very unique position in this moment in time.”

Over the last six years, anti-vaccine groups and leaders have begun to organize politically at a level like never before. They’ve founded state political action committees, formed coalitions with other constituencies, and built a vast network that is now the foundation of vaccination opposition by conservative groups and legislators across the country. They have taken common-sense concepts — that parents should be able to raise their children as they see fit, and that medical decisions should be autonomous and private — and warped them in ways that have set back decades of public health advances.

The power of anti-vaccine mobilization is particularly evident now in efforts to protect Americans against Covid-19. Only about 61 percent of eligible Americans are fully vaccinated — not enough to provide national protection — even though the vaccines are free and are the best tool for keeping people out of overcrowded hospitals. But those who are baffled by the outsize influence of the anti-vaccine movement must understand how carefully its leaders have navigated their way to this point.

Vaccine hesitancy has existed in some form since the development of the first vaccine over 200 years ago. But the 2014-2015 measles outbreak, which began among mostly unvaccinated visitors at Disneyland in California and led to more than 125 cases, woke up the nation to the threat of that hesitancy. The only reason measles had gained a foothold was that pockets of the country with low vaccination rates had led to the erosion of herd immunity in those places.

In years leading up to that outbreak, vaccines had not been a partisan issue in the United States. But something was changing . Politicians like Chris Christie and Rand Paul called for respecting parents’ choice to vaccinate their children or not (although Mr. Christie later backpedaled a bit).

Meanwhile, public outcry followed the discovery that the outbreak began with unvaccinated children, with everyone from soccer moms to late-night television hosts lambasting parents who refused to vaccinate their kids. A coalition of parents led by Leah Russin, co-founder of the nonprofit group Vaccinate California, worked with California legislators like Richard Pan , a state senator and pediatrician, to push for a bill that would remove all nonmedical exemptions for school vaccine requirements, which had grown in recent years to allow pockets of low vaccination coverage to spring up.

But the mockery of “anti-vaxxers” in that uproar also mobilized the movement.

Anti-vaccine activists of all political stripes pushed back — hard — against the bill. When they found that inaccurate claims about vaccines didn’t sway California legislators, they shifted gears and asserted that removing nonmedical exemptions impinged on their freedom to raise their children as they wanted. In the late-Tea Party era, that argument had traction.

Renée DiResta, a researcher at Stanford, found through Twitter analysis that there was “an evolution in messaging.” The movement discovered that a focus on freedom “was more resonant with legislators and would help them actually achieve their political goals,” Ms. DiResta said to me. Anti-vaccine Twitter accounts that had been posting for years about autism and toxins pivoted to Tea Party-esque ideas, leading to the emergence of a new cluster of accounts focused on “vaccine choice” messaging, she said.

Anti-vaccine activists used the measles outbreak and others to claim public officials would force “harmful” vaccines on people. They also found new ways to court politicians, especially those who take pride in bucking the system.

Just a week after the California bill had been filed, a well-meaning Republican legislator in Texas, Jason Villalba, filed a similar bill in Austin. But Mr. Villalba didn’t realize that anti-vaccine sentiment had been growing in his state, and his bill unwittingly “kicked the hornet’s nest,” said Rekha Lakshmanan, the director of advocacy and public policy for a Texas-based nonprofit group, the Immunization Partnership . “All of a sudden we saw a kind of new generation of the anti-vaccine movement in Texas emerge.”

Though Mr. Villalba’s bill never got to a vote, it helped drive the new guard to form Texans for Vaccine Choice, which would become a PAC, to lobby against the legislation. Other influential conservative state PACs took notice and may have joined forces with Texans for Vaccine Choice behind the scenes. The group’s emphasis on parents’ rights and medical freedom was a natural fit, aligning them with Tea Party-type Republicans like Jonathan Stickland , whose ringing cry for any issue was “freedom.”

Likely under the tutelage of conservative grass-roots groups, the fledgling anti-vaccine PAC learned effective political electioneering. It backed a champion for its cause to challenge Mr. Villalba in the Republican primary, a far-right politician named Lisa Luby Ryan. When Ms. Ryan defeated Mr. Villalba, Texans for Vaccine Choice cried victory . That Ms. Ryan eventually lost the general election was beside the point. Anti-vaccine activists had shown they were a formidable force, and Texas Republicans learned it was “politically expedient” to stay silent when, for example, Mr. Stickland attacked vaccine scientists , as The Houston Chronicle editorial board wrote .

With vaccine refusal reframed as “parent choice,” Republicans could no longer risk appearing to oppose “freedom of choice” on any issue. More state anti-vaccine PACs and nonprofit groups formed, and social media allowed greater collaboration. The “freedom” messaging united anti-vaccine groups, particularly those in Texas and California, and withstood social media platforms’ growing attempts to stanch false claims.

New anti-vaccine organizations also began fund-raising in earnest, bringing in millions of dollars, both from wealthy donors and by selling fear . They use this money to create slick propaganda for larger audiences, such as a spate of anti-vaccine films like “ Vaxxed ,” which provided a blueprint for pandemic denialism films like “ Plandemic .” And they donate funds to the politicians they hope to win over.

At the anti-vaccine Health Freedom Summit in 2020, several anti-vaccine activists spoke. Jennifer Larson, who believes vaccination caused her child’s autism, described how she had worked to gain the trust of Minnesota legislators. She and another vaccine opponent, Mark Blaxill, had formed a political party in 2011 to run candidates who oppose vaccine mandates and “medical injury,” but they found the two-party system to be too entrenched. So they pivoted to supporting major-party politicians who would champion their causes.

“If they say something that might be considered controversial, we have a community of people who will run to have their back and support them,” Ms. Larson said at the gathering. “If you can, get involved … Get to know them, get them to trust you.”

That became the anti-vaccine playbook across the nation. And in state after state, vaccine opponents have gradually leveraged their state and local Republican parties to their ends, riding the “freedom” wave that has become so central to party messaging today. Hence the seamless marriage between anti-vaccine activists and groups protesting mask mandates and lockdowns.

As one example, by 2020, anti-vaccine groups joined anti-mask groups in Ohio to support a Republican-sponsored bill to curtail the Department of Health’s ability to issue quarantine orders and allow legislators to rescind health department orders. Though that attempt failed, Republican legislators eventually succeeded in 2021 in barring public schools and colleges from requiring Covid-19 vaccination before the vaccines had full FDA approval. States like Texas and Florida are now trying to stop businesses from requiring Covid vaccines.

“The most dangerous thing that could happen,” Dr. Peter Hotez , a co-director of the Texas Children’s Hospital Center for Vaccine Development, told me, “is the Republican Party adopts anti-vaccine anti-science to the major platform.” He added, “This is the nightmare situation I’d hoped to avoid.”

Tennessee offers a glimpse of that nightmare.

Dr. Michelle Fiscus, Tennessee’s medical director in charge of vaccinations, was fired in mid-July after promoting vaccination to young people, an effort state legislators like Scott Cepicky, a Republican representative, found “ reprehensible .” And then the state suspended vaccination outreach for all vaccines.

Dr. Fiscus says the anti-vaccine movement is partly to blame. “I think it’s been this insidious growth of their influence on susceptible legislators,” she said, “especially in Southern states where they have taken the ‘medical freedom’ kind of angle.”

Though Tennessee has since resumed most of those programs, the pause was a bellwether. Had widespread Republican opposition to Covid vaccination now apparently reached the point of interfering with routine childhood vaccinations?

Those of us who have followed the anti-vaccine movement for years know that’s been the plan all along. Although the movement’s leaders could not have known a pandemic was coming, they were more ready to take advantage of the moment with their messaging than public health experts and policymakers were to combat it.

The nature of the scientific process during a pandemic, with its unrelenting influx of new data and constantly evolving understanding of it, makes health communication incredibly challenging. That reality, combined with botched messaging from public health agencies, has emboldened vaccine opponents.

Americans hoping to fight the anti-vaccine movement must learn to use the same tools of political rhetoric and mobilization, to speak up against misinformation and to swarm lawmakers’ phone lines to oppose bills that harm public health. Republican legislators must defend the importance of public health more forcefully.

The Covid vaccine hesitancy running through the Republican Party threatens to do more than prolong this pandemic. It also threatens America’s ability to fight other diseases, of the past and the future.

Tara Haelle is a science journalist who covers vaccine hesitancy and the anti-vaccine movement. She is the author of “ Vaccination Investigation: The History and Science of Vaccines .”

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Politicization and COVID-19 vaccine resistance in the U.S.

Toby bolsen.

a Department of Political Science, Georgia State University, Atlanta, GA, United States

b Urban Studies Institute, Georgia State University, Atlanta, GA, United States

Science is frequently used and distorted to advance political, economic, or cultural agendas. The politicization of science can limit the positive impacts that scientific advances can offer when people reject sound and beneficial scientific advice. Politicization has undoubtedly contributed to hesitancy toward uptake of the COVID-19 vaccine. It is urgent for scientists and clinicians to better understand: (1) the roots of politicization as related to COVID-19 vaccines; (2) the factors that influence people's receptivity to scientific misinformation in politicized contexts; and (3) how to combat the politicization of science to increase the use of life-saving vaccines. This chapter explores these issues in the context of COVID-19 vaccine resistance in the United States. After briefly describing the development of the vaccines, we describe the ways in which the disease itself became politicized because of statements by political leaders and also by media accounts including social media. We then review the politicization of the vaccine at both national and international scales, variability in public acceptance of the vaccines in the United States, and response to the emergence of variants. The next section summarizes social science findings on overcoming vaccine resistance, and the concluding section outlines some of the lessons of the politicization of the disease and the vaccine for health practitioners and life scientists.

Science is frequently used and distorted to advance political, economic, or cultural agendas. In this chapter, we focus on the politicization of science, or its use to advance a particular political agenda. Politicization can occur partly because science “is inherently uncertain… the bottom line is that science is easy to challenge because uncertainty always exists and questioning extant knowledge is part of the research process” 1 (p615) . One of the primary ways that science is politicized is the emphasis of inherent uncertainties to plant doubt among the public over the existence of any scientific consensus. 2 The politicization of science can prevent scientific advances from occurring and/or limit the positive impacts that ensue when people reject sound and beneficial scientific advice.

Politicization has undoubtedly contributed to hesitancy toward COVID-19 vaccination. It is urgent for scientists and health practitioners to better understand: (1) the roots of politicization as related to COVID-19 vaccines; (2) the factors that influence people's receptivity to scientific misinformation in politicized contexts; and (3) how to combat the politicization of science to increase the use of life-saving vaccines. This chapter explores these issues in the context of COVID-19 vaccine resistance in the United States. After briefly describing the development of the vaccines, we describe the ways in which the disease itself became politicized because of statements by political leaders and media accounts, including social media. We then review the politicization of the vaccine at both national and international scales, variability in public acceptance of the vaccines in the United States, and response to the emergence of variants. The next section summarizes social science findings on overcoming vaccine resistance, and the concluding section outlines some of the lessons of the politicization of the disease and the vaccine for health practitioners and life scientists.

1. The development of vaccines for COVID-19

The WHO declared COVID-19 a global pandemic on March 11, 2020, leading the United States to declare COVID-19 a national emergency 2 days later. Almost immediately, on March 16, phase I of clinical trials began for “an mRNA vaccine targeting spike protein” designed by the National Institutes of Health and Moderna (m-RNa-1273); Pfizer and BioNTech announced the start of a phase I/II trial of their mRNA vaccine (BNT162) on May 5, 2020. The US Food and Drug Administration (FDA) issued emergency use authorization of the Pfizer-BioNTech vaccine on December 11, 2020, and the Moderna vaccine on December 18, 2020. Emergency use authorization was granted to the Johnson & Johnson vaccine on February 27, 2021. The Pfizer-BioNTech vaccine gained full FDA approval on August 23, 2021.

The rapid development and testing of these mRNA vaccines was made possible by previous decades of work and many millions of dollars of investment in immunology and vaccine research programs by both the federal government, through the National Institutes of Health, and private foundations such as the Bill and Melinda Gates Foundation. 3 Previous work on the severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, and HIV viruses laid the foundation for strategies to neutralize these viruses, including development of antibody cocktails. The technology underlying the Pfizer/BioNTech and Moderna/NIH vaccines emerged over the last decade from university scientists working on HIV and influenza vaccines, which then sparked Zika, Ebola, and coronavirus vaccine programs at the NIH and in the pharmaceutical industry. The Moderna mRNA vaccine was made as a collaboration with the NIH's Vaccine Research Center, funded by U.S. taxpayers since 1997 to create vaccines against deadly viruses and other human diseases. 4 , 3

2. How did the COVID-19 virus itself become politicized?

The politicization of health-related issues occurs when political identities or cues become integrated into the public discourse surrounding any topic. 5 , 6 This can involve news outlets emphasizing political controversy over an issue that then colors partisans' evaluations of novel scientific information. The roots of politicization surrounding COVID-19 vaccines can be attributed, at least in part, to (1) statements and visual cues by leading politicians, (2) media coverage about the nature of the virus; and (3) partisan divisions in public discourse about vaccination. 7 , 8

• (1) Statements and visual cues by leading politicians and the CDC

President Donald Trump initially downplayed the threat posed by COVID-19 and compared it to the flu in public remarks. 9 The President also labeled it a “new hoax” [and said that] “the Democrats are politicizing the coronavirus—they're politicizing it.” 10 President Trump also promoted claims that the virus could be combatted by injecting or drinking disinfectant or bleach, and promoted hydroxychloroquine as a cure. 11 , 12 He also appeared in public without a mask and criticized his rival for the presidency, Joe Biden, for wearing one: “Did you ever see a man that likes a mask as much as him?… If I were a psychiatrist, I'd say this guy has some big issues.” 13

Politicization thus was “baked into the context of the emergent coronavirus… From the earliest alarm, Republican politicians followed Trump's lead in publicly downplaying the threat, while Democrats responded with more concern, exhibiting different public cues.” 9 (p969), 14 Further, portions of the American public were influenced by President Trump's messages on Twitter suggesting that the virus was a hoax, was not serious, or that unproven therapies should be used. 15 , 16 , 17

In the United States, the primary agency “recognized as the nation's premiere health promotion, prevention, and preparedness agency” is the Centers for Disease Control and Prevention or the CDC. 18 Established in 1946, this agency has made significant contributions to public health in the nation through its studies of communicable and non-communicable diseases. Unfortunately, in the context of the COVID-19 pandemic, the FDA conveyed mixed messages to the public about the risks of the disease and modes of prevention. As Michael Lewis described it, the agency's relationship to disease control “had changed in ways that eliminated its need for bravery. It had begun a descent. It had replaced the flowers on its porch with fake ones and hoped no one would notice.” 19 (p290) Guharoy and Krenzelok suggest that the CDC's “unquestionable record was tarnished by technical blunders, lack of leadership, and contradictory messages throughout the pandemic.” 20 (p4) They cite as examples the failure to provide a COVID-19 test kit during early stages of the pandemic and its probable acquiescence to pressure from the Trump administration “to encourage the use of unvalidated treatments.”

A staff report from the Select Subcommittee on the Coronavirus Crisis commissioned by the US House of Representatives identified 47 instances of government interference: “repeatedly overruling and sidelining top scientists and undermining Americans' health to advance the President's partisan agenda.” 21 (p1) Among the instances of such partisan government interference were delays in a CDC travel alert, the blocking of plans to send reusable masks to all US households in April of 2020, the lifting of shutdown orders recommended by the CDC, and the delay and censorship of scientific reports on the nature of the virus.

• (2) Media coverage

Conflicting partisan messaging has been propagated by various news sources since the beginning of the outbreak. For instance, several popular right-leaning media outlets suggested that the virus was not as severe a health threat as was being portrayed. Instead, they claimed that coverage of the seriousness of the virus was misleading, a conspiracy by the Chinese government to harm the US economy, or a plot by the “deep state” to spread panic and hurt President Trump's chances for re-election. During the COVID-19 outbreak, Fox News was far more likely than CNN or MSNBC to include phrases raising skepticism about the impacts of the virus, with language such as “normal flu,” “political weapon,” and “flu panic” more prevalent in their coverage from February 1 through April 30, 2020. 7 , 8 , 22

Social media messages compounded politicization of the virus. 23 , 24 Stories that circulated widely on social media included false claims (such as transmission of coronavirus through mosquito bites), conspiracy theories (the virus is spread by 5G towers) and pseudoscientific health therapies (eating garlic or drinking bleach can cure the disease). 25 The speed and extent of this spread of false information via social media has been characterized as a kind of epidemic itself: a “misinfodemic.” 26

• (3) Partisan differences in response

In the absence of a vaccine, governments implemented a variety of nonpharmaceutical interventions (NPIs) “such as social distancing, school closures, remote working, restrictions concerning public gatherings, quarantines, hand-washing and the use of masks to slow transmission of the disease.” 27 (p684) The success of these NPIs, as with vaccinations, was affected by politicization in media coverage and communication through social media resulting in, among other things, partisan differences in the perceived seriousness of the virus and willingness to comply with NPIs. 28 , 29 , 30 , 31 , 32 , 33

3. Politicization of the COVID-19 vaccine

Political conflict and coverage surrounding the nature and risk of the virus set the stage for segments of the public to be relatively more receptive to misinformation about COVID-19 vaccines. 34 Attitudes toward receiving a vaccine can be “understood as a continuum ranging from outright refusal to active demand for immediate uptake.” 35 (p1), 36 , 37 Since the beginning stages of testing for COVID-19 vaccines, polls indicated that a sizeable percentage of people in the United States were vaccine resistant , defined as unwilling to get vaccinated once one became available. 38 Many people were also vaccine hesitant , defined as a preference to wait for others have been vaccinated before deciding for themselves. 39 , 40 It is important to note that vaccine resistance/hesitancy has not been static but instead has been influenced by information, the current state of the epidemic, and a variety of individual-level characteristics. 41

• (1) Coverage of vaccine development and approval

On May 15, 2020, President Trump announced Operation Warp Speed, a public-private partnership with $10 billion in funding from Congress to enable faster development and approval of a vaccine for COVID-19. “That means big, and it means fast,” Trump stated, “A massive scientific, industrial and logistical endeavor unlike anything our country has seen since the Manhattan Project.” 42 The main goal, according to the Department of Health and Human Services, was to “produce and deliver 300 million doses of safe and effective vaccines with the initial doses available by January 2021.” 43 This provided support for pharmaceutical companies to conduct research and development on vaccine candidates, aid for manufacturing and storage of pre-approved vaccines, and coordination across other federal agencies to accelerate the process. Yet misinformation about COVID-19 vaccines was already widespread and “a more fraught scenario for science communication is hard to imagine: a novel vaccine, probably fast-tracked, in the middle of a highly politicized and badly mishandled pandemic.” 44 The Trump administration's title for this initiative likely played into the hands of anti-vaccine groups by allowing them to frame COVID-19 vaccine trials as prioritizing speed over safety. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases stated, “I'm a little concerned by that name because it can imply… that you're going so fast that you're skipping over important steps and are not paying enough attention to safety, which is absolutely not the case.” 42

Operation Warp Speed coincided with a US presidential campaign and election, during which the safety and efficacy of any emergency-authorized COVID-19 vaccines was the subject of media coverage driven by a focus on conflict and the partisan implications of vaccinations. China and Russia had been sharply criticized for authorizing emergency use of COVID-19 vaccines outside of clinical trials, which led to “worry that political forces—the U.S. presidential election on 3 November, nationalistic pride to ‘win’ a race, the need to resuscitate economies—could lead to premature and dangerous approvals…by the U.S. Food and Drug Administration.” 45 President Trump also had stated that emergency authorization for a COVID-19 vaccine prior to Election Day would likely help his chances for re-election. 46 The New York Times published an article voicing concerns about an October Surprise in which the FDA might rush a vaccine's approval to please the President. 47 In addition, the vaccine was the subject of political debates over the benefits of government-mandated vaccinations, concerns over “immunization cards” that people might be required to carry, and a loss of individual rights by allowing government to make personal health decisions. 48 , 49 This politicization of the vaccine's approval process, and the idea that the vaccine might be released before the election, reduced the public's confidence in its safety and their intentions to get vaccinated. 50

Vaccine development also was politicized on a national scale as China, Russia and the United States raced to be the first with an effective vaccine. Government agencies and leading news sources attributed this to “vaccine nationalism.” For example, comparing coverage of vaccine development in the Global Times (China) and the New York Times (US), Abbas found that Chinese state media started “a misinformation campaign against American vaccines” while US news sources raised doubts about the strength and effectiveness of the Chinese Sinovac vaccine. 51

• (2) Variability in vaccine acceptance/resistance

Politicization surrounding COVID-19 vaccines contributed to hesitancy, resistance, and opinion polarization. In June 2020, polls showed that about 34% of the U.S. public would accept a COVID-19 vaccine, and large differences existed in opinions between Republicans Democrats. 52 , 53 , 41 ; 1 Those who intended to vote for President Trump were 35% more likely to say that they would not get vaccinated for COVID-19. 54 As vaccine access expanded in the spring of 2021, the proportion of Americans stating that they intended to get vaccinated rose, but still lagged among Republicans. 55 As Allcott et al. summarized it: “partisanship is a primary driver of attitudes about the pandemic and self-reported behaviors.” 28 (p4)

Republicans were more likely than Democrats to believe anti-vaccine misinformation. 34 This reflected a growing skepticism among conservatives toward the scientific community in general, in part due to the rise of right-wing populist messages that pit “ordinary people” against “corrupt elites.” 56 , 57 This distrust of experts was associated with the rejection of scientific messages about vaccines. 58 Populist rhetoric may have primed anti-intellectual considerations that made public health messages less impactful among conservatives. 59

In this case, attention to the statements and endorsements made by trusted elite sources led to high levels of polarization. For instance, a study was conducted in late March 2021 on the effect of exposure to one of two short videos and statements endorsing COVID-19 vaccines—either from President Joe Biden or Former President Donald Trump. 55 Republicans hearing a message urging vaccination from Trump were more likely to state they would get vaccinated compared to a control group, but were less likely to state they would get vaccinated if the message came from President Biden, the out-party leader. Even for those seeking accurate information, differences in the perceived credibility of partisan sources could have driven the observed belief polarization occurring after exposure to identical messages from opposing partisan elites. 60 The key take-away points are that people's underlying goals, or motivations, vary across contexts and unvaccinated Republicans would be more likely to accept a COVID-19 vaccine after exposure to a pro-vaccination message endorsed by a Republican leader. Studies have also shown that people conform to the opinions of others living in the same area: a study showed that people living in areas with higher degrees of polarization were more likely to conform with others of their in-group with respect to health-behavior responses to the COVID-19 crisis. 61 , 2

Human decision-making and information processing is influenced by motivations that color how people evaluate scientific arguments, evidence, and political information. 62 , 63 , 64 COVID-19 was “a disease that quickly became politicized in the United States, [and] individuals are vulnerable [to vaccine misinformation] because they tend to rely on identity affirmation rather than a systematic assessment of information” in these settings. 55 A reliance on “identity affirmation” in processing scientific information means that people often are motivated to evaluate new information in a way that protects their prior beliefs, worldviews, and social identities: when forming beliefs and making decisions, people may seek out information that supports their existing views (confirmation bias), selectively avoid or counter argue against information that challenges and existing belief or identity (disconfirmation bias), and evaluate information that is congruent with an existing belief, worldview or identity as stronger than opposing arguments (prior attitude effect). 65 , 66

Politicization of the vaccine also interacted with the spread of conspiracy theories about the vaccine. 3 A conspiracy theory is an unconfirmed explanation for an event that involves a small group of actors engaging in a harmful deception for personal benefit at the expense of the collective. 67 In the case of COVID-19, conspiracy theories singled out “China, Russia, Bill Gates, Democrats, the ‘deep state’, and the pharmaceutical industry, to name a few.” 68 (p2) A national survey of US adults in June 2020 showed that conspiracy theories endorsed by partisan figures have a stronger impact on audiences' levels of misinformation about COVID-19 compared to medical misinformation about the transmissibility of the virus. 68 Individuals who are more open to believing in conspiracy theories, especially on issues where there is politicization and partisan polarization, tend to be more resistant to scientific information, more open to science politicization, and less willing to engage in pro-social health behaviors. 69 , 70 , 71 , 72

4. Emergence of variants and continued politicization

The SARS-CoV-2 virus, like all other viruses, change and evolve over time. It remains uncertain how the virus might change with respect to its infectiousness, virulence, and immune evasion. 73 At this point, the World Health Organization (WHO) has four “variants of concern” identified in the United Kingdom (alpha, September 2020), South Africa (beta, May 2020), Brazil (gamma, November 2020) and India (Delta, October 2020). 74 The WHO has also designated five other variants as “variants of interest” in addition to numerous other variants that are designated “Alerts for Further Monitoring.” The list is amended frequently as new mutations are identified and documented.

As of August 2021, the delta variant had become the most prevalent because of a mutation that made it more infectious than the original virus. Because of its increased ability to spread among human populations, “almost all current viruses are descended from it … evidence is accumulating that infected people not only spread the virus more efficiently, but also faster, allowing the variant to spread even more rapidly.” 73 (p846) With large numbers of people unvaccinated, the variants of the virus could become even more deadly immune to current vaccines. 75 , 76

Despite a barrage of media reports on renewed spikes in deaths and hospitalizations due to COVID-19, and warnings from various celebrities and political leaders, the response to the adoption of public health measures continues to be polarized. In summer 2021, 52% of Republicans said that they had received at least one dose of the vaccine or planned to get vaccinated as soon as possible as opposed to 88% of Democrats. 77 Further evidence of this division is the fact that 17 of the 20 States with the lowest vaccination rates in summer 2021 were carried by Donald Trump in the 2020 Presidential Election. 78 Politicization surrounding mask mandates in public spaces including classrooms and mandatory vaccinations or testing for some exemplify these ongoing divisions.

Reluctance to abide by mandatory masking edicts in public venues and classrooms became politicized early in the course of the pandemic as advice from the Centers for Disease Control and public health experts originally discouraged masks for people not showing symptoms. 79 Concerned about a possible shortage of masks, experts including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and Dr. Jerome Adams, former surgeon general argued that face masks should be reserved for front-line medical workers. 80 When the message changed and some school districts and government authorities began mask mandates, protests erupted arguing that mask requirements impinged on personal freedom. 81 In states such as Florida, Texas and Arizona, state leaders banned mask mandates for schools, while the University System of Georgia regents warned of disciplinary action for faculty members requiring COVID mitigation measures such as distance learning or mandatory masks in classrooms. 82 , 83 In each such case, the anti-mask position was backed by a Republican governor and/or Republican-dominated legislature arguing that such mandates impinge on parental rights to make decisions about the health care of their children. 84

The announcement by President Biden on September 10, 2021, that employers with 100 workers or more require their employees to get vaccinations or weekly COVID testing, was met with sharp criticism from Republicans who saw this move as “unconstitutional,” “un-American” and “an assault on freedom and liberty.” 85 , 86 , 87 At the same time, the chair of the Democratic National Committee, Jaime Harrison, enthusiastically supported this mandate, stating that the Democrats are “moving forward with protecting the American people” while the Republican response is “crazy.” 88

5. What does social science research conclude about promoting vaccine acceptance

To control the spread of COVID-19 through vaccination, it is imperative that communication strategies to overcome hesitancy and resistance among unvaccinated individuals and groups be developed. One strategy is to convey to the public the dangers of viral infection of themselves and others, and the value of vaccination to prevent disease and death, actions that might lead to decreased vaccination rejection. To better understand the causal impact of messages about COVID-19 vaccines, we conducted a controlled survey experiment in May 2020 that randomly assigned 1123 respondents to one of six different message conditions. 4 The messages (treatments) highlighted positive or negative considerations about the safety of the coronavirus vaccine, information about the likelihood that other Americans would get vaccinated when a vaccine became available, and politicization of vaccination as evidenced by suggestions that liberals sought to control individuals' personal lives or by President Trump's unsupported statements that vaccine approval was rushed for political gain by Democrats and other liberals. We found that those given a message emphasizing the safety and effectiveness of the vaccine reported increased intentions to get vaccinated compared to the control group of respondents who did not read or receive any information (treatment) but were simply asked about their intentions to get vaccinated. We also found that messages that most other Americans were not willing to get vaccinated decreased reported intentions to get vaccinated, demonstrating the powerful impact that communicating descriptive social norms can have on individuals. In addition, messages that suggested the vaccine was being rushed for approval prior to the Presidential election decreased reported intentions to get vaccinated. 35

Another study conducted in December 2020 and January 2021 on 24,682 unvaccinated Americans involved asking respondents to read one of five randomly assigned messages. These included whether the vaccine was recommended by the respondent's personal physician or “most scientists,” two moral frames that appealed either to patriotism (“doing what is right for one's country”) or preventing harm to themselves and others, or to a descriptive social norm treatment that communicated whether or not most people in one's social network were likely to take the vaccine. 89 The results showed that exposure to every message condition, except for patriotism, significantly reduced vaccine resistance. Further, the large sample offered an opportunity to explore how different subgroups responded to the different messages. Few differences in the effects of these messages on different partisan subgroups were found. These studies indicated that “multiple messaging strategies can reduce vaccine resistance.” However, a key question that remains is “when are these communications most effective, and for whom?”

Scientific messages that communicate the degree of scientific consensus on any issue can also have a powerful impact on audiences and may serve as one way to combat vaccine resistance. 90 , 91 One study that looked at perceptions of the safety of childhood vaccines found that agreement with the statement that “90% of medical scientists agree that vaccines are safe” was the strongest predictor of support for vaccines. 92 Shifting individuals' perceptions about the level of consensus among expert scientists about the safety and efficacy of the coronavirus vaccine might ultimately lead to a cascade of pro-social health behavior, such as getting vaccinated.

Other research has explored the extent to which exposing individuals to information that warns against and refutes, or “pre-bunks,” vaccine misinformation prior to actual exposure to the misinformation reduces or eliminates the effect it can exert on audiences in politicized contexts. 93 This builds on efforts to combat other forms of scientific misinformation by making respondents aware of such claims but then immediately refuting them in order to establish an initial belief that the misinformation is not to be trusted. 94 , 95 , 96 , 97 Although pre-bunking is a possible way of combatting vaccine misinformation prior to its politicized embedding in the public consciousness, it is not always possible to preempt the rise and spread of misinformation, especially in a transformed digital media environment. 98 , 99 , 100 In such cases, providing individuals with factually accurate and corrective information often can reduce political and scientific misperceptions. 101 , 102 In a study performed in the United States and United Kingdom, Carey et al. demonstrated that corrections reduced targeted misperceptions on incorrect beliefs—that hydroxychloroquine and antibiotics can cure COVID-19, that the virus was a bioweapon created by China or created by Bill Gates—but did not have a persistent and lasting impact on the prevalence of those same misperceptions even when survey respondents were repeatedly exposed to corrective information. On the positive side, providing factually corrective information increased the accuracy of respondents' perceptions about COVID-19 and reduced the prevalence of these misperceptions in the short-term; however, the effects of this information were “disappointingly ephemeral” on those respondents and completely disappeared over time. 103

6. What does politicization mean for practitioners of science?

Online social media has facilitated the spread of rumors, conspiracy theories and misinformation at a speed and intensity unprecedented in history. 104 When combined with the politicization of science, the results can be disastrous for objective reasoning in individual and collective decision-making. 105 What can science practitioners do to combat the deleterious impacts of politicization in the specific case of resistance to the COVID-19 vaccine? In addition to individual activities on the part of scientists themselves, there are several take-aways for life scientists and health professionals.

First, we need to recognize that science is politicized, but that such politicization has been the case throughout much of human history. From the conviction of Socrates (470–339 BC) for corrupting youth with his teachings, to Roger Bacon (1214–94) being imprisoned for finding logical inconsistencies in the Bible, to Galileo Galilei's arrest for his refusal to accept the Church's position on the nature of the solar system, scientists have struggled for independence and intellectual freedom. An account written in 2009 reports “threats from all sides of the political spectrum over the years” including restricting funding, dictating the curriculum in science classes, controlling the composition of scientific advisory committees, and reviewing or censoring scientific publications.” 106 (p4) Although the speed and efficiency of transmission of science skepticism has changed with the democratization of information, the tendency to resist ideas and inventions that would be beneficial to the world has a long history. 107 , 108 Understanding the context of skepticism about science should increase patience with short-term setbacks and also the need for persistence even under challenging situations.

Second, scientists need to be aware of how their communications affect people and tailor their communication styles to maximize effectiveness. Decades of research on effective communication of science suggests a few principles (1) effective communication leading to constructive action requires that the communicator has earned the trust of the audience, not through status or titles, but instead through mutual respect; (2) scientific information is more likely to be acted on if technical details are accompanied by content to which the audience relates, including storytelling; (3) information should be clear, consistent, understandable and actionable. 109 Just as social media has been used in the COVID pandemic to communicate misinformation, so too can it be a tool used by the science community to correct that misinformation and to enhance trust in scientific and medical research findings.

Finally, there is a need for more collaborative cross-disciplinary work to promote rapid adoption of important scientific findings. The complexity of the COVID-19 pandemic and its politicization at local, national, and international scales points to the importance of multifaceted approaches to understanding its disease-related, pharmaceutical, economic, geographic, cognitive, and psychological components simultaneously. 110 The improvement of COVID outcomes will only take place when global expertise gleaned from all relevant disciplines are marshaled. Life scientists and healthcare professionals will play a key role, but their work will be enhanced if they work in large-scale teams with social and psychological scientists as well as experts in policy and communication.

1 Several other demographic characteristics have also been associated with reported willingness to accept the COVID-19 vaccine. In general, people with less education, income, and who live in rural areas were less likely to get vaccinated for COVID-19; and, at least in the U.S., women and minorities were significantly more likely to say they would not get vaccinated. 40 Americans characterized as having high levels of religiosity are also both more likely to be misinformed about COVID-19 and also to refuse a vaccine. 111

2 It should be noted that this effect is conditional on the severity of the pandemic and highlights that there are ways to vitiate “biases” in information processing and reasoning.

3 A sizeable literature has shown that a general conspiratorial predisposition exists, independent of partisanship, that causes people to be receptive to conspiracy theories and claims and more skeptical of scientific counterclaims and recommendation.

4 This was a convenience sample recruited and remunerated through Amazon's Mechanical Turk (MTurk) platform.