This is the second instalment of Paula Jardine’s six-part investigation into the planning behind ensuring vaccine acceptance and countering vaccine ‘hesitancy’. You can read Part 1, published yesterday, here.
IN 2010, as GAVI, the Global Alliance for Vaccines and Immunisations (now called The Vaccine Alliance) was setting out on its ambitious ten-year strategic plan called the Decade of the Vaccine, Dr Heidi Larson, a professor of anthropology, risk and decision science, set up the ‘Vaccine Confidence Project’ at the London School of Hygiene and Tropical Medicine. It was funded by vaccine manufacturers and their European lobby group in conjunction with the European Commission, UNICEF and University College London. The ubiquitous Bill and Melinda Gates Foundation is unusually absent from this list. The project’s purpose was to challenge vaccine scepticism.
Larson explained: ‘I have a pretty mixed group – my team includes psychologists, anthropologists, social media analysts, mathematical modellers, and they all ask different kinds of questions. What we have in common is that we’re all working on the same challenge of trying to understand why people are questioning and refusing vaccines more than they used to.’
With the number of approved vaccines on national immunisation schedules increasing and with dozens of new vaccines in the pipeline, GAVI’s game plan had become ‘demand generation’, in other words getting people actively to seek out vaccination (the intention being for people to create bottom-up pressure on their governments). Strategic Objective 2 of the Global Vaccine Action Plan (GVAP), the implementation plan for the Decade of the Vaccine, which remains today, is that ‘individuals and communities understand the value of vaccines and demand immunisation as both their right and responsibility.’
The GVAP reframing of vaccination in terms of rights and responsibilities transforms vaccination from an individual (private) medical choice (even in the context of a national public health programme) into a civic rights issue, pitting choice against a (spurious) socio-political ordinance. Writing on her blog, Larson explains, ‘Immunisation, since its beginning, has always walked a tense line between individual rights to choice and societal rights to health. A tense line between rights and responsibilities – the right to choose, with the caveat that it does not injure those around you.’
The principal value of this utilitarian collectivist perspective is that it displaces, for ‘the greater good’ (as defined by certain elites), the well-established medical ethics principle that the benefit of a procedure to each individual recipient must outweigh the risk. The assumption here is that for an act to be morally right it has to be judged only on its consequences for the majority. And since vaccines are supposed to induce immunity and consequently prevent transmission of infectious diseases, mass vaccination in pursuit of disease eradication must be for the greater good. As the utilitarians say, the end justifies the means.
Winning confidence in vaccines, which means winning trust in their safety and efficacy, is therefore imperative. From the health system administering them to the motives of the policy makers, this is the requisite of demand generation. When and where this fails has been dubbed ‘hesitancy’, the reluctance or refusal to be vaccinated despite the availability of vaccines (as though vaccines were, per se and in all circumstances, an unquestionable good regardless of the chequered history of many). According to a World Health Organisation working group report, ‘As hesitancy undermines demand, to achieve the GVAP defined vaccine demand goal, countries will need to address hesitancy. High rates of hesitancy mean low demand.’
Vaccines have been recognised by courts in the US, including its Supreme Court, as unavoidably unsafe products. However, based on the precedent of smallpox eradication, public health agencies such as the Centers for Disease Control and Prevention (CDC) remain determined to use vaccination to eradicate diseases and therefore argue that the overall value of vaccines to the community outweighs the risk to any single individual.
Diseases are no longer just diseases, we’re told they’re vaccine preventable diseases. Evidence in the medical literature of people who fail to respond to vaccination (primary failure) or of waning protection following vaccination (secondary failure) is simply ignored. The single greater good concept has provided the justification for mandatory vaccination and, in Covid times, for restricting the freedoms of those who exercise their right to bodily autonomy by refusing a medical procedure. Those unlucky enough to be injured or die from vaccine administration are what the American bioethicist Dr Leroy Walters has called ‘injured recruits in the war on infectious disease’.
Despite the rationale that society benefits from universal vaccination, the burden of vaccine injury is largely borne by individuals. It’s now standard practice for vaccine manufacturers to bear no liability for their products. The precedent of indemnification was set by the ill-fated 1976 US swine flu vaccination campaign when the US government stepped in because insurers balked. It paid out almost as much in compensation for vaccine injuries as it spent on the programme, thanks to an active surveillance reporting system for vaccine injuries. Active surveillance has never been repeated. Today only 27 countries have compensation programmes for vaccine injuries, a small improvement on the dozen that had them when GAVI was created in 1999. As for the rest, their injured citizens are collateral damage in the Rockefeller-conceived War on Microbes.