How does a pandemic contribute to vaccine hesitancy?
How does a pandemic contribute to vaccine hesitancy?
How does a pandemic contribute to vaccine hesitancy?
1, Introduction
Baby Olpha Otis died at 4 months old..
Genie died at 8 years old in 1908…
These are the siblings of Clella B. Gregory from Kentucky, who describes the experience of her family during the influenza outbreak of the early 1900s.
Tragically, this included the deaths of two of her siblings. There are innumerable similar stories to this…
Clearly, diseases have been among the biggest destroyers of lives throughout history. This applies not only to those who pass away, but to families, friends, communities, and other loved ones. Therefore, it won't be surprising that there are many individuals asking very diverse questions around some of the most devastating diseases in history. These may include; what is the definition of a pandemic? What is the difference between this and an epidemic? What were the deadliest pandemics in history?
Further, with all the emotional, social and economic instability that they cause; creates a perfect ground for vaccine hesitancy to grow and be maintained. With that, I`m going to discuss some of the most deadly infectious diseases in history. I`ll talk about how they disrupted almost every aspect of life. Although vaccines had not been invented for all of them, my key aim for this article is to illustrate the disruption that they cause.
This will hopefully provide historical context to two important observations;
Vaccines are so crucial, have spared so many lives as well as improving quality of life for others and
Why mistrust and therefore hesitancy have such a high likelihood of developing in times like these
With that, what is the definition of a pandemic? Generally, they`re defined as a more localized disease outbreak (epidemic) that spread over a wide geographical region, crossing international boundaries and impacting lives on a large scale. The main difference between an epidemic and a pandemic is that disease incidences are distributed within a smaller geographical area in the first case, larger in the second.
It is unsurprising that disrupting many aspects of life on such a large scale causes stress, isolation and mistrust. That is a perfect culture for suspicion and division to grow, a climate which exacerbates most social issues beyond just vaccine hesitancy. I'll discuss some of the deadliest pandemics in history and the conditions they placed people in. From this it should be clear how hesitancy can develop.
2. Black Death Pandemic
We can't discuss this topic without referring to the Black Death pandemic that ravaged Europe from 1347 to 1352 and killed half its population (estimates range from 30 to 50 per cent, although that is debated in more recent research). Nonetheless, it was a devastating disease, which isn’t surprising with a name like “Black Death.”
The aetiologic agent is the zoonotic gram negative coccobacillus Yersinia pestis. Gram Negative means that the bacterium has a thick outer coat and coccobacillus means that the bacterium has geometry ranging from spherical to rod shaped.
“Zoonotic” refers to the bacterium`s usual mode of transmission. Yersinia Pestis is generally transmitted by rodents, other small animals and many different flea species. This occurs via bites, direct contact with infected tissues, such as exposure to infected material via cuts wounds or other skin abrasions, or handling infected animals. Inhalation of respiratory droplets is also a common route via coughing, sneezing, talking, singing and so on. There is also evidence that the plague can be spread via intensive contact with human corpses or animal carcasses that died of the disease
Once infected, one of three different types of plague may develop - pneumonic, bubonic or septicaemic. However, as the second type caused the Black Death pandemic, I`ll focus on that subset of plague cases.
According to the website of the World Health Organisation, bubonic plague is the most common form of plague, and occurs when Y. pestis enters at the site of the flea bite and travels to local lymph nodes via the lymphatic system, and replicates. The presence of the bacteria causes an inflammatory response, resulting in sore, swollen tense lymph nodes called “buboes”. They commonly occur in the axillae (armpits) and/or the groin.
Despite being a typical clinical feature of the infection , and being present in 96% of plaque cases at presentation, buboes have been poorly researched in scientific literature. More well-described are symptoms listed by the CDC, including varying levels of weakness, pain, shock, and internal bleeding. Other symptoms of the bubonic plague include acute febrile disease and other nonspecific systemic symptoms over a period of one to seven days.All plague subtypes (that is, pneumonic, bubonic, and septicemic) have very high mortality rates.
Such symptoms can appear and progress rapidly, thus early treatment is vital to enhance the potential for survival of these patients.A number of antibiotic classes are the standard of care for plague; including aminoglycosides, tetracyclines, and fluoroquinolones. More specifically, the FDA has approved streptomycin, doxycycline, several tetracyclines, and 3 fluoroquinolones including ciprofloxacin for plaque treatment. Experiments are also establishing the effectiveness of sulphonamides and non-antibiotic approaches like vaccines and bacteriophages in preventing and treating plague cases. That said, plague cases are scarce in 2024, mainly being confined to rural areas in western USA, and certain areas of Africa and Asia. For example, on 15th September 2021, 22 cases of plague were confirmed in Madagascar with 19 being pneumonic and 3 bubonic.
During the Black Death pandemic, doors of infected houses were marked with a red cross with “Lord have mercy upon us” inscribed on the doors. Trading routes were diverted due to increased mistrust of non-native individuals. According to a paper published in 2013 by Eugenia Tognotti “the fear of discrimination and mandatory quarantine and isolation led the weakest social groups and minorities to escape affected areas and, thus, contribute to spreading the disease farther and faster, as occurred regularly in towns affected by deadly disease outbreaks.”
Italian physicians were insulted in the streets for warning civilians about the spread of the Black Death. Due to this among many other factors, it often took weeks for outbreaks of the Black Death to be recognised in any given population.
This makes it clear what social environments can develop during a pandemic, or indeed any large-scale health crisis. The key word in the previous paragraph that sums this environment up is “mistrust”. Mistrust of health authorities. Mistrust of non-natives. Most importantly, mistrust of each other. This is the common denominator among all social issues that contribute to vaccine hesitancy - be it in the past, in current movements, and likely will be in future anti vaccine movements.
Of course, vaccines weren't discovered for over 400 years by Edward Jenner in 1796. However, my goal here is to illustrate the point that central drivers of modern vaccine hesitancy and anti vaccine movements are constant. The principle remains the same regardless of the era, geographical region, culture, political climate and many other variables. It is valuable to track these principles through history, because it may allow us to anticipate public reactions to future pandemics, and issues that might arise because of these reactions. With that, public health authorities may be able to take preventative approaches to addressing public concerns. This may be preferable to attempting damage control when mistrust and its consequences ( ie. rejection or delay of vaccines, conspiracies, and others we probably can't predict as of yet) have already set in.
3. Spanish Flu pandemic
Unfortunately, the Spanish Flu pandemic does not present a more pleasant picture. Unlike the Black Death, the Spanish Flu`s aetiological agent is a H1N1 virus with genes of avian origin, which killed 50 and 100 million people between spring and winter of 1918, with about 500 million people or one third of the world's population becoming infected. Its death toll exceeds even the number of deaths registered from World War 1.
Frequent and large-scale travel of military troops between and within the U.S and Europe increasing disease transmission, among other reasons, make it difficult to track its exact place of origin. Despite this debate around where it originated, it is known that a first or spring wave began in March 1918 and spread in a nonuniform way throughout the U.S. and possibly Asia over the following six months. In fall or autumn 1918, a fatal flu wave spread globally from September to November. According to a 2023 paper published by Florigio Lista and colleagues, “a third wave occurred in the first months of 1919 in many countries with different patterns: this wave had high illness rates in part of European countries, such as France, Scotland and Finland, lower rates in Sweden, Norway and Holland, while it was almost absent in Spain, Denmark and Italy.”
The majority of individuals experienced only common flu-like symptoms, particularly during the first pandemic wave.These included fever, aches, headaches, sore throats, coughing, and sneezing. More common during the second pandemic wave were extensive pathologies including primary viral pneumonia (pneumonia caused directly by the flu), acute respiratory distress syndrome, and secondary bacterial pneumonia (pneumonia not caused directly by the flu). Pneumonia was generally caused by colonizing strains of bacteria, which are strains of bacteria that “live” in the respiratory tract and are usually harmless. This was the most common cause of death, generally between 7 and 11 days following symptoms onset.
During the influenza pandemic, a variety of myths developed about their origins. A Milan newspaper was ordered by the Italian government to stop publishing daily death tolls of the Spanish flu as it was too demoralizing. In efforts to maintain morale, leaders inadvertently eroded trust in healthcare authorities. In addition, according to a 2021 paper published by Grace E. Patterson, there was a “disbelief of disease presence, misinformation, unclear public communication, disregard for governmental proclamations, and poor personal risk assessment were and are still common. ” Further, in a parallel to modern movements; official leagues against masks were formed who cited insufficient scientific evidence in their favor and violation of constitutional rights.
Many such issues are seemingly based on a perceived lack of control in circumstances such as pandemics. Efforts to maintain morale may also have been a measure to maintain control over the populace in such difficult times and prevent revolts. Further, regarding the disbelief of disease presence, it is much easier to have perceived control over one`s life if one ignores aspects of life that are out of one`s control - like a global pandemic. Leagues against masks may well have been another way to regain what the population perceived as control over the circumstances. This is not, of course, to say that efforts from authorities were ill-intentioned or that public health measures like masking are not effective. It is simply to discuss why the circumstances of a pandemic cause mistrust of health authorities and resistance to recommended public health measures.
5. COVID 19
Of course, I couldn`t end an article on pandemic without at least mentioning SARS-CoV2. I've discussed the biology behind the virus before so won't go into it again. I`ll go straight into why the most recent pandemic was fraught with mistrust and resistance.
It could be argued that the Internet is one of the defining features of modern anti vaccine movements. Arguably, one cannot talk about any significant modern event without mentioning its digital impact. It's very easy to find examples of media amplifying anti vaccine or vaccine resistant voices. The internet allows such messages to be disseminated on a large scale. This allows mistrust of vaccines to spread exponentially. Some anti vaccine pages, youtube channels and so on can gather up to millions of followers with little to no regulation. Further, even with increased regulation, tactics exist to evade it. These include symbols or code words to discuss vaccination, or moving to a different forum or creating a dedicated site.
Therefore, a volatile environment can persist despite interpersonal interactions being limited. Research has found increased violence against women from intimate partners during quarantine in Western and Southern European countries. Further, according to a 2021 paper published by Amiya Bhatia and colleagues, “the coronavirus disease 2019 (COVID-19) pandemic has affected children’s risk of violence in their homes, communities and online, and has compromised the ability of child protection systems to promptly detect and respond to cases of violence.” Creating further issues around this is that there remain questions about what the impact of the disease and quarantine was on the risk of violence towards such vulnerable groups. Questions also remain about how to best support survivors under circumstances of limited movement, increased financial strain, and reduced access to health care services.
5. Conclusion
To summarize, these features of pandemics among others can result in certain groups feeling isolated to some degree or another. This can be violence, perceived withholding of information by health authorities, among many others. Depending on this and other variables, they might experience some degree of hesitancy or resistance towards vaccines or other public health measures. Clearly, there are many factors involved in this. Therefore, it is crucial to develop tailored approaches to predict possible public concerns in future pandemics. This allows interventions that best support the public in these difficult times to be developed. Thanks for reading!
6. References
Molecular and Genetic Mechanisms That Mediate Transmission of Yersinia pestis by Fleas - PMC
Stay alert, infodemic, Black Death: the fascinating origins of pandemic terms
History repeating. The plague of 1630 in Milan and the COVID-19 pandemia - PMC
Plague: A Millenary Infectious Disease Re Emerging in the XXI Century - PMC
Successful Treatment of Human Plague with Oral Ciprofloxacin - PMC
Levofloxacin Cures Experimental Pneumonic Plague in African Green Monkeys - PMC
What can the Black Death tell us about the global economic consequences of a pandemic?
Lessons from the History of Quarantine, from Plague to Influenza A - PMC
https://archive.cdc.gov/www_cdc_gov/flu/pandemic-resources/1918-pandemic-h1n1.html
The beginning and ending of a respiratory viral pandemic‐lessons from the Spanish flu - PMC
World War I: what we’ve learned from the ‘war to end all wars’
Deaths from Bacterial Pneumonia during 1918–19 Influenza Pandemic - PMC
COVID-19 and Spanish flu-18: review of medical and social parallelisms between two global pandemics
Lessons from the History of Quarantine, from Plague to Influenza A - PMC
Gender-based violence against women during the COVID-19 pandemic: recommendations for future - PMC
For more interesting discussion; check out my other articles https://youmeandvaccines.ie/blog-you-me-and-vaccines-ireland-communication-on-vaccinations.html
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