Trust, Vaccine Hesitancy, and the COVID-19 Pandemic: A Phenomenological Perspective

ABSTRACT

Vaccine hesitancy has been a major cause for concern throughout the COVID-19 pandemic. The World Health Organization have previously addressed vaccine hesitancy via the ‘3C model’ (Convenience, Complacency, and Confidence). Recent scholarship has added two more ‘Cs’ (Context and Communication) to formulate a ‘5C model’ that is more equipped to adapt to the uncertainties of the pandemic. This paper focuses on the four ‘Cs’ that explicitly concerns trust (Complacency, Confidence, Context, and Communication) and phenomenologically distinguishes confidence from trust. Experts view vaccines in terms of confidence, where the prospect of an undesirable outcome is extremely rare. Hence, not vaccinating and compromising herd immunity is seen to be unreasonable. Hesitant individuals contest the expert perspective and view vaccines in terms of trust, where the prospect of disappointment is likely. From this perspective, to vaccinate is to take a risk, and it is within reason to have the freedom to choose otherwise. This paper focuses on the hesitant perspective to identify the two social indicators of trust in vaccines most prominently shown during the COVID-19 pandemic in the Global North: (i) the expert reaction to hesitant concerns and (ii) the loss of freedom in relation to vaccine requirements.

KEYWORDS:

• Vaccine hesitancy
• trust
• COVID-19
• phenomenology

Acknowledgement

I would like to thank one anonymous reviewer and the editors of this Special Issue T.Y. Branch and Gloria Origgi for their comments and suggestions. I am also grateful to Corinne Vandermeulen, Julia Jansen, Catherine Koekoek, Hanika Froneman, Donovan Guttieres, Thomas Bryne, Leonard Heyerdahl, Michael Hudeki, Phyla Kupferschmidt, Katie Jickling, Adele Guyton, Joel Grzywnowicz, Stef Dielen and Clarissa Simas for their comments and help with research material at different stages of writing. Special thanks for those in the audience who engaged with earlier drafts at the British Society of Phenomenology Annual Conference (2020), PERITIA International Workshop on Social Indicators of Trust (2020), and the Time, Object, and Consciousness in Phenomenology Workshop (2020).

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Notes

1. Haley Rudolph and Luis Barreiro state that there are two widespread approaches to building immunity towards SARS-CoV-2. The first is achieving natural immunity to the virus over time. For this approach to be viable, it would have to be carried out at a global level, which would have serious and far-reaching consequences resulting from a significantly high fatality rate (Randolph and Barreiro 2020, 741). Moreover, epidemiologists Gypsyamber D’Souza and David Dowdy note that natural immunity to SARS-CoV-2 may not be long lasting (D’Souza and Dowdy 2021). For these reasons and more, the second approach of attaining herd immunity through mass vaccination campaigns with safe and effective vaccines remains the preferred approach. However, some scholars stress the need for realistic expectations. The emergence of new variants, uneven vaccine rollouts, and inconclusive early evidence as to whether vaccines prevent transmission, among other reasons, makes reaching herd immunity through vaccinations alone unlikely (Aschwanden 2021).

2. Epidemiologist Paul Fine claims that there are many definitions of herd immunity. However, the concept tends to get framed in terms of the proportion of the population that needs to be immune so that new infections decline (as quoted in McDermott 2021, 2).

3. A systematic review of vaccine acceptance rates in February 2021 states that among the lowest rates were seen in Kuwait, Jordan, Italy, Russia, Poland, US, and France (below 60%). The highest vaccination rates were seen in Ecuador, Indonesia, China, and Malaysia (above 90%) (Sallam 2021, 8–9).

4. Before the pandemic, scholars developed two other ‘Cs’, namely ‘Calculation’ (engagement in information searching) and ‘Collective Responsibility’ (willingness to vaccinate for the sake of herd immunity), to formulate an entirely different ‘5C model’ (Betsch et al. 2018). In this paper, I follow Razai and colleagues, as their model is adapted to vaccine hesitancy during the COVID-19 pandemic.

5. Husserl does not identify two dimensions of sedimentation in his works. The two dimensions identified here represents my attempt to use Husserl’s notion of sedimentation to highlight the different ways in which vaccines, and the related scientific discourse, has been received.

6. Kant’s claims concern variolation, which was admittedly an extremely risky procedure that precedes the development of modern vaccines. Therefore, it would be a stretch to claim that Kant’s concerns make him an early anti-vaccine advocate. Lastly, the term that Kant uses in the text is ‘inoculation’, which was used interchangeably with ‘variolation’ at the time (Riedel 2005, 22).

7. Scholarship has recognised Benjamin Justy as the first to vaccinate against smallpox, around 1774 (Riedel 2005, 25). Mary Montagu and her continued advocacy is credited with the introduction of variolation in England. Montagu encountered variolation for the first time during her stay in Istanbul and provides details of the technique in her correspondences (Montagu [1763] 2012, 253–61).

8. To further stress the issue, it would be immensely problematic not to communicate the risks associated with vaccines. During the introduction of the Cholera vaccine in several African countries, implementors chose not to communicate about the vaccine’s low efficacy, or the fact that there is a delay between administering the vaccine and gaining protection. This was done owing to fears that such communication might reduce uptake. But when mild or adverse events occurred after vaccinating, rumours spread regarding the lethality of the vaccine, or that the vaccine transmitted the disease (Heyerdahl et al. 2018, 6495).

9. Husserl’s use of intentionality is both inspired by, and significantly departs from, the formulation of his mentor, Franz Brentano. I highlight two points where Husserl departs from Brentano’s conception of intentionality. The first concerns Husserl’s idea that objects are given in an intuitive and immediate manner. Such direct intentional experience sits uneasily with what Husserl claims is Brentano’s representationalism, where the subject is intentionally related to representations of the object rather than the object itself. In stressing the intuitive and immediate nature of intentionality, Husserl argues, contra Brentano, that “the intentional object of a presentation is the same as its actual object” (Husserl 2001, 127; emphasis original). The second sees Husserl criticise Brentano for overlooking the impact of sedimented history on intentionality (Husserl 1969, 245).

10. On recognizing that others have similar uses of coal, Husserl notes that coal “acquires an inter-subjective use-value in a social context” thereby contributing to it being perceived as a “commodity” that can be sold (Husserl 1989, 197–98).

11. The Philippines represents one example of leaders opportunistically extending their powers during the pandemic. Although initially underplaying the threat of COVID-19, President Rodrigo Duterte quickly moved to extend his authority and use military force to deal with the pandemic. However, the importance given to COVID-19 was often used as an excuse to silence opposition (Lasco 2020, 1421–22).

Additional information

Notes on contributors

Tarun Kattumana

Tarun Kattumana is a PhD student associated with both the Research Center for Phenomenology and Continental Philosophy at the Institute of Philosophy and the Access to Medicines Research Centre at the Faculty of Economics and Business at KU Leuven, Belgium.