Vaccine hesitancy expert says fear and emotion are neglected dimension of health

By Cristine Hall

In 2013, Colombia had one of the highest HPV immunization rates in the Americas with 90 percent coverage among its target population. By 2016, uptake among eligible girls had declined to 5 percent. The cause? Emotional contagion.

The viral spread of YouTube videos and disturbing images of girls ostensibly experiencing adverse reactions such as fainting and twitching after vaccination led to a viral spread of symptoms, said Heidi Larson, director of The Vaccination Confidence Project, professor of anthropology, risk and decision science at the London School of Hygiene & Tropical Medicine, and author of Stuck: How Vaccine Rumors Start and Why They Don’t Go Away.

“The root of the problem wasn’t the contents of the vaccine but the experience of vaccination,” Larson told more than 200 attendees of her recent Grand Rounds in Population and Public Health talk, “Emotional Contagion in Times of COVID—From Fear to Hope,” hosted by the USC Institute on Inequalities in Global Health and the USC COVID-19 Pandemic Research Center.

Vaccine hesitancy isn’t just about misinformation, but emotions. It’s not a symptom of public ignorance, but often of mistrust—a lesson that applies to the challenges of vaccination for COVID-19. Larson called upon scientists and scholars to think beyond numerical terms and factor in feelings, emotions and political influences that could affect risk perception when approaching their research.  

“Fear is the neglected dimension of health in terms of us actually characterizing it, studying it and recognizing how it can help inform not just our communication but how we engage and interact with people from an empathy perspective,” said Larson, who is also a clinical professor at the Department of Health Metrics Sciences at University of Washington, guest professor at the Centre for Evaluation of Vaccination at the University of Antwerp, Belgium, and visiting professor in the Department of Medicine at the National University of Singapore. “When people say, ‘I’m afraid of this,’ we can’t correct them. We have to empathize, and we always need to have credible information.”

Larson, who is an anthropologist by training, has been studying rumor in the context of vaccines around the world for more than 20 years. The girls in Colombia who experienced psychosomatic symptoms after vaccination lived in an area with a history of military sexual abuse, she said, “a place where a lot of repressed experiences and histories expressed themselves in a reaction to vaccination.”

Mass psychogenic reactions have become such an issue that the World Health Organization has created manuals for health workers on how to mitigate, manage and prevent what it calls immunization stress-related response.  

Larson discovered the importance of paying attention to even the smallest rumors after a 2003 boycott of the polio vaccine in Kano, Nigeria, cost the global polio eradication effort $500 million. The boycott came from rumors that the vaccine caused cancer, infertility and HIV.

“One of the first rumors was—and It’s almost not a rumor, it’s a perception, it’s a feeling, it’s a denial—is denialism,” Larson said. “We’ve seen it in COVID. We saw it in the beginning of Ebola. It was one of our biggest struggles in the early days of AIDS.”

Larson conducted a study last year to determine the impact of rumors on vaccine hesitancy. She found there was a 6 percent drop in a willingness to get a COVID shot among people who had been exposed to misinformation.

The talk featured commentary from Lourdes Baezconde-Garbanati, PhD, MPH, and Jeff Klausner, MD, MPH, both professors of population and public health sciences at Keck School of Medicine of USC. It was moderated by Howard Hu, MD, MPH, ScD, professor and Flora L. Thornton Chair of the Department of Population and Public Health Sciences, and Sofia Gruskin, JD, MIA, professor and director of the USC IIGH.

“Our hope in inviting Dr. Larson to speak is not only to help us think through the power of emotions and belief in the COVID response, but to help give some context and direction to the hard conversations that we’re having and need to keep having around vaccines and vaccine hesitancy, with particular attention to long-standing inequities and around the globe,” Gruskin said.

Larson emphasized that people value local health workers as sources for reliable health information. Klausner and Baezconde-Garbanati shared similar lessons learned on the importance of local partnerships, hiring vaccinators from local communities and partnering with faith-based organizations in vaccination efforts.

“We all need to remember that we are making history,” Larson said. “COVID is going to be a significant memory in both individual and collective history. So, the more we can make that vaccination experience—the access, the support around it—make sense in people’s values and community—the better.”

 Watch Larson’s talk and past Grand Rounds here.