Introduction to Health and Medicine

The COVID-19 virus began to infect humans in 2019 and by March 11, 2020, the World Health Organization had declared it a global pandemic. The virus includes severe acute respiratory syndrome and death among its most serious symptoms. In its first year, the pandemic caused between 1.8 and 3 million deaths worldwide, making it one of the deadliest in history. The common flu generally causes 290 to 650 thousand respiratory deaths each year (WHO, 2022a; WHO, 2022b). In Canada, COVID-19 became the third leading cause of death in 2020, with the loss of 16,151 Canadian lives attributed directly to it (Statistics Canada, 2022).

Like all virus pandemics, the contagion process was social. The virus primarily spreads between people through close social contact. Transmission is via aerosols and respiratory droplets that are exhaled when talking and breathing, as well as those produced from coughs or sneezes (Government of Canada, 2021). Social interaction is the disease vector that carries and transmits the infectious pathogen from person to person.

But this sociological component of the virus was perhaps overshadowed by another social phenomenon: social conflict over the public health measures deployed to combat it — a key part of the COVID-19 pandemic was the rise to prominence of vaccine hesitancy. The World Health Organization defines vaccine hesitancy as a “delay in acceptance or refusal of vaccines despite availability of vaccination services” (MacDonald, 2015).Vaccines are biological preparations that improve immunity against a certain disease. Since the invention of the smallpox vaccine in 1796 which eventually brought an end to the world’s second deadliest pandemic, vaccines have been one of the most effective lifesaving measures of modern medicine. Over the last 50 years in Canada, vaccines have saved more lives than any other treatment, procedure or policy (https://myhealth.alberta.ca/topic/Immunization/Pages/facts.aspx).  Vaccines have contributed to the eradication and weakening of many infectious diseases in human populations, including smallpox, polio, mumps, chicken pox, and meningitis.

Despite all this, vaccine hesitancy is not a new phenomenon. In 2012, a pertussis (whooping cough) outbreak in B.C., Alberta, Ontario, and New Brunswick sickened 2,000 people and resulted in an infant death in Lethbridge. In the United States, where there were 18,000 cases and nine deaths, it was the worst outbreak in 65 years and has been linked to a rise in the percentage of unvaccinated children and adults (Picard, 2012). Typically Canadian children are vaccinated for whooping cough, diphtheria, and tetanus (a combined vaccine known as DTaP) at ages 2, 4, 6, and 18 months, and then again at ages 4 to 6 years and 14 to 16 years (Picard, 2012). But what of people who do not want their children to have this vaccine, or any other? That question is at the heart of a debate that has been simmering for years.

A small but significant number of people express concerns about potential negative side effects from vaccines that, while not substantiated by scientific study, have led many to delay or reject vaccination. These concerns range from fears about overloading the child’s immune system to contentious reports about devastating side effects of the vaccines. One misapprehension is that the vaccine itself might cause the disease it is supposed to be immunizing. Another commonly circulated concern is that vaccinations, specifically the MMR vaccine (MMR stands for measles, mumps, and rubella), are linked to autism. Each of these concerns have been shown to be unfounded, with a prolonged investigation by the British Medical Journal proving the link in the initial study was nonexistent and that data had been fabricated (CNN, 2011). However, many parents in Canada still believe in the now-discredited MMR-autism link and refuse to vaccinate their children. Autism is a complex condition of unclear origin, yet the symptoms of its onset occur roughly at the same time as MMR vaccinations. In the absence of clear biomedical explanations for the condition, parents draw their own conclusions or seek alternative explanations. Other parents choose not to vaccinate for various reasons like religious or health beliefs.

Increasingly, social media has played a role in the spread of misinformation and disinformation around vaccines. The same media that make it much easier to disseminate public health messages and other important health information also make it easier to spread dangerous health myths. The algorithms and social networking functions of social media platforms like Facebook enable the spread of conspiracy theories and alternate realities by creating “echo chambers” and conditions of confirmation bias that create strong in-group identities unhinged from outside input (Theocharis et al., 2021).

This raises important ethical, political and, yes, sociological questions. Which social groups are more or less likely to resist vaccination and why? How do societies navigate the rights of individuals to engage in risky behaviour when that behaviour puts others at risk? What are the social, economic and technological explanations for the loss of trust in medical experts? How can we balance the role of critical examination of powerful groups, including scientists and the health industry, with the need for evidence based medicine?

Media Attributions

• Figure 19.1 Visualizing the History of Pandemics by Nicholas LePan and Harrison Schell (graphic design), is used by permission of Visual Capitalist.