Demographics of Vaccine Hesitancy in the Age of Vaccine Mandates
By Carina Harkin
“Goodness is something chosen.
When a man cannot choose he ceases to be a man.”
- Anthony Burgess, A Clockwork Orange (1)
There is vaccine hesitancy and as I call it, vaccine refusal; then there is COVID-19 vaccine hesitancy and COVID-19 vaccine refusal. I’ll refer to it as ‘vaccine hesitancy’ which in 2019, labelled by the United Nation’s (UN's) World Health Organisation (WHO) as one of the top ten threats to global health (2). The vast majority of those refusing COVID-19 vaccines will have fully vaccinated themselves and their children. Alternatively, I am sure that those who refuse vaccines outright will have also refused the COVID-19 vaccine. Whilst the idea of vaccine refusal is abhorrent to many, the fact remains that people who outright refuse vaccinations exist and our personal medical choices should be respected. Vaccination status should be no one’s business, but here we are living in a society that openly discriminates against those who refuse a COVID-19 vaccine. In this week’s discussion I thought it would be pertinent to speak for those of us living through the age of medical apartheid.
Mainstream media says we refuse COVID-19 vaccines because we are unable to reason
Public health experts and authorities purport that it is important to understand the reasons for COVID-19 vaccine hesitancy, as it is necessary to ensure maximum uptake needed for herd immunity. A cross-sectional survey among US adults between May and June 2020, asked why some people were reluctant to be vaccinated for COVID-19 and concluded that in order to increase compliance, health messages should emphasise the safety and efficacy of vaccines, and that vaccinating oneself is important, even if community uptake is high (3).
An article published in Vaccine before COVID (BC), described the perceptions of the vaccine-refusal movement among Australians who support vaccination and found that Australians describe fellow citizens who outright refuse vaccinations as “the mad leading the blind”. The findings suggest that stigma towards vaccine-refusing people may adversely affect their wellbeing and entrench their negative vaccine beliefs. The research suggested that more compassionate, nuanced discussion of vaccine refusal in the public domain is required (4). A compassionate, nuanced discussion is not what I see regarding COVID-19 vaccine refusal. US President Biden’s Christmas card 2021 to the unvaccinated read;
“We are looking at a winter of severe illness and death for the unvaccinated, for themselves, their families and the hospitals they'll soon overwhelm”
I would agree strongly with the article published in Vaccine that this stigma only ‘entrenches our negative vaccine beliefs’ or as I describe it, strengthens our resolve.
The demographics of vaccine hesitancy (not only COVID-19 vaccine refusal)
Contrary to popular belief, vaccine refusal is not something that affects people with low IQs whose belief systems have gone so awry. There is a stark difference between undervaccinated and unvaccinated. Undervaccinated children in the United States (US) tend to be black, born to young single mothers without a college degree, live in poverty and come from the inner city. Completely unvaccinated children tend to be white, born to married mothers with college degrees, and come from a household on an annual income exceeding US$75,000, whose parents expressed concerns regarding the safety of vaccines. The parents of unvaccinated children make their own decision about vaccination for their children, stating their doctors have little influence (6).
The demographics of vaccine hesitancy in Europe
The ‘philanthropic’ Wellcome Global Monitor website monitors how people around the world think and feel about science and health issues. According to Wellcome, in general, the richer a country is, the less its citizens agree that ‘vaccines are safe’. 72% of US and Canadian citizens believe vaccines are safe. 73% of citizens in the northern European arc, including Ireland, the United Kingdom (UK), through the Nordic countries, believe vaccines are safe. Confidence in vaccines is lower in Germany, France, Austria, Switzerland and the Benelux countries, where 59% on average believe vaccines are safe. Only 50% of Eastern Europeans believe vaccines are safe (7). These figures are in line with Germany and Austria’s lowest rates of COVID-19 vaccination uptake in Europe, with 68% of Austrians and 65% of Germans fully vaccinated; hence the introduction of draconian vaccine mandates (8).
The demographics of vaccine hesitancy in Australia, Ireland, the UK and California
In Australia’s richest suburbs, North Shore Sydney and Byron Bay, only 70.5% of five year old children are fully vaccinated. These suburbs are also the most educated areas in Australia, where 48.9% of the population hold a Bachelor degree or higher (9). Parents in the wealthiest parts of Ireland are also the most likely to refuse vaccines for their children. The measles- mumps-rubella (MMR) vaccine uptake among infants in richer southeast Dublin, Dún Laoghaire, south county Dublin and east Wicklow was 87% in 2019, compared with 95% in the poorer Mayo, Galway and Roscommon (10). Berkshire, near Windsor in the UK, is one of the wealthiest counties in the UK and has lower MMR vaccination rates than its poorer neighbours (11, 12). A study looking at the sociodemographic predictors of vaccination exemptions based on personal beliefs in 6,200 California schools published in the American Journal of Public Health found that vaccine exemptions were twice as common among those children attending private institutions (13).
Healthcare workers are statistically the most vaccine-hesitant group in society
BC, demographically speaking, healthcare workers (HCWs) had the highest lack of confidence in vaccines. According to the WHO, vaccination rates amongst HCWs are low throughout Europe, with vaccination coverage among HCWs generally less than 30% (14, 15). An Irish Health Protection Surveillance Centre (HPSC) report 2017-2018 looked at HCW vaccine uptake in public hospitals and found that influenza vaccine uptake for HCW was 44.8%, up from 34.0% (16). Public Health England (PHE) faired better at seasonal influenza vaccine uptake which ranged from 64.2%-80.8%, yet still only 27.5% of all PHE trusts achieved the desired vaccine uptake rates of 75% or more (17). An audit of Australian doctors revealed only 28% received influenza immunisation in 2007, down from 44% in any prior year (18). Importantly, even with Australia’s mandatory vaccinations for HCWs, vaccination uptake rates are still below 50% (19).
European COVID-19 vaccine hesitancy
A global survey of more than 13,400 people in 19 countries on potential acceptance of a COVID-19 vaccine published in Nature Medicine in October 2020, found that Polish citizens had the greatest vaccine hesitancy, reporting the highest proportion of negative responses at 27.3%. Sweden, Germany and Spain were more skeptical than the US and South Korea (20). A more recent University of Warsaw study in May 2021 however, indicated that 40% of the Polish population had refused the COVID-19 vaccine (21). A European survey on willingness to be vaccinated against COVID-19 was published in June 2020. In total, 73.9% of the 7664 participants from Denmark, France, Germany, Italy, Portugal, the Netherlands, and the UK stated that they would be willing to get vaccinated against COVID-19. 18.9% of respondents stated that they were not sure, and 7.2% stated that they would refuse a COVID-19 vaccine. The willingness to be vaccinated for COVID-19 ranged from 62% in France to approximately 80% in Denmark and the UK. Germany and France contained the largest proportions of the population opposed to a COVID-19 vaccination. France also has the largest group of people unsure about receiving the COVID-19 vaccine at 28% (22). Ironically, France also has the strictest mandatory vaccine laws in Europe. In January 2021, a survey by pollster Ifop for the newspaper Le Journal du Dimanche found that 59% of French people did “not have the intention to get a (COVID-19) vaccination when it becomes possible”. This was up from 46% found in an earlier Ipsos poll from late October 2020. Regarding confidence in vaccines, France ranked last out of 15 countries, trailing behind the UK (79%), Germany (69%), and Italy (65%) (23). A Eurofound survey published in May 2021 found that, in general, over 25% of European adults would refuse the COVID-19 vaccine (24).
COVID-19 vaccine hesitancy in European healthcare workers
HCWs are also the most COVID-19 vaccine-hesitant group in society. The possibility of mandatory COVID-19 vaccines for HCWs should raise serious ethical issues and prompt ethical debate (25). A survey of COVID-19 vaccine hesitancy in Maltese family GPs and their trainees found that vaccine hesitancy is greater in the young, with 33% of senior doctors compared to 66% of junior doctors saying they would refuse the COVID-19 vaccine (26). A video with German Doctor Dr Heiko Schöning introduces Netherlands Dr Elke De Klerk. Dr Klerk says 87,000 nurses in the Netherlands would refuse the COVID-19 vaccine because they don’t want to be, as they say in the Netherlands, a COVID-19 vaccine ‘rabbit’ (27). In 2017 there were 171,140 nurses employed in the care sector in the Netherlands, meaning that greater than half of all Netherlands nurses may have refused a COVID-19 vaccine.
A French poll of 2000 HCWs in December 2020 found that 76% of senior care home staff would refuse the COVID-19 vaccine. Austria’s public broadcaster reported that half of Austrian care facilities staff in the region of Vorarlberg refused the COVID-19 vaccine (7). The Italian Federation of Medical Professional Associations said 100 doctors had refused the COVID-19 vaccine and accused these Italian doctors of “promoting anti-vaccination propaganda” (28). On January 7th 2021, a poll conducted by BioNTech released in Germany in December 2020, found that 50% of nurses and 25% of doctors would refuse the COVID-19 vaccine. The paper reported these HCWs as being ‘vaccine shy’ rather than ‘anti-vaxxers posing the greatest threat to humanity and global security’ (29).
COVID-19 vaccine hesitancy in American healthcare workers
The Kaiser Family Foundation in the US released a survey in December 2020 that found that 29% of US HCWs would ‘probably refuse’ or ‘definitely refuse’ a COVID-19 vaccine (29). Following similar lines, in February 2021, a survey in Medscape reported that 33% of US HCWs were distrustful about COVID-19 vaccines (30). The Kaiser Family Foundation released a later survey in March 2021 with a more radical outcome showing that 48% of US HCWs had refused the COVID-19 vaccine (31). How have these poor HCW’s belief systems gone so awry?
COVID-19 vaccine hesitancy in healthcare workers globally
A study looking at the acceptability of COVID-19 vaccination in HCWs from the Democratic Republic of the Congo found that 72.3% of Congolese HCWs would refuse the COVID-19 vaccine (32). A survey conducted in April 2020 among Israeli HCWs found that only 61% of nurses and 78% of doctors say they would be willing to get vaccinated against COVID-19, with safety being the biggest concern (33).
COVID-19 vaccine hesitancy in other essential workers
The Firefighters Association president reported in December 2020 that 55% of New York Fire Department firefighters had refused the COVID-19 vaccine. In January 2021, The Los Angeles Times reported that 50% of frontline workers in Riverside, Calif refused the COVID- 19 vaccine. Between 20% and 40% of LA County’s frontline workers refused the COVID-19 vaccine (34). The United States (US) military’s high levels of COVID-19 vaccine refusal reflect other frontline professions. Pentagon officials said that 33% of all military troops refused the COVID-19 vaccine. Anthony Fauci accused these military servicemen and women of being “part of the problem” (35). Nearly 40% of US Marines refused the COVID-19 vaccine. This prompted President Biden to mandate the COVID-19 vaccines for the military (36).
COVID-19 vaccine hesitancy in non-essential workers
A probability-based internet panel survey conducted by the US Centres for Disease Control and Prevention (CDC) in 3,541 adults between September 3rd and October 1st 2020, reported that 63% of non-essential workers surveyed intended to receive the vaccine, leaving 27% of non-essential workers stating they did not intend to receive a COVID-19 vaccine (37).
The UN says, ‘the vaccine is trust’
Secretary-General of the UN, António Guterres, warns of a concomitant epidemic, a dangerous epidemic of misinformation, a ‘misinfo-demic’ of harmful health advice and snake-oil potions, of wild conspiracy theories and falsehoods. Guterres says “hatred is going viral” and “that people and groups are being stigmatising and vilified”. Guterres announced a ‘UN Communications Response’ initiative to flood the internet with ‘facts and science’ while countering the growing scourge of misinformation, or as he describes a “poison …putting even more lives at risk”. Guterres says ‘the vaccine is trust’. He says, ‘trust in science’, ‘trust in institutions’ and ‘trust in each other’, and that “mutual respect and upholding human rights must be our compass in navigating this crisis”. Guterres is obviously not walking a mile in the shoes of an unvaccinated societal outcast.
Guterres says one thing I agree with, “This is a time for science and solidarity”. It is high time for ‘Voices for Science and Solidarity’ (38). A voice for the 150,000,000 EU citizens that have refused the COVID-19 vaccine (39). A voice for the growing number of people who are refusing their COVID-19 booster, reported to be as high as 50% by the Health Service Executive (HSE) here in Ireland (40). A voice that understands that the conspiracies, falsehoods, misinformation and hatred is in fact falsely aimed at the unvaccinated. A voice for those who know that the ‘pandemic of the unvaccinated’ is a false narrative. A voice for those who know that fully vaccinated individuals with breakthrough infections have peak viral load similar to unvaccinated cases and can efficiently transmit infection to fully vaccinated individuals (41).
World Intelligence and Security Agencies censor anything outside the narrative
We need a voice also for those who know that ‘countering misinformation’ means censoring the truth. On March 18th 2015 the largest donor to the UN, Bill Gates, announced a Global Health Governance (GHG) worldwide militarised supranational authority capable of responding to infectious disease outbreaks, governed by western powers and exerting influence over poorer nations. Gates used the media-generated panic of the Ebola outbreak of 2014/15 to justify the need for his GHG (42, 43). The GHG is an extension the Global Health Security Agenda (GHSA) which was launched in February 2014. The GHSA is a group of 70 countries, international organisations, non-governmental organisations (NGOs), and private sector companies and serves to keep us ‘safe and secure’ from global health threats posed by infectious diseases (whether we like it or not). The GHSA is set by the World Economic Forum (WEF), World Trade Organisation (WTO), World Bank Group (WBG), International Monetary Fund (IMF), UN, WHO, CDC, Food and Drug Administration (FDA), WHO member states and private sector companies including Bill Gates and the Davos old boy network (44). The IMF, WBG, WHO and WTO launched a joint vaccine information website in July 2021 to serve as a platform for information on access to the COVID-19 vaccine and to ‘counter misinformation’ (45). In November 2020, Reuters reported that the UK’s Government Communications Headquarters (GCHQ) was told to “take out anti-vaxxers” online and on social media. The report said that the GCHQ had begun an offensive cyber operation to tackle online ‘anti-vaccine propaganda’ by ‘hostile states’. The GCHQ’s relationship with security and intelligence agencies in the US, Australia, Canada and New Zealand is an intelligence alliance known as the ‘Five Eyes’ (46).
When I studied public health many of my colleagues agreed that ‘anti-vaccination activists’ should not be given a say in the media (47). Gates’s GHG’s worldwide militarised supranational authority is putting in their best effort to ensure this. Miles Unterreiner’s Oxford University paper entitled, ‘Vaccines, Free Speech And The Harm Principle’ says, “whether antivaccination campaigns should qualify for free speech protection is a question that may quite literally determine whether some people live or die” (48). Both sides are concerned about life and death. The Immunisation Safety Review Committee admits to being unable to allay the fears of parents who are most wary about the safety of childhood vaccines. These anxieties should be openly discussed not dismissed as being from those deemed ‘unable to reason’ (49). In relation to vaccinations, we have already returned to a bygone era where the attacks on our freedom to choose by medical coercion has removed not only individual choice but also individual responsibility. Until there is free speech there is no free and informed consent. Public health efforts to silence vaccine safety concerns will backfire and destroy the public's confidence in both vaccine programmes and faith in vaccine authorities.
Newton's third law is for every action, there is an equal and opposite reaction. The COVID-19 unvaccinated however, are like Hydra, the serpent-like water monster with nine heads in Greek mythology; cut off our heads and two will grow. In the EU, we are currently number 150,000,000. Those who have chosen not to have the COVID-19 vaccine are our mothers, fathers, sisters, brothers, daughters and sons. As previously mentioned in ‘The Ethics of Public Health Infectious Disease Policy’, the COVID passport is an affront to Article 14 of the Human Rights Act which is to protect us from discrimination. Discrimination is outlawed on nine grounds including gender, marital status, family status, age disability, sexual orientation, race, religion and being a member of a minority community (50). Vaccination status needs be protected under human rights laws globally to end the threat of medical tyranny once and for all.
Look out for future contributions on VSS from Carina, ‘Natural Immunity to SAR-CoV-2’ and ‘Natural Medicine Prophylactics and Potential Treatments for SAR-CoV-2’
Before COVID (BC)
Centres for Disease Control and Prevention (CDC)
Healthcare workers (HCWs)
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
United Nations (UN)
World Health Organisation (WHO)
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