The World Health Organization has named ‘vaccine hesitancy’ as one of its top ten threats to global health in 2019, while the number of measles cases worldwide has increased by thirty per cent. The percentage of unvaccinated American children under two years old has quadrupled in the last eighteen years, while experts predict some US states are primed for a measles epidemic. New Zealand has had 914 confirmed cases of measles this year. The virus has even spread to the happiest place on earth. People still won’t bloody well vaccinate their children, and it doesn’t seem to matter how much we shout at them in Facebook threads or hand out public health leaflets or wave peer-reviewed studies in their faces.

The most vocal anti-vaxxers share with other groups a general mistrust of science and authority, and their doubts are exacerbated by an inability to assess large amounts of information for credibility and accuracy. They often exhibit a conspiracist mindset, and are prone to inferring dark motives behind events they experience or read about. These tendencies are encouraged by the algorithms of Facebook and YouTube. All this has been said before and is broadly true. However, the scepticism over vaccinations also contains a more specific strand of suspicion partly tied to the legacy of the women’s health movement, which fought against an ongoing pattern of sexist and racist medical paternalism.

Vocal anti-vaccination activism on social media is dominated by women. One in-depth 2019 study of Facebook postings had the gender of the participants at 89% female. Although a significant number of men may also be anti-vaccination or vaccine-hesitant, women spend the most time discussing their views publicly and are also the decision-makers. Parenting and choices made about child health are, of course, most often left up to women, so this isn’t really a surprise. However, what analyses of the movement often leave out is why women, in particular, might be suspicious of doctors and ‘big pharma’.

In the twentieth century, the women’s health movement fought for rights we still consider worthy of defending or expanding. Contraceptive rights. Abortion rights. The reduction of unnecessary medical interventions during childbirth. The expansion of medical trials to women, where once they were limited to men. More rigorous testing of the drugs used on women. The right for women to make their own decisions about their healthcare. The right for women to keep their healthcare private from their husbands or fathers.

These causes were important because pharmaceutical companies and doctors – primarily men, primarily white, all of them products of their upbringing and training, existing within patriarchal medical systems in patriarchal societies – treated women unacceptably, and women of colour especially so. The willy-nilly prescription of thalidomide to pregnant people from 1957 until the early 1960s caused tens of thousands of babies to be born with malformed limbs, brains or eyes, many of whom died. In their haste to get the contraceptive pill on the market in the late 1950s, researchers carried out cursory experiments on women of colour in Puerto Rico (not even bothering to disguise their racist desire to quell the ‘population explosion’ in developing nations), then marketed pills to the general population many times stronger than current dosages. This caused widespread side effects and many documented deaths from blood clots. The Dalkon Shield, an intrauterine device common in the 1970s, caused thousands of people to contract pelvic inflammatory disease and become infertile. Over 200 000 women filed lawsuits against the parent company. Black and indigenous cis women in the USA, Canada, and Australia were coerced into sterilisation, or sterilised without their knowledge throughout the twentieth century. In what became known as ‘Unfortunate Experiment’, New Zealand’s own version of the Tuskegee trials, doctors at the National Women’s Hospital deliberately under-treated women with cervical abnormalities for two decades (from 1966 onwards) without their knowledge or consent, leading to approximately twenty-five deaths.

Just ask fat women. Doctors often have negative attitudes toward them, spend less time with them, and are less likely to test them for a number of medical conditions. Fat women are consistently undertreated for conditions such as breast or cervical cancer, and are therefore more likely to die from them. Fat brown or black women are even more disadvantaged.

Those primarily white and middle class women who are vocally against immunisations on social media also create a smokescreen that masks another, less clamorous problem: that the many health inequities plaguing our societies, of which unequal immunisation rates are only a small part, are a manifestation of structural racism and the ongoing effects of colonisation. They are caused by things like poverty, or unconscious bias on the part of medical professionals, or ongoing – and sadly, often well-founded – suspicion by marginalised groups. Black children in the United States are less likely to be fully vaccinated than white children. The coverage for Aboriginal and Torres Strait Islander children has only recently reached parity with other Australian children, while indigenous American children have reached parity in the last 10-15 years. New Zealand childhood vaccination rates among Māori are still strikingly low. In Te Tai Tokerau, an area with twice the percentage of Māori compared to the rest of the country, only 53.2 percent of Māori children are currently being fully immunised according to the schedule.

If your health systems and the governments which support their infrastructure are unable to treat people equitably, how truly disinterested and objective can they be? If doctors and the pharmaceutical industry are quick to fall prey to social biases and slow to accept that they have been wrong even though people suffer, perhaps – think the anti-vaxxers – they are wrong about this too.

Some of the most vocal anti-vaxxers will appeal to medical sources, but they are usually alternative or discredited. If you don’t know which authorities are credible and which are not, and you don’t have the skills to assess information adequately, pharmaceutical companies and the medical profession have given you plenty of cause, for decades, not to trust them entirely. As the old joke says, just because you’re paranoid doesn’t mean that they aren’t out to get you. Shouting at people about how the science of vaccines is settled isn’t going to change their minds.

I want to be completely clear: vaccinations are great, and if you are able to, you should get them and so should your kids. They’re a medical success story for which we should all be profoundly grateful. But the paranoia about them springs from a thorny and complex cultural and political context. It will take a multi-faceted effort to eradicate it – not just another public health education campaign.

Those asking the general public to ‘trust the science’ are often uncomfortable or hostile when asked to acknowledge how biased medicine can be, and how it has even very recently committed crimes against marginalised groups in the name of health. We can only start having the right conversations about vaccine hesitancy when we start being more honest: about medical science being a product of the people who create it, about the disparities that still exist (and why), and about the need for committing to real changes in how our health systems work.

Image: James Gillray ‘The Cow-Pock—or—the Wonderful Effects of the New Inoculation!—vide. the Publications of y^e Anti-Vaccine Society’ (1802). Wikimedia Commons.