Vaccine Hesitancy in Historical and Contemporary Context
By Darrell Lee
Vaccination is one of the most profound public health triumphs in human history. From the eradication of smallpox to the dramatic reduction of debilitating diseases like polio, measles, and diphtheria, vaccines have saved countless lives and transformed societal well-being. Yet, almost parallel to the history of vaccination runs a persistent counter-narrative, vaccine hesitancy. This reluctance or refusal to vaccinate despite the availability of vaccines is not a monolithic phenomenon; its roots are complex, intertwining historical anxieties, personal beliefs, distrust of authority, and, increasingly, the pervasive influence of misinformation and conspiracy theories amplified by social media. Understanding contemporary vaccine hesitancy requires tracing its historical lineage, examining the conspiracy narratives that fuel it, and contrasting these unfounded beliefs with the overwhelming scientific consensus on vaccine efficacy and safety documented in established medical literature. The journey from early inoculation skepticism to modern anti-vaccine movements reveals enduring human anxieties. At the same time, the current landscape underscores the critical threat that disinformation poses to individual health and the collective immunity and scientific literacy essential for progress.
Resistance to inoculation predates even Edward Jenner's pioneering work with the cowpox-based smallpox vaccine in the late 18th century. The method used, deliberately infecting individuals with a mild form of smallpox to induce immunity, faced opposition in various cultures. In colonial America, figures like Cotton Mather (a prominent intellectual and public figure in English-speaking colonial America) championed this method during smallpox outbreaks in the early 1700s. Still, they encountered fierce resistance rooted in religious objections (seeing it as interfering with divine providence), medical skepticism (fears about the procedure's safety and efficacy), and concerns about individual liberty versus public health mandates.
Jenner's development of vaccination using the related but much safer cowpox virus marked a significant advancement. Yet, skepticism persisted and evolved as vaccination became more widespread and sometimes compulsory in the 19th century. Britain passed compulsory vaccination acts starting in the mid-19th century (e.g., the Vaccination Act of 1853 made it compulsory for infants). Various states in the United States also began implementing compulsory smallpox vaccination laws, often tied to school attendance, during the latter half of the 19th century. Consequently, organized anti-vaccination movements emerged in Britain, the United States, and elsewhere. Their arguments often centered on claims that early vaccines were less refined than modern ones, and occasional adverse events or contamination issues fueled fears about potential harm. Some questioned whether vaccines worked or if declining disease rates were due to improved sanitation and hygiene alone. Compulsory vaccination laws were fiercely opposed by leagues arguing for bodily autonomy and parental rights against perceived government overreach. Some religious leaders maintained objections based on perceived unnaturalness or interference with God's will. Finally, skepticism towards doctors and emerging public health authorities is often intertwined with anti-vaccine sentiment. These historical arguments—concerns about safety, efficacy, liberty, and trust in authority—form the bedrock upon which modern vaccine hesitancy has been built, demonstrating that questioning vaccines is not solely a 21st-century phenomenon.
The 20th century witnessed enormous progress in vaccine development (polio, measles, mumps, rubella, etc.) and widespread public acceptance driven by the visible reduction of feared childhood diseases. The success of the polio vaccine campaign in the mid-1950s, despite the tragic "Cutter Incident" (where improperly inactivated vaccine caused polio cases), essentially cemented public trust for a generation.
However, the 1970s and 1980s saw a significant controversy surrounding the whole-cell pertussis (whooping cough) component of the DTP (diphtheria-tetanus-pertussis) vaccine. A widely publicized British study suggested a link between the vaccine and rare but severe neurological conditions in children. The proposed link sparked intense media coverage, lawsuits, and declining vaccination rates, leading to a resurgence of whooping cough. While subsequent, larger studies largely debunked a causal link between the vaccine and permanent brain damage, finding the risks extremely low compared to the dangers of the disease itself, the controversy left a lasting impact. It eroded some public trust, empowered budding anti-vaccine groups, and led to the development of the acellular pertussis vaccine (DTaP), which has fewer common side effects but reignited debates about relative efficacy. This episode highlighted the impact of safety scares, even when later refuted by robust science, and the difficulty in fully restoring trust once shaken.
The modern anti-vaccine movement gained significant momentum in 1998 by publishing a fraudulent study in the prestigious medical journal The Lancet. Led by British former physician Andrew Wakefield, the paper claimed to find a link between the measles, mumps, and rubella (MMR) vaccine and the development of autism and bowel disease in a small group of children. Despite numerous methodological flaws, undisclosed conflicts of interest (Wakefield was being paid by lawyers suing vaccine manufacturers), and the small sample size, the study received widespread media attention and ignited global panic. Vaccination rates plummeted in the UK and elsewhere, leading directly to the resurgence of measles.
Crucially, numerous large-scale, rigorous epidemiological studies conducted subsequently across different countries involving millions of children have consistently found no link between the MMR vaccine (or any vaccine or vaccine component like thimerosal) and autism. The Lancet fully retracted Wakefield's paper in 2010, and Wakefield was stripped of his UK medical license for ethical violations and scientific misconduct.
Yet, the damage was done. The Wakefield study, despite being thoroughly discredited, provided a potent narrative that anti-vaccine activists seized upon and amplified relentlessly. Its emergence coincided with the rise of the internet and social media, creating a perfect storm. Online platforms allowed the disproven link between vaccines and autism to persist and spread virally, finding audiences susceptible to anti-establishment narratives and parental anxieties. Algorithms often promoted engaging but false content, and scientific refutations struggled to gain traction. The internet provided a space for disparate anti-vaccine arguments—old concerns about safety and liberty combined with new fears about autism, "toxins," and pharmaceutical industry conspiracies—to converge and reinforce each other.
Vaccine hesitancy today is often deeply interwoven with broader conspiracy theories, reflecting a more profound distrust of government, science, media, and corporations (particularly "Big Pharma"). Common conspiratorial themes include beliefs that vaccines contain secret harmful ingredients ("toxins," microchips, sterilizing agents) deliberately hidden by authorities or claims that vaccines are pushed solely for pharmaceutical profits, with efficacy exaggerated and risks downplayed. Some theories claim that vaccination programs are tools for mass surveillance and population control or that they are eroding individual freedoms or promoting ideas that "natural" or alternative cures for diseases are suppressed by "Big Pharma" to protect vaccine profits—lastly, the persistent, debunked belief linking vaccines (especially MMR) to autism spectrum disorder.
The rise of the QAnon meta-conspiracy movement provided fertile ground for anti-vaccine narratives. QAnon's core premise—a secret global cabal of elites involved in child trafficking and seeking world domination—readily absorbed anti-vaccine themes. Within the QAnon worldview, vaccines were framed as tools used by the cabal for nefarious purposes, such as controlling populations, causing illness, or furthering their sinister agenda. The movement's deep distrust of mainstream institutions (government, media, science) aligned perfectly with existing anti-vaccine sentiments.
During the COVID-19 pandemic, the overlap became particularly pronounced. QAnon influencers and adjacent communities actively spread misinformation about COVID-19 vaccines, framing them as dangerous experiments, tools for genetic modification or microchipping, or part of the cabal's plot. They promoted unproven alternative treatments and actively discouraged vaccination. This convergence amplified vaccine hesitancy related to COVID-19, contributing to lower uptake rates in specific populations and hindering public health responses. The QAnon phenomenon demonstrated how easily anti-vaccine ideas could be integrated into broader, politically charged conspiracy frameworks, further insulating believers from scientific evidence through layers of distrust and alternative "truths."
In stark contrast to the narratives of hesitancy and conspiracy, the overwhelming consensus within the global scientific and medical communities regarding the efficacy and safety of vaccines hasn't wavered throughout history. This consensus is built upon decades of rigorous research, extensive clinical trials involving hundreds of thousands of participants, and ongoing post-licensure surveillance systems monitoring billions of administered doses worldwide.
As a current demonstration of how conspiracy theories and vaccine hesitancy can have real-world consequences in May 2025, based on the latest report from the Texas Department of State Health Services, there have been 683 confirmed measles cases reported in Texas since late January 2025, primarily associated with an outbreak in West Texas. The overwhelming majority of cases (over 95%) have occurred in unvaccinated individuals or whose vaccination status is unknown. The outbreak has been heavily concentrated in close-knit communities with low vaccination coverage, particularly in Gaines County, where the Mennonite community is explicitly mentioned. Two fatalities have occurred. Both were unvaccinated, school-aged children.
It's important to understand that there isn't a single, monolithic "Mennonite stance" on vaccinations, as Mennonites encompass a wide range of groups with varying degrees of assimilation and different interpretations of faith and practice. However, some more conservative Anabaptist groups, which include specific Old Order Mennonite communities, tend to have lower vaccination rates compared to the general population. The reasons for vaccine hesitancy or refusal within these particular communities can vary, but many align with the historical beliefs already covered. Additionally, decisions about health practices, including vaccination, are often strongly influenced by community leaders and shared beliefs within these close-knit groups.
It's crucial not to generalize this to all people identifying as Mennonites. Many Mennonites fully embrace modern medicine and vaccination. The specific mention of the Mennonite community in Gaines County in relation to the Texas measles outbreak highlights a situation where lower vaccination coverage within that particular community contributed significantly to the spread of the disease, consistent with patterns seen in other under-vaccinated close-knit groups.
Peer-reviewed studies published in leading medical journals consistently demonstrate the remarkable effectiveness of vaccines in preventing targeted infectious diseases. Vaccines stimulate the immune system to recognize and fight specific pathogens (viruses or bacteria) without causing the disease. Large-scale epidemiological data show dramatic declines in the incidence, severity, hospitalization rates, and mortality associated with vaccine-preventable diseases following the introduction of vaccination programs. We will cover the specifics of these studies later in the article.
Vaccines are not 100% effective in every individual. Still, they provide substantial protection at both the individual and community levels (through herd immunity), and no medical intervention, including vaccination, is entirely without risk. Vaccines can cause side effects, but the vast majority are mild and temporary, such as soreness at the injection site, low-grade fever, or fatigue. Serious adverse events following vaccination are infrequent. Again, we will cover this later in the article, but here is a quick overview: severe allergic reactions (anaphylaxis) occur in approximately 1 case per million doses. Conditions like Guillain-Barré syndrome have been associated with specific vaccines (like some influenza vaccines) but at very low rates, often lower than the risk of developing the condition after the natural infection.
Potential risks are continuously monitored through robust surveillance systems like the US Vaccine Adverse Event Reporting System (VAERS), the Vaccine Safety Datalink (VSD), and similar systems globally. While VAERS allows anyone to report a potential adverse event, reports are not proof of causation; they require rigorous scientific investigation to determine if a vaccine caused the event. Numerous studies using these systems have confirmed the excellent safety profile of routinely recommended vaccines.
Leading medical journals such as The Lancet, The New England Journal of Medicine (NEJM), JAMA (Journal of the American Medical Association), Pediatrics, and BMJ (British Medical Journal) consistently publish studies reaffirming vaccine efficacy and safety, debunking myths, and documenting the real-world impact of vaccination programs. Numerous studies published in Pediatrics and JAMA have documented the dramatic decline in measles incidence following widespread MMR vaccination, often citing efficacy rates of ~93% for one dose and ~97% for two doses in preventing measles. Historical data comparisons published in these journals show reductions exceeding 99% from the pre-vaccine era. Articles in NEJM and The Lancet have chronicled the global polio eradication effort, citing the high efficacy of both inactivated polio vaccine (IPV) and oral polio vaccine (OPV) in preventing paralytic disease, leading to its elimination in most parts of the world. NEJM, JAMA, and The Lancet published numerous large-scale clinical trial results and real-world effectiveness studies for various COVID-19 vaccines, consistently showing high efficacy (often >90% initially) against severe disease, hospitalization, and death, even as efficacy against mild infection waned with new variants. Landmark studies published in NEJM, Pediatrics, and BMJ, often involving hundreds of thousands or even millions of children, have consistently found no association between the MMR vaccine and autism spectrum disorder.
These studies are frequently cited when debunking the claims originating from the retracted Wakefield paper. Large-scale safety analyses using systems like the Vaccine Safety Datalink (VSD), often published in Pediatrics or JAMA, confirm that serious adverse events following vaccination are extremely rare. For instance, rates of anaphylaxis are consistently reported at a few cases per million doses across various vaccines (as noted for COVID-19, the CDC reports approximately 5 cases per million doses). Research published in journals like Pediatrics has repeatedly shown no link between thimerosal (a mercury-based preservative formerly used in some vaccines) and autism or other neurodevelopmental disorders. Major health organizations like the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and national health ministries worldwide base their recommendations on this extensive body of evidence.
The scientific and medical consensus unequivocally concludes that vaccination's benefits in preventing severe disease, disability, and death outweigh the minimal risks of serious adverse events. The dangers posed by vaccine-preventable diseases like measles (pneumonia, encephalitis, death), polio (paralysis), pertussis (severe coughing, pneumonia, death in infants), and COVID-19 (severe respiratory illness, long-term complications, death) are significantly greater than the rare risks associated with the vaccines designed to prevent them.
Robert F. Kennedy Jr., a prominent environmental lawyer and descendant of America's most famous political family, has cultivated a public profile marked by deep skepticism towards established scientific and governmental institutions. His long history of promoting scientifically unfounded theories, particularly regarding vaccines and public health, has generated significant controversy. Appointed as Secretary of Health and Human Services (HHS) in the Trump administration in early 2025, his ascension to a key public health role brings his history of promoting conspiracy theories into sharp focus. Examining these theories, often propagated through interviews and books, and his leadership of the Children's Health Defense organization is crucial for understanding the potential implications of his leadership at HHS.
Kennedy's most persistent and widely criticized claims revolve around vaccines. For decades, he has been a leading voice promoting the thoroughly debunked link between childhood vaccines and autism. He has claimed, for instance, that ingredients like thimerosal (a mercury-based preservative removed from most childhood vaccines years ago) are responsible, stating in various forums that vaccines cause "an avalanche of neurological disorders," directly contradicting established medical science. His organization, Children's Health Defense, frequently publishes material questioning the safety and efficacy of routine immunizations.
The COVID-19 pandemic provided fertile new ground for Kennedy's skepticism. He propagated numerous conspiracy theories about the virus and the public health response. He questioned the severity of the pandemic, promoted unproven treatments like ivermectin and hydroxychloroquine, and fiercely opposed vaccine mandates and lockdowns. He made unfounded claims linking vaccine side effects to widespread death and injury, often citing anecdotal evidence or misinterpreting data from VAERS. Kennedy also gave credence to theories linking 5G technology to the pandemic and suggested figures like Bill Gates and Dr. Anthony Fauci were involved in orchestrating the pandemic for profit or control. In a widely condemned remark at a 2022 rally, he invoked Anne Frank when discussing vaccine mandates, stating, "Even in Hitler's Germany, you could cross the Alps into Switzerland, you could hide in an attic like Anne Frank did," a comparison for which he later apologized but which highlighted the extreme nature of his rhetoric.
Beyond vaccines and COVID-19, Kennedy has also questioned the scientific consensus on the causes of AIDS, giving a platform to discredited theories suggesting HIV does not cause AIDS. He has also raised concerns about the health effects of Wi-Fi, fluoride in water, and certain pesticides, often lacking scientific backing.
As Secretary of HHS, Robert F. Kennedy Jr. now oversees agencies central to American public health, including the CDC, FDA, and NIH. His primary stated qualification, beyond his name recognition, is his long career as an environmental lawyer, where he achieved notable successes suing polluters and advocating for clean water through organizations like Waterkeeper Alliance. Proponents argue this background demonstrates a commitment to public well-being and a willingness to challenge powerful corporate interests (like pharmaceutical companies). However, critics claim his qualifications for leading HHS are severely undermined by his decades-long promotion of scientifically disproven theories directly related to the department's core mission. His public stance against established vaccine science, epidemiology, and regulatory processes raises profound concerns about his ability to lead evidence-based public health policy and maintain trust with the scientific community and the public. His appointment places a figure with a documented history of promoting health-related conspiracy theories at the helm of the nation's primary health agency.
During visits to Texas, including College Station and the outbreak epicenter in West Texas, RFK Jr. made several notable statements. He suggested that measles deserved less media attention compared to chronic diseases like autism and diabetes. He said, "Every child who gets measles gets a headline... When I was kid, there were 2 million measles cases a year, and nobody wrote about them." Regarding the children who died, he suggested measles wasn't the direct cause, stating one child died from pneumonia or a "bacteriological infection" after supposedly recovering from measles. Early on, he described the outbreak as "not unusual" compared to previous years, a claim disputed by health experts given its scale. He repeatedly claimed the outbreak's growth rate was flattening or diminishing (e.g., "the growth rates for new cases and hospitalizations have flattened"), assertions contradicted by state data and epidemiologists at the time. While stating the federal position was that people should get the MMR vaccine ("The most effective way to prevent the spread of measles is the MMR vaccine"), he often immediately followed with caveats about mandates ("the government should not be mandating those"), emphasized it was a "personal choice", and sometimes raised questions about vaccine safety testing in the same breath. He mentioned providing CDC support for "alternative medicine" alongside vaccines and praised the use of vitamin A (while noting it doesn't cure measles). Finally, he stated more attention should be paid to autism and diabetes. His visits and comments often generated criticism from public health officials for downplaying the outbreak's severity, questioning established science, and sending mixed messages about vaccination.
Vaccine hesitancy is a complex, historically rooted phenomenon amplified by modern communication technologies and fueled by a mix of fear, misinformation, and declining institutional trust. While skepticism towards medical interventions has historical precedent, the scale, speed, and conspiratorial nature of contemporary anti-vaccine narratives pose a significant threat to public health. The thoroughly debunked link to autism persists online, weaponized alongside fears of "Big Pharma" and government overreach, finding commonality with broader conspiracy movements like QAnon.
These views oppose the overwhelming scientific evidence published in reputable medical journals and endorsed by global health authorities. Decades of research confirm that licensed vaccines are remarkably effective at preventing devastating diseases and possess an excellent safety profile, with the benefits vastly outweighing the infrequent risks. Addressing vaccine hesitancy requires more than simply presenting facts; it necessitates rebuilding trust, employing sympathetic communication strategies that acknowledge concerns without validating misinformation, promoting media and science literacy, holding social media platforms accountable for amplifying harmful content, and addressing the underlying societal anxieties and political polarization that make individuals vulnerable to conspiracy theories.
Protecting the monumental public health gains achieved through vaccination and ensuring readiness for future challenges depends critically on navigating this complex landscape with scientific rigor and a nuanced understanding of the human factors driving doubt. The official confirmed count from the COVID-19 pandemic is around 7 million. The WHO and other studies estimate that the total excess mortality associated directly or indirectly with the COVID-19 pandemic (including deaths from COVID-19 that weren't officially recorded, as well as deaths from other causes due to overwhelmed healthcare systems) is significantly higher, potentially ranging from 15 million to over 20 million globally. Over time, the virus has mutated, and it is generally accepted now that the mortality rate is similar to influenza, which has a rate of 0.1%. With that mortality rate, according to estimates from the WHO, seasonal influenza causes between 290,000 and 650,000 respiratory deaths globally each year. Scientists agree that the next COVID-19-like pandemic will be more of a matter of when and not if. Suppose the next new pathogen has a mortality rate like Ebola, which, according to WHO and CDC, averages around 50% (case fatality rates have varied from 25% to 90% in past outbreaks), and an infection rate of Measles, among susceptible close contacts, people without immunity who are exposed, up to 90% will become infected. Without science-based leadership at the political level, particularly at the federal level, and scientific literacy in the general public, the outcome of such a scenario is grim.
Darrell Lee is the founder and editor of The Long Views, he has written two science fiction novels exploring themes of technological influence, science and religion, historical patterns, and the future of society. His essays draw on these long-standing interests and apply a similar analytical lens to politics, literature, artistic, societal, and historical events. He splits his time between rural east Texas and Florida’s west coast, where he spends his days performing variable star photometry, dabbling in astrophotography, thinking, napping, fishing, and writing, not necessarily in that order.