Ros Taylor
Towards the end of 2021, when lockdowns in Britain were past and many people had already received one or more COVID jabs, graffiti appeared on a wall in my road in north London. ‘NHS 100K’, it read. At the time I was editing the LSE’s blog about COVID, and regularly photographed pandemic-era street furniture and slogans to help illustrate the pieces we published. I hadn’t heard of NHS 100K, but it was easy enough to find out what it was: a grassroots movement that resisted the plans to make COVID vaccinations compulsory for all health and social care staff. “We stand united in favour of freedom of choice, bodily autonomy and informed consent,” said the organisers, some of whom were vaccinated themselves.
The campaign was a success: the government withdrew the mandate, though the fact that vaccinated people could and do continue to catch COVID undoubtedly played a role in the U-turn. It had earlier been hoped that vaccination would stop transmission of the virus and that jabbed health workers would be unable to pass it on. Nonetheless, NHS 100K represented a phenomenon that policymakers struggled with during the pandemic. Health workers were less susceptible to vaccine dis- and misinformation than the rest of the population. They were often painfully aware of the risks of COVID. Some of them had nursed patients who died of it. Why, then, would they take a stand against compulsory jabs? For policymakers, the campaign jarred very uncomfortably with the trust and gratitude that ordinary citizens had been encouraged to feel for the ‘NHS heroes’ on the front line.
The importance of trust
As I explore in my book The Future of Trust, modern society requires large (and ever-growing) amounts of institutional trust to function. Some of that is vested in businesses such as banks, utilities, and corporations, but a great deal of it is demanded by the state. We are asked to trust the government to run public services efficiently, to spend taxpayers’ money responsibly, and to make highly consequential decisions about our health. Never had a government asked so much of a population during a public health crisis as it did during COVID. Lockdowns and restrictions were followed by the rapid development of vaccines. It was made clear to the public that only high vaccination rates would enable society to open up without large numbers of deaths and the collapse of the NHS. Establishing trust in these new vaccines was therefore paramount.
Unfortunately, the drive came at a time when the Q-Anon suite of conspiracy theories was gathering momentum: its adherents were among those who had stormed the US Capitol building in January 2021. Followers had seized upon the pandemic as evidence of a deep state conspiracy, in which the virus itself, or vaccines, or both, were efforts to exert a form of mind control over ordinary people. This belief exploited squeamishness about jabs and offered a rationale for refusing them. But although the ‘plandemic’ received a lot of media attention, it was only one strand of vaccine hesitancy.
The complex causes of lack of trust
Vaccination, because it is the injection of an artificial substance into the body, demands high levels of societal trust, and particularly trust in scientists and the NHS. People who are already inclined to mistrust the government were therefore more likely to hesitate before getting the jab. In one of the most revealing pieces I published on LSE COVID-19, a team of researchers at the University of Greenwich and two US institutions looked at why some health and social care staff in both countries initially refused the jab.
For some, it was because they felt that they had not been given adequate protection from the virus in the early stages of the pandemic. Vaccine mandates were perceived as a demand made by a government that had previously failed to care about their health. For others who were undocumented migrants, registering for the jab was felt to be risky. Some mentioned their experiences of racism when using health services and the history of medical experimentation on Black people.
In some countries, COVID vaccination and testing mandates might be one of the few ways in which migrants were acknowledged by the state. This led to resentment. In Italy, where vaccination was compulsory to get a new job (even an informal one), undocumented migrants resented the fact that the state would not regulate their status even though they had been jabbed. “COVID and vaccination were generally perceived in relation to the Green Pass,” wrote researcher Sara Vallerani.
Drilling down, research by the LSE found that in the UK some ethnic groups were more likely to refuse the vaccine than others. Like the Greenwich research, it identified an association between reluctance and experiences of ‘chronic discrimination’ in the NHS and government. This was particularly true among people of Caribbean heritage. They also found that these groups were unlikely to engage with the community and religious groups that were thought to be the best way to reach them. And just as the NHS 100k campaign had suggested, making the jab mandatory was more likely to make people refuse it.
Most of these reasons for avoiding vaccination were outside the experience of journalists and commentators, the majority of whom found that getting a jab was simple and unproblematic, a no-brainer: in short, just another interaction with a state that was largely trusted to provide healthcare. Vaccine hesitancy and refusal were blamed on selfishness, conspiracy theory, and ignorance. “You are stupid. Weapons-grade stupid, in fact,” wrote the Daily Mail columnist Sarah Vine.
Engaging with the causes of distrust
The truth is more complicated. Someone whose interactions with the state are occasionally frustrating rather than existential will struggle to understand that others feel afraid of or resentful towards it. Among some marginalised Britons, the perception that the state only cared about you if you might pass on COVID was commonplace. As the researchers at LSE Health observed, “policymakers and journalists would do well to carefully understand and honestly engage with these various causes of distrust.” We did not always do that.
Ros Taylor is a journalist, the host of the Oh God, What Now?, Bunker and Jam Tomorrow podcasts, and the author of The Future of Trust (Melville House).