The Political, Social, Historical, and Ethical Implications of the COVID-19 Vaccines

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I. Abstract

The present communication aims to evaluate the determinants that influence public confidence in the COVID-19 vaccine. Following the rollout of three FDA-approved vaccines, many Americans are still hesitant to get vaccinated for reasons ranging from concerns regarding the vaccine approval process to falsehoods stemming from conspiracy theories. Though the vaccines have been scientifically proven as safe and effective through challenge tests and clinical trials, a significant amount of skepticism persists from the ongoing anti-vaccination movement and an elevated distrust of the government. Collectively, this literature review assesses the dynamic social, political, and historical factors that shape vaccine hesitancy.

II. Introduction

Previously regarded as a hoax and countered with rebellious anti-mask and anti-social distancing movements, the COVID-19 virus is faced with another controversial issue — vaccination. In the United States, COVID-19 vaccinations are becoming widely prevalent with 2.25 million doses administered daily (Times, 2021). However, to warrant herd immunity, experts estimate that 70-90% of the population should be vaccinated (Times, 2021). A highly vaccinated population is necessary to counter the high transmissibility of COVID-19. However, the speed of overall population vaccination may be exacerbated by resistance to COVID-19 vaccination. Hence, as the world transitions from preventing the spread of the COVID-19 virus to directly tackling the pathogen’s presence, it is pivotal to address the politics influencing vaccination, the reluctance of historically marginalized groups, the anti-vaccination movement, and bioethical implications.

III. The Politicalization of the COVID-19 Vaccine: The Role of President Trump and the Spread of Misinformation

Polls have repeatedly shown a substantial difference in the rate of vaccine hesitancy among Republicans and Democrats. While 10% of Biden supporters said that they won’t get vaccinated, the rate jumps to 47% when surveying Trump supporters, representing nearly 35 million people (Khubchandani, 2021). This dynamic may come as a surprise as Former President Trump has advertised his administration’s success in developing the COVID-19 vaccine through Operation Warp Speed. The “Office of the Former President” recently put out a statement describing the vaccine as “beautiful” and telling Americans they should credit Trump for its existence (Reiman, 2021). However, it seemed that Trump’s promotion of the vaccine was more for political gain rather than convincing Americans to take the vaccine. 

Since the start of the pandemic, the majority of Republicans had already been primed to doubt the severity of COVID-19 and distrust the government’s involvement. Trump set this tone early by downplaying the coronavirus threat. He often equated COVID-19 to the seasonal flu and repeatedly criticized the top government infectious disease expert, Dr. Anthony Fauci, who often refuted Trump’s optimistic portrayal of the pandemic (Dwoskin, 2020). In turn, individuals who received Trump’s words through television or Twitter would become skeptical of the mask and social distancing health guidelines issued by the CDC and their local governments. A study conducted by the Institute of Biomedical Ethics at the University of Zurich identified Trump as the main driver of the COVID-19 infodemic. He was estimated as being 5.2 times more relevant than the World Health Organization in a coronavirus-specific social media model, which parallels Trump’s popularity as the U.S President (Germani, 2021). Due to his significant influence on social media, Trump has largely obscured the reality of the pandemic using politics and bias instead of shaping the outbreak as a situation that should be dealt with using science and truth. 

The disinformation machine led by Trump has also facilitated an increase of anti-vaccine sentiments among his supporter base. While Trump presented a message to distrust official authority, conspiracies and misleading narratives have moved from “the fringes to the center of the national conversation” (Dwoskin, 2020). His repeated claims of election fraud were directly correlated to a surge of published election and vaccine misinformation by right-wing outlets such as Breitbart, Newsmax, and One America News Network (Alba, 2021). Interestingly, as Trump’s challenges to the election results were knocked down by various judicial courts, vaccine falsehoods began to increase. According to an analysis by Zignal, election misinformation decreased from 375,000 mentions across social media and news networks to 60,000 mentions between November 4th and December 3rd (Germani, 2021). During this same time frame, false information regarding the COVID-19 vaccine steadily increased from 17,900 mentions to 46,100 mentions. 

The shift in pro-Trump misinformation efforts from election fraud to vaccine conspiracies illustrate an alignment between QAnon and the vaccine resistance movement. Both have put out similar misleading claims: the vaccine causes autism and that the Chinese loyalists inserted microchips into the vaccine to track American citizens (Dickinson, 2021). These theories have been shared numerous times on social media and even amplified by notable Trump allies such as Tucker Carlson and Laura Ingraham. Even though Trump did not post anti-vaccination content, his retweets of QAnon inclined his supporters to believe in conspiracy and disbelieve in official accounts. The design of social media strongly supports this notion (Dickinson, 2021). Social media is programmed such that users will continue to see the content they like in order to increase screen time and revenue for the company. This also means that sharing conservative tweets would increase the chance that a hesitant individual begins to see and delve in vaccine conspiracies. 

The merging of the anti-vax movement with QAnon poses a grave threat in undermining the public confidence in the COVID-19 vaccine. The full rejection of confidence in “doctors and drug companies, in media and philanthropy, in politicians and government agencies” has the capacity to prolong the pandemic (Dwoskin, 2021). As demonstrated by the storming of the Capital on January 6th, false information can have deadly consequences, not just for those immersed in the conspiracy. Trump had the influence to signal the vaccine’s safety, but he missed this opportunity by choosing to receive the vaccine behind closed doors in January (Acosta, 2021). Even without Trump, misinformation will continue to find its way through the loopholes of the internet, perpetuating vaccine falsehoods, and putting millions of American lives at risk. 

IV. Social Determinants of COVID Vaccine Hesitancy: Communities Rejecting Vaccination

While many conspiracies surrounding the COVID vaccine are unfounded there are certain ones that must be acknowledged and understood in order to help marginalized communities establish trust in the COVID vaccine. Past unethical practices of the U.S government towards marginalized communities have shown to increase hesitancy of the COVID vaccine in those communities. A recent study has found that compared to other groups, Hispanic and African Americans were more likely to be hesitant of the COVID-19 vaccine (Khubchandani et al., 2021). 

In a recent study that conducted focus groups in Black barbershops, they found that hesitancy to take the vaccine was high and that many participants would only consider taking it if it was recommended to them by their physicians. “Hesitancy against the COVID-19 vaccine was high due to mistrust in the medical establishment, concerns with the accelerated timeline for vaccine development, limited data on…effects, and the political environment promoting racial injustice”(Momplaisir et al., 2021). This is concerning considering the fact that COVID-19 had targeted minority communities, including the Black community, quite heavily as seen by the disproportionately high number of deaths compared to White Americans. 

The political environment created today on the basis of White supremacy, which has become increasingly normalized due to the actions of former President Donald Trump, has deepened the mistrust Black Americans have in the government. Furthermore, the origins of the distrust are numerous, though, based on a scientific standpoint, the ways in which Black patients have been used for research as a means to gain medical understanding have many believing that history is repeating itself.  In the Tuskegee Study, Black men were told they would be given treatment for their ailments, including syphilis, however, they were given no such treatment. In fact, when penicillin became more widely available as an effective drug against syphilis, the researchers prevented participants from the study to access the treatment (Center for Disease Control and Prevention, 2020). Although the participants of the study consented to the supposed treatments, they were lied to and thus they did not give informed consent. The Tuskegee Syphilis Study performed in 1932 has continued to fuel mistrust of scientific research and likewise new advancements made by scientists such as the COVID vaccine. In a recent study, eleven focus groups of African American adults were asked a series of questions about their willingness to participate in medical research, many cited mistrust of the government and of scientific research as a barrier. A large number of participants stated that they believe the federal government was responsible for the injection of syphilis into the study participants and withholding treatment options from them (Scharff et al., 2010). A participant of the study states, “Just that awareness [about Tuskegee] is enough to stand up generation after generation” (Scharff et al., 2010).

The Hispanic community has ingrained similar sentiments about the government and American medicine. A study analyzing population-based sterilization rates of The Eugenic Sterilization Program in California from 1920 to 1945 found that Latino men were 23% more likely to be sterilized than non-Latino men and that Latina women were 59% more likely to be sterilized than non-Latina women (Novak et al., 2018). These sterilizations were done on the basis of selecting who was “unfit” to be a parent and were done without the patient’s informed consent. Although this particular sterilization program was performed in the mid-1900s, America has not learned from its mistakes. As recently as the year 2020 there have been reported sterilizations performed at the border without informed consent. The recency of this blatant attack on the Hispanic community has succeeded in breeding more distrust of the government and its healthcare system. Consuella Hermosillo, an immigrant from Mexico, was sterilized without her consent when she went to give birth to her child in a hospital in Los Angeles (Hassanein, 2021). Her granddaughter is hesitant about the COVID vaccine as she is worried that she will not be able to bear children because of it. 

In order to better provide for these communities and increase their vaccination rates which would, at least according to early studies, decrease the percentage of hospitalizations and deaths, physicians and government officials must acknowledge the concerns of these marginalized communities. 

V. The History of the Anti-Vax Movement: Differing Viewpoints surrounding Public Confidence

A key element regarding differing viewpoints toward acceptance and reluctance to taking the COVID-19 vaccine is a sentiment that has maintained a strong following throughout history in both the United States and many other countries. This sentiment has historically been known as the anti-vax movement, a movement of widespread opposition in both opinion and the active formation of groups to oppose vaccinations as a form of disease prevention. Anti-vax movements have been around from as early as the nineteenth century, most notably from the formation of anti-vaccination leagues in the late 1800s. Various leagues existed within certain locations, for instance, “The Anti-Vaccination Society of America was founded in 1879, followed in short order by the New England Anti-Compulsory Vaccination League (1882) and the Anti-Vaccination League of New York (1885)” (Rothstein, 2015). Additionally, as other forms of disease prevention became more prominent, in addition to religious objections, distrust in vaccines continued throughout the 19th and 20th centuries. Essentially, “the discovery of the germ theory of disease in the mid-nineteenth century led to an increased interest in the importance of sanitation as a means of preventing disease” (Rothstein, 2015). As a result, many people within the anti-vax movement found another reason to oppose the administration of vaccines as a method of disease prevention, further strengthening the movement. In addition to an increased emphasis on sanitation, a reason for opposing vaccines also existed in religious causes during the nineteenth century. However, this has become a much less common reason for opposing vaccines today. Nonetheless, other causes have strengthened the anti-vax movement and allowed it to have influence up to the present day, as distrust continues to sprout from areas such as fear of certain side-effects and other concerns. “Even though vaccines continue to grow safer over time, they undoubtedly still have some side effects, as is also true of antibiotics, surgical procedures, and blood pressure medication” (Rothstein, 2015). 

There exists a strong connection between past anti-vax movements and the difference in opinion regarding public general confidence in COVID-19 vaccines in the United States. The same levels of skepticism that have been shown by people throughout anti-vax movements can also be found in many today, not simply in vaccines, but rather in the American government. Ultimately, a main source of public mistrust in vaccines both in the past and during this current pandemic has been dissent and suspicion of state and federal power with regards to the distribution of vaccinations in the United States. This is especially true for many communities that are often underrepresented by the American government. “Dissent has long been observed among communities who do not feel represented by authorities dispensing the vaccine or a sense of belonging to the broader public in whose interest they are asked to participate” (Harrison & Wu, 2020). Considering the lack of trust in authorities from many American citizens, anything promoted by the government, including the COVID-19 vaccine is easily met with skepticism and hesitance to take the vaccine. “Many of today’s concerns over vaccination are strikingly similar to those of the past: the belief that vaccines are unsafe and unnecessary often joins with a suspicion of government and the medical community” (Rothstein, 2015). Through this distrust, the idea that vaccines are unsafe is easily received by many, strengthening the same sentiment that has long lasted within the anti-vax movement. 

All things considered, the majority of United States citizens have been in favor of trusting vaccines that are distributed. According to the National Vaccine Advisory Committee, “Recent reports suggest that a majority of parents have favorable beliefs or perceptions regarding recommended childhood vaccines. A 2009 Health- Styles survey of parents of children aged 6+ years, for example, found that 79% were ‘confident’ or ‘very confident’ in the safety of routine childhood.” According to the National Opinion Research Center for Public Affairs Research (2020), though 49% of the public plan to get vaccinated once it is out, 31% have no opinion on the issue, and 20% plan not to get vaccinated. As conveyed, vaccine hesitancy is clearly present in the population. Ultimately, despite the strength of the anti-vax movement throughout history, it is important to recognize that a vast majority of American citizens have strong confidence in vaccines.

VI. Vaccine Safety, Efficacy, and Quality: A Conversation of Ethics and Anti-Vaccination Sentiments 

To ascertain the safety of vaccines and indirectly ensure public confidence, vaccine development is a lengthy process According to the Journal of Tropical Medicine and International Health (2021), “traditionally, vaccine development takes years, even decades: from about 40 years for polio to 5 years for Ebola, most vaccines took 15 years on average [to develop].” However, in dire need to save countless lives, the time needed to develop a COVID-19 vaccine has been cut short. To comprehend the scope of COVID-19 vaccine development, an understanding of the different phases of vaccine trial must be established. According to the International Journal of Molecular Medicine, in phase I of vaccine testing, a vaccine is administered to a small group of healthy volunteers between 10-100 people. The purpose of the first phase is to test for the safety of a vaccination and whether it causes severe side effects. In phase II, the vaccine is tested on a larger group consisting of 100 to 1000 people. Finally, in phase III, an even larger group is exposed to the vaccine, between 1,000-100,000 people. By conducting phase II and phase III trials, additional side effects of a vaccine are discovered. These distinct trials ensure vaccine safety through careful supervising and data collection. 

Figure 1

As depicted in Figure 1, COVID-19 vaccine stages of clinical trials are drastically shorter compared to that of classical vaccines. From “Towards effective COVID-19 vaccines: Updates, perspectives and challenges (Review),” by Calina et al., 2020, International Journal of Molecular Medicine, 46(1), 3+. Copyright 2020 by Calina et al.  

Compared to the development of classical vaccines depicted in the chart above, “the 2014 West African Ebola virus epidemic spurred rapid vaccine development [taking course over] a period of 12 months … to progress from phase 1 first-in-human trials to phase 3 efficacy trials (Slaoui & Hepburn, 2020). Putting this into perspective, COVID-19 research began in January 2020, phase 1 trials began in March 2020, and phase 3 trials began in July 2020. The speed of COVID-19 testing is unprecedented. However, people are already skeptical of the vaccine process and thus “…it is crucial that any new, incompletely tested, vaccine does not undermine confidence in existing effective vaccination programmes” (Komesaroff, 2020). 

The Journal of Tropical Medicine and International Health (2021) identified that two factors should be balanced in COVID-19 vaccine development, “immediate necessity for speed of vaccine research and the inherent need for protection of research subjects.” Capitalizing on both factors of rapid and protective testing of research subjects, the Trump administration declared on May 15, that Operation Warp Speed (OWS) — a collaboration between the Department of Health and Human Services (HHS), the Department of Defense (DOD), and the private sector — “will accelerate control of the Covid-19 pandemic by advancing development, manufacturing, and distribution of vaccines, therapeutics, and diagnostics” (Slaoui & Hepburn, 2020). Experts acquainted with experience on medical countermeasure research, vaccine development, and manufacturing will collaborate for this humane cause. In addition, “the initiative set ambitious objectives: to deliver tens of millions of doses of a SARS-CoV-2 vaccine — with demonstrated safety and efficacy, and approved or authorized by the FDA for use in the U.S. population — beginning at the end of 2020 and to have as many as 300 million doses of such vaccines available and deployed by mid-2021” (Slaoui & Hepburn, 2020). Throughout this hastened operation, the foundational characteristics of COVID-19 vaccines are safety, efficacy, and quality (Wibawa, 2021).

A crucial step in vaccine development is the challenge test which “[measures]  the potential protection of the candidate” (Wibawa, 2021). In the preclinical stage, classical vaccines are usually tested on animals. After a vaccine has been tested on animals, it may be tested on humans. However, due to time constraints, COVID-19 vaccine researchers skipped vaccine trials in animal models and directly administered the challenge test in human models. This type of challenge test falls under a CHI, or a controlled human infection model previously used to develop vaccines against malaria, typhoid, and cholera (Calina et al., 2020). Thousands of volunteers, from 162 countries, have expressed their willingness to participate in a controlled human infection study (Calina et al. 2020). One ethical consideration is that there is no standard treatment for the disease and so research subjects cannot be treated if they suffer. To ensure the safety of participants, it was suggested that an attenuated virus may be used for the CHI. However, this consideration is impractical since it will take time to produce this artificial form of the virus and results from this modified virus may not be generalizable.

Regarding the vast bioethical implications of the COVID-19 vaccine, there are safety concerns of DNA-based vaccines. DNA vaccines utilize plasmids to deliver DNA into cells where it is translated into proteins that generate an immune response: targeted T-cell and antibody responses (Wibawa, 2021). Thus, there is risk that DNA vaccines will trigger mutagenic effects in human genes. The risks for healthy individuals are very high. Furthermore, there may be a “possible existence of risks that have not been identified yet and will only show in the later phases of clinical trials” (Wibawa, 2021).

With it’s rapid development, human subject testing, and bioethical considerations of DNA vaccines, the COVID-19 vaccine will not cater to all groups of people. However, “psycho-social interventions should be developed to address the anti-vaccine movement”  and reduce the possible risk of the speedy process (Ransing et al., 2021). Though the ideal — herd immunity — may not be attained, taking the necessary steps to ensure the well-being of global populations through these difficult times is the main goal.

VII. Conclusion

In order to address the hesitancy and confusion surrounding the COVID vaccine, officials must collaborate with researchers and physicians so that the veil which separates the scientific community and the general public no longer exists as a breeder of conspiracy. Scientists should work to have the information of how the COVID vaccine was tested more readily available and easier to understand. This would then lessen the relevance of the reasons against the vaccine which is rooted in political rivalry and alienation, fear of a history of unethical practices against minority communities repeating itself, and the religious reasoning and unfounded health concerns raised by the anti-vax movement.

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