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What Drives Vaccine Hesitancy Among India’s Educated and Privileged?

What Drives Vaccine Hesitancy Among India’s Educated and Privileged?

Employees operate a filling machine inside a lab at the Serum Institute of India, Pune, November 30, 2020. Photo: Reuters/Francis Mascarenhas/Files

“[Published pseudoscience] is a serious threat to education and, I believe, to the democratic principle itself. … No amount of lying will alter the truth,—but lying can alter the willingness of a people to accept the truth.”

The Pseudoscience Wars (2012)

Mumbai: We recently wrote about how vaccine hesitancy works among the poor and the marginalised. For them, hesitancy is driven by hostility, suspicion and anger against the state and its agencies, resulting in a conspiratorial mindset.

The main problem with eliminating hesitancy of this type is that unless public authorities create an inclusive and caring ethos for these social groups, awareness and persuasion campaigns will find poor traction.

But we also see a lot of vaccine hesitancy among the economic middle class and more affluent sections of society. Where does this come from and what do we need to fight it?

We found three important factors.

Preponderance of misinformation

Vaccine hesitancy among the formally educated and better-off sections of society is fed largely by misinformation, of the more sophisticated variety. Its acceptance stems from a poor grasp of science, an abundance of half-baked knowledge – much of it now easily available on the internet – and an impaired ability to critically analyse the available information.

Talking to multiple people in this group, we discovered the wide range of “scientific” justifications they espoused: “in India, we are already immune because we live in such a dirty environment” is the most common. A more ‘reasoned’ argument is that vaccines require at least four to 10 years of research and trials, so the extant vaccines, made in a hurry, couldn’t possibly be safe. “Everyone who took the vaccine will die within two years” – this was a popular claim attributed to a celebrated French virologist (who didn’t actually say this, but advanced other false ideas). And then were the more technical “vaccines will alter our DNA” or that “they contain bluetooth microchips”.

‘Vaccines kill’

Evidence that vaccines kill or are ineffective is often gleaned from the much-publicised and greatly exaggerated anecdotal incidents of ‘vaccine escape’. Here, newer virus variants, such as the delta variant, have infected and sometimes even killed those who were fully vaccinated. This is offered as ‘proof’ that “vaccines do not work” or even that the vaccines themselves infect and kill. This is wrong.

As on June 28, 2021, data from the US Centres for Disease Control showed that 879 people who had been vaccinated died – out of 154 million recipients. A similar trend has held in India.

‘Big Pharma conspiracy’

The conspiracy that Big Pharma companies have created the ongoing crisis, or at least a mass hysteria for universal vaccination, is borrowed mainly from anti-vaxxers in the West. The general negative sentiment towards the very-expensive private healthcare industry in America nurtures this conspiracy – as do the numerous incidents of inflated hospital bills in India. In any case, it is important to separate well-known facts about [Big Pharma’s big profits from the science that has demonstrated that vaccines are necessary and productive.


A distinction blurred

The most troublesome contributing factor to the “educated” vaccine hesitancy narratives is the increasingly sophisticated presentation of anti-vaccine pseudoscience – with access facilitated by the internet and social media – exacerbated by the complexity of the concepts involved.

For example, to understand the design of mRNA vaccines or how certain virus variants can escape a vaccine, it’s important to be familiar with the relevant scientific concepts. One needs a certain amount of scientific literacy and analytical acumen to realise that new genetic technologies actually allow us to develop vaccines faster. That advancements in immunology can facilitate faster testing and feedback than what was possible before.

Then, the theories that mRNA vaccines alter human DNA, that vaccines contain bluetooth microchips and that the pandemic was orchestrated may sound “scientific” and therefore credible. But this stuff is so insidious that even well-read people sometimes have a hard time differentiating fact from fiction.

Consider the fact that there is an entire “scientific” journal – International Journal of Vaccine Theory Practice and Research ( – that publishes anti-vaccine articles. It is not recognised by the scientific community, has no apparent publisher and the editorial board consists of people who command no credibility, and are not even vaccine researchers. Yet, to most non-experts, it could look legitimate.

Why, lawyer and activist Prashant Bhushan’s recent write-up on Twitter is a stupendous demonstration of how a preponderance of misinformation can lead to a comprehensively misinformed stance on vaccines.

Not enough facts and data

Lies and half-truths take root easily, especially when the facts to counter them are not readily available.

If we are not really told how many people actually died of COVID-19 even after two vaccine doses, stories that claim that “this is common” will find many takers. Sensational and dangerous news travels fast, far and wide. If adverse effects following immunisation aren’t reported in a transparent manner, people are left free to believe anyone’s yarns.

However, if the truth is to find traction, we need two specific ingredients. First, any facts and figures being placed in the public domain should be independently verifiable and match the reports from ground-zero. Second, the institutions that release information should be very credible. Both these factors are currently missing from the mainstream discourse in India. Take a look at the following examples.

Loss of credibility

COVID-19 infections and fatalities have been severely under-reported in India. Experts’ comparative analyses of official data and ground reality show this. Courts have castigated systematic under-reporting; the “revised” figures released after court orders also demonstrate this issue (see here, here and here).

This story repeated itself during the second COVID-19 wave. People were left to deal with the humongous shortage of oxygen, medicines and hospital beds by themselves. Government officials responded with angry denial – and persisted with efforts to underreport the magnitude of the epidemic in many states. People were dying in parking lots; crematoria ran out of space; corpses were floating on rivers – all of this was visible. But the official stance was to squabble, deny and threaten.

This ethos has engendered grave doubts about everything that public institutions say, and taints claims of vaccine safety and efficacy as well. Many people don’t know what to believe.

Worse, the government itself has intensified this credibility crisis by pushing the use of vaccines and drugs without sufficient evidence that they work. Consider poor Covaxin, the COVID-19 vaccine made by Bharat Biotech and the Indian Council for Medical Research (ICMR).

In July 2021, ICMR chief Dr Balram Bhargava ordered a dozen hospitals around the country to complete Covaxin’s phase 3 clinical trials by August 15 – in just two months. The criticism of this absurd fiat was met by fierce abuse from trolls who said that critics couldn’t take pride in an “Indian vaccine”. Questions over safety and protocol were smothered by malicious vitriol that also helped those in charge to evade important answers.

In January 2021, the Union health minister Harsh Vardhan called questions about the data and missing protocol as attempts to “politicise the issue”. Even today, the WHO has not approved Covaxin, even as Bharat Biotech continues to hold data from its phase 3 trials out of the public domain. More than gaining “patriotic supporters”, this narrative has contributed to a negative view of what may well be a functional vaccine, and in fact all vaccines everywhere.

No data- or information-sharing

Other than what the ministries’, cities’ and towns’ dashboards show, the government has shared hardly any other information with the people, or even with scientists. Many of the latter have made representations to the Centre and filed court petitions asking for the data collected by government agencies. There have been assorted media reports that mention percentage efficacies of this or that vaccine, but it is very difficult to access the relevant details.

This failure leaves people with no option but to search the internet for answers – and bump into all sorts of narratives, most of them fake. From a social psychology perspective, in a climate of such hopelessness, anxiety and helplessness, individuals are more receptive to misinformation. A study published on April 16, 2021, had this to say:

“… schemata and other cognitive processes that are associated with a sense of uncertainty and stress might set in motion a never-ending chain reaction in which people seek for more information to reduce uncertainty and stress, but in contrast stumble upon stress-evoking discourses.”

Releasing data about vaccine trials into the public domain, for information and scientific review, will go a long way towards creating trust and a reassuring atmosphere.

On the other hand, low credibility and shortage of relevant data and information prime the ground to spread misinformation, and eventually vaccine hesitancy.

Cultural narcissism

Finally, we have a vaccine hesitancy driven by cultural nationalism. Hesitancy here is promoted by pride in ancient wisdom – and Ayurveda in particular. Such hubris can lead to the pseudo-logic that ayurvedic formulations could eliminate the need for vaccines.

Take the case of AYUSH 64, a polyherbal concoction that the Ministry of AYUSH recently said has been “found to be useful in treating mild to moderate cases of COVID-19 in clinical trials”. What trials? Where? With how many participants? What were the trial controls? None of these details are available, so no one knows how the ministry reached this conclusion – or which regulatory body examined that data and approved the concoction.

Then there was Patanjali’s Coronil, which Baba Ramdev’s company falsely claimed to have been certified by the WHO, and which health minister Vardhan endorsed in public.

Most of these promotions tread a fine line between calling something a ‘cure’ and calling it an ‘immunity booster’, and it is easy to get confused. A diffuse belief that “because we consume Ayurvedic tonics and potions, COVID-19 will not infect us” seems to be fairly common among the consumers of such products.

The extension of this line of reasoning by the more hardcore believers to the (nonexistent) COVID-protecting powers of cow urine and dung is ununsurprising. Interestingly, many people of this persuasion also believe in a conspiracy that the second COVID-19 wave was timed precisely to sabotage India’s great economic and political rise across the globe.

What can be done?

Without making data accessible publicly, together with transparent decision-making, doubts, anxiety and conspiracy theories will persist in the public imagination. Trivial reassurances like “vaccine is 110% safe” and “all protocols are being followed” – offered without any corresponding evidence – only add to suspicion that there is something fishy.

In turn, the official obsession with self-congratulatory narratives of the “largest” and “fastest” vaccine drive only twists the blade for those who are ill and those whose loved ones have died. In fact, in the context of our large population, the “fast” and the “large” are still highly inadequate.

For the economically middle and upper classes, who engage highly with many digital platforms, social media can be a good place to wage a pro-vaccine campaign. A study of vaccine-related rumours and conspiracies suggested that there is a “need for cognitive inoculation against misinformation”. It recommends tracking “COVID-19 vaccine misinformation in real-time and engaging with social media to disseminate correct information [to] help safeguard the public against misinformation.”

In addition, the government should undertake more ‘conventional’ campaigns like public messages through TV spots and newspaper advertisements in full swing. One multi-nation study concluded that “exposure to COVID-19 related information through traditional news media sources such as newspapers, radio, and television, is associated with lower beliefs in conspiracy theories and misinformation.”

This is a golden opportunity for government agencies, especially those dealing with science and technology, and COVID-related issues in particular. These are the Department of Science and Technology, the Department of Biotechnology, professional bodies like the ICMR, the Council of Scientific and Industrial Research, and the science and engineering academies. They can popularise scientific and technical articles, podcasts and videos – their own as well as those published by well-known scientific journals.

It would be truly useful if they made the more complicated and difficult scientific material accessible to everyone, in their local languages. Such activities would fit neatly with the outreach mandates of these organisations, and make an invaluable contribution to spread scientific temper and literacy. This will also be the surest way to create vaccine literacy, eliminate hesitancy and promote safe social behavior.

Anurag Mehra teaches engineering and policy at IIT Bombay. His policy focus is the interface between technology, culture and politics. Anshu Deshmukh is a psychologist and student counsellor, and works in the field of mental health.

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