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Vaccine Hesitancy and Religious Institutions

Written by Christopher Conti, MD and Sade Hawthorne, PharmD
Medically reviewed by Marianne Madsen

Edward Jenner, considered the “Father of Vaccinology,” first demonstrated smallpox immunity in a 13-year-old boy with cowpox in 1796.  Shortly thereafter, in 1798, the first smallpox vaccine was developed.  It wasn’t until 1980, almost 200 years later, that the World Health Organization (WHO) declared smallpox to be a globally eradicated human disease.  

 

The nearly two-century time interval between the introduction of a vaccine and the eradication of a global scourge is largely due to technology and a more organized and fortified medical, research, and public health infrastructure. But with the very first vaccine came the opportunity for the birth of vaccine hesitancy and skepticism.

 

Much of the initial and subsequent skepticism stems from several consistent areas of disconnect:

 

  • Incomplete understanding of the “science” behind vaccinations among vaccine-eligible individuals
  • Impact of organized religious influence and doctrine on health decision-making in general and vaccine choices specifically
  • Historical atrocities committed against marginalized populations and the poor in the name of science
  • Unreliable information that is not vetted and cannot be verified through the scientific method

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COVID-19 Vaccine

COVID-19 Vaccine

Incomplete Understanding of Vaccine Science and Vaccine Development

 

There has always existed a fine-line between medical science, religion, and mysticism.  Early medical and scientific practices often involved a synergy between science and the spiritual to gain a better understanding of the complexities of human substance and function. Investigating the unknown, harnessing the medicinal use of plants, invasive surgical exploration of the human body, post-mortem study of human anatomy, and the integration of religious practice have historically all been a part of the health, wellness, and healing arts and practices.  The overlap of these disciplines has never been seamless; many hard stops and other sources of tension between practitioners and patients often make it difficult for individuals to make healthcare decisions.

 

Prior to the COVID-19 global health pandemic, most vaccine development processes were measured in years and not months.  The process historically involved multiple layers of independent and transparent entities that enabled scientists, ethicists, and other laypersons to evaluate vaccine efficacy, safety, and a host of other factors.  The process was intentionally time-consuming and cumbersome, allowing for many places for pause and course correction.

 

Some skepticism and hesitancy is born from a belief that the process is driven exclusively by for-profit corporations within the context of government oversight such that money is the primary driver of the process.  Other skepticism and suspicion is driven by concern over the timeline, the process itself, and the validity and trustworthy nature of the data.  

 

Within the framework of the COVID-19 vaccine, the result has been skepticism and hesitancy driven by the contention that the vaccines were developed too fast and that the shortened process meant cut corners and compromised safeguards.  

 

The truth is that the COVID-19 vaccine development process, like other medication and therapeutic device development processes, includes multiple steps of oversight, ongoing surveillance, and reporting to ensure that patient safety and product efficacy remain the paramount area of focus.  The timeline was also shortened because the vaccine technology used was not “new” science; because there was a consensus, round-the-clock global effort to share information in order to stop the spread of a global, pathogenic serial killer; and because there was an enormous investment of capital and material committed to this single scientific effort.

 

Impact of Organized Religion

 

Historically, organized religious entities have been at the center of many innovative and transformative medical and public health innovations ranging from the beginnings of the pre-hospital/emergency medical services (EMS) system to some of the nation’s most storied and prestigious hospitals and health systems.  Many religious sacred texts provide stories that involve health and healing as the point of interface between people and the divine.  Religious organizations have established themselves as identifiable “help resources” within the healthcare realm with activities that have included health screenings, free clinics, low cost pharmacies, global health missionary work, and vaccine campaigns.  Within the framework of the COVID-19 global health pandemic, that challenge seems to stem from the fact that there is a disconnect and lack of consensus among organized religious clergy and lay leadership.  In other words, because the identified and trusted religious leadership is struggling with its own hesitance and skepticism, it is now impacting the ability of organized religious entities to become sites for community-based vaccination efforts.

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Faith - Patient-Provider Partnership

Faith - Patient-Provider Partnership

Historical Atrocities In The Name of Science

 

Although there are a number of historical atrocities committed on marginalized and non-consenting individuals, bias in medicine remains a prevalent and problematic phenomenon.  Within the last one or two decades, health equity research has identified biases that negatively impact both access and delivery of care.  From pain management to preventive health services, biased scientific approach has led to biased clinical practice.  The result is that many marginalized individuals, families, and communities now find themselves conflicted when presented with a vaccine with evidence-driven data suggesting its efficacy and safety. They appreciate science, but they remain skeptical and hesitant because of past experiences, either personally or historically.  

 

When these contemporary biases are overlaid with historical pseudo-medical and non-scientific atrocities, skepticism and hesitancy become logical and understandable responses to any new medical or scientific innovation.  With atrocities and injustices like the medical experimentation on the interred during the Jewish Holocaust, the phenomenon of the “Medical Plantation” where doctors convinced slave owners to consent to medical experimentation on slaves, the sterilization of women in the Jim Crow south termed the “Mississippi appendectomies,” the Tuskegee Study of Syphilis in the African-American male that spanned over 50 years, and the mistreatment of indigenous populations, immigrants, and the poor, it is no surprise that there exists skepticism that has nothing at all to do with 21st-century science or technology.

 

Bridging the expansive gap of trust that has been created with multi-generation instances of abuse and injustice will require creative and consistent dialogue and interface between the scientific, medical, public health, and religious communities.  The ongoing COVID-19 vaccination response might serve as a template for how these powerful partnerships might be used to eliminate the gaps in trust and confidence and heal the emotional wounds, all in an effort to create healthier individuals, families, and communities.

 

Keeping The Faith While Promoting Good Practice

 

The often confusing and conflicting divide between science and religion has been implicated in many areas of the Christian faith. For example, in the Book of Proverbs (Proverbs 18:4) it is stated that believers have access to counsel (reliable information) and sound judgment (common sense and intuition), and that these two elements working together allows access to both wisdom and power.  This powerful verse suggests that one need not compromise faith in order to take advantage of available knowledge and information.  As organized religious gathering events begin to increase in frequency, this foundational thought suggests that, in addition to vaccination, congregant gathering should be coupled with a continued attention to the core principles of general public health and hygiene including:

 

  • Proper and consistent use of face-coverings in those who are not fully vaccinated
  • Avoiding larger congregant gather settings for members of a vulnerable or at-risk population/group
  • Avoiding congregant gathering settings if one is sick or symptomatic, even if fully vaccinated
  • Careful attention to cough and sneeze etiquette and handwashing

 

Religious organizations can encourage these practices through both messaging and modeling within the venues where gatherings are being hosted without compromising a congregant-gatherer’s desire to live out their faith-driven practices.

 

Looking And Moving Forward

 

Within the framework of healthy, vibrant, and empowered communities are the organized religious venues and their discipleship and leaders.  Long heralded as accessible, available, reliable, and trusted “help resources,” it is no surprise that forward-thinking and innovative public health practices have looked to strengthen connections within these entities.

 

Beyond the optimistic hope that these connections can continue to fuel and bolster vaccine confidence and vaccine penetration into many of the current vaccine deserts and vaccine-deficient communities, the community health infrastructure is looking to these same faith-focused entities to help individuals, families and communities dig out from under the multi-dimensional weight of this pandemic.  From vaccine clinics to behavioral health services, from food insecurity solutions to routine primary care screenings, organized religion again will have an important role to play in the health, wellness, and empowerment of communities as they work to recover from the COVID-19 tidal wave.

 

As vaccine penetration improves and case numbers continue to decrease, the hope is that many currently hesitant and skeptical vaccine-eligible individuals will view their neighbors’ experience as evidence for their own information-driven decisionmaking.  As organized religious activity and congregant gathering continues to ramp up, it creates the opportunity for more interaction between the vaccinated and the unvaccinated in places typically considered “safe.”  Perhaps in these places and spaces of gathering, the seeds of vaccine confidence can be sown, and the skepticism and hesitance might fade away.  

 

Targeted efforts to connect to organized religious leaders and their lay counterparts in order to answer their questions and address their own hesitancy and skepticism will be an important step in harnessing the positively persuasive power of faith-based practice and organized religious activity.   Working together, all of the community health and wellness stakeholders will be able to partner with people to provide a framework for healing a recovery from the COVID pandemic that will serve as a model for community health for decades to come.

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