Understanding Vaccine Hesitancy

Unvaccinated Under God: Religion and Vaccine Hesitancy in Modern America, by Kira Ganga Kieffer, Princeton University Press, 304 pages, $29.95

In Unvaccinated Under God, Kira Ganga Kieffer unpacks the recent history of vaccine hesitancy in America. Kieffer, a religious studies scholar at Fairfield University, offers a way to understand hesitancy itself as a form of religious expression, even when it arises among people not bound by particular spiritual traditions.

Unlike many people who tackle this topic, Kieffer treats the vaccine-hesitant with respect and curiosity, not contempt. As a result, the book leaves you not seething in rage but a little sad, the same way you might feel if your grandmother’s vase shattered into a million pieces: wistful for what was before and resigned to the fact that it may never be that way yet again.

Kieffer opens in the 1980s, when worries about the safety of the DPT vaccine prompted parents to lobby for a safer vaccine and informed consent. They had reasonable concerns: As she notes, data in medical journals from the 1940s through the ’80s showed that the pertussis portion of the DPT shot “increased a vaccine recipient’s risk of developing encephalitis, or brain inflammation.” To show how vaccine hesitancy can be understood as religious expression, Kieffer unpacks what she calls “vaccine-injury conversion narratives”: personal testimonials from families whose children suffered brain damage after the shot. These narratives echo the sort of I-once-was-lost-but-now-I’m-found stories that show up on testimony night after a Wednesday-night church potluck.

The next section, on the fear of a vaccine-autism link, traces how the “implicit religiosity” of three cultural trends of the early 2000s—natural health, alternative spirituality, and intensive mothering—collided with other shifts in American culture, including rising individualism and growing distrust for authority. Like two weather systems meeting over Kansas, this collision produced a cultural tornado: a movement of mothers who valued their own intuition and moral certainty over mainstream views of the MMR vaccine. The doctors believed they’d provided more than ample scientific evidence demonstrating that the mercury in the shot couldn’t possibly cause autism. The mothers disagreed, and their belief got mixed with a fear that injecting foreign substances into their children’s pure bodies could cause “biological, psychological or spiritual disruption.” It didn’t help that at this stage, most experts didn’t try very hard to thoughtfully engage with the mothers’ sincere questions. The schism grew.

Kieffer also devotes a chapter to the Gardasil vaccine, where the religiously based objections were fairly straightforward, given that the vaccine protects against a sexually transmitted disease. Another chapter explores how a history of medical racism fostered vaccine hesitancy in minority communities. One of the most interesting chapters compares and contrasts the public health and media response to measles outbreaks among four distinct communities.

The four case studies involve a white, conservative evangelical megachurch in Dallas; a Somali-American Muslim community in Minneapolis; an ultra-Orthodox Jewish community in New York; and New York’s Green Meadow Waldorf School, a well-educated enclave of holistic, progressive families who didn’t subscribe to traditional religious beliefs but articulated their vaccine objections in the language of religious exemption. Though the measles saw no difference among its victims and the outbreaks began within a span of nine years (2011–2019), the experts tasked with managing outbreaks and the media telling their stories “regarded some groups as legitimate and others as illegitimate in their vaccine hesitancy.” The press treated the Somalis, for example, as “helpless victims of misinformation and manipulation” who therefore “deserved empathy and education,” while the evangelicals and Jews were hit with “moral shaming for displaying ‘willful ignorance.'” Even the experts use extra-scientific values, some held with religious-like ardor, when navigating the complexities of life.

Throughout those chapters, Kieffer avoids the easy tropes that often replace meaningful understanding, a lesson I wish more in the medical establishment would learn. Rather than framing vaccine hesitancy as “simply oppositional to science,” Kieffer recognizes that it stems from “critical perspectives on authority” and on “where knowledge derives, who is most in charge, and what really matters.” But she has trouble sticking to this objective position when she gets to COVID: She attributes vaccine opposition then to “conservative identity politics, in which primarily White conservative Christians questioned the validity of public health and biomedical authority.”

Kieffer looks at not just vaccines but masking, social distancing, and quarantining through this narrow lens, not recognizing that dissenters came from diverse ideological camps—and that sometimes they were right. Shutting down schools really did harm students, for example, and the virus may well have originated in a Chinese lab after all. The “dystopic vision,” as she calls it, of a world dictated by authoritarians who control supply chains and restrict freedom of movement wasn’t just the stuff of right-wing conspiracy theories; people watched what happened in China and Canada and worried about similar controls coming to the U.S.

Kieffer isn’t wrong that “MAGA media outlets framed lockdowns as assaults on personal liberties,” but that isn’t the whole story, and her COVID chapter would have been stronger if she’d spent more time taking dissenters seriously. For example, many conservatives’ objections weren’t just about personal liberty but were rooted in communal concerns as well: the well-being of schoolchildren, of people whose work was deemed “nonessential,” and of elderly people in nursing homes turned solitary confinement units. She deep-dives into various fringe conspiracy theories, such as the notion that COVID vaccines turn people queer—an idea I’d never heard before, and I thought I’d heard every coronavirus conspiracy theory under the sun—without spending even a paragraph addressing, say, objections to vaccine mandates for young men at an increased risk for myocarditis, or the ways reasonable COVID dissenters were belittled, ostracized, and professionally discredited. These failures of discourse make it even more clear why society needs to make space for conscientious objectors and dissenters, no matter how outlandish their ideas might seem to people more comfortable with the status quo.

Kieffer’s book also suffers from a perennial problem in modern religion reporting: It allows the rather capacious and nebulous category of MAGA-populist-Christian-nationalist to stand in as a synonym for evangelicals. There are millions of faithful American Protestants—politically conservative evangelicals, even—who vaccinate their children and do not elevate “oppositional positions toward the government” as a marker of spiritual fidelity. Indeed, many of the Americans she is describing have a penchant for individual spirituality rather than submitting to the strictures of organized religion. People often take religious exemptions from vaccine requirements because that is the only pathway of personal liberty available to them, not because their pastor told them to. Deeply held religious beliefs about the collective good, formed and taught in traditional faith communities, are not what discipled them to disregard expert instructions to vaccinate their children. They arrived at that decision because of deeply held beliefs that elevate personal autonomy and self-determination and intuitive decision-making above all.

The book reads at times like an autopsy following the death of our shared sense of the collective good. But it does not offer a bridge back together, even amid signs that the chasm is growing ever more devastatingly wide. (For example, some parents are now refusing the long-established Vitamin K shot, out of what ProPublica calls a “well-meaning but ill-informed abundance of caution.” The refusal can result in a newborn’s death due to being unable to clot if they experience sudden brain bleeding.) Shining a light on the beliefs driving the vaccine-hesitant movement is helpful to build understanding; but to bridge the divide, we need to do the same for the deeply held beliefs animating the other end of the spectrum as well.

Instead in those powerful places, where public health decisions are made, the loudest and most ardent experts often claim they just believe the science, though they frequently lack scientific curiosity about people who disagree with them. As Kieffer demonstrates, even the experts are making their own moral judgements. Admitting that, along with practicing some intellectual humility, would do more to help rebuild trust and recover vaccination rates than obstinately doubling down on strong-arm tactics. But that would be difficult indeed. As my own faith tradition teaches, you cannot force someone to love you. Genuine expressions of self-sacrifice and other-centered love are born only out of free will.