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Elena Conis, PhD, MS, MJ, is a writer and historian of medicine, public health, and the environment at the Graduate School of Journalism at the University of California, Berkeley. Her current research focuses on scientific controversies, science denial, and the public understanding of science.

On Friday, September 9, at 12:00 PM ET, Dr. Conis will join the UNC Center for Bioethics for our Merrimon Lecture series to give a talk titled “Vaccination and Its Historical Discontents: The Long-Term View on Skepticism and ‘Personal Belief Exemptions.’” We were honored to speak with Dr. Conis for a quick insight into the historical precedence of vaccine skepticism.


What do you understand to be the roots of contemporary vaccine hesitancy?

The number one thing to know about vaccine hesitancy is that the phenomenon is as old as vaccination itself. Vaccination resistance has generally reflected concerns about the power of the state, about health risks of vaccines themselves, and how the act of vaccination interacts with people’s religious or spiritual beliefs. I call these the three R’s of vaccine hesitancy: Religion, Rights, and Risk-based concerns.

We’ve had vaccination resistance and hesitancy for hundreds of years, but in recent years we’ve seen two emerging factors: an expansion of the articulation of these concerns and increased use of vaccines and vaccine mandates. Both of those have given us more opportunity to field more resistance from the public.

What made the hesitancy and skepticism towards the COVID-19 vaccine so widespread? Are there any historical parallels?

There are some simple explanations and not-so-simple explanations. One of the easy answers is that vaccination resistance in this country had been growing for decades by the time we developed a COVID vaccine. Secondly, we really haven’t seen this speed or scale of vaccine development and implementation. And third, we fairly quickly turned to mandate policies that required people to be vaccinated in order to engage in some aspect of public or civic life.

Previously, we had been relying mostly on vaccine mandates for school and a limited set of professions. But with the COVID vaccines, we saw a number of companies in the private sector requiring vaccination for employees. This is something that came on the tails of growing resistance and applied to a very quickly developed and distributed vaccine. So, we were poised for a lot of resistance to this vaccine, and political divisions in this country plus the existence of groups and influential politicians who very vocally expressed their skepticism about the reality and severity of COVID helped amplify it.

How have your thoughts on vaccine hesitancy and the culture/conversations surrounding vaccines evolved since your 2015 book Vaccine Nation? 

I would say that one of the things that I have tried to practice since publishing Vaccine Nation is empathy and understanding toward people with vaccine hesitancy. We are living in an era in which there is a lot of stigmatization and moralization around attitudes toward vaccination and not a lot of understanding toward people with fears and concerns about vaccines.

In recent decades, the scientific community had developed a habit of approaching the vaccine skeptical as if they just needed more education, or just needed to fall in line. Neither of those approaches respect the very real feelings that those with vaccine concerns are grappling with. Empathy, I believe, can take us some distance toward a shared understanding and cooperation when it comes to fighting pandemic diseases and other public health problems.

What questions are you currently asking in your research about science denial and hesitancy? 

I’m really interested in the in-between spaces that haven’t gotten a lot of attention when it comes to thinking about science denial. There are actors who deliberately obfuscate scientific truths solely to support their own personal ideology—not, for instance, because some corporation is paying them to do so. Some of these actors have had a tremendous influence over the public’s understanding of science in the last half-century. To me, this means science denial isn’t simply a manifestation of ignorance or a product of corporate machinations. It’s a function of our culture and politics.

The second thing that I’m looking at now is how the evolution of pathogens and transitions in our species’ relationship to pathogens changes how we see and think about diseases in different places, in different moments in time, and how all those shifts interact with the political, cultural, and social realm to shape how we prioritize certain public health problems.

What topics will you go over on your September 9 Merrimon presentation? Are there any topics/audience takeaways in the presentation that you think are especially significant?

In Friday’s talk, I’ll highlight the historical endurance of vaccine hesitancy and how we in the U.S. have managed the phenomenon over time — because we really have managed it in an almost uncountable number of ways for more than 200 years.

I’ll also talk about what it means when we have, in the past, framed diseases as “vaccine-preventable.” From the moment COVID arrived in this country, we talked about vaccination as the thing that would help us get this pandemic under control. That framing of COVID reflected a number of assumptions about the power of vaccination that were based selectively on historical experience. I’ll talk about how history set us up to be justified in those assumptions — but also more cautious.


For more information about the September 9 webinar, and for the link to join, please visit the UNC Center for Bioethics Calendar.