Stuck

by Heidi J. Larson

Vaccine reluctance and refusal are no longer limited to the margins of society. Debates around vaccines' necessity -- along with questions around their side effects -- have gone mainstream, blending with geopolitical conflicts, political campaigns, celebrity causes, and "natural" lifestyles to win a growing number of hearts and minds. Today's anti-vaccine positions find audiences where they've never existed previously.

Stuck examines how the issues surrounding vaccine hesitancy are, more than anything, about people feeling left out of the conversation. A new dialogue is long overdue, one that addresses the many types of vaccine hesitancy and the social factors that perpetuate them. To do this, Stuck provides a clear-eyed examination of the social vectors that transmit vaccine rumors, their manifestations around the globe, and how these individual threads are all connected.

Genres: Nonfiction, Science, Health, Audiobook, Medicine, Medical, Society

Audiobook

Published October 6, 2020

About the author

Prof. Heidi J. Larson is an anthropologist and Director of The Vaccine Confidence Project (VCP); Professor of Anthropology, Risk and Decision Science, Department of Infectious Disease Epidemiology, LSHTM; Clinical Professor, Department of Global Health, University of Washington,Seattle, USA, and Guest Professor at the University of Antwerp, Belgium. Dr. Larson previously headed Global Immunisation Communication at UNICEF, chaired GAVI’s Advocacy Task Force, and served on the WHO SAGE Working Group on vaccine hesitancy. The VCP is a WHO Centre of Excellence on addressing Vaccine Hesitancy.

Professor Larson’s research focuses on the analysis of social and political factors that can affect uptake of health interventions and influence policies. Her particular interest is on risk and rumour management from clinical trials to delivery – and building public trust. She served on the FDA Medical Countermeasure (MCM) Emergency Communication Expert Working Group, and is currently Principle Investigator for a global study on acceptance of vaccination during pregnanct; an EU-funded (EBODAC) project on the deployment, acceptance and compliance of an Ebola vaccine trial in Sierra Leone; and a global study on Public Sentiments and Emotions Around Current and Potential Measures to Contain and Treat COVID-19.

Reviews

[Emma Angeline · Rating 4 out of 5]

A necessary and accessible read. A more balanced, measured and empathetic explanation as to why people feel negatively towards vaccines. More relevant now than it’s ever been, and it’s not even about covid

[Rebe · Rating 3 out of 5]

Stuck is a rather short book at 127 pages, not counting the notes at the back. There is also an introduction of about 30 pages, so let's say 150 pages. Despite that, it took me several days to finish it. I struggled with Larson's writing, which is thorough and intelligent and a lot more diplomatic that I would be on this subject—but not very engaging. There's also the occasional typo or other small error that a good editor should have caught.

Mainly, though, it's just such a frustrating subject. I am strongly pro-vaccine, pro-science, etc. I have no sympathy for anti-vaxxers and struggle to comprehend what mental world they're living in. As Ethan Lindenberger (a pro-vaccine activist of anti-vax parents) put it, "There are misinformed ideas that there is even a debate around vaccines. That's not true. The debate around vaccines is a lie. That is misinformation in itself. The science has decided vaccines are safe and effective. Legitimizing the idea that there is a debate around vaccines is dangerous, it is a problem in itself."

This book tries to explain the causes and stories behind vaccine rumors, including by providing examples of various anti-vax rumors and campaigns. Reading about these events can be infuriating. For example, Larson describes how, in Kenya, a group of Catholic bishops who didn't appreciate not being consulted by a polio vaccine campaign responded by discouraging followers from getting the vaccine. To think of the harm they're causing and for what reasons, and to think how hard scientists worked to invent this much-needed vaccine in the first place and how bad polio can be... I found myself having to put this book down a lot to go take some deep breaths.

Ultimately I am glad I read this book. Larson debunks the view I had held, that all it takes to handle anti-vaxxers is a good dose of true scientific information. As her book reveals, the real causes of anti-vax sentiments are more complex, and so must be our response.

One big factor is the human communication element of vaccination. "Vaccine acceptance is about a relationship," Larson writes, "about putting trust in scientists..., industries that produce [vaccines], health professionals who deliver them, and the institutions that govern them. That trust chain is a far more important lever of acceptance than any piece of information" (xxxv). I learned from this book that the way doctors handle a patient's doubts and questions about vaccines can be so, so important. Apparently some people who feel unheard or dismissed or disrespected by their doctor become suspicious and turn to anti-vax resources for answers instead (yikes).

A lot of these resources are online these days, but you can't just blame it on social media. Larson argues that this is bigger than social media. In a physical sense, the reach of anti-vax propaganda extends beyond social media to billboards, pamphlets, etc. More abstractly, anti-vax sentiment is not a fluke; it's tied to a lot of other schools of thought, like homeopathy, distrust of government, and a broader preference for anti-chemical, organic, natural products. I found this passage especially interesting:

There is something powerful, almost religiously compelling for some, when it comes to trust in nature. When disease happens 'naturally' it is somehow more acceptable and begets less guilt than would any potential side effects from a vaccine. Psychologists call it the 'omission bias,' where choosing *not* to take an action, such as not getting a vaccination and instead letting nature take its course, feels like a lesser risk with less culpability, even when that action would ultimately reduce a greater risk.

As you can see from this, the decision not to vaccinate is not just a result of faulty logic or poor research skills. It's also got a strong emotional pull for some people, especially from a "natural lifestyle" perspective. Apparently a lot of misinformed anti-vaxxers think the body's immune system is enough and it would be better to expose their kids to, say, chickenpox than give them the chickenpox vaccine because that way it's more natural. This line of thinking is especially appealing in an age where we don't regularly see the awful effects of the worst viruses—vaccines work so well that these viruses are rarer and seem like more of a distant or abstract danger.

Then on the other hand, you have people who are not anti-vaxxers, simply people who are too complacent about certain viruses because the virus is too ordinary. Larson uses the example of the flu shot. People are really not scared enough of flu, considering how bad it can be and how many people it kills every year. A lot of people who are not anti-vaxxers just don't bother to get their annual flu shot. Larson includes a sad anecdote here about one young woman who died of flu after not bothering to get her flu shot.

One of the more bizarre aspects of vaccine rumors is the phenomenon of psychosomatic vaccine reactions. That is, sometimes a group of vaccinated people will all come down with similar symptoms that are caused not by the vaccine but by anxiety about the vaccine. I found it particularly ironic that one type of anti-vax "vaccine danger" is actually caused by anti-vaxxers stirring up fear, not by the actual (safe) vaccine.

Larson's conclusion is arguably the most powerful and eloquent part of the book, especially this passage:

A Babelian mix of truths, partial truths, and intentional lies has taken a toll on public trust in science. Waning vaccine confidence, skepticism about the safety and even the need for vaccines, and an overall tectonic shift away from trusting 'experts' to having more confidence in the opinions and 'evidence' shared in stories circulating among neighbors, friends, colleagues, and online social networks speak to a near reversal of the Age of Enlightenment... There is widespread trust in anything natural, tangible, and untampered with by modern man... As epidemiologist Stephen Ledeer rightly points out, 'Facts are not rejected because they are seen as being wrong, but because they are seen as being irrelevant' (117).

Ignorance is scary, especially mass ignorance.

While Larson doesn't think we can eradicate anti-vax beliefs, she does point out the problems that fan the flames of these rumors and explain why it's so important to work on the anti-vax problem instead of dismissing it, as I tend to do, as a fringe group of ignorant people. The issue goes beyond the health of the individual. We have a "planetary vaccine dependency" (126). And vaccine acceptance can be seen as a measure of the health of a society:

The quality of life that most of us enjoy today is dependent on vaccines. In many ways it is one of the biggest worldwide social experiments in collectivism and cooperation in modern times. The challenge is that it depends on a social contract whose fabric is eroding in a broader context of anti-globalization, nationalism, and populism (126).

In light of that, I hope more people will read this book, especially anyone who wants to understand anti-vaxxers or try to make a dent in their numbers.

[Scott Pearson · Rating 4 out of 5]

A casual perusal of social media will demonstrate an active debate about vaccines in contemporary society. Many cite (relatively rare) side effects and disregard abundant scientific studies about vaccines’ effectiveness; these people argue that they should have a “choice” over whether to admit a vaccine in their bodies. They do not heed arguments that herd immunity protects the herd better – that eschewing vaccines hurt us all.

In this sociological work, Larson addresses how these rumors take root and why they persist. She looks at the historical roots of these arguments, which date back to the earliest vaccines by Jenner. These arguments have only multiplied in the cyber age, where social media blindly amplifies any message, regardless of its truthfulness. Despite the overwhelming support of science and evidence, vaccines questions persist, and Larson finds that this persistence stems from people feeling “talked down to” by the medical establishment.

At times, this book can appear encyclopedic – that is, it describes event after event without a corresponding narrative of ideas. It tends to report and list instead of expositing and dissecting. However, Larson does a thorough job and makes a broad argument. She argues that social media tend to make rumors a social “contagion” that quickly take root among people. This contagion combines with existing belief systems (like religion or politics) to take abiding root.

I would also like to see Larson dive deeper into the psychology of anti-vaccine sentiment. Why are people so opposed to something that mainstream science has reported as good and that human history has shown to be good? “Natural” anti-modernism has wedded itself to modern media to distort reality. Larson shows instance after instance where this takes place, but I wonder why she doesn’t dive deeper about how it persists.

Overall, this is a relevant topic worthy of academic exploration. It’s nice to have all the history compiled in one place. However, the theoretical analysis is somewhat lacking. I’d like to see Larson take more courage to share her individual perspective while poring through these events. The policy proposals, abbreviated though they appear, are not presented until the very end of the book. Why not empower the reader to see the application earlier? This topic is important and needs a direct voice to address the reading public.

[David · Rating 4 out of 5]

Excerpts:

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Personal stories and emotional testimonies have become the new landscape of "evidence," capitalizing on the increasingly visual modes of social media, with highly emotive videos trumping dry scientific press and going viral more quickly than health officials could make sense of.
. . .
Patterns of rumor spread — the sharing of unverified information fueled by emotions, values, and beliefs — are signaling the need for very different strategies for engaging publics.

----

But science alone is not going to change the minds of those with strong beliefs. Changing fertile ground over time is another key factor in determining whether rumors thrive or hibernate, hiding like viruses until opportunities arise to reproduce and spread. Underlying histories that have seeded distrust or states of political or social turbulence or conflict can create a readiness to leap on to rumors that confirm already underlying suspicions.

----

Wakefield's appeal to the emotions of parents, listening to their views and giving them a sense of dignity, has won his followers. His "you know best" message appeals to his followers
. . .
scientists must take care not to treat fear and reservation as ignorance and then try to destroy it with a blunt "rational" instrument.

----

Vaccine resistance fits perfectly into populist agendas. It is an exemplar of what populism is all about. One analysis of the links between vaccine confidence measures and populism in Europe found significant correlations between the proportion of the electorate voting for populist parties, and the percent of people who reported low confidence in the importance, effectiveness, or safety of vaccines. The study goes as far as concluding that "popular distrust of elites and experts that seems to inform vaccine hesitancy will be difficult to resolve unless its underlying causes - an iniquitous economic system and unrepresentative political system, are addressed".

----

The quality of life that most of us enjoy today is dependent on vaccines. In many ways it is one of the biggest worldwide social experiments in collectivism and cooperation in modern times. The challenge is that it depends on a social contract whose fabric is eroding in a broader context of anti-globalization, nationalism, and populism.
. . .
It remains to be seen whether Homo sapiens will make the necessary adaptations socially and scientifically to sustain and extend the remarkable success of immunizations during this past century.

----

[Linda Anderson · Rating 4 out of 5]

There were so many excellent concepts and new thoughts about why certain groups of people are against vaccines. The author approached the topic as an anthropologist, which is a fascinating area for me. She actually completed the book before the Covid pandemic started, therefore, only her prologue discusses Covid. She tells stories of why groups of people over the world reject vaccines. While she encourages vaccines, she also appeals to humanity for kindness, empathy, understanding and cooperation.

[Dafna · Rating 3 out of 5]

I was mildly disappointed by the book. After reading the Introduction and listening to the author speak at an event, I was fascinated by her idea that vaccine rumors are not necessarily a bad thing and you have to treat a rumor as an ecosystem. Unfortunately, the book did not go further than this claim. It is too descriptive and not analytical enough as for my taste. I was also wondering how we can put Larson’s approach to vaccine rumors to practice and I never got an answer from this book. Finally, relying on the studies of mass psychology that were done by Le Bon in the late 1800s and seriously quoting them seemed to me as a bad idea: after all, those studies are more than a century old and not quite scientific. It also seemed a bit unprofessional for a trained anthropologist to rely on such studies when there are quite a few good anthropological studies of rumors that are not only more methodologically sound but also more recent and theoretically and contextually grounded.

[Wendelle]

This book was written, serendipitously, before the pandemic dropped on the globe. It is interesting because it looks at the psychology and anthropology of vaccine-hesitant people and anti-vaccine movements and observes them not as points of isolation but, as fitting for an anthropologist, as parts and parcels of ecosystems. For instance, looking at vaccine rumors as parts of ecosystems allows the author to deduce the new ecosystem of authorities and influencers on social media, where the stock of traditional authorities such as scientists and government officials fall and the outsized credibility of other commentators, such as right-wing media personages, opportunist populist politicians or religious leaders, are on the rise. Secondly, looking at anti-vaxxes as part of an ecosystem or milieu makes the anthropologist realize that it is not enough to just provide vaccine facts and reason. Instead, the anti-vaccine movement is concurrent with the backlash against 'elite' science, against big government, and against mass industrialization and the influence of multinational corporations on personal lives. Thus, anti-vaccination is partly wrapped up with the desire to go back to what is natural (homeopathy, just get sick naturally, etc.) and to living independently (protect oneself with one's own guns, being libertarian, going off the grid, fearing 5G tracking and chip-implanting with vaccination, fearing vaccination is a disguise for mass sterilization, etc).
This is a very thoughtful illumination of the milieu we live in and the more comprehensive set of attitudes of distrust, self-selection of authorities to listen to, and independence. This is a worrisome state of affairs because as the author says, preventable outbreaks such as measles now erupt in developed and developing countries due to the chilling effects of networked vaccine resistance, and people who tout the 'natural' movement do so with the privilege of not knowing what it's like when a virus does its natural rampage, such as in polio or the Spanish flu epidemics.
My main criticism of this book is that it does not do enough or state explicitly enough that science is not just one among many voices, but is as excellent a source of knowledge as humans could possibly devise. Instead, this book seems to me to not be strident enough and to allow readers to cultivate murky sympathies, since the book is presenting the battle of scientists as a battle for contested protection of their authority, giving the anti-vaxxer Andrew Wakefield too much air time, and saying repeatedly that 'vaccines also have their dangers' thus potentially lending a sort of false equivalency to vaccine dangers and anti-vaccine dangers for receptive anti-vax readers when no such equivalency exists. Still, this is a good book to read to understand the anti-vaxxer mindset.

[Laura · Rating 2 out of 5]

"(...) vaccines are a poignant example of a modern medical success where excessive confidence in the technology has overlooked the vulnerabilities it depends on, from pubic trust in governments and reliance on big business to assumption about societal cooperation."

This is not a book trying to convince you that vaccines are good. It's a book taking a rather detached look at how vaccine skepticism and rumors about presumed vaccine injuries spread. The author is clearly in support of vaccines but she's not preachy.

The book is well written, I just felt that it didn't really bring much new to the table. After all, it wasn't a big shock to read that:
"Individuals around the planet are 'living' new technologies now more than ever. Social media is ubiquitous even in the remotest, poorest corners of the globe. It has enabled as well as disrupted social life, it has had an impact on production, on knowledge sharing. It has allowed and disrupted democracy, and while being an asset to health surveillance and data sharing (...) it has taken an unexpected toll on global health."

It was interesting to read about young girls who had had dizziness and fainting spells prior to vaccinations. Once symptoms were reported also following a vaccine, more girls started having identical symptoms in what seems to be a nocibo effect or emotional contagion (as one of the doctors said, some of the face twitches the girls filmed didn't correspond to any motor injury/disease ever described - and I know what they mean, there are patterns of muscle movement, muscle and nerve deterioration determined by simple anatomy, but that wasn't explained in the book).
It was interesting to read about extreme fires in Australia and California, that were burning so hot their behavior became completely unpredictable and to see this compared to the extreme rumors spread by social media at much higher speed than ever before. But we already knew that social media amplifies users' emotions and creates echo chambers. I guess I expected the book would also hint at potential ways to address this problem, but it offered almost none. Maybe the problem was in my expectations.

Heidi Larson is right in pointing out that we're too focused on the numbers and we forget the social aspects of vaccination. After all, I'm not a vaccine skeptic, but I too fell pray to the Gardasil scare over 10 years ago, when the vaccine was recommended to girls in my native Romania, and as a result I missed the opportunity to get vaccinated at the opportune time.

So now, what do we do?

[Emily · Rating 3 out of 5]

The information was great, but by the end if felt a bit repetitive. It was a stretch making this a book (even a short one), though I understand why it is one. Most people won't go read a research paper on the topic, but they might pick up the book.

[Elizabeth · Rating 4 out of 5]

This slim but comprehensive overview of the history and current state of vaccine hesitation and resistance can be read in one sitting. "Stuck" does not discuss the science behind vaccines, but rather the social science behind why some are hesistant to vaccinate or refuse to vaccinate at all. Rumors spread via increasingly rapid and sophisticated tools for communication have lead to the situation we are in today: in the midst of a pandemic, with 25-30% of Americans saying that they will not take a vaccine that at this point is theoretical. Social media is a huge driver behind the increased vaccine hesistancy, in that it has allowed diverse groups such as the back to nature/homeopathy crowd to unite with populists over this issue.

There is some repetition between chapters (for example, Andrew Wakefield's story is told multiple times). What ultimately left me a bit unsatisfied is that the author lists all the things that do not work in changing peoples' minds (scientific evidence, shaming, removal of unfactual material from social medita, etc.), but offers little regarding what does work. There are some brief mentions of community outreach and cooperation with churches, but not much beyond that. The book was published in May 2020, but the manuscript was completed before COVID-19. The author did write a new forward which discusses the book in the context of the current pandemic, but based on what I see on local Facebook groups, one can only hope that there will be a follow up to this book with concrete solutions for moving people from vaccine hesitancy to acceptance.... it could be called "Unstuck."

[Pamela Usai · Rating 4 out of 5]

This is book is FASCINATING. It doesn't argue for vaccines per se (though the author is pro-vaccination), but it looks at how vaccine hesitancy has snowballed and highlights social issues that contribute to this (distrust towards medical establishments and intergenerational trauma, for example). It's a short, quick read, but extremely compelling and relevant - especially within the context of today's mass COVID-19 vaccination efforts.

[Carlin · Rating 3 out of 5]

i wish the entire book read like the last chapter did. overall informative and insightful; though there were some typos throughout that threw me off. some of the writing style was hard to digest and awkward, but it also read as very academic. not necessarily a bad thing, but i do struggle with that. i thought it was a perfect length.

overall i recommend!

[Steve · Rating 5 out of 5]

Excellent look at the persistence of vaccine hesitancy

This is one of those books where I was sad when the book ended and I had to say goodbye to the author. I enjoyed Heidi Larson’s engaging writing style and her clear, conversational tone. The book had started out with Larson citing research into rumors and I was not looking forward to reading a didactic book. I needn’t have worried. The research on rumors was just a setup for the rest of the book. This book is well worth the read.
Disclosure: I received a complimentary copy of this book via Edelweiss for review purposes.

[Andrei · Rating 5 out of 5]

Excellent review of mass psychology, motivations, and present day mechanics of opinion trends. In this case the trend analyzed is the widespread refusal of vaccination, its history, factors that influenced it and still do, as well as the factors that help propagate this refusal in society.
Well researched, documented, with good bibliography.
Concision and structure of the discussion are pluses of this scientific essay.

[Christophe Couckuyt · Rating 3 out of 5]

Interesting and well documented book. Provides good insights into what drives people who refuse to be vaccinated. However, it's not a lot of fun to read. There at far too many cases, examples and stories and often it feels like the book is just a sum of them, rather than a deep digging search into the mind and soul of antivaxxers. Still recommended though.

[Michele · Rating 5 out of 5]

Quick read (albeit repetitive at times) that I wouldn't have minded being longer and more in-depth! Really helped me have empathy for vaccine hesitant populations even though I strongly disagree with their logic and relationship with facts. I would've appreciated more of a checklist for the average person in how they can combat vaccine hesitancy in their social circles.

[Olwen · Rating 2 out of 5]

The author notes in the prologue that this book was published on the cusp of the COVID pandemic. So the text does not refer to COVID beyond the prologue.

A lot of background information is provided (although it's a slim volume). I feel that the final chapter 8 - Pandemics and Publics - sums up the pre-COVID situation well. Worth reading.

[Emily · Rating 4 out of 5]

Great thoughts and concepts - this could easily fill a 500 page book, but in its current short-and-sweet format is thought-provoking, rather than instructive, and I really appreciate that.
It needs some editing work for a number or typos and misprints, but otherwise is a great book I’d recommend to anyone and I will certainly be chewing on it in the back of my mind for a good while.

[Dee · Rating 4 out of 5]

It’s not just about the vaccines - anti-vaxxers have been around since vaccines started. It’s about fear, distrust, and feeling left out of the conversation. Debunking with logic and facts is not enough.

[Irene · Rating 4 out of 5]

Vaccine hesitance and resistance may be symptoms of larger societal information era distrust. Solution may be to acknowledge and appeal to emotions surrounding concerns and not to merely debunk specific rumors/misinformation.

[EricheBooks · Rating 5 out of 5]

I feel like it could have been longer, but I thought it was a great book. The case studies and the timing ensured this book lacked a sensationalist edge but gave some reasonable propositions for managing this aspect of public health (vaccine refusal).

[Ellen · Rating 5 out of 5]

Read for thesis! Really helpful study of the anthropology of vaccine-resistant movements, from MMR in the United States to HPV in Colombia. Strong background to start my research on response to the Covid vaccine. Wish it was longer :)

[Sakly Myriam · Rating 4 out of 5]

Read this for a class, it was comprehensive and dived in depth in the history of vaccine hysteria, despite being published around COVID times, the book only slightly references to it (thank god I was exhausted of reading and talking about the pandemic).

[Gabrielle · Rating 4 out of 5]

Information was credible but I wish the book would have went into more detail/was longer. It was very interesting to see an analysis on global pandemic scenarios in a pre-COVID environment and have the opportunity to compare that to our lived experience today.

[Shari · Rating 4 out of 5]

Great analysis of how health communication is an essential aspect of vaccination uptake. Written pre covid it offers a theory based look at what phenomena influence decision making and behavior change. Great read

[Sarah Holliday · Rating 4 out of 5]

I found this book fascinating and really helpful for understanding a perspective that is usually wholly vilified. The end got a little repetitive, but overall I think it did a great job at making some complex topics easily digestible.

[Ali · Rating 5 out of 5]

Excellent!

Thesis: Vaccine hesistancy and resistance is a proxy for larger geopolitical issues (ex. populist)

[Beth · Rating 2 out of 5]

Some interesting stories that supported points well. But overall not the depth I was hoping for especially the not going away portion beyond social media spread.

[Joanne · Rating 4 out of 5]

Really interesting book about the history of vaccines-actually published right when COVID started.

[Heather Lanthorn · Rating 4 out of 5]

A lot of neat & important information. Still working through whether it has helped me understand something new or think in a new way.