by Emma Brown (New York University)
On March 11, 2021, the Culture and Contemporary Life Talk Series hosted “Vaccinations in the Age of COVID,” a panel which discussed what cultural sociology uniquely reveals concerning the development and distribution of vaccines as well as the public reception of vaccines. Panelists Claire Laurier Decoteau (University of Illinois Chicago), Jennifer Reich (University of Colorado Denver), and Laura Mamo (San Francisco State University) were joined by moderator Margarita Rayzberg (Cornell University).
What does your work reveal about the role of culture in vaccine development and vaccine distribution?
JR said that since the polio era, we have lived in a landscape where most infectious diseases were seen as solved. In her research, she has found that a lot of the concerns around vaccines and distrust come from the complicated relationship between for profit pharmaceutical companies and the state as an institution of both regulation and enforcement. During the COVID era, this relationship come into sharp relief in ways that are really unusual, like people having the names of manufacturers of vaccines, and it’s a really different way of thinking about how people are interpreting science and the relationship between state and capital and trying to make decisions for themselves.
LM pointed to the paradox of biomedical culture, and the recent shift of vaccines being targeted to consumers and reframed as drugs that consumers can choose to opt into. She discussed the individualization of medicine as culture and how it reveals and produces inequities. It is also important to look at the political moment this exists within, particularly with Trump and the era of knowledge contestation.
CLD discussed vaccine hesitancy and the way that the media presented hesitancy among certain cultural groups as homogenous, reproducing a particular cultural deficit model around vaccines. However, hesitancy is often more tied to one’s relationship to the state, experts, and science than culture. She noted that vaccine decisions, for example in the Somali American community, are very context-specific, and cautioned painting groups with broad cultural brushstrokes. There is also epistemic injury involved, where people’s understandings of their own experiences are systematically denied by experts, which creates more feelings of distrust.
What do you think about the debate about vaccine prioritization? What does your research tell us about the possible models and logics of distribution that are available, but that we’re not seeing in this moment?
LM described the fragmentation of our healthcare system and the failures of the rollout being tied to the complex politics playing out between the private and public actors involved.
JR noted that the people at the center of these social determinations were medical doctors who had two goals, saving lives, and preserving social function. These goals identified two completely different subpopulations, and these decision makers also took a colorblind approach. Further, there was no common vocabulary about ‘risk’ and whether prevention was related to exposure or disease severity. These disjointed and tone-deaf processes are partly why so few states have adopted the CDC guidelines. Ultimately, the prioritizations were set in ways that were almost impossible to actualize. The defunding of the ‘public’ in public health and translating it into corporate and neoliberal partnerships set up the rollout to fail. It was designed to magnify the inequality we already had, and therefore, that’s what’s happened.
CLD discussed the reception of the rollout from her research on three different populations. Many residents have raised the unequal vaccine distribution as evidence of disinvestment in their communities. Many Black and Latinx residents, in particular, have said they will “wait and see” about getting vaccinated, since the vaccine was developed under the white supremacist Trump administration.
JR added that the vaccine distribution issue we are facing today (scarcity) will eventually give way to another problem: distrust among the communities who are not yet vaccinated once there are enough doses for everyone. The early inequities in the rollout could have great impacts on future vaccination efforts, because knowing someone who has received a vaccine is a good predictor of who wants one and how people understand who these technologies are for. In other words, the disparities in the initial rollout will likely become amplified over time.
What tools does sociology have to interpret vaccine hesitancy in different communities?
How we interpret the distrust of the state in groups that have very different historical trajectories? Is it the same or is it different?
CLD noted that vaccines are a biopolitical project, so whether you feel included in the body politic impacts whether you are willing to buy into the logics of herd immunity, etc. Anyone subjected to state violence has a harder time believing the state is concerned with their best interests. Also, people’s experiences with doctors and other local healthcare providers are important to understanding hesitancy and community levels of knowledge and trust. Many people are not opposed to the vaccine but are waiting for more information before making a decision.
JR does not necessarily believe that public health exists anymore because it focuses on personal behavior modification rather than community solutions. She raised the concern of what will happen when the private sector starts to take ownership of public health, like enacting vaccine requirements. She clarified that vaccines are not the problem but rather corporations which are driven by their interests instead of by the public good or worker advocacy.
LM underscored the consumer-driven message of public health and problematized how the vaccine is being sold as a personal choice by private companies who are taking control of knowledge and education around healthcare.
What are the sources of information that the groups that you all study are using? How do they determine the trustworthiness of different sources of information? What are the legitimate sources of expertise that they turn to when thinking about vaccination?
LM discussed her research on HPV to highlight the biomedical culture models being enacted in conversations among healthcare professionals about COVID, including vaccines, testing, and screening tools as preventive care.
CLD added that the infrastructure of contact tracing, which was highly ineffective, is now being used to disseminate information about COVID vaccines. Yet people remain distrustful of the contact tracers and city efforts. Cuts to social networks like ICE raids have also impeded trust building in communities over the past year.
JR spoke to the fact that doctors are now seen as one source among many for healthcare information rather than the ultimate authority, as they were in the past. She explained that the medical education model of decision making is not effective because people’s decisions are guided by more than just what they know. Tension exists between efforts to combat misinformation and the perceived irrationality of not following medical advice.
The first audience question was about how the COVID vaccines are described as a consumer good, and how the language of choice plays into a culture where we think about ourselves as consumers of health information.
LM pointed out the shift in drugs and vaccines from public health measures to prevent life-threatening disease to being marketed for non-life-threatening conditions as consumer goods. It also has to do with deregulation of the industry, particularly in direct advertising to consumers.
JR spoke about how historically, there were only a few vaccines which were created when national solutions were needed. As time went on, parents started associating children’s illnesses like seizures and autism with vaccines. The result was that in the 1980s, people began speaking back to medicine and growing distrustful. She argued that vaccine resistance is not unique in medicine but rather a product of a movement to question healthcare systems. Social activism changed how we think about risk and prevention in ways that have had both positive and negative consequences.
CLD echoed that vaccine decision making is emblematic of other healthcare and parenting strategies that involves doing personal research and making informed decisions on medicine and science more generally.
The second audience question was about the global politics of vaccine distribution and diplomacy.
CLD discussed how the global inequalities that have arisen in vaccine distribution are unsurprising, and that COVID may have longer term effects on the global South because of vaccine distribution but also economic and structural inequalities.
JR noted that while we have proven that fully funding science gets results, we simultaneously lost the opportunity to allow people to feel like they had ownership of the products that came from these public investments. This has made clear from the perceptions of their rollout. Two problems have emerged: the US was initially not going to participate in the global vaccine access effort, and the narrative remains that vaccines are intended for certain people or certain countries. Around the world, the relationships between the state and the pharmaceutical industry create distrust among citizens, and this will be important for the shift from pandemic to endemic — a virus we live with.