Vaccinating vaccines: Ethnography and the info-politics of public health

DAN ARTUS

What exactly can an ethnography of vaccination hope to achieve? And how could one be undertaken? Although any given individual is likely to have received multiple vaccines throughout their lifetime, the act of administering one is typically extremely quick via injection, oral drops or even a nasal spray. Moreover, it occurs in specific settings (healthcare institutions and schools) that can be challenging (logistically and ethically) to set research in, let alone undertake the kind of long-term participant observation that makes up the core of ethnographic research. An additional challenge for ethnographers is that when vaccines do work, their success is largely invisible. They are of interest, transformed into a ‘matter of concern’, by a reluctance to take them[1]. The term provided by the WHO is ‘vaccine hesitancy’:

‘Vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence’ (MacDonald et al. 2015, p.3).

If vaccines become an object of public interest when people refuse to take them, how does this position an ethnographer? That is, if vaccines become an object of interest via vaccine hesitancy, does it then follow that ethnographic research should have the purpose of raising uptake of (or trust in) vaccines? This is a risky framing for research that relies on the trust of participants. In the context of vaccines, people’s reasons for being ‘hesitant’ become problems to be solved or a type of ‘informational disease’ to be cured[2]. There is a notable hostility against ‘antivaxxers’, alongside a marked hostility to asking questions or expressing anxieties about vaccines (lest one be seen as ‘antivaxx’). Leaving aside the question of particularly esoteric conspiracy theories (population control or reduction) or ‘bad faith’ objections (people profiting from selling alternative treatments) a number of people, in good faith, want the best for themselves, their children and the society they live in. The Nigerian Polio Boycott in 2003 is an example of particularly complex factors; a misalignment between global health priorities and the local healthcare economics, corporate scandal, the geopolitical backlash of 9/11 and even the legacy of British colonialism (Ghinai et al 2013; Jegede 2007; Rene 2006 ). In the context of my own work in Ireland[3], many parents believe that their children have been seriously injured or disabled by the HPV vaccine. They explicitly reject the label ‘anti-vaccine’; instead casting themselves as advocates for increased vaccine safety and support for those that they believe have experienced vaccine injury – I refer to them as ‘Vaccine Safety and Injury Activists (VSIA)’. They routinely receive harassment and abuse online, as well as high-profile public condemnation. Yet some sections of the same community abuse public health workers in kind; from the nurses that administer vaccines to the office staff responsible for other hidden aspects of the ‘day-to-day’ in public health.      

I can only speak to the approach I have taken and the factors that I have noted – my fieldwork truncated by COVID, as it is[4]. In the first instance, vaccination requires careful choices to study – its successes are invisible, made interesting by its absences or disputes about seeming unintended consequences. I have chosen two ‘sites’; work with public health professionals in their offices and place-based ethnography around the community I live in in Dublin. My ‘third’ site is fragmented, wherever I can find VSIAs who are willing to talk to me. I find my own epistemic, ontological and ethical commitments challenged at nearly every turn. As an academic, married to a doctor and affiliated with the Vaccine Confidence Project it is easy to assume that my motivations and position are a mirror of those in public health. Contrarwise, anthropology is a critical discipline, having a doctrinaire sympathy for those in marginal positions. One of the most uncomfortable questions I have had to engage with is what this means in working with VSIAs. Their day-to-day experiences put them in a margin, yet it is widely seen as an acceptable margin. ‘Antivaxxers’, as has been stated, are not well-loved in the name of public health and fighting disease. I am radically unqualified to say that their loved ones were – or were not – injured by a vaccine. I chose early in my study to proceed with a methodological agnosticism that cuts both ways and reveals uncomfortable truths. It is easy to feel powerless to speak when you realise that much of your beliefs are sustained by trust in the makers of the web of technical objects that make up our world. With the increasing medicalisation and datafication (van Dijk, 2014) of day-to-day family, homes and bodies are ever more subject to invisible expert scrutiny and the notion that there is a clear ‘right answer’ to quotidian problems. It is at once a politicisation of intimate spaces through the de-politicising work. I am indebted to one participant for describing me as ‘on balance, pro-vaccine’. That there is a balance to be considered – whatever way it may swing, even if I am not qualified to weigh or measure it – is often enough.

If it is perceived that the norms that sustain public trust in vaccines are somehow failing or being challenged – a belief in Science, trust in doctors – then a study that proceeds on the basis of those norms risks undermining them further. Rather, I have chosen to interrogate the information ecologies of HPV vaccine in Ireland, sitting as close to the ‘sources’ of them as possible with an eye to how government and activist information mixes in the ‘mangle of practice’ (Pickering 1993). Ann-Marie Mol (2003) speaks of how atherosclerosis is rendered multiple through different practices, sometimes conflicting and at other times coinciding yet still ‘hangs together’ as a semi-coherent thing, allowing treatment and diagnosis. Her methodology has been an inspiration – yet with HPV vaccination, the struggle is decidedly more volatile. Things less ‘hang together’ than fall apart and periodically explode. Despite this, the situation begs similar questions as to who can speak, of insisting that social analysis occurs as more than an addendum to ‘harder’ forms of knowledge. Information, data, and facts are political entities as well as representational ones. Whether we like it or not, social and natural science are in the same room. An anthropology of vaccination finds itself in the room with these questions; big and small. Its reflexivity, nuance and conceptual flexibility are critical resource in understanding not just the vicissitudes and day-to-day realities of vaccination, but the wider schisms and conflicts that shape the world we live in.

ABOUT THE AUTHOR:

Dan Artus is a PhD candidate in Anthropology at University College London. His current research ethnographically explores the complex dynamics of vaccinations and public health campaigns in Ireland and the UK, and the associated phenomena that constitute the messiness of public health and immunisation in everyday life. He has also engaged in projects for UCL’s Extreme Citizen Science Group (ExCiteS), worked with the Ada Lovelace institute exploring the ethics of predictive data analytics in local government and is editing a volume on the themes of gender politics and patriarchal masculinities.


[1] There are large instances of vaccine hesitancy, or crises of vaccine confidence. Perhaps the most famous is the MMR controversy, focused on the potential linkage between the vaccine (or more specifically, thimerosal, an adjutant in the vaccine) and autism. The Omnibus Autism Proceedings (OAP) were held in response to a huge number of court claims in the vaccine court. The ‘test ‘cases trialled in the OAP would set the precedent for whether or not the link was viable. The hypotheses for the link put forward included, but were not limited to, those of Andrew Wakefield. See Kirkland 2016 for more analysis of the OAP. 

[2] The WHO published a piece titled ‘Immunizing the public against misinformation’, looking at the ‘UN Global Pulse’ team that engages in extensive social media listening to track rumours about the COVID pandemic. The term ‘infodemic’ and the emerging language of ‘digital epidemiology’ looks at

[3] My research explores a significant dip in HPV vaccine uptake in Ireland (Corcoran, Clarke and Barrett 2018). This was in turn part of a multi-national drop in HPV vaccine uptake (e.g. Simas et al 2019), linked to the circulation of viral videos depicting what were believed to be significant adverse reactions to the vaccine.

[4] The irony of a global pandemic interrupting fieldwork on vaccination is not lost on me.

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