Update: The vaccine hesitant are a group that has steadily shrunk over the last few months, with New Zealand hitting 90 percent of its eligible population fully-vaccinated on 16 December. The Government has stuck to its guns with pushing vaccination as New Zealand’s best protection against the virus.

Opposition to vaccines has been around for as long as the modern vaccine itself, but as New Zealand’s vaccine rollout works its way through the willing, hold-outs present a new problem for health officials

As Auckland’s lockdown drags on and frustration over international border closures reach a fever pitch, many New Zealanders are wondering what lies ahead for the island nation in a pandemic world.

Prime Minister Jacinda Ardern has long referred to the toolbox of things the Government and people of New Zealand can do to combat the virus – but more and more these days, the tool reached for is the Pfizer vaccine.

Most of New Zealand is ready to do what it takes to get a bit of certainty, with recent research showing 86 percent of eligible Kiwis have had their vaccine or intend to.

But that leaves almost 700,000 people who, for whatever reason, don’t want the jab.

It’s not a new thing.

Vehement opposition to vaccination can be traced to detractors of Edward Jenner, father of the modern vaccine, who realised in 1796 that exposure to a small amount of cowpox could protect a person from smallpox.

At the time, the disease, known popularly as ‘the speckled monster’, was killing 400,000 people across Europe a year, and leaving a third of the survivors blind.

It was a well-known fact that dairymaids were less likely to come down with smallpox – named so to differentiate it from syphilis, which was known at the time as the great pockes. Jenner had a theory that exposure to the pus-filled blisters of infected cattle was giving these women some kind of preemptive safeguard against the disease.

He took the eight-year-old son of his gardener and tested his theory with methods not for the squeamish. This involved getting hold of a dairy worker who had contracted cowpox from a cow named Blossom, and scraping the blisters on her hands in order to collect infected pus. He then made a few scratches on the boy’s arm and rubbed the pus into them.

It must have been a revolting scene – but his guinea pig James Phipps went on to a life without fear of contracting smallpox, and humankind was granted another weapon in its arsenal against the infectious and microscopic.

Oil painting by Ernest Board from 1796 of Edward Jenner inoculating eight-year-old James Phipps from smallpox. Photo: Wikimedia Commons

Thankfully, the entire procedure is a little less stomach-churning these days. Perhaps it stands to reason that some people found the whole process and concept controversial at the time. Jenner’s first description of the experiment was rejected by the Royal Society of London, England’s national academy of science, and his later self-published pamphlet was met with some raised eyebrows from the medical community.

Laypeople were less than certain about getting inoculated, too. Low health literacy and facing the choice to get vaccinated without centuries of hindsight showing the success of vaccination in protecting humans from disease left some Britons fearful and angry.

In 1885, almost a century on from Jenner’s discovery, thousands of vaccine-opposed citizens marched through the streets of Leicester, holding an effigy of his body with signs declaring him a child-slayer.

Today, widespread smallpox vaccination means the descendants of the protesters can go about their lives without fear of the speckled monster – the only extant smallpox specimens prowling tiny jail cells in a laboratory in Russia and Atlanta, Georgia.

But even with the 20/20 hindsight of success in humanity’s war with smallpox, vaccine hesitancy remains an epidemic of its own.

In New Zealand, just how to convince the remaining hold-outs who have shied away from the vaccine rollout has become a daily brainstorm for politicians and media commentators.

Sir John Key reckoned a $25 voucher ought to do it. Director-General of Health Dr Ashley Bloomfield has repeatedly stated that getting to go back to life as usual is its own incentive, and offered such dangling carrots as a night out on the town and international sports matches if Kiwis all get the jab.

Prime Minister Jacinda Ardern has put it plainly that vaccination is New Zealand’s best chance to escape future lockdowns – with not just a single imperative instruction, but one echoed three times. “Vaccinate, vaccinate, vaccinate,” she told New Zealand earlier this week.

Surveys from Horizon Research conducted shortly after New Zealand found itself back at Level 4 last month showed most Kiwis are happy to follow that instruction – but just who are the near 700,000 who fall outside of that description?

Horizon’s findings paint a picture of the vaccine-hesitant. The average Kiwi who said they were unlikely to get a vaccine could be either a man or a woman. They are slightly younger than the average age, with both household and personal income lower than the average. They are likely Pākehā, and less likely to have a job or university qualifications. More often than not they will live in the regions rather than the cities.

According to Horizon, the upper North Island DHBs excluding those in Auckland are the most likely opposition hold-outs, with findings pointing to the Bay of Plenty in particular.

On average, they are more likely to live in a two-parent household with one or two kids.

So not to single anybody out, but as a sort of thought experiment, one could imagine a 35-year-old Pākehā father of two in Whakatane. He earns $54,000 a year, and if asked, might have a few different reasons why he’s Pfizer-skeptical.

The survey asked people who were unsure or unlikely to get the vaccine why they felt that way, and found some shared reasons floating to the top of the list.

Chief among these was believing it is too soon to know if there are long-term effects, which two-thirds of people not planning to get vaccinated believe.

Next was wanting more assurance of the vaccine’s safety, wanting to see if others suffer side effects, and worries the vaccine may prove ineffective against new variants.

The survey also took a look at common thoughts that had occurred to anybody yet to get vaccinated. As can be seen in the chart below, concerns about side effects came out as the most frequent.

It can be easy to overlook factual evidence when one is worried about personal safety – this is why many people are uncomfortable with opening umbrellas inside, or why school children take care to hop over cracks in the pavement. The nagging worry that we may do something to inadvertently doom ourselves or our young ones is capable of convincing us not to look at the numbers – maybe to find that the luck of mirror-breakers is about the same as everybody else.

According to the Centers for Disease, Control and Prevention, of the more than 363 million doses of Covid vaccine given in the United States between December 2020 and August 2021, 0.0019 percent resulted in a death. And as the FDA requires healthcare providers to report any death after vaccination, it’s unclear whether the vaccine was the cause of these.

Yet superstition persists.

The Ministry of Health contends that there are a multitude of reasons somebody might not yet be vaccinated.

“There is not necessarily a link between vaccination rates and vaccine hesitancy,” a spokesperson said. “Reasons why individuals may not yet be vaccinated are varied.” The reasons include location, with some people living far from vaccination centres; age, with 16-35 year-old-males less likely to opt for vaccination; and ethnicity.

“We are targeting our efforts in this area to boost the rate of vaccination in these populations,” the spokesperson said. “The deprivation index also has a correlation to whether people are getting vaccinated, which indicates a range of practical issues preventing vaccination. Similarly, we have targeted initiatives to address this.”

The amount of people in this situation – happy to get vaccinated, but not having done so for reasons of accessibility and the like – is slowly decreasing as vaccinators work through harder-to-reach sections of the population.

The same can’t be said for the willingly non-participant, who harbour similar suspicions to groups like the Minneapolis Anti-Compulsory Vaccination League, which formed after a smallpox outbreak led to vaccine mandates in Minnesota at the beginning of the 20th Century.

The group called vaccines “an imposition and a crime on personal rights when forcibly applied” and spread the idea that smallpox was not as contagious as popularly thought.

Charles Stevens, the league’s secretary, eschewed a clause in his life insurance policy that required him to get the jab.

With cruel poetic justice, Stevens died from smallpox. His anti-vaccination stance continued to dog his family even after his passing, however, as they struggled to cash in the policy.

“Rather than submit to vaccination, he agreed to waive the smallpox clause in the policy,” the Minneapolis Tribune reported in 1903. “It was not long after, however, that he was stricken with the plague in its most malignant form and died.”

Smallpox is now just a word in a history book. If the world hopes the same fate will eventually befall Covid-19, there must be a few lessons to learn from the tragic story of Charles Stevens.

Matthew Scott covers immigration, urban development and Auckland issues.

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