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Vaccine Hesitancy: The Evolution

Mariana Nicolaides, MPH Candidate 2022, Associate Editor at Arizona Physician

Print - Spring 2022

Advances to combat vaccine-preventable diseases have been hailed as one of the greatest public health achievements. While some believe recent arguments over influenza, MMR, or COVID-19 vaccines are new, it should be known that this is not the case. Vaccines have long stirred public passions, going back 300 years ago to the 1721 smallpox inoculation in Boston. One cold November day in 1721, a bomb was thrown into the residence of Cotton Mather, a local Boston Reverend. While the bomb did not detonate, there was an explosive letter signed to Mather with the message: “Cotton Mather, you dog, dam you! I’ll inoculate you with this; with a pox to you.’’ This was a violent response to Reverend Mather’s promotion of smallpox inoculation in response to the deadly ongoing epidemic (Niederhuber, 2021). During the late 1700s, Edward Jenner discovered milkmaids who had been ill with cowpox were immune from smallpox, and the use of cowpox in vaccinations became widespread while the fear of the unknown (see Figure 1) continued to spread throughout the masses (Ault, 2021).


Immunization has contributed hugely to preventing deaths and has been found to dramatically increase life expectancy and economic development (Bustreo, 2017). That said, there are numerous reasons why this movement has been hotly debated, with parents passionately fighting for what they think is safest for their children, and pushing individuals to refuse vaccines. Reasons such as personal freedoms, lack of government trust, poorly conducted studies, and a mistrust of science have plagued vaccine acceptance. The decision one makes to not vaccinate oneself or one’s children affects everyone, and individuals shying away from vaccination due to uncertainty risk the possibility of infectious diseases reemerging in their communities.



The state of Arizona legally allows vaccine exemptions for religious and moral reasons, but what many miss is the responsibility the government must take to safeguard life. While no vaccine is 100% effective at preventing disease, it is crucial that the childhood vac­cine coverage of 95%-100% is still met to fully protect communities and reduce the spread of diseases such as polio, measles, mumps, and rubella (AZDHS, n.d.). According to the Office of Disease Prevention and Health Promotion, national immunization coverage of children receiving the recommended doses of DTaP, polio, MMR, Hib, HepB, varicella, and PCV vaccines by age 19–35 months in the United States is at 72.8%, with Arizona falling behind at a 69.6% vaccination rate (see Figure 2). Rates so far below the target percentage leave communities at risk for contracting preventable diseases, giving them opportunities to spread.



Vaccine hesitancy may come from feeling as though personal choice and freedoms are at risk, but a lack of trust in one’s government also plays a role in hesitancy. According to the United States Census Bureau, 48.1% of those who are hesitant to take the COVID-19 vaccine do not trust the US government (Anderson et al., 2021). To further that statement, a study published by Jennings et al. (2021), found that those who said they would take the COVID-19 vaccine were more likely to have stated they trusted the government’s handling of the pandemic because they “followed the science,” while those refusing vaccines were more likely to believe conspiracies, that data was “made up,” and that the government put too much emphasis on lockdown measures at the expense of the economy. Many Americans are skeptical, especially people of color. “The African American community, for good reason, unfortunately, has seen a legacy of disparate care, of lack of care, including several high-profile incidents like Tuskegee and others where they feel the medical system abandoned them,” says Arther Daemmrich, director of the Lemelson Center for the Study of Invention and Innovation at the Smithsonian Institution. “There’s a lot of distrust,” Daemmrich adds, “it’s not entirely clear how you overcome that distrust, [...] but just showing up now in the midst of the pandemic and saying okay trust us now isn’t the way to do it.” (Ault, 2021).



It’s hard to trust something one doesn’t understand, and “bad science” has a way of sneaking into the spotlight. One well-known example was Andrew Wakefield’s study in 1998. Wakefield suggested that there was a link between vaccinations and autism spectrum disorder and was later found guilty of ethical violations, scientific misrepresentation, and barred from practicing medicine. Since then, there have been over 25 different studies showing that there is no connection between the two. Yet, people still believe the connection holds truth (LeGare, 2017). As of 2019, 45.3% of adults 18 years of age and older were, on average, unsure if vaccines caused autism, and 9.3% believed there was a connection (Elflein, 2020). While the spread of misinformation travels like wildfire, dispelling the myths created by misinformation can take years to resolve.


The number of individuals choosing to not vac­cinate their children in Arizona has risen in the last few decades. Non-medical immunization exemption rates among Arizona children had more than tripled between the years 2000 to 2017, which is leaving room for these infectious diseases to spread (Lewis, 2021).


Vaccine hesitancy puts Arizonan lives at risk for these vaccine-preventable illnesses, and as trusted voices, physicians play a significant role when it comes to making health decisions. Be prepared to speak to those that are hesitant, or against vaccines in general. Healthcare workers are heroes, the power of their voice can change communities, and help shame them into a stronger, healthier future.



·     Anderson, L., File, T., Marshall, J., Mcelrath, K., & Scherer, Z. (2021, December 21). New tool tracks vaccination and vaccine hesitancy rates across geographies, population groups. Retrieved January 23, 2022, from 

·     Ault, A. (2021, January 26). History shows Americans have always been wary of vaccines. Retrieved January 13, 2022, from 

·     AZDHS. (n.d.). AZDHS: Epidemiology & Disease Control - Immunization. Arizona Department of Health Services. Retrieved January 18, 2022, from 

·     AZDHS. (2018). Non-medical immunization exemption rates among Arizona’s children have more than tripled from 2000-2017. Chart.

·     Elflein, J. (2020, February 3). Opinions on vaccinations causing autism by age U.S. 2019. Statista. Retrieved January 24, 2022, from

·     Gillray, J. (1802). The Cow-Pock-or-the Wonderful Effects of the New Inoculation! [Hand-coloured etching] 1851,0901.1091, London (England). The British Museum. London; Hannah Humphrey.

·     Jennings, W., Stoker, G., Bunting, H., Valgarðsson, V. O., Gaskell, J., Devine, D., McKay, L.,     et al. (2021). Lack of Trust, Conspiracy Beliefs, and Social Media Use Predict COVID-19 Vaccine Hesitancy. Vaccines, 9(6), 593. MDPI AG. Retrieved from

·     LeGare, J. (2017). Autism-vaccine link debunked. Mayo Clinic Health System. Retrieved January 24, 2022, from 

·     Lewis, K. (2021, February 17). Vaccine hesitancy puts Arizonan's at risk for diseases. The Arizona Pulse. Retrieved February 8, 2022, from

·     Niederhuber, M. (2021, August 2). The fight over inoculation during the 1721 Boston smallpox epidemic. Science in the News. Retrieved January 13, 2022, from 

·     Bustreo, F. (2017, April 26). Embrace the facts about vaccines, not the myths. World Health Organization. Retrieved January 13, 2022, from 

·     ODPHP. (2018). State-level data. Data Map | Healthy People 2020. Retrieved January 18, 2022, from

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