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If the goal is to impact meaningful change, it might prove helpful to view vaccine fear through a trauma informed-lens. There is an intentional shift from the use of the word “hesitancy” and instead using the more specific and appropriate term “fear”. We are more likely to change that which we better define and understand. The following memo has been developed with input from an interdisciplinary team of community, clinical and academic thought leaders from the trauma healing field to offer supportive guidance to the Administration. To successfully address this challenge, we need to shift the fundamental question from “What’s wrong with these people?” to “What happened to them?” While the reasons for vaccine fear are diverse, complex and bipartisan, we believe that individual and collective trauma is an underlying issue responsible for attitudes and beliefs in the vaccine fear-laden population.
Trauma and Chronic stress have reached epidemic levels. 47.9% of American children have experienced one or more Adverse Childhood Experiences (ACEs). 61% of US adults (157.6 million) experienced at least one ACE and 16% (41.3 million) experienced four or more types of ACEs [1]. In addition to ACE related traumas, there is a whole spectrum of community and personal experiences that can be traumatizing. When we experience trauma, particularly that which occurs during early stages of development, historical and persistent in nature (i.e. structural racism, intentional exclusion and discrimination), it fundamentally changes an individual shifting their world view to become hypervigilant toward threat and danger. Those with a history of trauma, rightfully so, have difficulty trusting others. Any perceived agenda from an untrusted source feels like a life threat that will be reflexively met with resistance. Because trauma survivors have had their autonomy taken away at crucial periods of development, physical and psychological safety and choice is critical in meaningfully engaging them and allaying valid fear.
In addition to individual trauma, we believe there are four primary collective traumas that are important to consider in addressing vaccine fear:
1. MEDICAL SYSTEM TRAUMA:
Given that preventable medical error was the #3 cause of death in the US[2] until COVID-19, people have good reason to be fearful, ambivalent and mistrustful of the medical system. Many who have medical system trauma from our overburdened and compassion-fatigued medical system do not trust medical science at all and would rather die than see a doctor (or get a vaccine.)
2. PHARMACEUTICAL INDUSTRY TRAUMA:
While the for-profit pharmaceutical industry gives lip service to patient wellbeing, the public is well aware that, by definition as publicly traded companies, the financial bottom line is the #1 priority. Especially when the public perceives that the government protects private pharmaceutical industry interests above the interests of individuals who are harmed by medications or vaccinations, it’s no wonder trust in pharmaceuticals is wounded. There is a historical woundedness inflicted by the pharmaceutical companies and the FDA on society. There has yet to be effective repair of that woundedness, which compromises trust.
3. RACIAL TRAUMA:
Given that chronically and intentionally marginalized people have historically been unethically and inhumanely oppressed under systemic racism, not to mention scientifically experimented upon during atrocities like Tuskegee there is a significant historical and active breach of trust that breeds ambivalence and fear. Studies show that the greater than usual trauma burdens on historically and chronically marginalized groups may make their weakened nervous systems and immune systems even more at risk of severe COVID, which, among other factors, helps to explain why Black people make up 13-15% of the United States population, but about 27% of COVID-19 cases in the US and Black Americans are dying from COVID-19 at nearly 2.5 times the rate of white people .[3]
4. GOVERNMENT/POLITICAL TRAUMA:
Public trust in government is at an all time low: Less than one-quarter of Americans say they can trust the government in Washington to do what is right “just about always” (2%) or “most of the time” (22%). [4] So many policy decisions that impact millions of people’s lives are made by the private interests of a few who can fund lobbyists and political campaigns. The divide between Democrats and Republicans continues to grow larger. Real and rhetorical mistrust built in our current governing system is mirrored in our public health system.
Telling the truth helps rebuild lost trust, so acknowledging the systems level trauma that has impacted so many individuals, families, and communities is going to be a key first step to any effective strategy in addressing vaccine fear. Much like the Truth & Reconciliation process, it will be impossible to re-establish trust without these institutions taking ownership of past actions that have been traumatizing and followed with a compassionate and empathetic message that mistrust/fear around the vaccine makes total sense and is completely valid.
In order to reduce vaccine fear, we must promote resilience and nurture healing, not just trauma surrounding COVID-19, but also the epidemic of trauma that this crisis compounded. A trauma-informed, resilience-focused, healing-centered, and grassroots-led approach to increasing vaccine uptake will have other impacts that will also improve our society, such as decreasing rates of overdose, suicide, and violence-related deaths - all of which have risen during the pandemic - while also preparing communities for cascading climate-related disasters and reduce the civil unrest that has exploded since the beginning of COVID-19. There must be a coordinated approach across the country that addresses the various forms of trauma that are impacting vaccine fear, and a sustained approach to reach better outcomes broadly.
In conclusion, we believe that the best way to decrease vaccine fear and get broad buy-in is to develop a health and well-being initiative that has trauma-informed policies and practices as its central operating principle. There has been success in distributing vaccines through a trauma-informed, resilience-focused, healing-centered, and grassroots-led approach to communities predisposed toward vaccine fear. Small examples have been seen in Pennsylvania and Louisiana communities[5][6]. Individuals and small organizations took this responsibility, and the effectiveness could be amplified by funding to support these and similar efforts to help the public heal trauma affordably, accessibly, and on a mass scale.
Contributors:
JESSE KOHLER, Executive Director, Campaign for Trauma-Informed Policy & Practice (CTIPP)
CHRIS RUTGERS, founder of The Trauma Foundation:
LISSA RANKIN, MD, author, founder of Heal At Last
JEFFREY REDIGER, MD, MDIV, Harvard Medical School Faculty Psychiatrist, Medical Director McLean Hospital
PETER LEVINE, PHD Founder of the Somatic Experiencing™ Trauma Institute
GABOR MATE, MD, author, featured in The Wisdom of Trauma
RESMAA MENAKEM, author, trauma-informed anti-racism teacher
RICHARD SCHWARTZ, PHD, founder of Internal Family Systems (IFS)
LAURENCE HELLER, PHD, founder of NeuroAffective Relational Model (NARM)
ROBERT SCHWARZ, PSYD, Executive Director of the Association For Comprehensive Energy Psychology (ACEP)
VICKI ROBINSON, Developmental Trauma Therapist
JAJA CHEN, Licensed Clinical Social Worker-Supervisor (LCSW-S) and Certified EMDR Therapist
SANDY BLOOM, MD, Associate Professor at Dornsife School of Public Health, CTIPP Board Chair
ALISHA MORELAND-CAPUIA, MD, founder and director of McLean Hospital’s Institute for Trauma Informed Systems Change
DANIEL PRESS, CTIPP General Counsel
Sources:
[1] https://www.cdc.gov/vitalsigns/aces/index.html
[2] https://www.bmj.com/content/353/bmj.i2139
[3] https://mhanational.org/bipoc-...unities-and-covid-19
[4] https://www.pewresearch.org/po...overnment-1958-2021/
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