Please sign onto and share this memo supporting using a trauma-informed approach to decreasing vaccine hesitancy! Many of the challenges we are facing with vaccine hesitancy can be better understood by looking at the issue through a trauma-informed lens. The following memo has been developed with input from many of the 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 hesitancy are diverse, complex and often come from both sides of the political spectrum, we believe that individual and collective trauma is the underlying issue responsible for attitudes and beliefs in the vaccine hesitant population.
Our theory spelled out below is supported by research done by the University of Pittsburgh and Carnegie Mellon University, which found that vaccine hesitancy is driven primarily by concerns about safety and potential side effects, and distrust in the government[1].
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 [2]. 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, it can often shift our 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, choice is critical for trauma survivors, making them prone to resist even the healthiest boundaries, mandates, or rules. Any perceived violation of their free will feels like abuse, as if their autonomy is yet again threatened.
In addition to individual trauma, we believe there are four primary collective traumas that are important to consider in addressing vaccine hesitancy:
1. MEDICAL SYSTEM TRAUMA:
Given that preventable medical error was the #3 cause of death in the US[3] until COVID-19, people have good reason to be hesitant 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. Our society is collectively still in the throes of the opioid epidemic, created by drug manufacturers pushing deadly medications for their own profits and supported by the FDA. People are not quick to forget the number of times that drugs were rushed through FDA approval or given emergency authorization only to later be recalled or pulled from the market because of dangerous or even lethal side effects.
3. RACIAL TRAUMA:
Given that oppressed and marginalized people have historically been unethically and inhumanely oppressed under systemic racism, not to mention scientifically experimented upon during atrocities like Tuskegee, it’s no wonder that Black, Indigenous, People of Color (BIPOC) communities might be wary of complying with vaccine recommendations made by a government that has upheld white supremacy for hundreds of years in this country. Sadly, their greater than usual trauma burdens 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 .[4]
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%)[5]. 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. With so much real and rhetorical mistrust built into our current governing system, how can we expect people to trust the public health recommendations from a government that has not always had their best interests in mind.
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 hesitancy. 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/hesitancy around the vaccine makes total sense and is completely valid.
In order to reduce vaccine hesitancy, 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 needs to be a coordinated approach across the country that addresses the various forms of trauma that are impacting vaccine hesitancy, and a sustained approach to reach better outcomes broadly.
In conclusion, we believe that the best way to decrease vaccine hesitancy 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 hesitancy. Small examples have been seen in Pennsylvania and Louisiana communities[6][7]. 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.
RESOURCES
[1] https://www.upmc.com/media/new...ia-vaccine-hesitancy
[2] https://www.cdc.gov/vitalsigns/aces/index.html
[3] https://www.bmj.com/content/353/bmj.i2139
[4] https://mhanational.org/bipoc-...unities-and-covid-19
[5] https://www.pewresearch.org/po...overnment-1958-2021/
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