Global health leaders often dismiss politics as antithetical to the aims of public health, but Luisa Enria and colleagues argue that political analysis can offer new ways to build trust in vaccination in the context of growing online misinformation
In April 2020, as covid-19 spread across the world, the director general of the World Health Organization, Tedros Adhanom Ghebreyesus, appealed to the global community: “please do not politicise this virus.” Later that year, as covid-19 vaccines became available, scientists expressed concerns about the dangers of immunisation becoming political. This desire to keep politics separate from health is “misguided,” as the two are “inexorably intertwined.”1 Rather than wish politics away, understanding exactly how it shapes health outcomes can help to identify new ways to tackle global health challenges. Vaccine confidence is a prime example of this.
Vaccine confidence refers to trust in the safety or efficacy of vaccines, encompassing trust in the vaccine (the product), the vaccinator (the service provider), and those who make decisions about vaccine provision (the policy maker).2 Conversely, vaccine hesitancy refers to “refusal, delay or acceptance with doubt about vaccine usefulness.”3 In 2019 WHO declared vaccine hesitancy to be among the top global health challenges. In recent years, mistrust in vaccination has come centre stage in the aftermath of resurgent outbreaks of preventable diseases and through the rise of organised anti-vaccination movements that became particularly visible during the covid-19 pandemic. These concerns are further heightened in the context of what many are calling an “infodemic”—that is, the drastic increase in circulation of information, including misleading and false news, that has accompanied the rise of social media and hyperconnectivity in the digital age.4
Public health approaches to these challenges have tended to focus on individual or cognitive drivers of decision making around vaccination. Resulting …