Childhood vaccination rates have slumped globally . In several countries, people are more hesitant about getting vaccinated. Populist political actors promote distrust of government and scientific institutions. And the disinformation economy means we can't agree on the facts behind policy debates.
Did COVID vaccine mandates - which placed legal limits on where people who didn't receive a COVID vaccine could go or work - produce this mess?
Some scholars in the United States seem to think so .
Australia's COVID inquiry found COVID vaccine mandates drove vaccine hesitancy and scepticism. It drew a clear line between mandates and mistrust in government and medical science.
But it's hard to establish COVID vaccine mandates were entirely to blame for today's laundry list of woes. It's difficult to disentangle the effect of vaccine mandates from those of other coercive COVID-era policies, such as lockdowns or border closures.
Yet, the mandates had their after-effects, as my colleagues and I are discovering.
Leaders thought vaccine mandates were needed
We are evaluating the effects of COVID vaccine mandates on the uptake of COVID vaccines, how people felt about the mandates, groups that may have been harmed, and how mandates have been legally contested .
As part of this ongoing MandEval project , I have interviewed more than 130 senior people in government and policy in Australia, the United Kingdom, Europe and California to find out why many decision-makers thought vaccine mandates were necessary.
Although the analysis of these interviews has yet to be published, generally speaking each Australian state and territory had its own reasons to mandate COVID vaccinations, as did governments overseas.
Leaders anticipated some negative consequences. They worried about backlash, including from people who were willingly complying with other prevention policies such as lockdowns and border closures. They feared people might start resisting, or become less trustful of vaccinations in the future. But they believed vaccine mandates were necessary to protect lives.
The policies certainly produced higher vaccination rates .
But there may be a cost: childhood vaccination coverage is now sub-optimal in Australia. More parents are succumbing to misinformation about vaccines than in pre-pandemic times. Uptake of adolescent and adult vaccinations is even more worrying.
Yet individuals disgruntled by COVID vaccine mandates aren't driving all these changes. Less direct mechanisms are also contributing.
So what's going on?
COVID vaccine mandates have contributed to " reactance ", where people respond to limits on their freedom by pushing back.
Mandates can also worsen political polarisation on vaccination . This is where political "camps" are divided over questions of vaccination's safety or benefits. This is dangerous, because high rates of vaccination rely on it being boring and bipartisan.
Influencers get on board, following the money that can be made through public engagement on divisive issues. Even before the pandemic , foreign actors were using bots to fuel vaccination debates with the goal of destabilising societies.
There are both financial and geopolitical incentives for content creators to prompt outrage or polarisation. As the disinformation economy thrives, populist politicians capitalise on low trust and high disenchantment with institutions.
In this environment, a small number of people - but larger than before COVID - refuse vaccinations. Nevertheless, mandates are, at best, one driver among many. These problems also plague countries that largely avoided vaccine mandates.
Lowering trust in government
A distrust of vaccines is also related to a distrust in government and health care institutions.
For instance, people's concerns about the safety or efficacy of vaccines can reflect deeper worries about the expert systems that govern vaccination programs . Such distrust animated the minority who refused vaccines well before COVID vaccine mandates.
COVID vaccine mandates have also eroded some people's perceptions of government.
My team's research in Western Australia found people who refused COVID vaccines already viewed government negatively, but when governments introduced mandates they had a sense of being morally punished.
This produced nightmarish predictions of industrial-scale persecution and harms. Based on their dismay and distrust, several of our participants who had vaccinated routinely before the pandemic vowed to never do so again.
More recently, we tried to understand the political shifts of mandate opponents in the otherwise progressive city of Fremantle.
Our new publication details how potential participants' deep distrust of government and university researchers meant they declined to take part altogether or were sparing in what they would reveal.
What next?
If we are to use vaccine mandates in the future, we need to work differently with communities before the next emergency disease outbreak.
Building trust in vaccination and government institutions is not easy in the present environment. However, governments can lead with transparent communications about vaccinations' benefits, risks and uncertainties, and with programs that are accessible and well-communicated.
We also need mechanisms in place to allow communities to participate in decision-making about such outbreaks. Governments could establish panels of citizens who could comment on proposed policies, question experts, and provide recommendations about communications.
We must also communicate the reasoning behind vaccine mandates more clearly. Populations need to hear transparent ethical reasoning and to understand the public benefit .
Finally, there's the issue of vaccine side effects. We know vaccines, like all medicines, come with the risk of side effects. But during the pandemic, this was generally thought to be far lower than the risk of side effects of catching COVID.
The COVID inquiry recognised the importance of a compensation scheme for rare vaccine injuries. But Australia's scheme was short-lived and was criticised for being difficult to access. The inquiry noted very few claims had been paid out.
Without an accessible and fair scheme, disgruntled consumers learn to distrust government motives and programs. This sentiment threatens vaccination programs not just during a pandemic, but afterwards too.
I acknowledge feedback on this article from Chris Blyth, Amy Thomasson, Jane Williams and Chas Dolphin. I recognise the wider MandEval team's ongoing intellectual contributions.
Katie Attwell leads 'MandEval: Effectiveness and Consequences of Australia's COVID-19 Vaccine Mandates' funded by the Medical Research Future Fund of the Australian Government (Grant ID: 2019107). She has received an unrestricted research grant from SANOFI Winthrop Industrie, Grant: RSV501. All funds were paid to her institution.
