Beyond Hesitancy: The State in a Brazilian favela and the social signification of the covid-19 vaccine

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 2. Navigating the COVID-19 Pandemic

Abstract

While the hesitancy approach to vaccination enabled a detailed understanding of proximal causes of refusal, it over-emphasizes the deviant behavior to be corrected. This obscures the complete meaning-making process shapes the entire spectrum of vaccination decisions, from acceptance to refusal. In this paper, I argue that the analysis of social patterning of vaccination must start from such a shared core meaning network, rather than taking refusal or hesitancy as a starting point. To do this, I draw from interviews conducted in a highly vaccinated, poor informal urban community in Brazil. The interviews show that the COVID-19 vaccine was interpreted in relation to three main social systems: the market, the State, and biomedicine. In relation to the market, while corruption was more closely linked to refusal, an analysis of the profit motive of vaccination led some to confidence while others to mistrust. In relation to the vaccine as a bureaucratic tool, mandates made vaccination a part of the backstage work necessary to maintain social rights. While to some this was seen as a normal part of being a citizen, for others, it was another tool for the perpetuation of social exclusion. Finally, the vaccine as biomedicine required using trust in doctors or, when absent, folk epidemiology. An understanding of the vaccine as belonging to one or other system was not a “determinant” of vaccine hesitancy. Rather, the same framing could lead to acceptance or refusal depending on past experiences and interpretations of such systems that preceded vaccination. I also show how the role of the State permeated all three framings, which has implications in moving outreach away from information and toward creating islands of trust within the government.

Author

• Murilo Enrique Dorion Nieto, Princeton University