In the midst of the coronavirus outbreak, we witness the profound impact a virus can have when vaccines are unavailable. This situation raises questions about vaccination attitudes.

In early February, Frederike and Peter welcome their first child, Tim. Peter is determined that Tim will receive his vaccinations as appropriate. However, Frederike is filled with uncertainty. Surrounded by staunch anti-vaccine advocates, she finds some merit in their concerns, even while considering herself logical and not prone to conspiracy theories. She does not subscribe to beliefs that vaccines cause autism, for example.

She feels frustrated by the polarized nature of the vaccination debate: one is either a supporter (#vaccineswork) or an opponent (#vaccineskill), and differing opinions often lead to accusations of ignorance or stupidity. "I don’t buy into Vaccinvrij's claims, but I also question everything that child healthcare centers assert. They have their own agenda," she remarks.

Frederike grapples with the idea of having a substance injected into her healthy child, aware that there are slight risks involved. To mitigate this, she received a whooping cough vaccine during her pregnancy, thereby reducing the number of shots Tim would need later.

As the coronavirus spreads across Europe, some people on social media ironically note, “Didn’t anti-vaxxers wish for a world without vaccines? Here it is!” A key factor in the growing skepticism toward vaccines is that many individuals have become disconnected from the severe illnesses that vaccines guard against.

From the outset of the pandemic, experts have underscored that life will not return to normal until a vaccine is available, leading many to believe there is a collective desire for a vaccine. But is this genuine yearning or mere wishful thinking?

Vaccination is a hallmark of medical advancement. In the Netherlands alone, the National Vaccination Programme has prevented between 6,000 and 12,000 deaths.

After a decline over several years, vaccination rates in the Netherlands stabilized last year, with a slight increase noted at the start of this year. The measles vaccination coverage stands at 92.9%, short of the 95% needed for herd immunity, partly due to the efforts of the Vaccination Alliance initiated by State Secretary Blokhuis. However, the ongoing pandemic may hinder this upward trend, as many childhood vaccinations have been deferred.

The crisis may also influence people's willingness to vaccinate. Bart Penders, an Associate Professor in Biomedicine and Society at Maastricht University, explains that most individuals do not seek detailed information about vaccine production or potential rare side effects, as they trust government guidelines. "However, if they begin to doubt these institutions, particularly regarding their response to the pandemic, perceptions may shift."

Specific concerns arise regarding the coronavirus vaccine. Researchers at the University of Erfurt have been monitoring German sentiments toward the vaccine, revealing a drop in willingness from 80% in mid-April to 63% by May 19. This trend aligns with a CivicScience survey conducted in the U.S. during the same period, where 69% expressed interest in the vaccine, though other polls indicated only half of Americans would accept it. "Even with an effective vaccine, this may fall short of achieving herd immunity," remarks Professor Cornelia Betsch, who is heading the German study.

One reason for this decrease, Betsch suggests, may be the prevention paradox; as the pandemic response shows signs of success, the stark images from nations like Italy and China fade, leading many to view the virus as less threatening.

Additionally, individuals exhibit less confidence in the safety of the new coronavirus vaccine compared to established vaccines. "This skepticism is understandable, as the vaccine is new and was developed and tested rapidly, prompting closer scrutiny of its risk-benefit ratio," Betsch notes.

While these concerns are valid, other factors are at play as well. The global anti-vaccine movement has launched a vigorous campaign online, not limited to safety worries. An anonymous anti-vaccine activist shares articles suggesting that the virus is not contagious and that the rare Kawasaki disease in children is vaccine-related, asserting that healthy individuals face minimal risk from the virus, which she equates to the flu. (Scientific consensus indicates that the coronavirus is significantly more lethal than seasonal flu, primarily affecting vulnerable populations, while healthy individuals can also experience severe symptoms or death.)

Notably, many online discussions about the coronavirus revolve around philanthropist Bill Gates, with false claims alleging that he aims to implant microchips to monitor vaccine effects. Although Gates has warned of a pandemic threat and conducted a major exercise in the U.S. shortly before the outbreak, there is no evidence suggesting he orchestrated the pandemic.

Researchers at George Washington University examined the online competition between pro- and anti-vaccine advocates on Facebook, publishing their findings in Nature. They found that the smaller group of opponents is more effective at reaching the undecided than the larger pro-vaccine community.

Recent data not included in their study indicate that the anti-vaccine movement has gained momentum within discussions about the coronavirus, as noted by researcher Rhys Leahy. "This is concerning. Many new 'undecided' individuals who have not considered vaccinations for years may adopt skepticism towards the pharmaceutical industry, government, and Gates."

Hedwig te Molder, a Professor of Language and Communication at VU University Amsterdam, shares this concern, though she approaches it differently. "Opponents of vaccinations seem adept at tapping into people's underlying anxieties and core values."

The narratives surrounding Bill Gates partly stem from apprehensions about his influence, as his foundation is the second-largest donor to the World Health Organization after the U.S. "To address these concerns effectively, one must engage with them, not dismiss them. The fear of confronting the issue plays into the hands of anti-vaxxers: 'See? They’re ignoring this again.'"

Te Molder prefers the term "questioners" over "vaccine doubters," emphasizing that asking questions is a social norm rather than an indictment of intelligence. "We want individuals to think independently, yet they are expected to trust scientific consensus without question. That’s not feasible."

Frederike embodies this sentiment. While not entirely against vaccinations, she felt dismissed by the pediatric nurse who visited her after Tim's birth when she expressed her doubts. "It seemed like it was off the table," she recalls.

Recognizing this issue, municipal health services experimented with vaccination discussions last year, allowing more space for questions. Te Molder, funded by the Ministry of Health, Welfare and Sport, is researching how to balance encouraging vaccinations with accommodating inquiries. Penders is concerned about how this will play out with the coronavirus vaccine, given the urgency to administer millions of doses. "There’s little time for meaningful conversations, which is necessary to address concerns."

Conversely, the current context, where health measures dominate daily life, might bolster support for vaccines, according to Professor Betsch. "Individuals who get vaccinated contribute to herd immunity, thereby protecting vulnerable individuals in their surroundings. People are responsive to that."

Frederike experiences this firsthand. The pandemic has reinforced her understanding of the purpose of vaccinations. She secretly appreciates the delay in her son's vaccinations due to the lockdown and intends for him to receive his shots soon. "I approach it with a heavy heart. But I also don’t want to carry the burden of knowing mumps could lead to infertility for him."

She is likely to receive the coronavirus vaccine later. "With cautious optimism. The information is incomplete. For me, it’s manageable, but I worry for my son."

This article was originally published in the Dutch newspaper Volkskrant. Translation by Nicolette Marié. Frederike, Peter, and Tim are pseudonyms used at their request; their actual names are known to the editorial team.

Contextual Note on the H1N1 Vaccine: During the H1N1 pandemic in 2009, vaccines were developed rapidly, leading to approximately 2,000 cases of narcolepsy among vaccinated individuals in Europe. The cause remains unclear, but it appears that the circulating virus bore similarities to a brain protein, triggering immune responses in a small fraction of the vaccinated population. Both manufacturers and the European Medicines Agency have implemented stricter screening processes and testing protocols since then to prevent similar occurrences.