The COVID-19 pandemic has led to more than 176 million confirmed cases and over 3.8 million confirmed deaths. These numbers are likely dwarfed by the true rates of infection and death, which will remain unknown well into the future and will likely never be fully elucidated.[1] During this time, several countries have vied for the unhappy honour of being the worst affected by the pandemic, including Italy in early 2020, the United States through 2020 and early 2021, and most recently India in April and May of 2021.
The emergence of highly effective vaccines in late 2020 and early 2021 suggested some relief might be on the horizon. The optimism proved to be somewhat short-lived, as questions of vaccination and vaccine availability (not unanticipated, but now real) arose. India provides perhaps the most dramatic example: despite the initiation of vaccination programmes, India suffered a devastating second wave of infection and death in 2021 that eclipsed the relatively mild first wave of 2020.
With this second wave appearing to recede, and other parts of the world cautiously reopening, one of the most pressing questions related to the pandemic is surely whether we can exploit this respite and vaccinate as many individuals as possible, to delay or dampen future waves of SARS-CoV-2 infection. With this in mind, we can consider the total human population as either vaccinated or unvaccinated. Every individual whose status changes from unvaccinated to vaccinated represents a further step in controlling the pandemic. The unvaccinated group can in turn be divided into subpopulations of individuals who are involuntarily unvaccinated (for instance, because of being immunocompromised or lacking access to vaccines) and individuals who remain unvaccinated by choice. The latter group—comprising those unvaccinated by choice—may shortly become the main barrier to achieving the long-awaited herd immunity. The herd immunity threshold for any infectious disease is usually substantially lower than 100% population immunity. If vaccine-hesitant individuals can be persuaded to seek vaccination, it may be possible to acquire some form of herd immunity without needing to engage in the vastly more daunting task of persuading vaccine refusers to seek vaccination.[2]
In this essay I would like to examine some of the sources of vaccine hesitation I have observed amongst friends, family, and acquaintances in India. It would be preposterous to claim to speak ‘for Indians’ or provide a view on ‘the Indian experience’. Rather, I relate some instances—largely from my own experience of the pandemic in India— to illustrate the types of vaccine hesitancy that might be operating in India and elsewhere in the world. My hope is to frame my observations in such a way that they may be amenable to more rigorous survey studies that could elucidate the distribution of these attitudes. My general point is that there are numerous types of vaccine hesitation, and many of these differ quite dramatically (in kind and not just degree) from the beliefs characterising the anti-vaccine movement.