Vaccination and the defence of democracy
Authors: Roger L Albin
Journal: The Lancet (2024)

Richard M Carpiano and colleagues provide a useful summary of anti-vaccine activism in the USA.1Carpiano RM Callaghan T DiResta R et al.Confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 era.Lancet. 2023; 401: 967-970Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar Their policy prescriptions are sensible but are likely to fall short because they fail to confront a fundamental feature of anti-vaccine activism. Anti-vaccine activism is one of numerous right-wing initiatives defending free market fundamentalism.2Oreskes N Conway EM The big myth: how American business taught us to loathe government and love the free market. Bloomsbury, New York, NY2023Google Scholar The anti-vaccine movement is, in part, a cynical effort to use fear to defend the interests of the wealthy. In societies where political power and legitimacy derive from voting, appeals to the irrational are necessary for conservatives to be competitive in elections. For the American right, the need for irrational appeals is acute because of the failure of Reaganomics. Rather than the promised broad increase in prosperity, the neoliberal era brought economic stagnation and increased inequality for most Americans.3Gerstle G The rise and fall of the neoliberal order: America and the world in the free market era. Oxford University Press, New York, NY2022Crossref Google Scholar To maintain power, American conservatives amplified their appeals to bigotry and pursued dishonest efforts to discredit almost any broadly beneficial application of state power.2Oreskes N Conway EM The big myth: how American business taught us to loathe government and love the free market. Bloomsbury, New York, NY2023Google Scholar, 4Hacker JS Pierson P Let them eat tweets: how the right rules in an era of extreme inequality. WW Norton, New York, NY2020Google Scholar The anti-vaccine movement is part of a major effort to shield the privileged position and power of the wealthy from democratic interventions. As pointed out decades ago by Antonio Gramsci, ruling class efforts to maintain ideological and political hegemony are a characteristic feature of developed capitalism.5Martin J Antonio Gramsci.https://plato.stanford.edu/entries/gramsci/Date: Jan 13, 2023Date accessed: March 21, 2023Google Scholar Just as anti-vaccine movements are part of a broad front of right-wing activism, successful defence of vaccination requires a broad response. Defence of vaccination will only be successful in the context of vigorous defence of democratic institutions and explicit advocacy of using state power in the public interest. I declare no competing interests. Confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 eraOver the past two decades, anti-vaccine activism in the USA has evolved from a fringe subculture into an increasingly well organised, networked movement with important repercussions for public health. The COVID-19 pandemic has exacerbated this evolution and magnified the reach of vaccine misinformation. Anti-vaccine activists, who for many years spoke primarily to niche communities hesitant about childhood vaccinations, have used traditional and social media to amplify vaccine-related mistruths about COVID-19 vaccines while also targeting historically marginalised racial and ethnic communities. Full-Text PDF Vaccination and the defence of democracy – Authors' replyRoger L Albin's Correspondence shows some of the many ways to conceptualise the potential mechanisms underlying the evolution and expansion of anti-vaccine activism in the USA. Two of Albin's points prompted us to elaborate here on ideas we discussed in our Viewpoint.1 Full-Text PDF