Conspiracy theorists are an alt cause to pandemic readiness. You can make as many vaccines as you want but they’re entirely ineffective if nobody uses them.

The COVID-19 Vaccine The COVID-19 Messenger-RNA (mRNA) vaccine represents a new approach to vaccines. Although other vaccines rely on inactivated pathogens to trigger an immune response, the COVID-19 mRNA vaccine gives cells the instructions to make a small piece of the ‘spike’ protein found on the surface of the virus. As the protein has been made, the body’s cells break down the instructions and remove them from the body (Centers for Disease Control and Prevention [CDC], 2020). The body’s cells display the protein fragment on its surface, thereby prompting the immune system that recognizes the protein as foreign and thereby building an immune response and making antibodies (CDC, 2020). It is noteworthy that conspiracy theorists and anti-vaccination groups claim that vaccines alter the body’s DNA. In fact, the COVID-19 mRNA never enters the nucleus of the cell; therefore, it does not encounter the cellular DNA (CDC, 2020). It has been established that children’s rates of hospitalization and death due to COVID-19 are significantly lower than adults (World Health Organization [WHO], 2020a). However, a rare disease named multi system inflammatory syndrome that causes critical illness in children has been linked to COVID19 (WHO, 2020a). Al though the priority is to target high-risk groups in the adult population, vaccination against COVID-19 for children may be required. It has been recommended that older children and adolescents who are more at risk of severe and fatal disease than younger children be vaccinated first, and then extend the vaccination to younger children (Wong et al., 2021). The CDC (2021) recommends everyone 12 years and older should get a COVID-19 vaccination. Currently there are three major vaccines available. The U.S. Food and Drug Administration (FDA) has given the Pfizer-BioNTech COVID-19 vaccine emergency use authorization for children ages 12 through 15 years. The FDA has also approved this vaccine, now called Comirnaty, to prevent COVID-19 in people age 16 years and older. The PfizerBioNTech vaccine has been authorized for young people aged 16 and above, and trials for those 12 to 15 have been announced by Pfizer (Jenco & Korioth, 2021). Pfizer and Moderna have been given permission to increase the size of their clinical trials for children ages 5 to 11 years. Moderna’s vaccine has re - ceived emergency use authorization (EUA) for those aged 18, and Moderna has started trials on children from 6 months to 12 years (Jenco 2021). The KidCOVE Study conducted by Moderna is researching a COVID-19 vaccine that may protect children who are ages 6 months to 11 years (Kaiser Perma - nente Research, 2021). Johnson and Johnson/Janssen has also received EUA for individuals 18 years and older (Verdict, 2021) to test its vac cine on newborns, pregnant women and those with a compromised immune system. The Rise of the ‘Anti-Vaxxer’ The anti-vaxxer movement is almost as old as the history of vaccination itself. Edward Jenner, the originator of the smallpox vaccine, faced opposition from both physicians and clergy, and called these people ‘anti-vaxx’ in the early 19th century (Howard, 2003). The medical men were a powerful opposing force, using the developing power of the ‘press’ to spread their arguments against the procedure, arguing that the safety of vaccination could not be proven (Howard, 2003). As smallpox case numbers dropped significantly, the efficacy of the vaccine became clear, and this first wave of opposition waned. People eagerly took up vaccination against this disease. However, the poorer classes were unable to afford treatment, and unhygienic procedures often led to secondary infections leading to a drop in vaccination rates among the working class. To counteract this, the United Kingdom government passed an Act in 1853 making smallpox vaccination mandatory for infants, with parents facing a fine or imprisonment for disobeying the law. Similar laws were also passed in the United States to mandate vaccination (Howard, 2003), resulting in an organized and formal anti-vaccination movement on both sides of the Atlantic. Both middle- and working-class people fought against what they saw as increasing coercion by the elite forces of government and medicine, threatening their rights and liberties (Durbach, 2005). In the United Kingdom, the Leicester Anti-Vaccination League formed in 1869, and mass demonstrations of up to 100,000 people protested in the streets of Britain (Wolfe & Sharp, 2002). This League and its American counterpart, the Anti-Vaccination League of Ameri - ca, claimed that improved hygiene was the cause of decrease in disease, rather than the vaccinations them- selves. To address these fears, the British Vaccination Act 1898 introduced the concept of ‘conscientious objection’ to mandatory vaccination, which was picked up rapidly by the antivaccination activists (Howard, 2003). In the early years of the 20th century, a series of devastating epidemics, namely, smallpox, diphtheria, cholera, measles, and polio, prompted a greater uptake of vaccines despite the antivaccination lobby. Vaccination programs for an increasing number of diseases led to what became known as ‘herd immunity.’ However, several tragic events involving contaminated and faulty vaccines eroded public trust and confidence (Flaherty, 2011; Wolfe & Sharp, 2002). These disasters added to the argument against vaccination. Public fear was also compounded by apathy, as vaccines became ‘victims of their own success’ (Camargo, 2020, p. 2). As herd immunity grew, once-common diseases became less visible in the community. The importance of vaccination began to wane, leading to rejection or at least, hesitancy (Smith, 2017). This situation deteriorated further with what has been described as “the most damaging medical hoax of the last 100 years” – Andrew Wakefield’s infamous study (Wakefield et al., 1998) linking the measles-mumps-rubella (MMR) vaccine to autism (Flaherty, 2011), later proven to be completely unsubstantiated. Moreover, autism is a condition with no known etiology and no cure and affects children in the age range during which most vaccines are administered. Nonetheless, for parents grief-stricken to discover their child had developed autism and searching for something to blame, this study provided them with a reason they could understand (Flaherty, 2011). Parents began to refuse the MMR vaccine, and it seemed the proven benefits of vaccination against these common childhood diseases were outweighed by the tiny possibility they might cause another condition that would be life-changing. Vaccination rates consequently plummeted (Smith, 2017). Today’s antivaccination move ment may seem to fly in the face of science, but it may simply be due to hysteria, a response that depends not only on what is happening now, but also on what happened in the past. Many of the issues prompting antivaccination sentiment today can be seen in the history of the antivax movement – mistrust of a new and unproven treatment, fear of curtailment of liberties, class struggle, public apathy, and the spread of misinformation through a new and rapid form of communication (Wolfe & Sharp, 2002). Vaccine Hesitancy An important consideration in the immunization debate is vaccine hesitancy, defined as “the reluctance or refusal to vaccinate despite the availability of vaccines” (WHO, 2019). Vaccine hesitancy has been described as the main contributor to the reduction to herd immunity globally (Haroune & King, 2020) and contributed to outbreaks of preventable diseases in some countries (Gordon, 2020). It is, therefore, an important issue that needs to be addressed early before it becomes vaccine refusal, which is an increasing problem (McGee & Suh, 2019). Vaccine-hesitant people have not yet decided about whether they will vaccinate or not; they instead are merely questioning whether they should vaccinate and therefore can be persuaded to immunize. In comparison, those who are ‘anti-vaxx’ have already made up their minds to not vaccinate, hence why it is important to address hesitancy before this situation arises. Vaccine hesitancy is complex and not just about parents agreeing or disagreeing to vaccinate their child or themselves (McGee & Suh, 2019). Factors that contribute to vaccine hesitancy have been explored in a study that identified three main themes: vaccine safety, effectiveness, and health care issues (Haroune & King, 2020). Vaccine safety referred to a concern about the ingredients in the vaccine as well as toxicity and potential side effects from the vaccine, with autism being the main concern (Haroune & King, 2020). This theme also included pain/discomfort from the vaccination and that vaccinating weakens the immune system. The effectiveness of the vaccine included the belief that some diseases had been eradicated, questioning the need for the vaccine. There was also a desire to fight off disease with natural immunity rather than by vaccinating, including breastfeeding, in the belief that this was more effective. The third contributing factor arose because of previous negative experience with health care, including delayed immunizations due to the child being unwell or difficulty getting appointments due to either the carer or general practitioner being too busy (Haroune & King, 2020). These parents may be motivated to vaccinate but have logistical difficulties, including not being able to take time off work or lack of public transport to access services. Conflicting or confusing vaccine information may also inhibit the decision to vaccinate. Vaccine-hesitant parents are also more likely to access social media for information to help them make the decision to vaccinate or not (McGee & Suh, 2019). A substantial amount of information is available through these platforms, and it is easy to find. Although it may lead to parents making the right decision for their child, it can also be detrimental because much information is inaccurate, and in some cases, deceptive (Grant et al., 2015). Generally, these platforms focus on creating communities of vaccine affected families, including resourc - es about vaccinations allegedly presenting an unbiased opinion. However, these sites are found to be strongly biased against vaccinations (Grant et al., 2015). Social media vaccine sceptical information is, therefore, considered to be troublesome, discouraging parents from vaccinating through several strategies. These include portraying themselves as authorities on vaccination, listing adverse effects, presenting themselves as unbiased, and appealing to the user’s emotions through personal testimonies of adverse effects (Grant et al., 2015). The problem is compounded by the fact that vaccine critics are more successful at using social media then vaccine promoters. Further more, the information disseminated is more difficult to dismiss by trying to educate the public to the contrary (Grant et al., 2015). Other issues that social media may present in the context of the vaccination debate will be further discussed below. Conspiracy Theories Conspiracy theories explain the origins of world events or situations as plots, led by powerful groups of people, usually malevolent, who hide the truth and disseminate misinformation (Douglas et al., 2019; Sutton & Douglas, 2020; Wood, 2017). They are also associated with medical conditions such as COVID19 (Andrade, 2020; Chen et al., 2020; Duplaga, 2020; Romer & Jamieson, 2020) and HIV/AIDS (Brotherton et al., 2013; Friedman, 2020), vaccination use (Brotherton et al., 2013; Douglas et al., 2019; Romer & Jamieson, 2020), and can be detrimental to health promotion and illness prevention. Under - pinning conspiracy theories is a distrust of people in power (Sutton & Douglas, 2020; Romer & Jamieson, 2020), an alleged conspiracy (Douglas et al., 2019), and belief in the conspiracy despite evidence of more probable causes (Brother ton et al., 2013; Freeman & Bentall, 2017; Wood, 2017). Confirmation bias, the acceptance of evidence that confirms a person’s existing beliefs and rejection or failure to consider contradictory evidence (American Psychological Associa - tion [APA], 2020), and the backfire effect, whereby a person’s beliefs are strengthened in the face of contradictory evidence (Noor, 2020), can perpetuate conspiracy beliefs. A range of psychosocial and demographic factors are associated with holding conspiratory beliefs. A tendency to accept weak beliefs (Sutton & Douglas, 2020) and attempts to make sense of life during uncertainty and when faced with complex and threatening phenomena can contribute to a belief in conspiracy theories (Douglas et al., 2019; Freeman & Bentall, 2017). Younger people; males; those with lower levels of education, income, and health literacy; those from an ethnic minority; the socially disconnected; and the politically disenfranchised are more likely to believe in conspiracy theories (Duplaga, 2020; Freeman & Bentall, 2017; Romer & Jamieson, 2020). Support of conspiracy theories is also associated with traits of individual and collective narcissism and exaggerated feelings of self-importance (Cichocka et al. 2016; Golec de Zavala & Federico, 2018). Subscribing to conspiracy theories can have adverse impacts on an individual’s health and wellbeing, including their mental wellbeing. Freeman and Bentall (2017) demonstrated in a general population that those who held a conspiratory world view had lower levels of physical and mental wellbeing, were more likely to have had adverse childhood experiences, had fewer current social connections, and experienced more negative emotions. Chen and colleagues (2020) found that health care workers who believed COVID-19 conspiracy theories were more likely to report psychological distress, anxiety, and lower satisfaction with their work and life as compared to those who did not. Conspiracy beliefs may also be associated with some mental health conditions. People who experience paranoia, a mistrust and fear of harm from others, and who meet the diagnostic criteria for a paranoid personality disorder are likely to accept the beliefs of malevolence espoused in conspiracy theories (Andrade, 2020). Even after controlling for paranoia, those who adopt conspiratory beliefs were more likely to meet the diagnostic criteria for a mental health disorder and to consider attempting suicide, as compared to those who did not hold such beliefs (Freeman & Bentall, 2017). To counteract vulnerability to the misinformation of conspiracy theories, health professionals have a role in the promotion of critical thinking skills and development of coping strategies in health care consumers (Andrade, 2020; Friedman, 2020). There are significant numbers of people worldwide who espouse conspiracy theories, which are explanations for important events that involve secret plots by powerful and malevolent groups (Douglas et al., 2017; Douglas et al., 2019), when other explanations are more plausible (Brotherton et al., 2017). For example, significant numbers of people around the world believe COVID-19 was created deliberately, is a hoax, and has killed far fewer people than reported, and the vaccine will have untenable side effects (Henley & McIntyre, 2020). Con - spiracy theories are dangerous and even more so in a pandemic when they encourage people to ignore the official advice (Henley & McIntyre, 2020).