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Celebration of Scholarship and Creative Activity 2021

An Integrative Review of Civil Liberty-Based Rationales for Vaccine Hesitancy and Denial

Mikayla Cann

Senior, Nursing


Vaccinations are cost-effective interventions that have successfully reduced the morbidity and mortality of many infectious diseases. Still, vaccine hesitancy, or the reluctance and refusal to vaccinate in spite of vaccine availability, has been increasing worldwide. Reduced vaccination uptake has caused outbreaks of preventable diseases and will challenge the establishment of herd immunity against the novel coronavirus (COVID-19) and its variants. Civil liberty-based rationales that frame vaccine refusal as a right have become more prominent during the COVID-19 pandemic. However, there is limited guidance for healthcare providers who provide vaccinations as to how best to respond to such rationales. The purpose of this integrative review was to describe the current empirical evidence related to civil liberty-based rationales for vaccine hesitancy and recommend potential nursing informed strategies for health care provider response. Eight databases (Academic Search Complete, Alt HealthWatch, Cumulative Index to Nursing and Allied Health Literature, Health Source, MEDLINE, PsycARTICLES, PyscINFO, and PubMed) were searched to locate peer-reviewed articles published since 2013. Eleven articles were included in this review. Thematic analysis identified three essential themes: Freedom from oppression, perceived autonomy, and resisting interference. Findings support inclusion of assessment of civil liberties-based rationales in the clinical encounter and the provision of informational strategies that support individual control over vaccination decision-making. Continued understanding of the nuances of civil-liberties based rationales for vaccine hesitancy are essential for developing and implementing applicable evidence-based recommendations aimed to maintain and increase vaccination rates. 

What Do You Think? 

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  1. Dr. Paula McNiel

    Outstanding work! Very timely and needed during this pandemic. I strongly encourage you to publish your findings. The implications on ways to introduce new and creative interventions for vaccination outreach are needed now more than ever.

    • Mikayla Cann

      Thank you for your kind words Dr. McNiel! We are working on publishing the findings.

  2. Steve Sheehan

    Interesting work. I’m not a health care provider, but I have certainly been exposed to the logic of “civil liberty based refusals” of vaccines in informal interactions with acquaintances. It’s good to see you and others doing systematic research into the problem.

    Can I ask you to speculate? What might an appropriate “evidence based intervention” to a “civil-liberty based refusal” to a vaccine look and/or sound like?

    I also have a question about your definitions and findings. Could you clarify the difference between the themes that you identify as “freedom from oppression” and “perceived autonomy?” And is the poster saying that “perceived autonomy” is the most prevalent or important of those three themes?

    • Mikayla Cann

      Thank you for the response and questions! This work is not at the stage of intervention development yet. However, the findings of this work can be used to support the development of human subject research aimed at intervention development. Potential evidence-based interventions for responding to civil liberty-based rationales may center on health care provider and/or public service messaging that emphasize positive aspects of vaccination in relation to taking personal control for one’s health.

      Freedom from oppression is the idea that vaccination itself is the agent of institutional oppressive control. These institutions are most often described as the government or the pharmaceutical industry. Individuals view an authoritative figure, such as a pediatrician, politician, or anyone recommending vaccination, as an oppressor.

      Perceived autonomy is the idea that vaccinations are a form of behavioral control or a loss of autonomy. This theme is different from freedom from oppression, as it is not dependent of an outside force. This theme is more related to an individual feeling that their autonomy and their ability to self-manage is being threatened by vaccination recommendations, requirements, or mandates. Of the eleven articles included in the review, seven of them displayed the theme of perceived autonomy, so this theme was the most prevalent throughout the articles analyzed.

  3. Jack P

    Remarkable! You broken down and defined the specific reasons people may be hesitant to receiving a vaccine. Now these specific reasons could be applied to other things intended for safety of the user. Lets use seatbelts as an example, I think it’s around ~85% of Americans regularly use a seatbelt. The remaining 15% probably could be classified into one of the categories you have highlighted. Recently, I’ve heard statistics that a higher percentage of Americans are hesitant to getting a vaccine compared to using a seatbelt. Admittedly, it’s been 30 or so years since seatbelt use became mandatory; but why, according to any of your potential findings, are people in today’s world more hesitant toward something to guarantee personal safety.

    • Mikayla Cann

      Thank you for your thoughtful response. I agree that these findings could possibly be applicable to other areas in society. Civil liberty-based arguments frame vaccination refusal as an individual choice and shift attention away from the responsibility to protect the community at large, such as protecting vulnerable populations. These findings show that vaccine opponents are increasingly opposing vaccination as a matter of political principle, rather than because of concerns with safety and efficacy.

  4. رعاية مسنين بالمنزل

    great job, and I agree with you, These data indicate that vaccine critics are increasingly rejecting vaccination as a matter of political principle, rather than safety and effectiveness concerns.


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