Published: 18 February 2021
Last updated: 4 March 2024
After failing to control the spread of Covid by conservative means such as test-trace-isolate, Israel has placed all its chips on the Pfizer vaccination, embarking enthusiastically on a massive campaign to vaccinate the whole population of the country.
Israel is an ideal field for such a vaccination experiment. Firstly, due to the organized set-up of public health, and secondly due to traits like flexibility and adaptability of the “Israeli character” mentioned above. Indeed, public response at the start of the vaccination campaign exceeded expectations.
But two months into the campaign, the rate of vaccination appears to be declining. Alongside that, there has been greater media attention to people voicing their refusal to get vaccinated. Naturally, those voices are raising anger amongst the majority of the population because the success of the operation and the subsequent opening the economy is dependent on the full cooperation of the public.
The public anger is also directed at the nature of the arguments which the refuseniks are presenting, arguments which are usually based on a compilation of distorted medical explanations, alongside baseless rumours and conspiracy theories.
A recent study conducted by the Institute for Social Policy at the University of Washington has shown that hundreds of thousands of Israelis aged 50 and over have not yet been vaccinated, even though the injection has been available for them since December-January - 30% have stated that they have no intent to vaccinate in the future as well.
The highest rate of refusal is found in the Arab population (42%), followed by ultra-Orthodox population (26%). This data may be explained by the weaker sense of trust of the state by these two groups, each in their own way, and a disconnect with the greater population and its values.
But as the research indicates, refusal rates in the general population, although lower, are still significant in absolute numbers, and can impact the success of the vaccination campaign. This article does not focus on attitudes towards the vaccine in specific minorities, but rather discusses this phenomenon from a broader perspective.
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Vaccine hesitancy
The phenomenon of vaccine hesitancy, also known as “anti-vax”, is not new. In fact, it is as old as vaccine itself. When the first vaccine for the smallpox plague was created by infecting the blood with the harmless cowpox, more than 220 years ago in England, it was met with strong opposition. Many resisted the vaccine even though it was proved to be 95% effective and saved the lives of hundreds of thousands.
The vaccine terrified people into believing that something in the essence of a cow would alter their body and soul. In this famous cartoon from 1802, British cartoonist James Gillray depicted the public anxiety around the vaccine, ridiculing people‘s overly creative imagination by illustrating little cows sprouting from their bodies.
One can understand the fears about the side effects of this pioneering innovation. But more than two centuries since then, after the tremendous successes of many vaccinations, it is harder to explain the current opposition to this medical tool. In fact, it seems that despite the astronomical advances in science and medicine, many people are still responding to the idea of vaccination with a striking similarity to past fears.
Is it possible that the various explanations voiced lately by many Covid vaccine refusers conceal deeper reasons, perhaps even reasons they themselves are not fully aware of?
Here we offer an explanation for the origin of this refusal which is rooted in the elusive nature of the human moral structure.
Moral foundations theory
In his ground-breaking book The Righteous Mind, Jonathan Haidt, a Jewish-American leading scholar in the field of moral psychology, investigates the common origin of human morality. Haidt shows that the moral principles and norms of people from different cultures and traditions stem from six common roots, which he calls moral foundations.
The different foundations are: Protection from harm; Fairness and equality; Freedom; Loyalty; Respect for Authority; and Sanctity. Many readers, especially those who hold liberal values, may not identify with some of the moral principles in this list. Indeed, Western culture and liberal worldview consider some of these foundations as “primitive” or “conservative” and reject their validity.
According to Haidt, liberal morality employs only the first three moral foundations, namely: Protection from harm; Fairness and equality; and Freedom. In contrast to the liberal worldview, traditional or conservative societies give expression to all six moral foundations, all of which hold a legitimate place in the culture.
However, while liberal morality has downplayed the significance of Loyalty, Authority, and most relevant for our subject, Sanctity, these values still exist to some extent under the surface, and play a significant, though elusive role, also in the moral matrix of individuals in the Western culture.
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The impact of Sanctity
How is this discussion relevant to vaccine refusal? The piercing of a needle through the flesh and the insertion of a powerful substance into the body can easily feel threatening. For some people, the mere thought of being injected can challenge the moral foundation of Sanctity and arouse strong repulsion.
The principle of Sanctity relates to perceptions of the purity of the human body. This principle has played a central role in the morality of human groups in the past, creating various sets of rules and norms that distinguish between pure or impure.
In the modern era, in the West, however, Sanctity has lost its significance and has been criticised for being primitive, superstitious and unscientific. As a result, Sanctity has gone “underground” to the sub-conscious. Some readers may be familiar with the experience of feeling disgust towards something, even though they know they should not feel that way.
When American super-athlete, Carl Lewis, was asked whether he had used performance enhancing drugs, his answer was that he loves his body too much to stick needles into it. We might have expected his answer to employ the moral logic of the Fairness and Equality, one which emphasises his adherence to fair play and sportsmanship.
Alternatively, we would not be surprised if he mentioned the harm to his health that such an act would result in. However, Lewis’s intuitive response manifested the principle of Sanctity which we are not used to hearing as a moral argument.
The image of a needle penetrating the flesh can certainly arouse in most people a sense of aversion, and yet this reason is not usually considered a valid enough argument in the liberal moral discourse.
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The Jewish tradition knows intimately the morality of Sanctity. The laws of Sanctity, in the form of impurity and purity, can be found in large parts of the books of Leviticus and Numbers in the Torah. It is also prominent in the Mishnah, the Talmud and later Halachaic literature.
While given a central status in daily practice and discourse, the Jewish laws of impurity and purity have received no single acceptable reasoning for the rigid distinction between holiness and uncleanliness, and the indication of specific substances as prohibited.
While the renowned rationalist philosopher Rambam (Maimonides) considered impurity as a symbolic practice with no physical or spiritual essence, many of the commentators and thinkers in the Jewish world still perceived it as existing in the physical realm, despite not being attainable to the senses.
According to this view, the spirit of Tumah (impurity) will harm the soul of anyone who comes in contact with it and adhering to the laws of purity will protect from it. Consequently, references to impurity in the religious texts as “demons”, “bad spirit” and “harmful entities” may easily resonate with modern perceptions of physical and mental illnesses and lack of hygiene.
An interesting observation has been made by renowned anthropologist Mary Douglas, who analysed the laws of purity and impurity in the book of Leviticus in comparison to other ancient cultures. She described impurity as a way of societies to draw their social boundaries, determining anomaly and preventing liminal margins.
The anxiety that stems from the mixing of the boundaries is graphically demonstrated by the public response to the smallpox/cowpox vaccine: the insertion of a substance taken from cows into the human blood was experienced as a blurring of the boundaries between humans and cows, thus conjuring terrifying images in people’s imaginations.
With regard to the Covid vaccine, it may well be that people who are more inclined to refrain from taking it, are those for whom the principle of Sanctity is dominant in their internal moral matrix. While others can appreciate the vaccine as a miracle of science, these people may perceive it as witchcraft that has the power to defile the body and harm it.
Searching for an acceptable reason
Such a moral logic does not find a sympathetic ear in the value system of today’s Western culture and is considered illegitimate in the liberal discourse. The absence of this principle from the liberal moral discourse means, however, that arguments based on the Sanctity principle must be argued for indirectly, based on the other accepted moral foundations.
Thus, rumours about horrific side effects are aligned with the Protection from Harm principle and describing the greed of the pharmaceutical companies and their willingness to cheat and distort data, taps into the principle of Fairness. Conspiracy theories about tracking chips being inserted into our bodies make use of the Liberty principle.
If they could, Covid vaccine opposers might have used arguments which express directly the Sanctity principle, such as “I just love my body too much to stick needles into it” or “I don’t want foreign substances defiling my blood”. But in the absence of such “language” in the liberal discourse, they are left to cling to flimsy reasoning and theories.
Based on this analysis, the question is what can be done in response to vaccine refusal. For most refuseniks, it may be just a matter of time for their opposition to decline, as the safety and effectiveness of the vaccine become clear. As for the persistent minority, there may be a need to devise a plan that limits their freedoms in a way that will protect them and the community.
In the meantime, an attempt to understand the possible intuitions and elusive moral logic that drive the vaccine refusers may help reduce some of the anger and vengeance directed at them and pave the way to a more respectful and healthy dialogue in the society.
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Cartoon: James Gillray lampoons reaction to the smallpox vaccine, 1802
