COVID-19 changed everything, but also, in many ways, it changed very little. COVID-19 amplified the dilemmas we collectively faced and the fractures we already had. To those who were not thinking about rising rates of vaccine hesitancy before the pandemic, it may appear that COVID newly politicized science and created vaccine hesitancy. Yet, as anthropologist Heidi Larson shows, vaccine hesitancy and vaccine refusal are as old as vaccines themselves. In Stuck: How Vaccine Rumors Start—and Why They Don't Go Away, Larson—a professor of anthropology, risk, and decision science, and the founding director of the Vaccine Confidence Project, a research center focused on perceptions of vaccines around the world—explores how distrust of vaccines has been ever present but has ebbed and flowed with public frustrations and levels of anxiety and uncertainty. As such, this book is a useful text that weaves moments of suspicion of vaccines across time around the globe with empathy for how people come to these views.
Larson, a longtime researcher on children's health and immunization, wrote this book before COVID. As she explains in the prologue to the hardcover edition, the book entered production two days before the World Health Organization (WHO) declared that a novel coronavirus outbreak had become a “Public Health Emergency of International Concern” (xxiii). Rather than expressing regret that she was not able to address COVID directly, Larson writes of her sense of relief: if her last months of writing had been during the pandemic, “it would have changed what Stuck was meant to be about, which is the myriad of (pre-COVID-19) societal, technological, and political influences that have changed the public's relationship with vaccines and what they stand for” (xxiv).
Larson's book focuses specifically on the role of rumor in shaping vaccine hesitancy and refusal. Rather than treating rumor as a kind of misinformation that spreads easily and quickly and that must be stomped out, Larson is committed to examining how rumors spread and what role they serve in communities. At their core, rumors emerge anywhere uncertainty exists. Rumors, Larson and others suggest, can serve as “a type of collective problem-solving while people navigate risk and uncertainty” (4). Larson points to the places and moments when rumors spread that then undermined vaccine campaigns, often with tragic results. Yet she shows great sensitivity to the reasons rumors exist as a kind of resistance to a lack of self-determination, alienation from democratic processes, and indignities created by inequality. Larson shows that rumors critical of vaccines do not represent the dismissal of science but instead reflect individuals’ willingness to embrace and share alternative understandings that feel more true and more aligned with their values. This is an important intervention given how much of public health, data analytics, and medical communication scholarship—particularly since COVID—calls for “inoculation against misinformation to improve vaccine adherence” (Islam et al. 2021) rather than exploration of the rumors themselves or the lived experiences of the people who believe and repeat them.
Rumors, it turns out, are not always terrible and can in fact be important and useful. In fascinating parts of the book, Larson offers rich examples of how rumors can offer “illuminating important insights on human sentiment and behavior” as well as “important signals of information, especially in the context of infectious disease” (5). In one notable example, Larson describes how the WHO maintained registries of rumors from 1966 to 1980 to track any possible cases of smallpox, which would undermine their presumed accomplishment of eradication. Larson shows great respect for local knowledges as she offers stories from different historical moments and global contexts to show how rumors can be harmful, reassuring, or even lifesaving. This commitment to the dignity of those who question vaccines and the experts who disingenuously insist they are always safe—despite the reality that risk, however minute, is inevitable—exists alongside her unwavering support for immunizations, and this is perhaps the strength of this book. This is not to suggest that Larson supports all rumors; rather, she says that learning to mitigate “purposeful scare tactics while listening for important clues that need further investigation” is the real work of public health (47).
Larson's approach is refreshing in a landscape of medical providers, public health researchers and practitioners, and media accounts that chalk up vaccine refusal to a problem of gullible parents who have fallen prey to misinformation. The solution from this perspective is to deplatform misinformation content producers, as we saw with the identification of the “disinformation dozen” (CCDH 2021), or to flood information systems with more reliable information, which are too often densely packed with statistics and “facts” that do not resonate with parents experiencing uncertainty and fearing adverse outcomes. There is, in fact, strong evidence that much misinformation is intentionally unleashed to sow political polarization, which Larson discusses in several places in the book. Russian bots, for example, are deeply embedded in vaccine debates, “not to undermine vaccines, but . . . to further destabilize democracy” (83). Yet the process of spreading that misinformation is more complex and often less malicious. To explain how and why that happens, Stuck comes back to respect for the people faced with uncertainty in a social context of frustration, condescension, or constraint. Larson's training as an anthropologist asks the reader to take people, their perspectives, and their culture seriously. She insists that people are active participants in their own processes of meaning making and that some information is compelling because it more fully addresses their feelings, experiences, and anxieties. Respecting people and their lived experiences, which include rumors, Larson argues, is necessary for improving communities’ well-being and provides the best path forward. She looks forward to identify the possibilities for progress and insists that “building that dialogue between citizens and scientists and engaging citizens as part of the public health endeavor, rather than shutting down the conversation with seeming censorship around alternative voices, will be crucial. It's a matter of survival” (47).
It is notable that this review has been published in an academic journal since this book is clearly not written for academics. There is no bibliography, and the footnotes too often include a URL link with no citation information, or even a pathway to Larson's own local download folder. This book is nonetheless useful to scholars as a reminder of the importance of listening to the local knowledge systems and lived experiences of people who navigate medical decisions, legal requirements, and perceptions of risk. It is also useful for scholars who must themselves make vaccine decisions, but it is not primarily for them. I imagine this book was written for your mother, your neighbor, or anyone who looks at parents who oppose vaccines and asks with the confidence that the voice of scientific certainty offers those who embrace it: “What's wrong with them?” Larson's answer is equal parts nothing and many things that are neither about science nor vaccines.
As mentioned, the book was written before COVID. Thus the last chapter, “Pandemics and Publics,” offers a cautionary tale of how few adults sought out vaccines during the 2009 H1N1 “swine flu” pandemic. Pointing to the good fortune that rates of fatalities were lower than anticipated, Larson warns, “If the world responds to the next high-risk pandemic with same level of vaccine reluctance it did in response to H1N1, we may not be so lucky” (118). As it turns out, the next pandemic was less fortunate and less vaccine hesitant. By 2023, at least 70% of the world's population had received at least one dose of a vaccine against SARS-CoV-2, the virus responsible for the pandemic (Holder 2023), even as it saw more than 1.8 million deaths in 2020 (WHO 2021) and more than seven million deaths by March 2024 (Worldometer 2024). Larson explains in her prologue that “the chapters in Stuck remain more relevant than ever—from the power of belief to risk and rumor, dignity and distrust, volatility, emotional contagion, wildfires, and publics in pandemics. These issues, though, played out in even more extreme and unpredictable ways, fueled by the hyper-uncertainty of the pandemic” (xiv). Larson did not write this book about COVID, but the lessons within it are indeed, and perhaps depressingly, more relevant than they were when the book was finished in 2020. Confidence in vaccines has declined in nearly every country in the world (UNICEF 2023); in the United States, more people now support parents’ rights to reject vaccines “even if that may create health risks for other children and adults” than did before the pandemic (Lopes et al. 2022: online). Stuck offers pathways for reimagining how information fuses with politics, emotions, fear, faith, and care—and then travels. In offering this account, Larson suggests that we can collectively do better to build connections and restore community trust—which, like rumors, could spread like wildfire.
