Populist Politics and Vaccine Hesitancy in Western Europe: An Analysis of National-level Data

Anecdotal evidence suggests a connection between the rise of populist politicians and political movements in Western Europe and increasing levels of vaccine hesitancy. For example, in 2017, a New York Times editorial entitled "Populism, Politics and Measles" noted that Italy's Five Star Movement (5SM) has raised concerns about vaccine safety and the link between the measles, mumps, and rubella (MMR) vaccine and autism. It is argued that these concerns caused MMR vaccination coverage to fall from 90% in 2013 to 85% in 2016 and that they resulted in an increase in measles cases from 840 in 2016 to 5,000 in 2017. In the context of such developments, this paper analyses national-level data to examine the link between political populism and vaccine hesitancy in Western Europe.

As Jonathan Kennedy explains, for most of the post-World-War-Two era, Western European parliaments were dominated by parties from the centre-left and centre-right. In the last few years, however, a number of new or newly popular parties have come to prominence (e.g., the United Kingdom (UK) Independence Party, or UKIP). The distinguishing characteristic of populist parties is their anti-establishment message. In Western Europe, support for populist parties comes from parts of the population who feel that their culture is threatened by immigration, that they are economically marginalised by advanced capitalism, and that they have been abandoned by mainstream political parties.

Kennedy reviews insights from a variety of social theorists that can help to explain the purported link between anti-establishment politics and vaccine hesitancy. Until the mid-20th century, science was seen as the ultimate form of knowledge, but in recent decades, social scientists have challenged natural scientists' claims to epistemological supremacy. This is based on a valid critique of the scientific method and its inability to uncover objective truth. Nevertheless, it has helped create a situation in which many laypeople distrust scientific expertise. This phenomenon has been referred to as technological or scientific populism. Even where public health programmes objectively improve the health of populations, they can be viewed with suspicion by communities that do not trust elites and experts. In the case of vaccine hesitancy, distrust is focused on public health experts and pharmaceutical companies that advocate vaccines.

For the present study, 14 Western European countries - i.e., the European Union prior to the pre-2004 enlargement - are included in the sample. Political populism is operationalised as the percentage of people in a country who voted for populist parties in the 2014 European Parliament elections. Vaccine hesitancy is operationalised as the percentage of people in a country who believe that vaccines are not important, safe, and effective, according to data from the Vaccine Confidence Project (VCP), which surveyed 65,819 individuals across 67 countries in 2015.

The investigation found a highly significant positive association between the percentage of people in a country who voted for populist parties and who believe that vaccines are not important (R = 0.7923, P = 0.007) and effective (R = 0.7222, P = 0.0035). The percentage of people who think vaccines are unsafe just misses being significant at the 5% level (R = 0.5027, P = 0.0669).

Kennedy considers whether there are correlations between measures of vaccine hesitancy and variables related to educational attainment, economic development, and religiosity, which the literature suggests could be confounders. The only significant correlation is between the proportion of Muslims in a country and vaccine safety. Muslim populations are not, however, large enough to drive anti-vaccine sentiment. For example, France has the highest values for both variables, but its Muslim population (7.5%) is far smaller than the percentage of people with concerns over vaccine safety (41.0%). It is likely that fears over Muslim immigration drive support for populist parties, which foment and exploit concerns about vaccine safety.

In short, the analysis in this paper indicates that there is a link between populism and vaccine hesitancy. This finding has these policy implications:

• At present, surveys of attitudes to vaccines are not systematically undertaken. In the absence of such monitoring, it is possible to analyse political opinion polls, which are regularly carried out. Support for populist parties could be used as a proxy for vaccine hesitancy, at least in the Western European context, with an increase in support being a signal for public health actors to be vigilant.
• Vaccine hesitancy in Western Europe should be understood within its specific socio-political context. While public health scholars and actors need to work to rebuild trust with parents who are reluctant to vaccinate their children, there are limits to this strategy. "The more general popular distrust of elites and experts that seems to inform vaccine hesitancy will be difficult to resolve unless its underlying causes - an iniquitous economic system and unrepresentative political system - are addressed."