Urban/rural split on vaccine confidence echoes health-care history

A pandemic reveals much about society — some surprising, some familiar. 

Survey found more urban residents are eager for vaccine than rural

On April 13, 1955, technicians at the Connaught Laboratories in Toronto harvest the virus to be used in the new anti-polio vaccination developed by Dr. Jonas Salk of the University of Pittsburgh. (Fox Photos/Getty Images)

This analysis piece was written for CBC Opinion by Merle Massie, an author, historian, farmer and co-ordinator of undergraduate research at the University of Saskatchewan, and Paul Hackett,  whose research explores the history of Indigenous health, with a specific focus on the impact of changing cultural patterns on community and population health.

Their analysis references a recent survey by the Canadian Hub for Applied and Social Research. Read more about that survey here.

For more information about CBC's Opinion section, please see the FAQ.

A pandemic reveals much about society — some surprising, some familiar. 

The recent Canadian Hub for Applied and Social Research (CHASR) survey tested public waters on the pandemic, in particular those around Saskatchewan residents' interest in lining up for COVID-19 vaccination.

Those waters are surprisingly warm. Nearly four of five surveyed (78.8 per cent) said they would likely or very likely get the vaccine

Considering how pandemic leadership and media worked to manage public expectations around how long it usually takes to develop a new vaccine, how quickly the multiple vaccines were developed, and a noted surge in anti-vaccination rhetoric in the social media era, nearly 80 per cent is a fairly strong response.

Those numbers split along rural/urban lines. A full 88 per cent of urban residents are ready to roll up their sleeves, while a more tepid 68 per cent of rural respondents plan to get the jab. 

Historical precedent

The rural/urban split in some ways resembles the historic roots of the anti-vaxxer movements of Victorian England, which drew energy from working-class culture.

Compulsory smallpox vaccinations for infants and children in the 1800s was a singularly awful process. Vaccinators used a lancet to cut a hashtag pattern in four places on a child's body. Then the cuts would be smeared with lymph from the blisters of a second child, who had been through the process several days earlier. 

That it was compulsory — and a parent could be fined for refusing to vaccinate their child — added another layer of anger and revolt. Anti-vaccination protests erupted across Britain. 

Children line up for polio innoculation. (Provincial Archives of New Brunswick P342-1143)

Closer to home, we have historical evidence of smallpox vaccination co-operation. In the 1830s the Hudson's Bay Company carried out an ambitious vaccination program west of the Great Lakes, across what is now Canada. 

The campaign was met with eager participation among First Nations people, who knew the tragic impact of the disease. By 1940 smallpox was gone from Saskatchewan and by 1980 it was eliminated across the world. 

In the 1930s, diseases that we now consider vaccine-preventable — among them diphtheria (ranked third in terms of mortality by communicable diseases in the province), whooping cough (fourth), typhoid fever (fifth), and measles (10th) — all took a toll in Saskatchewan. These have faded into obscurity, through co-operation by the public and health officials alike. 

In the 1950s, governments in Saskatchewan and across Canada fought a virulent polio epidemic, assisted by domestic and international research laboratories. Facing mass infections in 1952, the province mobilized a two-pronged approach: develop an effective vaccine and isolate those infected. 

During the second half of that decade a comprehensive vaccination program — first targeting children and later adults — virtually eliminated polio. Compliance, however, was not universal. Only 65 per cent of those aged 20 to 40 were vaccinated, in part due to decreasing interest caused by declining mortalities. 

Rural residents put more on individuals

While many historical vaccination programs were aimed first at children, the demographic is flipped for the COVID-19 vaccine. In this case, it's the elderly (and front-line medical personnel) who need the vaccine first. 

Saskatchewan's First Nations communities, whose Elders and knowledge keepers are at great risk, have declared themselves ready to step up. Urban residents, as the CHASR survey showed, are also ready. Rural residents have some skepticism. 

The survey also asked who respondents think is responsible for controlling COVID-19: the individual, the government, or both equally?

Almost three-quarters of rural respondents said that individuals bear the greatest responsibility, compared to slightly more than 50 per cent of urban respondents. Urbanites were more likely to say that government and individuals bear equal responsibility.

Rural residents also gave higher marks than urban respondents to the Saskatchewan government for its handling of the pandemic. The provincial government's preference for promoting personal responsibility in the COVID crisis resonates well with rural perspectives on individual responsibility.

Poliomyelitis - aka 'the crippler' -- targetted youth and children in waves of epidemics through the 1950s. (University of Manitoba Archives & Special Collections)

In some ways, all of these responses underscore political lessons learned from the Victorian working class: government intervention at the household and personal body level is unwelcome.

Yet, the survey also reveals the counterargument, one that echoes historically and resonates among urban residents, recognizing the need for government public health interventions as necessary to find a path out of the ravages of disease for everyone.

Despite a preference for individual responsibility, the Saskatchewan government has inserted itself at the household level in a fundamental way, with strict limits on gatherings. The CHASR survey team asked whether respondents were following the five-person limit in your household.

A whopping 95.5 per cent of respondents said yes. The follow up question was, will you comply with those restrictions through the holiday season? About 90 per cent said that they will.

That reassuringly high level of compliance goes a long way to explain why so many are willing to be in line for the vaccine.

It just might be our 'get out of the house free' Monopoly card.

This column is part of CBC's Opinion section. For more information about this section, please read this editor's blog and our FAQ.

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About the Author

Merle Massie (right) is a Saskatchewan author, historian, farmer, and coordinator of undergraduate research at the University of Saskatchewan. Paul Hackett’s research explores the history of Indigenous health, with a specific focus on the impact of changing cultural patterns on community and population health.


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