From mobilization to fragmentation: approaching COVID-19 vaccine hesitancy through the lens of the polio epidemic

Finlay Pilcher is a medical student at the UVM Larner College of Medicine Class of 2024. In the first of a two-part series, she explores her lifelong interest in vaccines and how the COVID-19 pandemic has impacted her both on a personal level and as a burgeoning healthcare professional. Finlay is planning to become an infectious disease physician and is especially interested in public health.

Finlay Pilcher poses for a photo outside the UVM Given Building. Pilcher wears a puffy winter jacket.
Finlay Pilcher poses for a photo outside the UVM Given Building.

When the iron lung took my breath away

I have clear memories of the first time I learned about vaccines. 

I was visiting the Franklin D. Roosevelt Presidential Library and Museum in Hyde Park, New York and was fascinated to discover that the late president’s paralysis was caused by a virus. I remember seeing those awful photographs of the iron lung—a mechanical ventilator used in the 20th century to treat poliomyelitis (polio)—and feeling relieved that no one I knew would ever have to be put in one.

Wanting to know more, I researched the history of the 1938 March of Dimes, which helped fund the creation of the first polio vaccines. I was particularly struck to learn that the campaign, for which so many mothers famously advocated door to door, began when actor and comedian Eddie Cantor joked that everyone should send a dime to the White House to show President Roosevelt that they were with him in the fight against polio.

By the end of that week, the White House received 2,680,000 dimes.

I loved imagining myself as a child in the 1930s, stuffing a dime into an envelope and writing “To: The Oval Office” on the front. It felt like an act of defiance against a virus that had hurt so many children, but more importantly, one of strong support and solidarity in the battle to defeat it.

Greyscale historic photo depicting nurse standing and speaking to a patient who's entire body except for their head is encased in a metal tube - an Emerson respirator, also referred to as an "iron lung."
(Photo & caption adapted from Centers for Disease Control & Prevention) This historic 1960 photograph shows a nurse caring for a victim of the Rhode Island polio epidemic inside an Emerson respirator, also referred to as an iron lung. Devices like these were used to assist polio patients, whose ability to breathe was thwarted by paralysis of respiratory muscles.

March of D(ifferent T)imes

Since beginning medical school at the UVM Larner College of Medicine in Vermont (the state where the first major U.S. polio outbreak occurred), my curiosity about vaccines has evolved into an interest in vaccine equity—promoting fair and just access in communities with structural barriers such as historical racism, limited resources, or zip code. In between studying, I have spent my time trying to understand and mitigate the challenges Vermonters face related to avoiding vaccine-preventable illness. What I did not expect was that I’d also have a role in advocating for vaccination in my personal, very privileged life.

I grew up in Marin County, California, which made headlines in 2015 as a nidus in the resurgence of measles cases in the state. For years, Marin was a vaccination paradox. Despite possessing high rates of wealth and seemingly unlimited healthcare access, Marin County residents opted out of routine childhood vaccinations due in large part to the perceived (and unsubstantiated) risk of their association with autism spectrum disorder.[1] At the time, Marin was even credited as the epicenter of the anti-vaccine movement in the United States, though this trend has been completely reversed amid the COVID-19 pandemic. 

Pandemic fire, meet anti-vax gasoline

The COVID-19 pandemic changed the anti-vaccine landscape from fears of autism to broad medical and scientific mistrust and discord. Unlike our 1938 counterparts who mailed dimes to Washington, D.C. to join in the fight against polio, we hoarded toilet paper and hand sanitizer. Rather than raise funds for the creation of a life-saving vaccine, we did our own research.

The new wave of skepticism hit even closer to home than my county. Suddenly, my closest childhood friend – who could never understand my fascination with science – had many thoughts about SARS-CoV-2, the virus that causes COVID-19. Though originally frightened, he quickly shifted his stance to argue that the shutdowns were overblown and that the risk was minimal. He debated with me that we had reached herd immunity during the March 2020 spike in New York City and has many times likened COVID-19 to the flu.[2] 

In addition to feeling frustrated, I was so worried about him. The more he emailed me about the anti-parasite drug ivermectin[3], the more I feared our different views would become incompatible with us having a relationship. More than anything, though, I was afraid that he would put himself at risk in the name of standing up for his beliefs. Though we disagreed about so much, I was not prepared to lose the boy who climbed trees with me as kids or, 25 years later, cried at my wedding.   

Thankfully, I remain somewhat of a trusted source. Because of our relationship, I can toe the line between being educated in science and “uncorrupted by medicine.” I listened to his concerns, answered his emails, and shared both trusted peer-reviewed resources and my own perspective. When the time came to get a vaccine, he got his first and second dose, and I was relieved.

Finlay Pilcher poses against a grey brick wall giving the “thumbs up” sign with her left hand and holding up her CDC COVID-19 Vaccination Card in her right hand. Identifying information on the card has been greyed out. A Band-Aid is stuck to the upper right portion of her right arm.

A motivational booster

Though it was emotionally taxing, this experience fueled me. 

It taught me the importance of meeting people where they’re at and finding common ground, rather than winning an argument. My role as a medical student and future physician is to care for people – no matter what they believe – and strive to educate and support, not judge. I realized if I could help restore my friend’s trust in medicine, maybe I can do that for other people too.  

In my next post, I will share my experience working on an Albert Schweitzer Fellowship project aimed at improving HPV vaccination in three schools in Lamoille County, VT, and what I learned from it. As with my childhood friend, this project taught me valuable lessons and moved me to continue the important work of compassionate and humanistic vaccine advocacy during medical school and in my future career.

[1] This belief was based on a fraudulent paper by Andrew Wakefield that was published in The Lancet in 1998 and subsequently retracted. Neither vaccines nor their ingredients cause autism.

[2] Though both COVID-19 and influenza are very harmful, patients with COVID-19 have a higher risk of systemic illness and death than those with influenza.  

[3] There has been a recent uptick in ivermectin-associated illnesses following publication of a study which showed that ivermectin inhibited SARS-CoV-2 replication in vitro (in a petri dish). Ivermectin does not improve healthcare outcomes or reduce viral load in vivo (“within the living”).