A History of Vaccination Hesitancy

While we in the U.S. have been blessed with abundant vaccine supply and access, much of the world has struggled to receive needed vaccines. We know in the U.S. that even when vaccines are available, distrust of the government or the vaccines themselves may keep parts of the population from becoming vaccinated.

That distrust is prevalent in the Guatemalan Maya villages. Pastora Karen of the ILAG tells us that Guatemala’s government asked the country's millionaires to loan it money to buy vaccines, which the government subsequently did not buy. Most of the vaccines available in Guatemala are donations from the U.S., Mexico, Spain, Israel, India and other countries.

To worsen the situation, the head of the agency in charge of investigating corruption was fired to keep him from looking into this situation. A national strike demanding the president to step down was called, blocking roadways and stopping commerce. There was talk of another civil war. The sentiment was that “the Guatemalan government is stealing the money from the vaccines and militarizing the country to protect itself.”

Pastora Karen tells us that people in the villages do not want another war, and they are hesitant about vaccines.

Distrust of the government in Mayan communities seems justified, as does distrust of vaccines, given the history of vaccines in the country. The association of vaccines and government coercion began with the smallpox vaccination campaign of the 18th century. Actions since then have caused association of government vaccination campaigns with co-opting and destroying Mayan traditions as well as violence against villages.

Smallpox, measles and typhus arrived with the Spanish conquerors, and roared across Central America in waves, decimating indigenous populations. By 1790, the first vaccine against Smallpox was being developed. The government of Guatemala felt it was its obligation to help “the poor and downtrodden,” Maya, or as it described as “minors to be cared for,” deserving of the help of Christian charity. Elites such as medical doctors and government ministers felt responsibility that ‘these poor ones’ received aid, to ensure the health of Maya populations--whose labor and taxes provided the basis for the continued stability of the colonial state.

As is true now, pro- and anti-inoculation debates played out; a centralized plan was made for Guatemala City inoculation in the 1790s, with the stipulation that inoculation must be voluntary and not forced on anyone. This was true until the anti-smallpox efforts expanded to rural areas and regional towns.

Maya healers traditionally used temascales, a type of low-heat sweat lodge for general health and for illnesses, including typhus, measles, and smallpox. A room was filled with heated water vapors mixed with burning medicinal plants, animals and other ingredients from the local environment.

Leaders of the campaigns against epidemics frequently complained about temascales and pushed to destroy the buildings and outlaw their use, especially during outbreaks. The increased spread of smallpox was attributed to their use. Parishioners heard warnings from the pulpit not to treat the sick in temascales.

The Maya medical specialists who healed in temascales were viewed as subverting state-mandated guidelines. When the use continued, doctors and regional political officials brought in the military to destroy them. Local leaders argued that they had to resort to violence and threat of violence to ensure that Maya residents adhered to state-sanctioned smallpox treatment guidelines.

Forced Removals

In addition to the destruction of temascales, authorities used forced removal of the sick from their homes to quarantine in temporary smallpox hospitals guarded by armed men. Armed militia and local men enforced quarantines and acted as guards for inoculators. They also worked with medical teams to identify and destroy the homes and belongings of those who died from smallpox, typhus and measles, leaving survivors with nothing. In addition, Maya children with smallpox were removed from their homes to quarantine in safe homes by medical people accompanied by armed guards.

Threat and coercion linked militia with public health campaigns and the forced removal of infected children from their parents continued over a decade as multi-year, concurrent outbreaks of measles and typhus repeatedly burned through the region, increasing mistrust of medical campaigns. Doctors, inoculators and regional political officials filed reports that Maya towns outright refused medical treatments or that residents fled to disperse into the highland forests when word arrived that a medical campaign was on its way. Other Maya towns used or threatened violence themselves against medical campaign workers.

Videos Encourage Vaccinations

Given that understandable hesitancy, Pastora Karen asked if partner churches here would send videos describing the importance of vaccines, our willingness to be vaccinated, and our hopes for the villagers to receive them. At least eight partner churches and many individuals quickly responded with videos! After the first of the pastoral visits in late July, Pastora Karen reported that the videos were well received, with villagers happy to see familiar faces, and that people in two communities were encouraged by your experiences to get vaccinated.

We continue to pray for our Guatemala partners during this challenging time, awaiting news that vaccines are available to them, that they are willing to be vaccinated, and that their communities can be COVID free.

Sandra Eliason, MD
St. Michael's Lutheran Church
Roseville, Minnesota

Resource:
Few, Martha. “Epidemics, Indigenous Communities, and Public Health in the COVID-19 Era: Views from Smallpox Inoculation Campaigns in Colonial Guatemala.” Journal of Global History, vol. 15, no. 3, 2020, pp. 380–393., doi:10.1017/S1740022820000297.