As the Delta variant spreads, much has been made of the American anti-vax movement — its political character, its expressions, its impact. Elsewhere, the question of who has access to vaccines has frequently been more urgent than who is choosing to get one. And yet, across the globe, we’re seeing instances of vaccine hesitancy and refusal, for a wide variety of reasons. 

We asked writers around the world: Who’s vaccine-skeptical, and why? What historical events and experiences, trusted political or religious leaders, and media narratives are shaping vaccine skeptics’ beliefs? Who is dead-set against the vaccine, and who is holding out temporarily? Who’s waiting for a different vaccine than the ones currently on offer? And how are these people registering their dissent?

On September 14, Edwige, a medical secretary at the I.C.U. of the Lariboisière Hospital in Paris, walked across the nineteenth-century complex to a Covid vaccination center set up for hospital staff. She didn’t want to be there, and neither did her coworkers. “It was D-Day,” as she put it, the last day before a national vaccine mandate for health professionals would go into effect. In the waiting room, a few people appeared visibly distressed. Edwige, however, was “zen” — by necessity, she said. “I was relaxed,” she recalled, when the nurse inserted the needle. “I had no other choice.”

She hadn’t been swayed by the near daily outreach from hospital officials, nor by the hassle of undergoing a PCR test every 72 hours to adhere to the latest rules. When her coworkers in the I.C.U. learned that she was unvaccinated by choice, many were “saddened” and “surprised,” she said, and tried to dispel her skepticism. She listened to their entreaties, which she experienced as a well-intentioned and relentless barrage of opinions. Edwige was determined to wait, perhaps indefinitely, until evidence of the vaccine’s safety satisfied her own personal prerequisites. But on July 12, President Emmanuel Macron effectively banned this kind of hesitancy: he announced that any medical professional who refused inoculation would be suspended without pay starting September 15. Health minister Olivier Véran said that a doctor or nurse taking such a stance was “nonsensical.” It weakened the already understaffed hospital system, putting both patients and employees at risk during future outbreaks. Over the first and second waves of the pandemic, more than 25,000 patients were infected with Covid during visits to the hospital for unrelated reasons, and another 15,000 workers also fell ill due to hospital-based transmissions.

The policy seemed punitive to many health workers, nearly twenty percent of whom were still unvaccinated by early August. In a popular TikTok video released on July 13, Laura, a 35-year-old nurse, declared that she would rather “turn in her scrubs” than receive the shot. (“You’ll insert your own catheters,” she declared.) Hospital and nursing home workers joined ongoing national protests against the mandate and health pass. “The State wants to euthanize us!” demonstrators chanted in Marseille, while hospital employees in Valence printed “Je ne suis pas un QR code” shirts. The medical professionals, who tend to eschew political affiliation, bolstered an eclectic coalition of the far left and the far right, including trade unionists, anarchists, gilets jaunes, and conspiracy theorists.

Still, Macron’s vaccination policy seems to be well-received more broadly: on August 7, when more than 200,000 protestors marched in opposition to the vaccination obligatoire, about twice as many people were vaccinated nationwide. At hospitals, vaccination rates among employees rose in the late summer. Compared to the enthusiastic springtime rush, the appointments themselves were often longer and more emotionally taxing on vaccine providers, who had to assuage lingering fears in addition to administering the shot. But by the September 15 deadline, nearly all 2.7 million French medical professionals had either received their first doses or left the health system. The following day, the health ministry reported that only 3,000 workers had been suspended and that fewer than a hundred had resigned.

After her first vaccine, Edwige had a headache, sore arm, and stiff neck, but she showed up to work. Taking a seat beside another newly-vaccinated coworker who had almost quit to wait for the French-manufactured Sanofi shot, Edwige plugged in her headphones and transcribed the latest batch of medical reports dictated by the doctors in the I.C.U. There were toxicological emergencies and other critical illnesses. Forty percent of the beds were occupied by Covid-19 patients, almost all young and unvaccinated.

— Zoey Poll, Paris, France

Back in 2018, when the anti-vaccine movement was most popularly associated with affluent California parents, I joked to a friend that the next polio infection cluster wouldn’t be in Pakistan, one of the few countries where the affliction is still a problem, but at the Silver Lake location of Moon Juice. In that era, vaccine skepticism seemed largely confined to the woo-woo Goop types who espoused nootropics and chaga dust over modern medicine. 

At the time, I was reporting on efforts to eradicate polio in Pakistan, a country plagued by violent anti-vaccine sentiment. I was one of a series of international journalists who had come to investigate why Pakistan couldn’t eradicate polio, even as the rest of the world, including many impoverished nations with poor public health infrastructure, had. There was an air of condescension in all the reporting, even my own. Western media seemed to be saying: Look at these poor, backwards people.

Over 70 polio vaccinators have been killed in Pakistan since 2012, when the public learned that, as part of a covert operation designed to locate Osama bin Laden, the CIA disguised attempts to collect DNA that could link back to bin Laden as a Hepatitis B vaccination campaign. Shakil Afridi, the Pakistani doctor who led the operation, was arrested for espionage months after the bin Laden raid. He still languishes in jail. 

In the wake of the operation, the Taliban and other militant groups have painted vaccine workers as agents of Western imperialism and enemies of Muslims — never mind that most of the workers who administer vaccines are young Pakistani women. (This is because women usually  answer doors in Pakistani households).  

Now, with the Covid vaccination campaign picking up in Pakistan, vaccine hesitancy is widespread. The campaign borrows from the structure of polio campaigns of the past but isn’t nearly as organized, partly because polio eradication in Pakistan has millions of dollars of foreign backing from organizations like the Bill and Melinda Gates Foundation and Rotary International. But health workers are experienced with vaccine resistance. When I’ve trailed vaccinators running campaigns, they’ve never fought with the skeptics, never mocked them. They knock on their doors, year after year, and every year, a house that said no the last time agrees. 

— Meher Ahmad, Pakistan

From the start of the pandemic, Australia approached the virus with the goal of eliminating community spread and — unlike in many parts of the United States, where contact tracing was compared to planting petunias in a hurricane — it succeeded. There were outbreaks, but through testing, isolation, contact tracing, strict stay-at-home orders, and, above all, an uncompromising border regime, Australians managed to limit the number of cases. For a lot of late 2020 and early 2021, Australia enjoyed noisy, bustling pubs, in-person schools, and crowded sporting events. In February, as his show opened to theaters full of unvaccinated crowds, the director of Hamilton in Sydney claimed the production was a “beacon for an industry devastated.” 

The success of this approach to the pandemic became a source of pride, but along with it came scant urgency for vaccinations. “It’s not a race,” the prime minister noted at the outset of the vaccination campaign — a comment he later said he “regretted.” When a limo driver in Sydney contracted the Delta strain after transporting a flight crew in June, kicking off the current outbreak, only three percent of the population had been fully vaccinated. 

Australia’s slow start had more to do with a shambolic rollout, fluctuating supply, and inadequate communication than with local vaccine “hesitancy.” There are certainly pockets of ardent anti-vax sentiment, but for most people the concern is which one and when, as opposed to whether to get it at all. In fact, when AstraZeneca vaccines became widely available, the government recommended that those under the age of 60 wait for the Pfizer, because at the time the very small risk of a rare blood clot complication was higher than the risk of dying of Covid-19. That risk calculus changed as the outbreak spread.  

Australians generally enjoy the benefits of a robust public health infrastructure capable of ramping up quickly. This apparatus is now being mobilised to get people vaccinated, but underneath the lack of supply and tolerance for risk, there is also a lack of will. Given the nation’s long-standing refusal to take in refugees and its history of policies that favor white Australians, it is perhaps unsurprising to see such little motivation to loosen the strict restrictions on departures and arrivals. An Australian approach that back-burnered vaccinations while trying to eliminate community transmission made some (short-sighted) sense, but it’s hard not to see that isolating the infectious, and self-isolating against the infectious outside, meshed well with the preexisting isolationist attitudes of an island nation eager to pull up the drawbridge and hunker down. After all, Australia has long shown a greater desire to immunize itself against foreigners than against germs.

— Pamela Maddock, Australia

In December, Brazil’s President Jair Bolsonaro warned that if the vaccine turned people into alligators, the public would have no recourse against the pharmaceutical companies. Bolsonaro’s comment spawned many memes, as well as alligator video filters on social media, but little actual fear. Anti-vax sentiment in Brazil exists, but it’s not regarded with any seriousness by the majority of people. While many of Bolsonaro’s supporters believe every word he says, Boilsonaro was forced to change his tune when opinion polls revealed the unpopularity of his anti-vaccine views.

Brazil has a history of successful vaccination campaigns, which have long been used as models for initiatives in other countries. Brazil provides 300 million doses of 43 different kinds of vaccines to its population every year, and in 1994, efforts to vaccinate children against polio in Brazil and other countries in South America resulted in the eradication of the illness. The robust public healthcare system has made the necessity and the safety of vaccines clear to most of the population.

After, in a slight hiccup, fake headlines about people getting vaccinated with expired vaccines filled What’sApp groups, public healthcare workers fine-tuned their procedure. They now show every patient the vaccination vessel and explain the whole process painstakingly. They’re determined to get the job done. 

— Nicole Froio, Brazil

As of September 18, 857,000 people have been fully vaccinated against Covid-19 in Kenya, while a further 2.4 million have received their first doses. This is a brisk pace of vaccination, as Kenya has only received 6.3 million doses, with most arriving in the country only within the past few weeks as nearly-expired overstock from the West. Against this backdrop of clear, positive momentum, the strongest voice against vaccination has been Dr. Stephen Karanja. 

Until a few months ago, Karanja was chair of the Catholic Doctors Association in Kenya, a pulpit from which he for years condemned international health programs. In 2014, he claimed that a World Health Organization program to provide tetanus shots was a ploy to sterilize women. More recently, he deployed a similar argument against Covid-19 vaccinations. The Catholic Church in Kenya stood with his organization in the first claim, as Kenyan Catholic clergy had preached against tetanus vaccines for years. But this time, the Church cut ties with Karanja.

In early March 2021, Karanja made a blunt declaration: “We appeal to all the people of Kenya to avoid taking the vaccines.” He advocated instead for steam inhalation, hydroxychloroquine and zinc, a recommendation directly disputed by the WHO. By the end of April 2021, Karanja was dead, killed by Covid-19. 

— Carey Baraka, Kenya

We Icelanders are a people tragically susceptible to flattery, and these days our leaders are indulging us with repeated assurance that the pandemic has brought out the best in us — namely, our congenital commitment to collectivism. In a recent (and, as it turned out, untimely) declaration of triumph over the virus, our prime minister credited Iceland’s “success” to the sacrifices that individuals have made for the whole, adding, “I am proud to belong to a society where the power of unity and compassion for others is as great as we have seen here.” Such quixotic pronouncements about our bonds of cohesion are premised on the fact that we have, above all, been exceptionally cooperative as quarantiners, vaccine-takers and infection-trackers. Support for these and other measures taken by authorities have not once fallen below 90 percent since the onset of the pandemic. 

The secret behind Iceland’s success at collective atomization? For starters, a pre-existing tendency to marginalize anything resembling lunacy, irrationality, or stupidity. The few sorry souls who have actively resisted widespread physical isolation and vaccination seem to have been isolated socially. There is no real need to incentivize vaccination in such a society.

Meanwhile, lawyers, journalists, and elected officials who belong to the individualist strain of conservative politics have not found an audience in Iceland for even their tepid Covid-skepticism. To be sure, these respectable right-wingers rarely operate at the level of outright anti-vaccine conspiracy theory, let alone the appeals to law-breaking that distinguish some anti-vaccine movements in the United States and elsewhere in Europe. Skepticism about the vaccine or lockdown measures is usually formulated simply as ambiguous appeals to “inalienable human rights.” 

Yet what makes the people peddling such criticisms of “government encroachment” easy to shun is in part how frivolous they have been in the past about the most serious cases of state violence and rights abuses. For instance, among those who have recently fallen out of favor for engaging in “human rights” activism against Covid-containment measures is a former justice minister who, during her time in office, weakened already-enfeebled mechanisms for the overturning of wrongful convictions and hardened whatever was still “soft” about Iceland’s unforgiving asylum system. Now that she has found herself on the wrong side of the public consensus, who will believe that she is truly concerned with human rights? 

— Tryggvi Brynjarsson, Iceland

It has become dogma among much of the liberal-left that the real coronavirus tragedy is the uneven allotment of vaccines around the world, what some call “vaccine apartheid.” Western nations have protected intellectual property rights to the vaccines, hoarded injections, and used the World Health Organization’s COVAX program to restrict supply to global South countries. But where does the Democratic Republic of the Congo, which has vaccinated only 130,000 of its nearly 100 million residents and had to offload 1.3 million of its vaccines to other COVAX countries, fit into this story?

Distributional problems are not new to Congo. However, articles on vaccine shipments in the Congolese press have focused less on access than on hesitancy, making clear, in particular, that the vaccine would not be mandatory — despite Ministry of Health recommendations to get it. On my visit to Lubumbashi, the second largest city in DRC, between May and June 2021, there seemed to be deep reticence about the vaccine.

Most days, I visited the Bibliotheque de Saint Francois de Sales, paging through the archives of Mwana Shaba, a company newspaper for Belgian mining giant Union Miniere. Repeated articles on “Les Vaccinations” emphasized the need for inoculation against smallpox, typhoid, polio, diphtheria, and pertussis. One entry from November 1958 called those spreading doubt about vaccinations “malicious people,” and in August 1959, another writer expressed surprise that his colleagues showed “an incomprehensible fear” of remedies that had already saved countless lives.

These writers — many of whom were Congolese — insisted that they had an obligation to explain “the error” of resisting vaccination. They spoke not to “reasonable and sensible readers,” but to the “undecided, ignorant, unbelieving,” those residing in the mining towns far from the company headquarters in Elisabethville (Lubumbashi). The magazine attributed opposition to a view that “the remedies of whites must be harmful for blacks.” That view, whether commonly held or not, would not have been unfounded; historian Guillaume Lachenal has shown how the French colonial campaign to eliminate sleeping sickness in Africa with Lomidine not only failed to halt the disease, but produced deadly responses in many patients. Writers of Mwana Shaba offered a humanist plea: “Medicine has only one goal — to save lives, ALL lives — because it doesn’t know country nor border nor race.” But no matter how much they implored, many workers and their families refused vaccination.

In Congo, those who question the vaccine are known as les-ont-dit — literally, “they said it,” a phrase with echoes of the Trumpian “many people are saying.” Some suggest that “they say” God will protect them; others argue that “they say” Covid-19 is only a Western virus. In interviews in the national media, people from Kinshasa expressed hesitancy about issues with the AstraZeneca vaccine, low (but very inconsistent) infection numbers in DRC, and the history of vaccination in Congo.

These views do not come from nowhere. Early in the pandemic, widespread reports that African countries had found ways to manage the crisis better than America and other places encouraged a lingering sense of apathy, even as the Ministry of Health warned of future waves. While “vaccine apartheid” surely presents a problem for the DRC, focus on it has come at the expense of acknowledging more intractable issues — a struggling public health infrastructure, widespread hesitancy, and the powerful weight of history.

— Peter Vale, Democratic Republic of Congo