RESEARCH REPOSITORY 
 

This is the author’s final version of the work, as accepted for publication  
following peer review but without the publisher’s layout or pagination.  

The definitive version is available at: 
 

 
http://dx.doi.org/10.1007/s11673-016-9756-7       

 
 
 
 

Attwell, K., Leask, J., Meyer, S.B., Rokkas, P. and Ward, P. (2017) 
Vaccine rejecting parents’ engagement with expert systems that inform 
vaccination programs. Journal of Bioethical Inquiry, 14 (1). pp. 65-76. 

 
 
 
 
 
 

http://researchrepository.murdoch.edu.au/id/eprint/34803/ 

 
 

Copyright: © 2016 Journal of Bioethical Inquiry Pty Ltd. 
It is posted here for your personal use. No further distribution is permitted. 

 
 



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[issue] 14(1) 

[category] Symposium: Public Trust in Expert Knowledge 

[title] Vaccine Rejecting Parents’ Engagement With Expert Systems That Inform 

Vaccination Programs 

[subtitle] 

[authors] Katie Attwell, Julie Leask, Samantha B. Meyer, Philippa Rokkas, Paul Ward 

 

 

[author details] 

K. Attwell [corresponding author]  

Sir Walter Murdoch School of Public Policy and International Affairs, Murdoch University 

South Street, Murdoch, WA 6150, AUSTRALIA 

Immunisation Alliance of Western Australia, Cockburn Integrated Health and Community 

Facility 

Suite 14, 11 Wentworth Parade Success, WA 6164, AUSTRALIA 

e-mail: k.attwell@murdoch.edu.au 

 

 

J. Leask 

School of Public Health, Faculty of Medicine, Faculty of Nursing 

University of Sydney, NSW 2006, AUSTRALIA 

e-mail: julie.leask@sydney.edu.au 

 

S.B. Meyer 

University of Waterloo, 200 University Ave West 

Waterloo, Ontario, N2L3G1, CANADA 

e-mail: samantha.meyer@uwaterloo.ca  

 

P. Rokkas 

Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA 5001 

e-mail: philippa.rokkas@flinders.edu.au 

 

P. Ward 

Department of Public Health, Flinders University, Adelaide, SA 5001 



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e-mail: paul.Ward@flinders.edu.au 

 

Keywords Vaccination; Vaccine hesitancy; Qualitative; Trust; Giddens; Modernity 

 

Abstract In attempting to provide protection to individuals and communities, childhood 

immunization has benefits that far outweigh disease risks. However, some parents decide not 

to immunize their children with some or all vaccines for reasons including lack of trust in 

governments, health professionals, and vaccine manufacturers. This article employs a 

theoretical analysis of trust and distrust to explore how twenty-seven parents with a history of 

vaccine rejection in two Australian cities view the expert systems central to vaccination 

policy and practice. Our data show how perceptions of the profit motive generate distrust in 

the expert systems pertaining to vaccination. Our participants perceived that pharmaceutical 

companies had a pernicious influence over the systems driving vaccination: research, health 

professionals, and government. Accordingly, they saw vaccine recommendations in conflict 

with the interests of their child and “the system” underscored by malign intent, even if 

individual representatives of this system were not equally tainted. This perspective was 

common to parents who declined all vaccines and those who accepted some. We regard the 

differences between these parents—and indeed the differences between vaccine decliners and 

those whose Western medical epistemology informs reflexive trust—as arising from the 

internalization of countering views, which facilitates nuance. 

 

Introduction  

Childhood vaccination is one of public health’s salient achievements (Larson et al. 2014). 

Alongside environmental public health measures, it constitutes the most successful and cost 

effective global public health measure to reduce disease-related mortality (Andre et al. 2008). 

Like any medical intervention, vaccines can cause common minor side effects (e.g. fever) and 

very rare serious ones (e.g. Guillain-Barré syndrome) (ATAGI 2015). Accordingly, the 

immunization process induces complex decisions, both rational and emotional, in some 

parents faced with balancing the welfare of the community with a “do no harm” ethos for 

their own child.  

While parental rejection of vaccines is complex and context-specific, varying across time, 

place, and vaccine (MacDonald and SAGE Working Group on Vaccine Hesitancy 2015), key 

themes recur in studies, with safety a predominating concern (Casiday et al. 2006; Mills et al. 

2005; Smith et al. 2011). Other widely held concerns include the number of vaccinations and 



3 
 

perceptions they may overload the immune system (Hilton, Petticrew, and Hunt 2006). Some 

parents believe alternative medicines may suffice in place of vaccines (Zuzak et al. 2008), 

and some are unsure why their children still need to be vaccinated against diseases that are 

now rare (Janko 2012). Occasionally, parents may also recognize that if there is a high 

proportion of individuals who are already vaccinated, their own child can “hide in the herd” 

(Offit and Moser 2009).  

Trust arises as an issue in numerous studies of why people do and do not vaccinate their 

children (Mills et al. 2005; Dube, Vivion, and MacDonald 2015; Yaqub et al. 2014), but the 

extent to which trust and distrust—as distinct concepts—shape vaccination decisions remains 

underexplored. In this study, we theoretically analyse trust and distrust to investigate parents’ 

perceptions of the expert systems central to vaccination policy and practice in Australia, 

where approximately 3.3 per cent of children are not up to date with their vaccinations due to 

their parent or caregiver’s active rejection of some or all vaccines (Beard et al. 2016).  

We start with an important observation: trust and distrust are not binary categories whose 

qualities can be populated by the converse of the other. They are conceptually and 

semantically distinct from each other. Trust may be considered to fall somewhere on a 

spectrum between complete trust to complete distrust (Brown and Meyer 2015; Gambetta 

1988). Distrust is often a focus of study; since distrust correlates with vaccine refusal, 

policymakers want to understand it in order to address it. Our work is situated in this realm. 

However, what trust and distrust share is that both are rooted in the cognitive (rational) and 

affective (emotional) and embedded in broader social contexts, health system understandings, 

socioeconomic structures, and illness vulnerability and chronology (Brown and Meyer 2015), 

as well as within health experiences and narratives. We follow a particular narrative here—

that most of us appear to trust (for reasons relating to late modernity’s complexity), and some 

of us distrust (for reasons we further elucidate through empirical study). However, we do not 

suggest that the cognitive and affective drivers of vaccine refusers’ distrust are mirrored (in 

the opposite) by vaccine acceptors. We argue, on the contrary, that there are many pathways 

to the active acceptance of (as well as passive compliance with) vaccination, and trust need 

not be written on their signposts. When it comes to distrust, however, the strong relationship 

between distrust and refusal demands our attention, and is the focus of the present paper. 

First, then, we explore “the rest of us,” in order to contextualize our analysis of vaccine 

refusers’ distrust. Given that the vast majority of parents in developed countries with access 

to childhood vaccines make use of them, one might deduce that these parents trust those who 

make, recommend, and administer them. Trust can be seen as a function to overcome the 



4 
 

uncertainties parents face in the decision to vaccinate, since informed medical decision-

making requires that an individual grasps the condition and clinical context and has evaluated 

his or her preferences (Rimer et al. 2004, 1214). Complete knowledge is not always possible 

(or even perhaps desired) and therefore, accordingly, parents are called to place trust in 

healthcare providers to act in the interest of their child. Since providers are embedded within 

broader systems of service organization, professional expertise, and knowledge development 

(Mollering 2001; Mollering 2006; Luhmann 1979), trust extends to include health systems 

and broader social systems (e.g., economic, political, judicial) that shape knowledge and 

assumptions of health and healthcare (Luhmann 1995).  

Conceptually, disentangling trust in individuals from trust in systems is challenging, since 

individuals (e.g. GPs, midwives) are seen to represent institutions and thus as “part” of them 

rather than distinct from them. Giddens (1990) refers to the “meeting places” for 

interpersonal and institutional trust as “access points”—the doctor for the medical system, the 

researcher for the scientific system, the politician for the political system, the news reporter 

for the media and so on.  

Although everyone is aware that the real repository of trust is in the abstract 

system, rather than the individuals who in specific contexts “represent” it, access 

points carry a reminder that it is the flesh and blood people (who are potentially 

fallible) who are its operators. (Giddens 1990, 85) 

According to this reasoning, we arrive at the centrality of both the individuals (“access 

points”) and institutions which together comprise expert systems. Expert systems penetrate 

nearly all aspects of social life in conditions of modernity (Giddens 1991; Habermas 1997; 

Scambler and Britten 2001). We trust in expert systems as a way of managing the limited 

technical knowledge that most of us possess about the information that routinely affects our 

lives (Giddens 1991). We need not have direct experience with that which we trust or 

distrust; social or cultural norms underpin the decision to trust and are based on a constructed 

characterization or stylized notion of the institution (Govier 1998). When we are faced with 

the uncertainty and risk central to health and medical decision-making, trust in expert systems 

reduces complexity; empirical research has demonstrated a “will to trust” that veils patients’ 

anxieties regarding a treatment or medical condition (Brown 2009).  

Continuing with this narrative, a key marker of contemporary society is that trust can no 

longer be simply taken for granted or expected (Giddens 1994) and distrust (or at least 

healthy scepticism) has become the norm (Sztompka 1999, 6). To apply this reasoning to the 

present context, the bewildering array of individuals professing (or indeed holding) expertise 



5 
 

on vaccination in high income countries is in many ways emblematic of late modernity. 

Today, western medical epistemology is not the only system appealing to parents as a 

repository for their trust—alternative modalities also entice with critiques of that 

epistemology. Accordingly, parents choose “what” or “whom” they view as the expert system 

and, placing trust in that system, make the decision to vaccinate or not (Brownlie and 

Howson 2005). It is here that we can start to see the relationship between distrust in the 

dominant expert system and vaccine refusal.  

Current literatures consistently link institutional distrust in government, pharmaceutical 

companies, healthcare professions, and medical science and technology to vaccine rejection 

(Dube, Vivion, and MacDonald 2015). In a British study, parents of under-vaccinated 

children found it difficult to know where to place their trust and did not trust the government 

(Austin et al. 2008). An American study identified trust as playing a key role in where parents 

were situated along the vaccine acceptance spectrum (Benin et al. 2006). Another found that 

parents who sought exemptions from vaccination were more likely than other parents to 

report “little or no trust in health information provided by … government agencies, health 

provider groups or organizations and to distrust local doctors” (Gaudino and Robison 2012, 

1135). Parents’ experiences with health professionals (“access points” of the vaccination 

expert system) are also significant, with insufficient, biased, poorly communicated advice 

from healthcare providers provoking distrust (Donovan and Bedford 2013).  

Current social trends towards patient advocacy, empowerment, and choice are heightening 

some parents’ distrust in vaccines. While a conventional public health approach might concur 

with a Giddens-style (1994) narrative of an erosion of trust (“once we trusted, now we 

don’t”), we are cautioned by research on healthcare and trust to take a more critical view of 

compliance. Patients often follow the instruction of healthcare providers, not because they 

explicitly trust them but because they feel dependent upon them, particularly in high risk 

situations or when the public health system precludes choice (Ward et al. 2015). They may 

also feel obliged to follow directions—to “do as they’re told”—when these instructions come 

from government. This links to working class or specific culturally mediated notions of duty 

to the state (Ward, Coffey, and Meyer 2015). Such accounts of compliance remind us that we 

should not assume that the flipside of vaccine refusing parents’ reflexive distrust is a coherent 

and deeply held sense of trust experienced by the rest of us. Nor, indeed, can we nostalgically 

look back to a past where such a deeply held trust determined societal acceptance of 

vaccination. Lack of choice, lack of knowledge, and obedience to authority may explain this 

historical compliance as well.  



6 
 

Accordingly, it is more helpful to conceptualize a “contemporary health consciousness” 

(Crawford 2004, 50) driving many parents today to undertake protective action for their 

children. Protection from perceived risk of vaccines jostles against protection from disease. 

Parents pursue health information through unfiltered channels such as the Internet (Yaqub et 

al. 2014), which offers quick access and the advantages of interactivity, information tailoring 

and anonymity (Cline and Haynes 2001). Health information is one of the most frequently 

sought topics online (MuMullan 2006), with access growing rapidly through globalization, 

the diffusion of the news media, and social networking. Although moderated by other factors, 

information we encounter affects us—one study found that exposure to (what the authors 

described as) anti-vaccination conspiracy theories reduced the likelihood of intent to 

vaccinate (Jolley and Douglas 2014). When engaging with conflicting material it can be 

impossible to know the quality of the evidence chosen by those who assert knowledge.  

Brownlie and Howson (2005) argue that “when parents are identifying good reasons to either 

vaccinate or not, they are acting as bricoleurs, piecing together different knowledges” (226), a 

troublesome process because there are “good reasons” on both sides of the argument (224). In 

addition, current research identifies the role of social relationships and identities in 

vaccination decision-making, emphasizing that refusal is not simply a rejection of an offered 

benefit, but rather a process through which parents navigate social norms and articulate social 

inclusion and exclusion in relation to those around them (Sobo 2016).  

The perceptions of members of this research team, as “experts” whose epistemological 

standpoint enables us to trust those whom we regard as experts, cannot negate the experiences 

of these parents whose knowledge is otherwise (socially) constructed. Accordingly, we take 

seriously our participants’ formulation of logic regarding vaccination even as they differ from 

our own assessments. While our approach privileges scientific knowledge, we acknowledge 

the body of literature critiquing evidence-based public health as being misappropriated by 

vested interests, lending support to calls for greater emphasis on lay experience and 

knowledge to guide policy and practice. Greenhalgh et al. (2014, 1) argue that the “evidence-

based brand” is currently distorted as “the drug and medical devices industries increasingly 

set the research agenda” and “define what counts as a disease and pre-disease ‘risk states.’”  

Accordingly, critical reflection on the means by which knowledge (and our consequent 

labelling of “experts”) is constructed requires that we engage seriously with our participants’ 

questioning of the values underpinning Australia’s vaccination schedule and policies, and the 

interests being served, in order to better understand what informs their decision-making.  



7 
 

These considerations inform our analysis of Australian vaccine rejecting parents’ 

construction of “what” or “whom” they trust and distrust when making decisions about 

vaccines. We asked questions about institutions with which we assumed they, as parents, 

would have direct experience in relation to childhood vaccinations. However, the parents may 

also be drawing from media representations and/or shared cultural values of the institutions, 

rather than direct experience. Our results and previous research (Gaudino and Robison 2012; 

Benin et al. 2006; Leask and Chapman 2002) depict competing expert systems at work, with 

allopathic healthcare (buttressed by scientific research, government and industry) challenged 

by the alternative epistemology of complementary and alternative medicine (CAM). Our aim 

is to understand what it is about allopathic healthcare—the expert system behind 

vaccination—that leads some parents to distrust both its “access points” (healthcare 

professionals in particular) and the system as a whole. 

 

Methodology 

We interviewed parents in Fremantle, Western Australia (WA) and Adelaide, South Australia 

(SA), who declined some or all vaccines for their children. Each recruitment site involved 

distinct research projects undertaken in different years but with convergent aims and methods 

sufficient to justify a pooling of data. Both studies aimed to better understand vaccine 

hesitancy; used a qualitative methodology with semi-structured interviews; and explored in-

depth the underpinning perceptions of vaccinations, healthcare professionals, and social 

systems influencing the structure and function of immunization programmes. In Adelaide, 

interviews specifically sought to explore trust and distrust, while in Fremantle, interviews 

were conducted as part of a pro-vaccination campaign development and evaluation (Attwell 

and Freeman 2015). While each study explored these a priori interests, both focused on 

parental influences and experiences with vaccination expert systems. The qualitative in-depth 

interviews enabled us to provide rich accounts of the unique practices and experiences of 

each parent.  

In Fremantle, parents were recruited between September 2013 and April 2014 from postcodes 

surrounding the City of Fremantle, which at the time recorded full vaccine coverage rates at 

below 87 per cent for children under five compared to the Australian average of just over 90 

per cent (National Health Performance Authority 2014). Parents were recruited through 

posters, advertisements in the local newspapers, social media, and snowballing. Participants 

were screened prior to interviews to ensure that they met study inclusion criteria of delay or 

refusal of recommended vaccines and had a child aged five or under. In Adelaide, parents 



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were recruited between October and December 2015 from areas within postal codes 

identified as having low immunization coverage rates; less than the South Australian average 

91.3 per cent at sixty to sixty-three months of age on the Australian Childhood Immunisation 

Register. Parents were recruited by the researcher at a suburban organic farmers’ market and 

by snowballing, then screened to ensure that they met the study inclusion criteria of either 

delaying or refusing vaccination for their children. The University of Western Australia and 

Flinders University Social and Behavioural Research Ethics Committee provided ethical 

approval for the project under permit RA 4/1/5890 and project number 6976 respectively. 

To explore our participants’ engagement with vaccination expert systems in late modernity, 

we applied deductive social theoretical reasoning (Willis et al. 2007) with a narrative analysis 

approach to our data. We worked from key principles of narrative analysis: recognizing 

overlapping stories from participants, interpretive explanations, and the future conclusions 

our readers would construct (Riessman 2008, 6). Lacking access to our participants’ 

“unmediated experience,” we were conscious of narratives constructed by “socially situated 

individuals” within the interview setting (23) and the impact of our interviewing, 

transcription, and analysis in the stories ultimately told (50). We focused on participants’ 

interactions with the allopathic healthcare system and other systems and notions of trust and 

distrust. KA and PR interviewed participants face to face. Following transcription and 

narrative-reading, KA developed an initial coding tree using QSR International’s NVivo 10 

Software. This involved developing a visual representation of expert systems as constructed 

by participants. PW and JL evaluated a sub-set of the transcripts with continued input from 

PR, and the team agreed on a final coding structure based on the expert systems connected to 

vaccination policy and practice. During this process, personal reflection and open discussion 

during team meetings facilitated reflection on how our knowledge, experiences, beliefs, and 

backgrounds influenced our reading of the data.  

 

Results 

Semi-structured interviews were conducted with a total of twenty-seven parents: nine from 

Fremantle and eighteen from Adelaide. Twenty-four participants were women and three were 

men. Seventeen parents were aged between thirty-six and forty-two; the youngest was 

twenty-five and the oldest was fifty. The Fremantle parents were younger because of the age 

requirements of the youngest child. Over half of the parents had university qualifications. The 

sample included ten parents who had never vaccinated, five who commenced but ceased, 

seven who were currently delaying or partially vaccinating, and five former delayers now up 



9 
 

to date. We recognize differences between parents who decline all vaccines and those willing 

for their children to receive some or all vaccines eventually. However, in terms of how the 

participants in our study viewed the vaccination expert system, their fundamental perceptions 

were similar; for most it was only the strength of these perceptions that determined whether 

they could vaccinate despite their reservations. For some participants, the willingness to 

vaccinate despite their distrust developed over time, while for others the converse was true; 

their distrust of vaccinations increased as time progressed. 

Unequivocally, parents’ distrust specifically pertained to the pharmaceutical industry and the 

means by which it “infiltrated” other systems, thereby diminishing trust in allopathic 

healthcare. This concurs with Luhmann’s (1979) theory of relational trust in social systems. 

In such a “web of trust” (Meyer et al. 2008), trust or distrust in one system impacts upon trust 

or distrust in others. As our parents described their interactions with, and perceptions of, the 

expert systems pertaining to childhood vaccination, their broad distrust of the pharmaceutical 

industry cast a shadow over other institutions and individuals. Everything, it seemed, was for 

sale, and this meant the parents could not trust the “experts.” 

 

Pharmaceutical Industry as “Puppet Master” 

Our participants’ distrust of the pharmaceutical industry (and the related systems in the 

“web”) can be explained by their perception that it acts as a “puppet-master.” Almost all our 

participants saw the pharmaceutical industry as the dominant force behind the expert systems 

pertaining to vaccination, “tainting” systems of research, the motives of health professionals, 

and the operation of government. Many framed this distrust of the pharmaceutical industry 

within a broader objection to capitalism. It is on this basis that we emphasize similar 

worldviews between those parents who outright declined all vaccines and those who, despite 

their dim view of the vested interests, factored in other considerations enabling them to 

accept some or all vaccines eventually. Almost all our participants depicted companies as 

responsible to shareholders rather than societies, with the profit motive itself suspect. 

Participants spontaneously linked the pharmaceutical industry to the resources sector, with its 

use of fracking; and agribusiness, with its use of genetic modification. “They don’t care about 

us. It’s all a big moneymaking scam and we are the cattle that is having money made off of 

us” (female, forty, SA, ceased vaccinator). Participants recounted events like those 

surrounding the pesticide DDT (dichlorodiphenyltrichloroethane) and the birth defects caused 

from the anti-nausea drug, thalidomide, in the 1950s and 1960s as part of what one called the 

“horrific history of the industry” (female, twenty-five, WA, partial vaccinator). 



10 
 

 …[T]he whole pharmaceutical thing, to me it’s just a big money making 

scheme…They’re a business. They make money from people being sick, so they 

don’t want to find a cure for this or that, because that means people won’t rely on 

their drugs to help them get through their disease, or whatever it is that’s making 

them sick. They want people to stay sick so that they keep buying their drugs, 

essentially (female, thirty-two, SA, non-vaccinator). 

The pharmaceutical industry’s untrustworthiness involved a perception of companies limiting 

information about risks and inefficacies. In explaining her distrust, the partial vaccinator 

above described “missing data, unpublished stuff when things don’t turn out how they want 

them to turn out, the regulations around drug development and testing, and the information on 

that” (female, twenty-five, WA). Another participant referred to an alleged cover-up, 

“They’re not going to advertise any negative about their stuff. They bury it. They go to great 

lengths to make sure that people don’t actually see the negative effects” (male, forty-one, SA, 

non-vaccinator). The overall sentiment of most participants can be summed up thus: 

“Vaccines are run by Big Pharma companies; to me it’s all about making money” (female, 

thirty-nine, SA, delayed vaccinator).  

Rarely was this given a nuanced interpretation. However, the partial vaccinator who had only 

declined the varicella vaccine for her son rejected the notion that all pharmaceuticals were 

untrustworthy. 

The notion that Big Pharma is only ever out to do evil is a bit naive and 

delusional. Is it evil to make money? … [T]he Marxist in me probably thinks 

“Well, yes,” but the pharmaceutical industry has developed drugs that treat cancer 

(female, twenty-five, WA, partial vaccinator). 

Another was even more positive:  

Look, a lot of people are pretty nasty about the pharmaceutical industry and they 

don’t understand … the research that goes into these drugs and the expenses and 

the costs and everything that happens, and they’ve got to make good money out 

of it once they get it. When you pay for a vaccine you’re not actually paying for 

the production of the vaccine, you’re paying for the twenty years of research and 

testing that went before it, so I don’t have a problem with that’ (female, forty-

seven, SA, partial vaccinator).  

The only other parent to be equanimous stated, “I don’t trust them in certain areas, I guess. I 

do think they’re all about making money, and clearly we’ve seen evidence of it, especially in 

the US, the way they’re involved in politics, those companies … ” However, she went on to 



11 
 

reflect, “It’s a funny one, isn’t it, because obviously I trust them to a degree because I give 

my children medicines or immunisations that come from these companies … ” (female, 

thirty-eight, SA, full but delayed vaccinator). 

This last quote encapsulates the difference in degree between partial vaccinators and 

complete decliners. Partial vaccinators could “get on board” with vaccination to an extent, 

but still ultimately distrusted its agents on the basis of the pharmaceutical industry’s profit 

motive. Complete decliners’ more extreme perceptions ruled this out:  

I see that the pharmaceutical companies … were founded by war criminals from 

Nazi Germany and they were taken over to America and they started 

pharmaceutical companies. So are they practising Eugenics on us beyond our—

like, without our knowledge? (female, forty, SA, ceased vaccinator).  

Such distrust of the influence of the pharmaceutical industry was so pervasive that we now 

track it through the other systems of expert power that emerged from the interviews. We have 

adopted this approach because in seeking to answer the question: “What makes the 

vaccination expert system so untrustworthy for parents?” almost every road from the data led 

to the pharmaceutical industry. By illustrating exactly how the parents perceive its role, with 

tendrils curling into multiple facets of “expertise,” we can demonstrate how this expertise—

the very expertise that we ourselves privilege as researchers—is contingent; socially 

constructed through cues to trust that do not reach all members of the public. 

 

The Pharmaceutical Industry’s Influence on Research 

Most participants were very suspicious of studies into vaccination, reflecting an assumption 

that all were funded by vaccine manufacturers and the results, or the dissemination of results, 

were biased by the profit motive. One respondent, who reported meticulous reading of 

numerous studies, complained, “Most research seems to be funded by pharmaceutical 

companies” (female, thirty-six, WA, unvaccinated). Another stated, “There is a lot of conflict 

of interest within the scientific field of vaccinations because the researchers have shares in 

outcomes so they only publish favourable outcomes” (female, forty, SA, ceased vaccinator). 

Participants were also concerned that comparative studies between vaccinated and 

unvaccinated populations, which might expose some of the risks they feared, would never be 

conducted. 

You are not going to put a heap of money into something to prove something that 

is going to affect you negatively, and when you have got one kind of, like, main 

corporation, or a few corporations controlling everything; that’s what they do. 



12 
 

They are not going to do any kind of research … (male, forty-one, SA, non-

vaccinator) 

Non-vaccinators are often accused of cherry-picking data to support stories of harm, cover-

up, and collusion. However, our parents’ accounts highlight two key concerns that cannot be 

so easily dismissed. The first concern is that funding of research does matter to perception. 

The political economy of university research—in particular the prevalence of researchers on 

“soft money”—renders researchers reliant on commercial funds (indeed, this is true of one of 

the studies in this paper). The second is that, given this political economy, certain research 

questions are unlikely to ever be asked, because even public money orients towards 

intervention-focused studies that can employ technocratic expertise in problem solving—with 

vaccine refusal a “problem” to be “solved.” This is the world with which we, as researchers, 

make accommodations, but those outside can perceive its limitations. They recognize, with 

an acuity not always recognized by “experts,” that researchers can pursue objectivity and 

neutrality but research context is anything but (Leach and Fairhead 2007, 23). 

 

Pharmaceutical Companies’ Influence over Doctors 

Health professionals in general, and doctors in particular, also emerged as important “access 

points” for parents encountering the vaccination expert system. Participants were concerned 

about the access pharmaceutical companies had to influence doctors through presentations, 

“kickbacks,” and junkets, damaging their trustworthiness. 

[Pharma] are a huge, billion dollar industry. Their shareholders want to make a 

profit … they’re giving doctors world class, first class flights to somewhere all 

over the world. If they sell enough of their drug, we will fly you first class, and 

your wife, to a lecture on this drug. (Female, thirty-nine, SA, non-vaccinator) 

Participants perceived this financial reach stretching right back to doctors’ training.  

The pharmaceutical companies supply the universities with funding … so it 

comes down to the doctors that have, you know, their information that they have 

and … their scope of operation comes from their training which is funded by, you 

know. They have got a certain way of being taught and that’s it. (Male, forty-one, 

SA, non-vaccinator) 

These data point broadly to the perception of collusion between the pharmaceutical industry 

and medical professionals, whereby doctors may recommend vaccines that conflict with the 

interests of the recipient. However, one participant noted, “I have quite a few family 

members in the medical community, and I find the complete distrust of medical community 



13 
 

to be offensive, really...” (female, twenty-five, WA, partial vaccinator). This participant’s 

personal connection to medical professionals she regarded as trustworthy appeared to 

influence her perception, though she immediately followed this statement with an unsolicited 

declaration of distrust in drug companies. We will return to the significance of this later. 

 

The Pharmaceutical Industry’s Influence over Government and Bureaucracy 

A particular concern for participants was the influence of pharmaceutical companies over the 

state. It was in these responses, in particular, that the perception of the pharmaceutical 

industry as ultimate “puppet-master” became clear. The participant who described doctors’ 

“junkets” went on to question (rhetorically), “What are they [the pharmaceutical industry] 

doing to the government?” She queried whether advisors who help Parliamentarians make 

decisions were paid or biased (female, thirty-nine, SA, non-vaccinator). Another declared 

outright: “I think that they [the pharmaceutical industry] own the government” (female, forty, 

SA, non-vaccinator), and a third stated, “[T]he leaders of the government actually have shares 

in the pharmaceutical companies that these vaccines represent, so it’s a very big conflict of 

interest” (female, thirty-six, SA, non-vaccinator). 

Participants saw the pharmaceutical industry’s government influence playing out in two key 

ways. First, through the technocratic decisions of highly specialized bureaucrats and advisors 

who compile the vaccination schedule. Participants were suspicious that the large number of 

vaccines on the schedule was driven by profit. Even the participant who was most 

equanimous about the industry’s morality, “wonder[ed] about over immunisation, if it is 

really about moneymaking” (female, twenty-five, WA, partial vaccinator).  

Concerns about the schedule also contributed to broader fears of government power, 

informed by vested interests: 

[T]hey’re bringing out all these schedules and all this stuff and it’s like, “Give us 

a break.” … I don’t trust these people to—you know, because it’s all interlinked 

with the power of government and the agendas. (Male, fifty, SA, non-vaccinator) 

Second, participants perceived pharmaceutical companies’ reach in governments’ use of 

policy levers to coerce parents to vaccinate. After the WA data collection, the Australian 

Federal Government initiated a more “hard line” policy towards vaccine exemptions. “No Jab 

No Pay” withholds access to financial benefits, including childcare subsidies, from those who 

decline vaccines by removing a previously available “conscientious objection” (Parliament of 

Australia 2015). South Australian respondents interviewed after the policy change responded 



14 
 

strongly to it. More than one queried its logic, given that the small numbers of parents 

affected would not produce savings for the government. Rather, it was a matter of control: 

It’s just knowing that the pharmaceutical companies have got such a strong hold 

on the government that they make those kinds of decisions … [The government 

are] not going to benefit [financially] … so the only reason I can see for them 

doing it is the pharmaceutical companies are taking a stronger hold on our lives. 

(Female, forty-two, SA, non-vaccinator) 

This participant continued that she did not see every politician as implicated in “individually 

think[ing] about it.” Rather, “there are much higher levels in the government and higher 

people who are pulling the strings.” “Ultimately,” concluded another participant, “money 

drives decisions” (male, forty-one, SA, non-vaccinator). 

Another participant elaborated how she saw this policy change playing out:  

I feel like the pharmaceutical company is getting … a huge say in … how the 

government chooses to go with those things and if they are going to get a lot of 

money … or there is going to be a payoff for certain things. I believe that that is 

also an issue. I think there is a, you know, underhanded deals that, “Yeah, let’s 

make it so they all have to do it now.” (Female, forty-two, SA, non-vaccinator) 

 

Construction of Consensus 

Part of the role of the pharmaceutical industry as puppet-master was its capacity to construct 

and sustain ideological hegemony with regard to vaccination in broader society, through 

sheer financial muscle. 

I just always wondered about the power of the pharmaceutical companies and the 

people who make money out of this and the huge power they might have in—

which would be a pretty big opponent for people who had other ideas. I could see 

that just being a very scary environment to step into and present any other ideas 

or any other research, even. (Female, thirty-nine, SA, delayed vaccinator) 

The media was part of this picture for respondents who presented a web of profiteering 

relationships between pharmaceutical companies, magnates, and the government: 

… When you see things like Rupert Murdoch [owner of many Australian 

newspapers] was friends with Tony Abbott [Prime Minister at the time] and 

Rupert Murdoch’s son sits on the board of GlaxoSmithKline [pharmaceutical 

company producing vaccines], it just doesn’t—you know, your mind goes “Why? 

Why are you doing this?” (Female, fifty, SA, non-vaccinator) 



15 
 

 

Other Features of Expert Systems 

Although the dominance of the pharmaceutical industry was the clearest theme to emerge 

from the research, participants described other quasi-malignant features of the expert systems 

they had encountered on their (non)vaccination journeys. Several participants used “the 

system” in their discussion of Western medicine, and one-sidedness, authoritarianism, and 

rigidity were its key perceived failings, echoing other studies (Brown et al. 2010). Many 

distrusted Western medicine because they saw it as narrow, symptom-focused (with links 

back to pharmaceutical companies) and the opposite of holistic. Often, perceptions related to 

negative experiences with specific health providers, highlighting again how “access points” 

are central to perceptions of institutions as a whole—in this case the entire institution of 

Western medicine.  

 

Discussion  

Our study found that the discourse of parents who reject vaccines is dominated with notions 

of the pharmaceutical industry and the profit motive. This finding echoes those of a number 

of other studies (Sobo 2015; Benin et al. 2006; Brownlie and Howson 2005). The parents we 

interviewed saw the pharmaceutical industry as exerting a wide-ranging influence on 

vaccination research, the motives of health professionals, and the construction of government 

policy consensus. This discourse was readily mobilized in their rationale for their vaccination 

decisions. 

There was a general lack of specificity regarding the agencies and mechanisms through 

which industry explicitly influenced vaccination policy, although we did not probe for this. 

We could draw one of two conclusions. Suspicion of the pharmaceutical industry may indeed 

form a genuine basis for decision-making, but it possibly also serves as a salient post-hoc 

rationale within a mainstream Australian framing of non-vaccination as deviant. However, 

the parents in both Fremantle and Adelaide were actively choosing alternative lifestyles—

eating organic food and utilizing alternative healthcare and education. A distrust in big 

business to look after the concerns of the public—coined the Greedy Bastard Hypothesis by 

Graham Scambler (2001)—is indicative of a left-wing ideology and “off the grid” 

philosophy. Rejecting capitalism would fit with our parents’ Habitus and their social 

identities, with vaccine refusal in valued social settings generating bonds and affirmation 

(Sobo et al. 2016). Accordingly, we take seriously the parents’ representations of the 



16 
 

pharmaceutical industry as a significant driver of the distrust that induces vaccine refusal, and 

recognize its socio-political elements.  

Our study demonstrates that perceptions of expertise with regard to vaccination are socially 

constructed, and that judgements of whom or what is trustworthy arise in specific contexts 

that may facilitate or block the development of trust. We learn from our participants to look 

to our own social contexts and methods of reasoning, and to ask ourselves how we differ 

from them in our acceptance of childhood vaccination programs as a public good. Analysing 

these differences serves two purposes. First, it reminds us to focus on what it actually means 

to “trust the experts,” something we might otherwise gloss over, given the consensus, at least 

within our research team, to consciously and reflexively trust expert systems with regard to 

vaccination. (We do not assume that such trust is a driving factor for the rest of the 

vaccinating population, since they may be motivated by other factors.) Second, distrust in 

vaccination can manifest in a “public bad,” with refusal correlating with outbreaks of 

preventable disease (see Omer et al. 2008). Since the political economy of research inevitably 

draws us to considering technocratic responses to this “public bad” (to restore the “public 

good” of herd immunity), it is useful to assess whether interventions address how these 

parents differ from those who reflexively “trust the experts.” 

To engage in this comparison, we first return to the political economy of research itself, and 

our intimacy with government, the public sector, and vaccine manufacturers, as researchers 

(and sometimes advocates) addressing non-vaccination. As researchers, we are familiar with 

both the objectivity of the research process and the political and economic drivers of the 

research we do. Our intimacy with research (including the meaning of systematic reviews, the 

distinction between correlation and causation and the synthesis of numerous methods to 

arrive at the same result) provides some of the basis for our trust.  

Second, we can enhance the comparison between those who trust and those who do not by 

returning to the distinction between partial vaccinators and complete non-vaccinators. As we 

noted above, the parents who ultimately consented to some vaccinations still distrusted the 

industry and its profit motive and did not follow the schedule on this basis. Their acceptance 

of some vaccines, however, demonstrates mitigation of this distrust with other factors, such 

that they came to be sufficiently comfortable with nuance. The pharmaceutical industry 

remained untrustworthy, with its tendrils infiltrating research, medical professionals, and 

government negatively, yet parents incorporated contradictory beliefs into their assessments. 

Pharmaceutical companies make drugs that treat cancer. There are good and trustworthy 

doctors. Parents accept vaccines despite their distrust. 



17 
 

We suggest, then, that ultimately the difference between those who trust “enough” to 

vaccinate and those who do not, is the absolutism of the worldview that the profit motive 

facilitates only bad. Here, absolutism is not only the strength of the belief; but also the extent 

to which it is untempered by other considerations, the comprehension of complexity, and 

sitting with dissonance. It may not be possible to counter all-encompassing worldviews of 

corporations that seek to profit through harm—inducting and corrupting governance and 

healthcare in their mission—head on. One possible answer derives from our reflections on 

how we and some of our research participants arrive at nuance, supported by research that 

shows selectively vaccinating parents oscillate between numerous standpoints and tend 

towards indeterminate positions on vaccination (Sobo et al. 2016). We should avoid attempts 

to drastically re-orient worldviews, given that those initiating them would be distrusted 

anyway. Instead, we could creatively develop ways of priming for nuance, capacity building 

for dissonance, and sharing our own insights into how we see what the parents see, but see it 

differently from inside the system. Additionally, we need to explore mechanisms for 

increasing trust and consider whether the expert systems under study in this article can do 

better in this regard.  

 

Conclusion  

Our actively non-vaccinating parents conveyed a perception of vaccination expert systems as 

tainted by the profit motive of pharmaceutical companies. This “taint” linked to broader anti-

capitalist critiques of big business, with parents perceiving the pharmaceutical industry’s 

reach over research, doctors, governance, and society. With reflection on our own 

relationship to the vaccination expert system, we suggest that degrees of distrust appear to be 

determined by the incorporation of countering views. Accordingly, one set of strategies to 

address the deep distrust that provokes vaccine refusal could involve openly acknowledging 

the pharmaceutical industry’s sometimes pernicious role, while sharing experiences and 

perspectives to facilitate nuanced views that can sit alongside it. 

 

Competing Interests 

See under “Funding.”  

 

Funding 

The Fremantle data was gathered by Katie Attwell while working for the Immunisation 

Alliance of Western Australia, a not-for-profit immunization advocacy organization. The 



18 
 

Alliance received funding from Sanofi Pasteur in the form of a $20,000 unrestricted grant to 

develop and evaluate the “I Immunise” campaign, which itself was funded by the Department 

of Health, Western Australia. Neither external organization contributed to the study design; 

data collection, analysis, interpretation, or writing, nor did they influence manuscript 

submission decisions. The data collection in South Australia was funded by the Flinders 

Medical Centre Foundation as a Seeding Grant, with no input into the decisions and 

processes outlined above. Julie Leask receives funding from the Australian Government 

Department of Health and the National Centre for Immunisation Research and Surveillance 

for research in addressing vaccine hesitancy. She is in receipt of an NHMRC Career 

Development Fellowship.  

 

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