COVID-19 and Social Justice: A syndemic approach to vaccine hesitancy

Abstract

The effects of COVID-19 pandemic depend on socio-cultural determinants that shield some individuals or groups from the most severe effects or make others more vulnerable to suffering harms to their health, social position, or economic stability. The case of vaccination is symptomatic of how specific groups suffer a higher degree of vulnerability due to socioeconomic inequalities and cultural determinants. Consequently, vaccine hesitancy among these groups might deepen the vulnerabilities, which is why it is necessary to design strategies that, while confronting vaccine hesitancy, do not ignore those structural inequalities which could continue feeding skepticism and resistance to vaccination, if unattended. In this work we claim that public health policies focused on promoting vaccination may benefit from a syndemic approach that considers the synergies between diseases and socioeconomic and cultural determinants. This implies introducing social justice issues into the planning of public health strategies. By critically analyzing the work of bioethicist Norman Daniels —who goes over the moral importance of public health from an interpretation of John Rawls’ theory of justice— we explore the criticism to justice as fairness made by the communitarian and the politics of difference standpoints (specifically, I. M. Young), to show that a syndemic approach to public health is essential to achieve complete vaccination: the design of strategies will have to consider the specific contexts of vaccine hesitant groups, to achieve efficiency vaccinating in the short, medium and long term.