Een fenomenologie en systeemtheorie van vaccinatietwijfel

Vaccine hesitancy refers to the delay or refusal of vaccines despite their availability. Although it gained widespread attention during the COVID-19 pandemic, vaccine hesitancy is not new. It dates back to Edward Jenner's development of the first modern smallpox vaccine in 1796. The phenomenon has resurfaced periodically, most notably around the turn of the millennium, when Andrew Wakefield's now-discredited paper falsely linked the Measles-Mumps-Rubella (MMR) vaccine to autism, contributing to declining childhood vaccination rates. In 2019, the World Health Organization listed vaccine hesitancy among the top ten global health threats, noting a five-fold rise in cases and 207,500 deaths from vaccine-preventable diseases such as measles. This dissertation is divided into four chapters and approaches vaccine hesitancy as a 'wicked problem'—a type of complex social issue marked by competing perspectives, making consensus difficult and effective interventions elusive. To address this state of affairs, I propose a combined approach using phenomenology and systems theory. Chapter One introduces Rittel and Webber's concept of wicked problems as a critique of overly simplistic policy responses that reduce complex social crises to technical issues. Using Husserlian concepts such as "attitudes," "attention," and "sedimentation," I move away from the style of intervention design critiqued by Rittel and Webber and recharacterize vaccine hesitancy as resulting from a clash between the public health attitude and the hesitant attitude. Chapter Two expands this view by presenting a systems-theoretical account of vaccine hesitancy, drawing on the theory of autopoiesis developed by Humberto Maturana and Francisco Varela, and its sociological rearticulation by Niklas Luhmann. This analysis frames vaccine hesitancy as emerging from a boundary problem impacting public health practice. On the one hand, public health crises span multiple social systems—science, politics, law, religion, and economy—each with its own logic and boundaries. To effectively address these crises, interventions must operate across multiple systems. However, such expansive interventions risk overextending the public health system's capacity and imposing its logic on other domains, potentially leading to resistance or failure. In Chapter Three, I integrate the phenomenological and systems-theoretical perspectives through Autopoietic Enactivism (AE), a framework developed by Varela that attempts to reconcile subjective experience with systemic complexity. AE provides the basis for a comparative analysis of vaccine hesitancy as both a phenomenological clash of attitudes and a systems-theoretical boundary problem. The chapter concludes by critiquing both the Husserlian pursuit of common ground between conflicting perspectives and Luhmann's view that embracing systemic complexity offers a sufficient path forward. Chapter Four builds on the preceding analysis and identifies Luhmann's underexplored account of trust, informed by a Foucauldian critique of power and biopolitics, as the most viable approach for engaging with vaccine hesitancy. The chapter concludes by augmenting Luhmann's theory with critical phenomenology and emphasizing the role of the phenomenological epoche in fostering trust.