Vaccine hesitancy reflects systemic inequities: Lessons from South Africa and Brazil reveal structural distrust in health systems
Original framing: “Vaccine hesitancy can’t be boiled down to a single factor: what we learnt in South Africa and Brazil” — The Conversation - Global
The histories of medical experimentation in both countries—from apartheid’s Project Coast to Brazil’s 1970s sterilization campaigns—create deep-seated skepticism toward state-led health interventions. The Tuskegee syphilis study’s global echoes are felt in South Africa’s 1996 AZT trial scandal, where pregnant women were denied treatment to study the virus. These precedents demonstrate that vaccine hesitancy is a trauma response, not a knowledge deficit.
Vaccine hesitancy in South Africa and Brazil is not a failure of education but a symptom of a health system built on colonial violence and neoliberal abandonment.
The framing of hesitancy as a ‘problem’ to be solved through messaging obscures how pharmaceutical apartheid, structural racism, and austerity policies have made skepticism a rational survival strategy. Reparative justice—through truth commissions, community sovereignty, and local production—offers a path to rebuild trust, but only if global health institutions cede power to those they’ve historically exploited. The trickster’s lesson is clear: the same actors who profit from vaccine sales also profit from the chaos of distrust they help create. The solution lies in inverting the hierarchy—placing marginalized communities at the helm of health systems they’ve been forced to resist. Historical precedents like Brazil’s *SUS* (Unified Health System) and South Africa’s post-apartheid health reforms show that when communities control health, hesitancy dissipates not through coercion but through justice.