“It’s about the bottom dollar:” The Opioid Crisis, Neoliberalism, and the Political Economy of Vaccine Hesitancy

Vaccine hesitancy is often characterized as a lack of scientific literacy or as a consequence of anti-scientific thinking. To expand beyond the scope of these individual-level explanations, this article undertakes a more comprehensive examination of hesitancy as a rational response to the confluence of two factors: first the hegemonic ideology of neoliberal health, and second perceptions of diminished institutional reliability. The present study draws on focus groups conducted after the height of the COVD-19 pandemic to investigate the political and economic logics underpinning vaccine refusal. The analysis indicates that participants employ a sophisticated understanding of the health system and political economic beliefs when determining the reliability of individuals and the health decisions to be made. Participants cited the opioid crisis, the revolving door, and perceived disenfranchisement as evidence that public health is undermined by "elite capture" and corporate profiteering. It is argued that these perspectives align with prevailing neoliberal ideologies, culminating in the emergence of a "biological consumer patient." This study posits that vaccine hesitancy functions not merely as anti-scientific refusal but as a strategic navigation technique through a healthcare system defined by neoliberal responsibilization and perceived institutional failure.