“It is easier to fool people than to convince them that they have been fooled.”

— Mark Twain, as quoted on scamdemic.org

“[While] often attributed to Mark Twain, there’s no evidence that the author actually wrote this phrase.”

— fact-checking website snopes.com

If a vaccine against the coronavirus became available to you, would you get vaccinated, or not?

Most people would say yes. When polling firm Angus Reid asked Canadians that question in April, 83% said they would get the vaccine immediately or eventually. Only 10% said no, and 6% were unsure.

But once the numbers were broken down by province, one stood out, and not in a good way.

More than a quarter of Albertans said they were either unwilling to be vaccinated (15%) or uncertain (13%), the highest figure of any province. To put that in perspective, the combined figure of unwilling and uncertain responses in British Columbia was 14%.

This is, to put it mildly, a problem: immunization campaigns are only effective when they include a percentage of the population above the herd immunity threshold (HIT). For COVID-19, researchers have estimated that could be 75%, which makes Alberta’s high rate of vaccine hesitancy or opposition “a real concern,” said Cheryl Peters, an epidemiologist at the University of Calgary.

For those who would readily welcome a vaccine, it can be hard to understand how anyone could feel otherwise.

The term “vaccine hesitancy” can encompass a large range of attitudes, from mild concern or uncertainty about the vaccine’s side effects, to the belief there is a link between vaccines and autism (there isn’t), to the suspicion that the entire pandemic is a hoax perpetrated by Bill Gates to inject people with microchip-laden vaccines (also false).

Cora Constantinescu is a pediatrician who works in the Calgary Vaccine Hesitancy Clinic at the Alberta Children’s Hospital. She believes misunderstanding the problem prevents us from addressing it.

“Whenever anyone says ‘vaccine hesitancy’ in the media, they assume it has something to do with some conspiracy theory,” she said.

But many people are overwhelmed with conflicting information, or lack the media literacy skills needed to recognize disinformation. Many are just looking for clarification.

Rather than trying to convince people to get vaccinated, clinic staff support them as they wrestle with the decision, Constantinescu said: “We show empathy and we validate their concerns because they’re trying to make the best decision they can.

“We don’t need to validate their cognitive bias. We need to validate their emotion.” She added. “I care deeply for all my vaccine hesitant patients.”

A global pandemic presents a unique crisis. The virus is everywhere, and it is invisible. Every single human being is connected to the crisis as both a potential victim and potential vector.

Because of these characteristics, controlling a pandemic requires broad collective cooperation. But a government-led effort that necessarily imposes limits on personal freedoms for the well-being and survival of the collective is anathema to the libertarian-flavoured conservatism embraced by Alberta Premier Jason Kenney and, to one degree or another, a large swath of Albertans.

This is one piece of the puzzle: an engrained political identity based on small, hands-off government and an individual’s right to make choices selfishly.

The other pieces fit perfectly inside: the rising distrust of government and the media, along with an epistemic shift among many conservatives away from traditionally trusted sources of knowledge such as science and journalism; the dark and growing corners of the internet that push conspiratorial worldviews and disinformation designed to elicit a maximal emotional response.

Put it all together and the resulting picture explains how Alberta has become the worst COVID-19 hotspot in North America with the highest rate of vaccine hesitancy in Canada.

The history of vaccine anxieties and misinformation goes back as far as vaccines themselves.

But our relationship to information has radically changed in the past two decades. The internet challenged the traditional gatekeepers of information, giving rise to a democratization of access to information—for better and for worse.

“It’s not as though there was this previous era in which people were getting ‘correct’ information and now they’re not,” said Tamara Shepherd, an associate professor and social media researcher at the University of Calgary. “It’s just different channels of power that are influencing the way that information circulates.”

The way we engage with the information we receive has also changed.

“A lot of people are more likely to want to believe information from someone they already know and trust in real life instead of an expert they don’t know,” Shepherd said. “Moreover, the kind of language used by your acquaintances, which is more anecdotal, often resonates better with people than, say, broad-brush statistics.”

A perfect example is the risk of blood clots posed by the AstraZeneca vaccine.

“If you hear one story about someone who gets a blood clot, that’s often more powerful to people than understanding the extremely minimal risk of actually getting a blood clot from the vaccine,” Shepherd added.

The characteristic that unites much if not all of the vaccine-hesitancy spectrum is distrust—of government, of journalism, of science. The depth of one’s distrust determines which rabbit hole you go down, and how far.

It’s tempting to look at these trends in our politics and discourse and connect them to Trumpism. Undoubtedly there is a connection, given the tremendous influence of the United States on our culture. But we also have our own homegrown peddlers of disinformation.

Distrust of institutions has long been stoked by some for personal gain, typically by politicians appealing to populist anti-elite sentiment—think Ralph Klein and William Aberhart. But in the era of social media, the creation and spread of information—or misinformation—occurs at warp speed. As with the spread of a virus, each of us is both potentially a victim and unwitting propagator.

A handful of the operators in this space might be recognizable names, such as Rebel News or True North.

Then there are the less well-known sources. Kevin Johnston is a fringe Calgary mayoral candidate recently charged with assault after allegedly punching an employee of a Dawson Creek, B.C., store who asked him to put on a mask or leave. But he is a savvy self-promoter—describing himself as “Canada’s MOST CENSORED MAN!”, his Facebook page has over 7,600 followers—and the content he propagates has a higher production value than most.

Like Rebel founder Ezra Levant—a longtime friend of Kenney—Johnston has gotten into legal trouble for defamation. But unlike The Rebel, Johnston fully embraces COVID-19 conspiracy theories, framing vaccines as yet another scheme by evil forces determined to control you.

The content produced by these outlets is then shared on social media. One of Johnston’s Facebook posts promoting a video about “The PANDEMIC BEING A LIE” and “The Deaths from VACCINES” has been shared 286 times.

There are many Facebook communities catering to those who resist vaccines or public health restrictions, including several Alberta-specific groups, where agitators organize rallies and protests in the name of freedom.

If the originators of this misinformation are motivated by self-interest, who are the people buying into and sharing that content?

In a study conducted in March of 2020, researchers found that Canadians who identified as politically conservative were more likely to have misperceptions about the coronavirus, a finding that tracks with other similar research.

“The reason why this occurs is the cultural narratives that have emerged,” said Gordon Pennycook, a professor of behavioural science at the University of Regina, and one of the authors of the study.

In their paper, which is expected to be published shortly, the researchers also note that political conservatism was a predictor for lower levels of trust in mainstream news outlets such as CBC or Global News, while trust in conservative-leaning media such as Rebel News was “significantly correlated with higher misperceptions and weaker COVID risk perceptions.”

Overall, political conservatism “was strongly associated with engaging in weaker mitigation behaviors, lower COVID-19 risk perceptions, greater misperceptions, and stronger vaccination hesitancy” in both Canada and the US.

Much has been made of the UCP’s dramatic fall in public opinion polls since their 2019 election. For many Albertans appalled by the government’s conduct and policies, these numbers are encouraging signs that their fellow citizens have become equally appalled, perhaps paving the way for the return of Rachel Notley and the NDP.

That may be, but the devil is in the details. According to an Angus Reid poll in April, 45% of Alberta respondents are dissatisfied with the pandemic restrictions, not because they have been too mild, but because they have been far too heavy-handed. Meanwhile, 42% said the restrictions don’t go far enough.

Given that the United Conservative Party (UCP) is, despite the name, built on a long-standing divide in Alberta conservatism that falls roughly along the lines of the former Wildrose and Progressive Conservative parties, Kenney might be more concerned about his right flank than his left.

In other words, the premier seems hesitant to upset his base by making science-based decisions that would help rein in the pandemic, yet it’s his own supporters who are most likely to ignore restrictions or share misinformation, thereby prolonging the pandemic.

So what can the government do about vaccine hesitancy?

“There’s a spectrum of hesitancy,” Peters said. “There are people who are militantly, absolutely not going to do it.” But there are also many people who are more hesitant than opposed, and “those people, I think, can be convinced, and they might be convinced by some kind of incentive.”

Officials elsewhere are getting creative about vaccine incentives, such as New Jersey’s “shot and a beer” campaign. Some are simply offering to pay people to get the vaccine. A community in Nunavut is offering a cash draw for vaccinated residents.

Peters said that some Albertans, such as racialized communities and new Canadians, might be hesitant “for very good reasons, [such as] the racist ways they can be treated by the medical system,” and that even a minor incentive like a gift card could be enough to draw people in.

Given that those two groups are at higher risk of experiencing the worst outcomes of the coronavirus, immunization is even more important.

Both Peters and Shepherd said framing the vaccine as something you do not for yourself but for your community might be a more resonant message.

Kenney and Chief Medical Officer Deena Hinshaw regularly talk up the importance of vaccines and highlight them as vital to ending the pandemic. Both shared photos of their vaccinations on social media, which were quickly inundated with anti-vaccine replies and links to misinformation.

Of course, for those deep in conspiracy theories, anything the government says will just be grist for the mill.

But could the UCP be doing more to directly take on hesitancy and misinformation about the vaccine?

“I don’t think it’s a controversial position to say that most Albertans know that misinformation is spreading, and that some people are willingly spreading it,” Peters said. “I don’t think there would be any harm in calling that out, even in a way that encourages people to speak to their primary care physician.”

Constantinescu said people who overcome their vaccine hesitancy often identify factors such as seeing the government as transparent and following the advice of experts and front-line workers.

Certainly, the UCP has done itself no favours here. The government’s handling of the crisis has frequently been out of step with best practices advocated by experts, from a quarter of its caucus opposing restrictions, to an MLA suggesting not getting the vaccine is a reasonable choice, to Kenney’s acceptance of other anti-science positions within the party.

Steve Buick, press secretary to Alberta Health Minister Tyler Shandro, did not return a request for comment.

However the government approaches the problem, it’s clear that vaccine hesitancy, and the forces driving it, are serious issues Alberta will have to reckon with sooner or later. For now, Constantinescu said, relying on the vaccine alone without meaningful restrictions is foolhardy.

“I am convinced that we cannot vaccinate our way out of this third wave,” she said. “A lot of people are going to die if we’re just going to try to vaccinate our way out of it.”

Taylor Lambert is The Sprawl's Alberta politics reporter.

CORRECTION 05/08/21: An earlier version of this story misspelled the name of Dawson Creek, B.C. The Sprawl regrets the error.