Shame and Medicine Exeter
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Vaccine Hesitancy, Death Shaming and COVID-19

On the 24th of August 2021, the online media platform New Frame published a satirical cartoon by the South African illustrator Carlos Amato. The cartoon depicts several rows of gravestones, each etched with a trope from vaccine-hesitant discourses: ‘My body my choice’, ‘I trust my own immune system’, ‘Who stands to gain?’, ‘They developed it too fast’, ‘Free thinker’, ‘Did my own research.’ Whether through circulation of Amato’s cartoon or a like-minded perspective on the situation, photographs of home-made Halloween decorations with identical imagery were widely shared on social media later that year. This trope – in which the poor judgement of the unvaccinated coronavirus (COVID-19) dead stands as their epitaph – crystallised a nexus of social and political shaming around vaccine hesitancy or refusal in countries with mass vaccination programmes.

Posthumous shaming of notable or vocal anti-vaxxers was not merely a matter for satirical cartoons. It was particularly evident in the online sharing of obituaries for such individuals. While some of the most visible instances of ‘death shaming’ have been decried, they nonetheless remain as extreme iterations – and a logical product – of a more pervasive culture of shame over vaccination, or lack of it. Rather than paying close attention to the contexts (including a trusting and shame-less engagement with public health messaging and communication) which enable different publics to make informed decisions about vaccination, the ‘unvaccinated’ have increasingly taken on the characteristics of a shamed population, culpable for the spread of the virus, for other adverse health outcomes produced by a health system under strain, for the threat of future public health restrictions to everyday life, and for their own suffering and death.

Indeed, the relationship between vaccine hesitancy and shame must be understood in light of the long history, and on-going ambivalence, regarding the use of shame and shaming within public health. A high-profile twitter debate between Brené Brown and Naomi Klein in May 2021 on the efficacy of shaming in relation to COVID-19 vaccines, which was discussed in a previous Blog post, highlighted some of the core concerns regarding the use of shaming to motivate individuals to take up vaccines, as opposed to the use of shaming to motivate governments to make vaccines more widely available. Shaming, Brené Brown argues, “is a tool of oppression – it will never be a tool for social justice (or public health).” Klein and Brown exemplify two sides to an ongoing debate around the use of shame in public health. While public health initiatives often use implicit, and sometimes even explicit, shaming as a means to motivate individual or social change in the service of public health, shaming is a highly contested and much-criticised practice. Those who defend the use of shame as a tool for positive change point to the fact that it sometimes works; by appealing to an audience’s sense of shame around particular behaviours or practices, it has been possible to effect a shift in habits among some of those targeted.

The use of shame as a tool of persuasion carries the seeds of a deeper erosion of sympathy, shading into ridicule and scorn; when shaming tactics fail to result in the desired-for change, the shame that they deploy does not simply dissipate easily or without harm. In the case of vaccine shaming, it resulted in a phenomenon which has been usefully termed ‘vaxenfreude’, in which any claim to a generative use of shame was largely abandoned.

Brought to prominence in September 2021 by Tyler Weyant, an editor at the US politics website POLITICO, ‘vaxenfreude’ denoted ‘the joy the vaccinated feel when the unvaccinated get COVID-19.’ Weyant named vaxenfreude to write against it; he described it as a ‘dark spirit’, rooted in smugness and judgmentalism, a problem which underlined the disintegration of collective empathy and community spirit supposedly present at the beginning of the pandemic.

The day after Weyant coined ‘vaxenfreude’, an article in The Week connected it specifically with shame and death, reproducing the testimony of a funeral director in Pennsylvania who reported that families were requesting that COVID-19 be left off death notices. Drawing heavily on Weyant’s piece and an episode of the National Public Radio (NPR) podcast All Things Considered, the article cited research on grief undertaken by Ken Doka, senior vice president of the Hospice Foundation of America. For Doka, specific kinds of death, and their subsequent mourning by relatives and friends – are ‘disenfranchised’, a process through which death is ‘tinged with a supposed moral failure and mourners fear judgement from others.’

How did shaming discourses around vaccine hesitancy inflect experiences of dying? A recent Lancet Commission report has explored and (re)asserted the need to properly value death and dying; the extreme circumstances of the pandemic have taken us even further away from anything vaguely recognisable as a ‘good death.’  People have died in jarring and abject ways: before they grew old, on ventilators, and on video calls with relatives. The presence of shame disrupts and distorts grief even further. Contributing a written testimony to the Mass Observation Archive, a project which has sought to document everyday life in the pandemic, one respondent wrote that ‘my neighbour lost her husband and didn’t tell anyone at all for two weeks, she felt shamed by him dying of this disease.’ The shame that accrued around dying from COVID-19 – let alone dying unvaccinated from COVID-19 – worked to exclude her from a relational experience of mourning, isolating her further in her grief.


Fred Cooper, Postdoctoral Research Fellow, Wellcome Centre for Cultures and Environments of Health, University of Exeter.

Luna Dolezal, Associate Professor in Philosophy and Medical Humanities, Wellcome Centre for Cultures and Environments of Health, University of Exeter.

Arthur Rose, Senior Postdoctoral Research Fellow, Wellcome Centre for Cultures and Environments of Health, University of Exeter.


20th March 2023

Photo by Sandra Seitamaa on Unsplash


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