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Covid-19 and the Challenge of Vaccine Hesitancy

Studies show that up to 1 in 3 people might refuse to take a Covid-19 vaccine. This problem must be overcome – but it can't be addressed by writing off large swathes of the population as anti-vaxxers.

Like me, I suspect you’re still recovering from the rare event of two good news stories occurring within days of each other in 2020. Namely, a certain election result and the revelation that a new coronavirus vaccine can prevent more than 90% of people from getting Covid-19.

There is every reason to be optimistic about this vaccine revelation. Now more than ever we need some hope ahead of what could well be the bleakest winter ever for the NHS. But there is important context to bear in mind when interpreting the headlines.

For example, we don’t yet know how effective the Pfizer/BioNtech vaccine is at preventing coronavirus transmission and we won’t until a vaccination programme is well underway. The 90% figure refers to the development of symptoms, but it’s possible to be infected with the virus without displaying symptoms – and this has significant  implications for a national vaccination strategy.

On Monday, Health Secretary Matt Hancock announced that the NHS is ready to commence roll out of the vaccine “as fast as safely possible.” The government has already released a preliminary list of the ‘high risk groups’ who will be prioritised, including the elderly, those with high risk underlying conditions, and health and social care workers.

Targeting priority groups is a tried and tested immunisation strategy that we employ every year with the flu vaccine. But, even with high vaccine effectiveness, this strategy is unlikely to be sufficient to achieve the much lauded state of herd immunity. And of course, vaccination is a much safer and ethical way to achieve herd immunity than allowing coronavirus to run rampant through our population.

Professor John Bell, who sits on the government’s coronavirus vaccine taskforce, said that he would “worry about not giving this to as wide a percentage of the population as we can.” He advocates vaccinating “further into the population and vaccinat[ing] younger people as well, partly because we don’t really know what the long-term effects of this disease are.”

So if mass vaccination is to be adopted as the sensible long-term goal, the government must make tackling the phenomenon of “vaccine hesitancy” a number one priority. Only last year the World Health Organisation (WHO) named vaccine hesitancy as one of the ten greatest global health threats.

We can’t afford to let it get in the way of our path to recovery, though preliminary evidence suggests that this is going to be an uphill struggle. Results from a report released on Tuesday by the British Academy and the Royal Society found that 36% of the British public say they are either uncertain (27%) or very unlikely (9%) to agree to be vaccinated against Covid-19.

This figure should alarm us all and illustrates the urgent need to understand the problem of coronavirus vaccine hesitancy, and devise a strategy for dealing with it. But firstly, we should be wary of equating those who are vaccine hesitant with “anti-vaxxers.”

There will always be a group of ardent anti-vaxxers intent on spreading misinformation, entertaining conspiracy theories and stoking fear to suit their agenda. The nature of this pandemic, including its geopolitical implications and requirement for rapid vaccine development, only serves to bolster this truism. Indeed, the Covid-19 anti-vaccination movement commenced long before vaccine trials had even got underway. 

This doesn’t mean that we should ignore Covid-19 anti-vaxxers though. We should do everything possible to limit the influence of their diatribe of fake news that often seeks to take advantage of the most vulnerable members of society. But it would be a fatal error to assume this alone can deal with the much broader and nuanced issue of vaccine hesitancy. 

The WHO describes vaccine hesitancy as a “reluctance or refusal to vaccinate despite the availability of vaccines.” You can be vaccine hesitant without being an anti-vaxxer and the evidence is clear that only a very small proportion of people are completely opposed to vaccines. Instead, there is an entire spectrum of attitudes to consider. 

So what factors precipitate vaccine hesitancy, if not a conspiratorial world view? A group advising the WHO on vaccine strategy identified three key drivers: complacency (i.e. perceived risk of infection and/or disease), inconvenience in accessing vaccines, and lack of confidence. Lack of confidence can stem from a perceived lack of knowledge about vaccination, which is intrinsically linked to the amount of trust people have in the institutions that produce and disseminate information.

No-one denies that we need a huge public health education campaign to complement the Covid-19 vaccination programme. But we can’t rely on paternalistic lecturing that demands passive acceptance of what scientists and politicians have to say. An information campaign should be characterised by transparency and a willingness to tackle common concerns head-on. 

Furthermore, we must not underestimate the importance of a localised approach to Covid-19 vaccination programmes. A local approach has too often fallen by the wayside during this pandemic, despite the fact it is typically bolstered by a wealth of experience and expertise that national approaches could never hope to offer.

Local councils need to be adequately funded and resourced to ensure they are able to reach so-called ‘under-served’ communities. This must also include dissemination of culturally sensitive and non-English language material where appropriate.

I would be passing the buck if I didn’t acknowledge the obligation of healthcare professionals to support mass vaccination efforts. After all, we are the ones who will be having discussions about vaccination and administering the vaccine, and we know that advice from healthcare professionals is one of the most important predictors of vaccine acceptance.

The lack of face-to-face consultations will no doubt make having these discussions more difficult, but one tangible action would be to introduce a mandatory and concise online learning module for healthcare professionals that educates us on vaccine hesitancy and gives us useful pointers on how to broach this difficult topic. 

People have clung to the hope of a coronavirus vaccine throughout this crisis for a reason: it is the ethical and safe way of achieving herd immunity and a return to “normal life.” Now, with the promise of what may be an effective vaccine on the horizon, the government must ensure that navigating the nuanced area of vaccine hesitancy takes a central role in its strategy.

We cannot squander this opportunity. A successful coronavirus vaccination programme offers a path to recovery from the biggest public health crisis in a century, but it also has the potential to influence attitudes towards vaccines for many years to come.