Convincing the Hesitant: Governments must implement plans to build vaccine confidence

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This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD.

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Following promising early efficacy results, Pfizer recently sought approval in the United States for it’s candidate vaccine against SARS-CoV-2, cause of the COVID-19 pandemic. Moderna, and AstraZeneca have also posted promising vaccine results. Other manufacturers are making progress on vaccines as well, and will soon seek regulatory approval. The development, testing and deployment of multiple vaccines against a novel disease in less than a year is one of the greatest scientific achievements in history. Forever eliminating SARS-CoV-2 may be out of reach in the short term, but these vaccines will allow us to significantly reduce the incidence of COVID-19, as well as the risks associated with a return to more normal levels of public activity.

However, vaccines work best when large portions of the population receive them. Much of the work of convincing the hesitant will be done by creating incentives to vaccinate, such as access to public spaces and certain jobs. Mandates can create a perception of enhanced risk, and fines can lead to paradoxical decrease in vaccination as people see the fine as a “price” to buy out of compliance. Those who are not swayed by incentives must be persuaded: they are making a risk assessment about the costs and benefits of being a “free-rider” on the public good of herd immunity, and the benefits that belong in their risk assessment need to be communicated to them.

On our COVID-19 Hub: Transparency, communication and trust: The role of public communication in responding to the wave of disinformation about the new Coronavirus

Work is already underway among anti-vaxxers, conspiracy theorists and disinformation campaigns to discredit, sow doubt and slow the uptake of future vaccines. In the midst of what the World Health Organization has called an “infodemic”, manufacturers and governments have relied on press releases, statements from CEOs and sporadic disjointed communications. In that vacuum of information, misinformation flourishes. Without a strong communication plan for vaccine confidence, anti-confidence communication plans will dominate discourse, and make future vaccines less effective. With the challenges of manufacturing and distributing vaccines, it will be some time before the supply of vaccines exceeds the number of people who want to be vaccinated – and that time gives a brief window of opportunity.

We need a unified vaccine confidence project that is global in scope and local in focus. An effective communication plan will focus not on anti-vaxxers, but on the vaccine hesitant. There are more people with doubts about vaccine safety or efficacy than dedicated anti-vaxxers. Appropriate messaging is key to persuading the vaccine hesitant to get vaccinated. Effective campaigns partner with the communities they are addressing, work with religious and community leaders and are delivered by spokespeople who come from those communities.

A community focus has multiple benefits, and fits how vaccine hesitancy tends to cluster, with those clusters then becoming sites of disease outbreaks. Social networks are powerful persuaders, and the people in someone’s network are often a bigger predictor of their vaccination decisions than their own demographic characteristics. In the United States, some of the highest hesitancy about a future vaccine exists among Black Americans, despite the Black community being one of the hardest hit by the pandemic. These concerns are based in a very real history of medical mistreatment of Black Americans, including the infamous Tuskegee Experiment in the 20th century when Black men were offered medical care, but were neither informed that they had Syphilis nor treated for it when penicillin became standard of care. A communication strategy that does not acknowledge this past will be less effective than one that reckons with it.

More on the Forum Network: Novel Virus, Novel Vaccine: Communicating clearly and honestly around a COVID-19 vaccine by Sandra Kanthal, Series Producer, How to Vaccinate the World, BBC Radio 4

One of the most effective means of encouraging prosocial behavior is to show that it is, in fact, prosocial behavior. In a study, hotel guests are more likely to reuse towels if a sign said “Join your fellow guests in helping to save the environment”, than if the sign said, “Help save the environment”. The desire to adhere to social norms is a powerful motivator, and vaccine messaging that makes it clear that vaccination is a social norm is effective.

In Western Australia the “I Immunize” campaign was effective in reaching about a third of vaccine-hesitant parents by making use of these persuasive tools, and featuring ad placements with parents who were “out and proud” about the fact that they vaccinated their children. Similar approaches can be effective worldwide as we seek to achieve high vaccination rates.

I urge decision makers to focus quickly on working together toward a vaccine confidence project with a unified communication strategy that can persuade the vaccine hesitant in advance of vaccine rollouts. Right now purveyors of misinformation have little competition, and the greatest success will come from fast action.

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Jonathan Berman

Assistant Professor, New York Institute of Technology

Jonathan Berman is a scientist and science educator. His research focuses on renal physiology and the biophysics of ion channels that contribute to the regulation of sodium and water balance and hypertension. He was a national co-chair of the March for Science in 2017 and is the author of Anti-Vaxxers: How to Challenge a Misinformed Movement. His writing has also appeared in New Scientist, STAT, The Scientist, and Slate.

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