Uniquely Uncertain: The impact of COVID-19 on vaccine hesitancy

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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. It aims 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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Vaccine hesitancy refers to people who are uncertain about vaccination, and they may delay or refuse some or all vaccines. They are not the “anti-vaxxers” who oppose vaccination and can be quite vocal about their opposition. Those who are vaccine hesitant are of most interest to public health authorities, as a potentially large group with the possibility to be persuaded to vaccinate.

COVID-19 presents a unique situation of mass vaccination during a pandemic, with new vaccines — some using novel technologies — likely to undergo emergency authorisation. Due to expected initial scarcity, guidance has been issued by the World Health Organization and government advisory groups for vaccine prioritisation. The targets are older adults, health and social care workers and those with comorbidities. Involving the public in this process of prioritisation may be crucial for buy-in and perceptions of fairness. For example, France is currently engaging in a citizen consultation via several advisory groups (le Conseil scientifique and le Comité analyse, recherche et expertise), to avoid the problems with vaccine uptake they faced with 2009 H1N1 pandemic.

We can also learn from previous vaccine campaigns, where certain sections of the population have been the focus for influenza, shingles and pneumococcal vaccinations. While uptake based on influenza vaccination by older adults in some countries looks promising, those in older groups have also tended to be more supportive in polling. The at-risk groups are more problematic to vaccinate, and may need more tailored messaging and help with access. For the COVID-19 vaccines deployed, while there may be a high demand on one hand by people who want to be protected and return to normality, low vaccine uptake is still a threat.

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

Indications are that people may be hesitant because of the newness of the vaccine; the technologies used; and speed of development that has caused concerns about side effects, including in the long term. There is also misinformation and disinformation circulating about mRNA vaccines being able to change DNA, and about bad intentions of governments, pharmaceutical companies and international organisations. One popular conspiracy theory argues that Bill Gates intends to microchip and control people with a vaccine.

While it is important to remove such false information online, proactive messaging is also needed in order to counter alternative views and fill information voids. Where people have legitimate questions and concerns, these should be answered. The content should include the process of vaccine development, how vaccines are tested for safety and effectiveness, how ongoing monitoring occurs and how deployment will happen fairly. Such messaging should start early to engage with communities and understand their views.

Where people have legitimate questions and concerns, these should be answered.

Health professionals and scientists tend to be more highly trusted than governments and pharmaceutical companies, so it should be these groups — along with community and religious leaders and media personalities — that deliver messages. The role of respected public institutions, such as universities and research institutes, and the integrity of regulatory bodies should be highlighted.

If vaccine hesitancy has a significant impact on uptake, at the extreme we may see governments deciding to make vaccination mandatory. This possibility is already emerging as a concern for those hesitant or opposed to vaccination, and may be counterproductive if it produces a backlash or weakens trust between the public and the government. What is more likely is the occurrence of “conditional mandatory vaccination”, where vaccination is required in certain situations. For example, vaccination can sometimes be attached as a condition of employment in some institutions. It remains to be seen whether health and social care workers will be compelled to be vaccinated by their employer. In addition, vaccination is required for travel for some diseases and countries and even for particular events, such as the pilgrimage of Muslims to Mecca.

Also on the Forum Network: From Vaccines to a Global Cure: Why international co-operation is so important for stopping COVID-19 by Mark Pearson,  Deputy Director of Employment, Labour and Social Affairs, OECD

What is known currently is that as vaccines are being deployed, it will take time to manufacture and distribute them. While problems may also be faced in vaccine uptake, there is a danger of complacency and fatigue with public health measures. There will be a continued necessity to adhere to handwashing, mask-wearing and social distancing in the meantime before the promises of vaccines become a reality.

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Samantha Vanderslott

University Research Lecturer, Oxford Vaccine Group and the Oxford Martin School, University of Oxford

Samantha is a University Research Lecturer at the Oxford Vaccine Group and the Oxford Martin School at the University of Oxford. She works on projects about health and society, including attitudes to vaccination, the history of typhoid fever, neglected tropical disease advocacy, and public health responses during outbreaks. Samantha draws on perspectives from sociology, global public health, history, and science and technology studies (STS), and has experience working in government as a Senior Policy Advisor. Her PhD at UCL (University College London) was on the policy and history of neglected tropical diseases, where she conducted fieldwork in Brazil and China, and was a Visiting Fellow at the Harvard Kennedy School of Government and the Brocher Foundation in Geneva.

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