Vaccines, Hesitancy and Public Health Communications: The hurdles ahead

Heading into 2021, light has begun to appear at the end of the COVID-19 tunnel as the first vaccines are approved and deployed. But the biggest public policy challenge of all is perhaps to come.

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Heading into 2021, light has begun to appear at the end of the COVID-19 tunnel as the first vaccines are approved and deployed. But the biggest public policy challenge of all is perhaps to come.

The proportion of Americans who would “probably” or “definitely” get a vaccine for COVID-19 plunged from 72% in May to 51% in September 2020. The prevalence of not only anti-vaxxers but also of the vaccine hesitant is an indication of the challenges ahead.

It is the result of the current “infodemic”, a portmanteau of “information” and “epidemic” that reflects the deluge of information available on COVID-19. First coined in 2003 during the SARS outbreak, infodemics – whose impact, not unlike other areas of public discourse, has been supercharged by social media – underline the difficulties policy makers face with informed, scientific information competing with fabricated news for the public’s attention. Moreover, it puts the question of how to build trust in public institutions, and in the medical, scientific and other specialist communities, front and centre of the policy debate.

At the OECD, we have been acutely aware of the gaps between disinformation and evidence-based analysis for some time – most notably since 2016 when the post-truth phenomenon entered the popular imagination. The challenge to expert orthodoxies has cast a spotlight on how organisations like ours and other policy specialists must seek to engage more meaningfully with people and their everyday lives.

The speed of development of COVID-19 vaccines – notably from Pfizer-BioNTech, Oxford-AstraZeneca and Moderna, with others to follow – has been impressive. However, it is only the first hurdle: production and distribution are important, but it is the last mile – uptake – that is now critical for policy makers. And the key to getting that right? Getting the public communications right.

Misinformation, disinformation and getting your message across

Misinformation is defined as the communication of inaccurate information without an explicit intention of deception; disinformation is the deliberate communication of inaccurate information with the end-goal of influencing public opinion or obscuring the truth. Both are making the public health task of inoculating whole populations much harder.

To better understand these phenomena and discuss the challenges for policy makers, late last year we organised  an OECD Forum Virtual Event, “Communicating on Public Health and Vaccines in a Climate of Misinformation”, which gathered leading international figures and organisations in the public health communications space.

Three broad insights emerged from opening presentations from the Wellcome Trust, the Pew Research Center and the Vaccine Confidence Project:

  1. People in high-income countries are less likely than those in low-income countries to strongly believe that vaccines are safe (see the Wellcome Trust’s insights on global vaccine confidence trends since before COVID-19, presented by Lara Clements)
  2. Rapid, hard-to-predict shifts in public opinion reflect the influence of the constant news cycle about COVID-19 (see the Pew Research Center’s work on the evolution of public trust in science since the COVID-19 outbreak)
  3. Trust and context are vital in boosting vaccine confidence (see the Vaccine Confidence Project’s analysis of the main communication lessons from previous immunisation campaigns)

Going deeper into Pew’s research on public opinion, Director of Research on Science and Society Cary Funk highlighted the significant split in attitudes towards COVID-19 along party political lines in the US, notably regarding the threat Coronavirus poses to the health of the population. It also revealed the startling drop in numbers of Americans saying they would be happy to get a vaccine, reflecting the declining trust in providers, policymakers and governance systems.

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Public health communications: principles and best practices

Having grasped some of the broad policy hurdles, we explored some of the principles and practices that could help underpin policy makers’ approach to public health communications. Of vital importance from the outset is the need to understand the distinction between “anti-vaxxers”, who are explicitly opposed to vaccines in principle, and the vaccine hesitant, who constitute a far broader group. The latter’s misgivings are directly linked to the current COVID crisis, reflecting high levels of anxiety and uncertainty generally, as well as specific concerns about the record-breaking speed of development of the new vaccines. They are nonetheless open to robust, reasoned arguments – and the consensus view was therefore that public communication efforts should be aimed at them.

Pointing to his personal experience, activist Ethan Lindenberger – who on turning 18 chose to vaccinate against his mother’s wishes – emphasised the power of empathy, which helps avoid alienating those open to having an open, good-faith conversation about health and vaccines. Effective public communication in the current context demands dexterity, skill and an ability to understand – indeed feel – the emotions and feelings of those concerned as a starting point.

Melissa Fleming, the United Nations’ Under-Secretary-General for Global Communications, was at pains to emphasise the dangers of falling back on facts alone – and why “how we frame information has a marked effect on outcomes.”

Consider your response to the following statements from two doctors describing an operation: first, “of 100 patients who had the operation, 90 were alive after five years”; second, “of 100 patients who had the operation, 10 were dead within five years”. It is certain the first doctor will perform more operations, even if both are saying the same thing. These psychological and behavioural insights can help us think more methodically about how we talk about vaccines. A similar logic applies to the language we use: what is our reaction when we hear the term “community immunity”? How does compare to our reaction to hearing “herd immunity”? Both mean the same thing – but might the more human connotations of the former elicit a more positive response from the latter?

Moreover, we can consider initiatives that help bolster public trust – for example, the UN’s Verified, which seeks to improve disinformation literacy, and Team Halo, which helps scientists diffuse their knowledge using accessible, entertaining formats on social media platforms such as TikTok and Instagram. “It is about infusing statistics with human experiences and engaging with the reality of people’s daily lives”, explained Melissa. “We must consider how to get a response from hearts as well as from minds, how to humanise information, how to present evidence.

Lastly, honesty and humility are critical, according to Peter Liese, a European Parliamentarian since 1994, whose professional background as a physician gave him the ideal platform to build bridges between policy makers and health professions. “It is important to be clear about what we do not know,” he argued. “We are in uncharted territory with a constant battery of information even experts may struggle to process – and should acknowledge that mistakes will be made” – for example, the guidance on masks at the beginning of the pandemic. In sum, “it is important both not to over-promise and to ask the right questions. Who will get the vaccine first? Is making the vaccine compulsory a viable solution?”

During this OECD Forum Virtual Event, we polled our global audience and found that 70% of respondents had direct contact with others who were either vaccine averse or vaccine hesitant, providing an indication of the scale of the very real challenge policy makers face.

What can history tell us about these policy challenges? One example is Denmark’s HPV (human papillomavirus) immunisation rates between 2000 and 2005, which plummeted from 90% to 20% following allegations of harm caused by the vaccine. Heidi Larson pointed to the government’s response: focus on the risks of the disease, explain the consequences of inaction (e.g. through stories of women who had died from cervical cancer) and directly engage with girls and their parents. The Danish experience underlines why taking on-board some of the principles and practices we have discussed above – empathy, how we frame information, honesty and humility – will bolster efforts to communicate effectively.

The COVID-19 infodemic as an opportunity

Combating misinformation and disinformation is an ongoing struggle that requires more dialogue, greater international co-operation, and a constant exchange of ideas, expertise and best practices. It is a Herculean effort, yet the debate about COVID-19 vaccinations is only the latest and most public front in the battle royal between truth and “post-truth”.

The “anti-vaxx” movement itself is by no means a modern-day phenomenon. Its origins lie in 19th century England when smallpox, the “Speckled Monster”, was the scourge of the age. Following Dr Edward Jenner’s discovery of “cowpox” as an effective protection at the turn of the century, the treatment went global. However, in England it provoked decades of debate and disquiet that took on sanitary, religious, scientific and political dimensions. In 1869, the first “Anti-vaccination league” sprang up in response to legislation making the Smallpox Vaccine free (1840), compulsory in adults (1853) and, critically children under 14 (1867). The anti-vaccination movement that gripped Victorian England, began in Leicester, in the English Midlands. It promoted quarantine and disinfection without vaccination (with the fundamental exception of all health workers!), which came to be called “The Leicester Method”.  It continues to be referenced in anti-vaxx circles to this day, despite question marks over its efficacy – and underscores the challenges of immunisation campaigns face. Its efforts resulted in a “conscientious objection” clause being inserted in the Vaccine Act in 1898, illustrating how tendentious and potentially counterproductive the issue of compulsion can prove in such cases.

19th century cartoon. A woman turning into a mermaid, a physician riding a cow and an apothecary wielding a syringe form a grotesque procession that scares children; referring to the distrust of the French public in the face of vaccination. Source: Wellcome Library

Building trust around vaccination efforts and tackling unfounded rumours is fundamental to policy efficacy. We must think of the messenger as well as the message. Healthcare workers are now sharing photos capturing the moment of their inoculation with a V sign on social media. It is a small gesture, but it comes from the frontlines and helps to chip away at the edifice of doubt. Ultimately, it helps to build confidence.        

The challenge is to communicate on something whose exact features are still being defined. We must be transparent. We must address illegitimate and legitimate concerns. We must work in partnership with stakeholders and key actors to find the right solutions, to improve the quality of public discourse. Tackling post-truth and getting it right matters not only for public health, but also for the many public policy challenges ahead. And the current pandemic is the opportunity to get it right – a collective V for victory.

Find out more about the OECD’s work on The race to vaccinate

Find out more about the OECD’s work on The race to vaccinate

Related Topics

Tackling COVID-19 Vaccines Health Post-truth

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