COVID-19 vaccines have been developed at a record pace thanks to the collaborative efforts of governments, industry, academia and other organisations. The primary purpose of vaccination is to protect individuals against severe infection. Vaccination also protects populations by providing ‘herd immunity’, if done on a large scale. Globally, vaccinations against polio, small pox, meningitis and so on have seen huge success.
But there seems to be problem in vaccinating people against COVID-19. The possibility of a significant number of people not getting vaccinated thwarts our collective ability to reach the herd immunity threshold of 70-85% against SARS-CoV-2. As we mitigate the problems surrounding vaccine shortage and logistics, the issue of vaccine hesitancy needs to be urgently addressed.
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Vaccine hesitancy
The results of a 2020 Gallup poll, conducted before the vaccine roll-out, were published on May 3, 2021. In the poll, one in three adults worldwide (32%) said they would not take the COVID-19 vaccine. India performed better in this poll with only 18% stating that they won’t take the vaccine. But vaccine hesitancy has gone up in India since then, due in part to largely overblown reports of complications or even deaths.
Vaccine hesitancy is complex and context-specific, varying across time, place and vaccines. The influencing factors include a lack of awareness of the extent of benefits, fears based on inaccurate information, lack of access to vaccine, civil liberty concepts, cost, cultural issues, and various layers of confidence deficit (mistrust of intent, lack of confidence in the system) sown by conspiracy theories and disinformation. Disinformation is rife, especially on social media. Among those who are extremely hesitant are the ‘anti-vaxxers’. The rest comprise those who delay getting vaccinated, accept vaccines in principle but are sceptical of their use, accept certain vaccines but not others, etc. ‘Free riders’ are those who do not want vaccines, but wish to derive the benefits of herd immunity.
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The consequences of vaccine hesitancy are disastrous. If herd immunity does not develop, disease outbreaks and pandemics will prevail. The slower the vaccination rate, the wider the spread of infection and the greater the chances of mutations and the emergence of new variants.
The right message
To allay vaccine fears, our messaging needs to focus on simple facts. Vaccines have been widely tested. The side-effects that may last a couple of days are a very small price to pay to vastly reduce getting seriously ill from disease. The less than one-in-a-million chance of getting serious side effects far outweighs the effect the disease is likely to have.
Addressing the strategies to blunt disinformation, especially on social media, Lisa Rosenblum says in an article in the New England Journal of Medicine that quashing rumours and conspiracies with truth and reliable information alone may not suffice. Before attempting to persuade people, we need to understand the basis of their fear, hesitancy and the anti-vax attitude. By challenging untruths, we inadvertently feed the perception that we are actively suppressing the “real” truth. She concludes that often, the most educated sceptics will be against explanations of scientific facts.
While not different from prior vaccine drives, the objective now is to reach more people faster with a message that doesn’t just provide more science but includes guidance. Providing practical information through social media, alternatives to apps for those lacking easy access to vaccines, and taking the help of well-informed frontline workers will all help.
T.S. Ravikumar is President, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, and Member, Patient Safety Curriculum Working Group, World Health Organization, Geneva; Rajeev Aravindakshan is Additional Professor, Community and Family Medicine, AIIMS, Mangalagiri