Vaccine Hesitancy

As the rollout of COVID vaccination programs progress, the issue of reaching as many people as possible becomes critically important. 

The anti-vax movement gets a lot of press in the news but that is not the group I want to talk about.  They seem to be broadly typical of conspiracy theorists, so there is nothing I have to say which would make any sense to them. 

The group that is far more interesting are the vaccine hesitant, who are not conspiracy theorists but often have rational foundations for not wanting to take the vaccine.  I should be clear that I am very pro-vaccine and got mine as soon as I could and encourage others to do so, but I would like to explain why and how my views might differ to a vaccine hesitant person.

My friends and family don’t trust it so nor do I

I would think this is the most common reason and the most easily understood.  They will often put more weight on the opinions and behaviors of those close to them, and so it should not be a surprise that vaccine enthusiasm/hesitancy exists in pockets with groups of friends and family likely to have similar views.
Reaching out to communities in ways that make sense to them is key and there is no simple answer.

I have a personal history to not trust new medicines

This is very real and very understandable.  People who have had bad experiences with other medical treatments are likely to be cautious and require more convincing to participate. 

I don’t trust the government

Nor do I.  I have a lot of sympathy with people who are confused by the messaging and have lost faith in this government.  Boris and his cronies lie all the time; they have used the crisis to create a kleptocracy where they and their friends are given lucrative contracts and serial failures like Dido Harding are promoted and given £37bn to waste.  I am particularly annoyed that in the chaos of Boris Johnson’s government, important public health messages are often hidden. 

But thankfully we do not have to take Boris’ word for the vaccine being good.  The globally available information is compellingly behind the vaccination program including every government, international agency and scientific body.  To think that there is collusion between all of these groups takes us into the realm of conspiracy theorist rather than hesitant.  A good rule of thumb to know whether a conspiracy theory is plausible is to think about how many people have to be in the conspiracy and for how long.  Tens of thousands of unconnected people keeping the massive secret for over a year is just not possible. 

I have Information overload

There is vast amount of information available on COVID and the vaccine.  Plenty is true but complicated, and a reasonable amount is misinformation.  Sorting through it is not simple, especially for a general population with no particular training in medicine, statistics or ethics with low trust in authority. 

In the face of this, people can find it very hard to make decisions and ‘doing nothing’ becomes the default and easiest outcome.

The technology is too new

mRNA technology has actually been around for a long time.  The first vaccines were developed 30 years ago and 10 years ago we had good working candidates.  But it took the pandemic for the funding and regulatory attention to move them into production. https://www.nature.com/articles/d41586-021-00019-w

I expect to hear much more about this technology in the coming years as we develop new ways to treat diseases such as cancer. 

The vaccine was rolled out too quickly to be safe

This was a concern of mine but some research last year showed that a lot of the slowness in previous vaccine approvals came from bureaucratic delays rather than safety requirements.  Much of the approvals process can be done simultaneously rather than sequentially which really sped things up.  Similarly the vast funding enabled us to develop later stages of the research before waiting to finish the early stages.

Also, each vaccine had to be separately approved by each country’s own regulator ie you have a very large number of independent entities with chance to raise issues with the vaccines or the process.

It is best to wait to be sure it is safe

This makes sense as an argument. 
The reason I do not agree in this case is that normally you would be waiting until lots of people have done it in case there is a problem which the testing stage missed.  This normally takes time but given the speed of the rollout this time there have now been 5.6 BILLION doses delivered.  This is an unfathomably large number, so far above the number you need to get approval which is in the thousands. 

I am worried about the side effects

This would be a sensible reason for hesitation and is a normal human response.  I do not share it as, related to the point above, we know so much from those 5.6 BILLION doses.  With that many doses, it would be a shock if there were no individual tragedies, but the scale of the rollout means that our confidence is very high that the risks are vanishingly small.  Unlike for COVID where the risks are well documented and much higher. For example, the risk of blood clots from the vaccine do exist but are vastly less than the risk of blood clots from COVID.

A complicating factor is misinformation about side-effects (e.g. leads to fertility issues or contaminates breast milk) – these are simply untrue.

Another common fear is that there might be a long-term problem (e.g. you will get cancer in 20 years’ time).  I do not have much to counter this except to wonder why no other vaccine has ever had that problem.  I am also very well aware of the long-term effects of COVID which are very real and could be very severe so I would much rather be protected from that. 

I value my freedom and do not want to be forced to take it

This argument feels backwards as freedom for most people increases if we all have the vaccine as the vulnerable can safely leave their homes.  I wonder if they feel this way about other forms of government coercion and want to protest their right to drive through red lights at 100 mph outside schools while drunk.  Sometimes society limits our “freedom” to damage other people. 

The vaccine does not really work

The argument here is that you can still catch COVID after being vaccinated.  This is true but misses that you are drastically reducing the risks of more serious problems and virtually eliminating the risk of death. 

Similar arguments are made about masks and other prevention measures, but I think this is a conceptual error on safety.  Reducing risk is still a good idea even if it cannot be reduced to zero.  I happily wear a seat belt and drive a car with an airbag even though it is still possible to die in a car accident.

The best metaphor I have seen about combining risk reducing strategies is to think of each of them as a slice of Swiss cheese.

Any single slice has large holes in it.  But put them all back-to-back and you cannot see through it.

Some of the slices such as masks may have larger holes and some like vaccination have smaller holes.  They are not alternatives but work best in combination.

You can still pass on COVID if you are vaccinated and so my decision only affects my health which is my business

This has some appeal as an argument.  Even if you are double jabbed then you can still catch COVID and you can still infect other people.  So what is the point?

This is misleading because vaccinated people:

1. are less likely to catch COVID ie less likely to have it
2. likely to have a much lower viral load ie are less infectious
3. are likely to recover much more quickly ie are infectious for less time

The combination of these three means that you do not have the exponential growth in the population and the virus dies out. 

Conclusion

With a little reflection, it is pretty obvious that if no one were vaccinated right now, deaths in the UK would again be in the thousands per day not dozens.  If everyone took the decision to delay, we would collectively be in a terrible situation.

In fact, a notable positive from the rollout has been how large the take up has been.  Polls suggested that a large number would not take the vaccine but the take up has been far in excess of that. 

This suggests to me that the anti-vax believers have likely not changed their mind but the numbers of vaccine hesitant has been steadily reducing.  The arguments I have made above are far from new, and people are gradually moving towards accepting the vaccine.