Tackling Vaccine Hesitancy

I have long been fascinated by conspiracy theories. Until now, though, I had found them simply issues of amusing curiosity, academic side-notes glancing off the serious world of evidentiary science.

But, as they say, s@#t just got real.

There is only one exit door for the COVID-19 pandemic, and that is through exhaustive vaccination of the humans on this planet—at least 80% of the population is the number oft-quoted. Leaving aside the thorny issue of global vaccine availability, one of the distressing reasons we are not reaching those sorts of percentages is the problem of vaccine hesitancy (the term adopted by the World Health Organization).

Vaccine hesitancy, of course, is nothing new. It has a long and ‘proud’ heritage, ever since immunisations were first introduced. Before we take a brief jog through history, it is important to distinguish those who are vaccine hesitant from ant-vaxxers. Anti-vaxxers are in a league of their own, and are involved in dragging many others into their warped world view. They are also not a recent phenomenon but they tend to fall into a fairly narrow category. Those leading anti-vaxxer movements, certainly in the past, have tended to be wealthy, middle class, often white, and had something to gain by promulgating their ideas and influence. For example, Dr Alexander Ross, a Canadian homeopath in 1885 fought against vaccination as this would heighten his own fame and professional standing. Andrew Wakefield, the king of fraud and disinformation, is another in this vein. In July 2021 the White House put out a report stating that in the current pandemic, serious anti-vaccination information dissemination could be traced back to just twelve influential individuals (named online ‘personalities’). Many of these are seeking both fame (infamy?) and financial gain, peddling supplements, snake oil and false cures.

True vaccine hesitancy is different—where there is an unwillingness to either get the vaccine for the individual or enable those close to be immunised—and encompasses a cornucopia of reasons. Like with most complex societal memes, it is easier to understand the present if we look to the past. It is interesting to see how these arguments repeat themselves through time.

• Disease minimisation. It has been a common argument that the disease, or an epidemic, does not exist, or is a minor threat only, seen initially with smallpox.
• The idea that the vaccine will cause significant harm. In the 1800s groups were saying vaccines caused blood poisoning, in the 1920s cancer, in the 1970s autism. Now we have interference with fertility, magnetism, microchip control (how far we have come!). This extends now into the theory that the vaccine is DESIGNED to cause harm, currently riding the airwaves.

We know that we now reside in a misinformation ecosystem. This is the infodemic holding hands with the pandemic. The internet allows misinformation to spread to those vulnerable to anti-scientific sentiment faster than the Delta variant. And it’s not only the bad-influencers at fault, but the internet algorithms—these are designed to keep users engaged, continually scrolling for neurotransmitter hits, showing them more and more and more of the same things that caught their eye in the first place. It’s extreme confirmation bias.

The above points might be on the more radical levels of misunderstanding. However, there are many other reasons for vaccine hesitancy, several of which are partly understandable, which really is the point of this column. Education is a two-way street. To tackle vaccine hesitance, we need to understand what is driving it for the individual in front of us. Other reasons for vaccine hesitancy, which have some basis in validity are:

• Distrust of government. Hardly surprising. If the government are putting out the edicts, and in the same breath are lying through their teeth about pretty much everything (and I’m looking at all world governments here. Well maybe not you, New Zealand), then there is understandable hesitation in taking up their messaging. This is particularly true for BAME communities, who have good reason to believe that entrenched systemic racial inequities will work against them.
• Compulsory health mandates. We have bodily autonomy, after all.
• Poor scientific communication to a population without a firm grasp on the scientific method.
• Religious and other spiritual beliefs.

There are countless other reasons people may be fearful or nervous about getting the COVID-19 vaccination, and herein lies exactly the point. You can’t tackle vaccine hesitancy without knowing the root cause that’s driving such hesitance in an individual. One thing we know does not work in combating misinformation, is spewing forth facts, such as quoting percentage risks and statistics. Often it will make things worse, and cause people to dig their heels in.

The hardest thing you might have to do as a clinician, when you know the facts, you are exhausted and still scared by the pandemic, and know that vaccination is the only way to safeguard the patient, their family, your family, hell, the whole planet, is to ask gently, respectfully, with a true curiosity, why. Why is the patient in front of you vaccine hesitant, and then your response can be tailored to their specific concerns. We do know that the act of positive discussion with a care-giver that is both genuinely concerned, and is one that the patient respects, is one of the safest ways to break down those barriers.