There is anxiety that one in five Kiwis have reservations about getting vaccinated. However, people can have active concerns and worries about side effects and risks, and still get vaccinated. Jess Berentson-Shaw has some ideas on how to support them. 

This pandemic is a long haul eh? Just when we think we know what is happening, that we have a clear idea of the path ahead, things change.

It’s a marathon, probably a 100 mile ultra marathon through mountains and deserts. In New Zealand, the path has been relatively smooth. Many things have contributed to that. We are geographically isolated with a smaller population (it helps), we acted confidently and early to stay home, stay apart, we still wash our hands a lot, we shut the border to the virus, set up systems to find and track the virus when it did get in, and adapted to mask-wearing (after a bit of a faffing around).

And as science and knowledge improves and the virus does what a virus wants to do, we are taking the next steps needed: getting vaccinated. And because we did everything as we did, took a precautionary approach to centre the wellbeing of our most vulnerable, we have a little breathing room for making sure this next step happens well.

Watching what is happening in India, and for some of us experiencing it through our families and friends, is a reminder that people in other countries are facing a much harder journey, with no breathing space at all. So while it was always an important next step, getting as many people vaccinated has become even more so as we are reminded what this virus can do if left unchecked. 

We know that vaccination is a very powerful tool in our Covid-19 tool kit. Naturally there is anxiety about vaccination roll-out. Anxiety that about 20 percent of people say they are hesitant about getting the vaccine in New Zealand. Alarm when false information arrives in our mailboxes. But it is important to know that while we can be alarmed about false information, and we should act to prevent it from spreading because it is harmful, we should also be clear that people who are hesitant about getting vaccinated still get vaccinated. The proponents of false information are not as effective as they would like and there are many other things we can do to support people who are hesitant to get vaccinated.

Hesitant people still get vaccinated. Here’s why: “Vaccine hesitancy is more complex and context-specific, and often reflects diverse, everyday anxieties – not just, or even primarily, exposure to misinformation or anti-vaccine campaigners.”

Basically, vaccine hesitancy is driven by many different factors – not solely or even primarily by knowledge, information and false information. For example, social and cultural notions of bodies and health, trust, experience of racism, humiliation, not being heard by people working in health, the political economy, experiences of exclusion in the process of decision-making all drive people’s hesitations.

If the public conversation focuses too heavily on false information, and often links that to people’s hesitations, there is a risk people will believe vaccination strategies need to start and stop with false information.

And really importantly, how accessible a vaccine is to people matters. This includes how easy it will be for them to get it, will it cost them time, money, opportunity, stress at work or at home? Will it be given by someone they trust, is it the most pressing issue for them? Or do people have issues that are far more present and near for them like poverty, stress, major health issues to deal with? These are all important issues that drive vaccine hesitancy and that people in governments, healthcare settings, workplaces, and across communities can work together to address.

All this is to say that a successful vaccination strategy, in which hesitant people get vaccinated, means addressing as many of these factors as we can. If we do we will be less exposed to the harm of people spreading false information. Importantly, access remains a big issue people in government need to take seriously. This means making the vaccine not just free but freely available everywhere, and ensuring the people talking about and administering it are trusted by the communities receiving it.  

People can have mixed feelings about vaccination and still get one

It also helps to understand that people can sit with mixed feelings about vaccination, can have active concerns and worries about side effects and risks, and still get vaccinated. We don’t need to disappear all of their concerns. People’s thinking and behaviour is not monolithic. The research shows that when people planning vaccination make it easy for people to get a vaccination, when people with concerns feel like they are being heard by the person giving a vaccination, when they see others who have expressed hesitation get a vaccine, they too get vaccinated. This is all good news, and good news we can share.

But I have a few concerns about the current framing of the Covid-19 vaccination issue. Firstly, if the public conversation focuses too heavily on false information, and often links that to people’s hesitations, there is a risk people will believe vaccination strategies need to start and stop with false information. We know a lot more is needed.

Secondly, if we focus too much on people’s unwillingness (one theme of this narrative) we provide too much social norming around unwillingness. Experiments show that framing people’s unwillingness, intention not to vaccinate or active declining of vaccination, reduces people’s intention to vaccinate for Covid-19. 

A third concern I have is we may be framing the idea that only full enthusiasm about vaccination is acceptable. This will “other” hesitant people, which will not create the conditions for them to opt into getting vaccinated.

To counter these issues arising, I suggest more work needs to be done to tell the story of people who had hesitations and still got vaccinated. It is important to tell the stories of the different drivers of hesitation too, from lack of trust in people who are doctors and nurses, fear of injections (it is a real thing), to having some unanswered questions about how safety is monitored, through to concerns about accessing the vaccines, and experiences of racism, belittlement, or shaming. It is important to be upfront about the harm people have experienced in healthcare settings to rebuild trust. Vaccination for Covid-19 is not about getting a one-off  “quick win” and forgetting about people. It is a long-term investment in people and their relationship with the health system. 

How to talk about false information then?  

There are many evidence-based ways to address false information. Here is something we have produced with support from Te Pūnaha Matatini for people in the media. I have written before about inoculating people against misinformation also. 

Instead of talking about false information too much (the story we don’t want to tell), people doing research, people rolling out the vaccine, people in government, and people in the media can focus on providing proof that people with hesitations do get vaccinated. Vaccination is a social activity, and by its nature a collective action. We are influenced by others in our collective. When we see them get vaccinated, even though we may have hesitations about it, we can more easily cope with the fact there are things that give us pause as individuals, while still choosing to participate for greater good.

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