How to tackle vaccine hesitancy

How to tackle vaccine hesitancy 14th October, 2021

In rich countries there are plenty of vaccines, but we seem to be running out of people who want them. This is frustrating. The vaccines are a medical miracle — safe, more effective than we dared to hope and produced with unprecedented speed. They are the way out of this global crisis. No wonder vaccinated people often look at holdouts with contempt, pity or fury.

I chuckled at the recent McSweeney’s article “Oh My Fucking God, Get the Fucking Vaccine Already, You Fucking Fucks”. Then I wondered who was really the butt of the joke. Was it the anti-vaxxers? Or was it the anti-anti-vaxxers? Either way, it was unlikely to catalyse many decisions to get vaccinated.

I realise that a humorous rant is not a public health policy, but there was something about the McSweeney’s piece that perfectly symbolised a dangerous temptation. Do we want to do the patient work of increasing vaccine uptake? Or would we prefer to enjoy that smug feeling of superiority to those incorrigible, unvaccinated idiots?

Not every unvaccinated person believes Covid-19 vaccines are a genocidal conspiracy. According to polling in the US from the Kaiser Family Foundation, fewer than half of unvaccinated people say they will “definitely not” get the vaccine. Others say they’re keen to get it as soon as possible or they will get it if they’re required to or that they want to wait and see. The “wait-and-see” group, once large, is steadily moving over to the ranks of the vaccinated. This is progress.

If we want vaccination rates to improve further, we should help people who are already halfway to getting it. The starting point is clear, honest communication about benefits and risks, but we should also reframe the alleged problem. All too often I see headlines along the lines of “40 per cent of adults under 30 are unvaccinated” rather than the arithmetically identical “60 per cent of adults under 30 have already received a jab”. It is counterproductive to highlight antisocial behaviour when instead you could be pointing out that most people are doing the right thing.

“Most people are getting vaccinated, so don’t miss out,” is a more persuasive message than, “Why are there so many idiots like you?” If the Kaiser Family Foundation’s poll is to be believed, 85 per cent of Americans over the age of 65 are vaccinated. And despite endless stories about Trumpist vaccine refusal, so are more than half of Republican voters.

The sociologist Zeynep Tufekci rightly warns against “the lure of the caricature”, those viral stories about anti-vaxxers who catch a severe case of Covid but refuse to recant even on their deathbeds. Yet while such ghastly tales loom large on social media, we could more usefully focus on mundane obstacles. Some people are scared of needles or worry about missing work because of side effects or can’t easily arrange childcare to get to a clinic. Solving these problems needn’t be hard — there are a thousand tiny things we could try to make things easier.

A large team of behavioural scientists including Katy Milkman and Angela Duckworth recently tested a range of tactics to persuade people in the US to get the flu vaccine. The most effective approaches involved sending a couple of reminder text messages and saying that the flu shot had been “reserved for you”. It’s all so mundane, but the uptick — a few percentage points — is large enough to be well worth a try.

After doing all this easy stuff, we have to ask ourselves a tough question: what are we actually trying to achieve? It would not be difficult to push vaccination rates up by brute force. The UK government could introduce a “rebuild the NHS” tax of £100 a month. Anyone who was fully vaccinated — or could persuade two different doctors to sign a certificate of exemption — need not pay the tax. There would be a fuss and some anti-vaccination campaigners would hope to become martyrs but most people would shrug and get vaccinated. I suspect the vast majority of already-jabbed people would regard this as a perfectly reasonable tax on selfishness and idiocy.

But if that idea makes you squirm as much as me, perhaps that is because we sense that the real problem is rather different, and much bigger. It’s that a small but significant minority lack confidence not just in vaccines, but in the state, corporations, experts and modernity in general. Heavy-handedness might force their grumbling compliance, but at what cost?

The Vaccine Confidence Project, a group of researchers based in London, has spent more than a decade studying attitudes to vaccines, misinformation about vaccines and confidence in vaccines. Recently they launched The Confidence Project examining issues of trust, doubt and misinformation beyond vaccines. It is unclear whether this should be regarded as a noble enterprise or some serious mission creep. They may be biting off more than they can chew, but I applaud the effort.

Lack of confidence in vaccines is a problem in its own right, but also a sign of a more worrying fraying of the social fabric. Repairing that fabric is a harder job than simply pushing up vaccination rates. That is because while vaccines have proved to be highly effective, one cannot say the same about our governments.

Written for and first published in the Financial Times on 17 September 2021.

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