Vaccine hesitancy: how can we persuade a reluctant minority to get a jab?

The UK has one of the highest rates of vaccine positivity in the world according to Nadhim Zahawi, the UK’s vaccine deployment minister, if not the highest. At the latest count, ONS figures show that 94 per cent of British adults say they are either very or fairly likely to get the vaccine or have already been vaccinated or booked an appointment, up from 78 per cent in December.

Yet vaccine hesitancy – defined as being very or fairly unlikely to accept being vaccinated or having already declined a vaccine – is noticeably higher among some groups, such as people aged 16 to 29 (17 per cent), parents of young children (16 per cent), and inhabitants of deprived areas (16 per cent).

Ethnic minorities are also more likely to be vaccine-hesitant. Only 8 per cent of white adults were classed as vaccine-hesitant, compared to 44 per cent of black and black British respondents. Other minority ethnic groups also reported higher levels of hesitancy of around 16 per cent.

What drives vaccine hesitancy and how can it be overcome?

Professor Helen Bedford, Professor of Children’s Health at UCL, who has been researching attitudes towards vaccines for 30 years, says: “The key is a sense of safety. People make mental calculations balancing the perceived risk of the vaccine vs the perceived risk of the disease. As a result you get some people who are perfectly happy to get other vaccines but are hesitant about this new one. The speed of its development has left some people worrying it has been rushed.”

Indeed, ONS polls found that across all demographic groups the main reasons for hesitancy cited were worries about side effects, long-term effects, and vaccine efficacy.

On the question of why these fears are more prevalent among ethnic minorities, Professor Bedford said:  “Early talk about trialling the vaccine in Africa made a lot of people uncomfortable – black people worry they’re being used as guinea pigs. Some of these communities also face problems of deprivation – poor education and poverty makes people less trusting of vaccination.”

She added: “Another key factor is institutional racism. People are less likely to get the vaccine if they feel that they have broadly been treated poorly by the system.”

There has been little research conducted on the specifics of these experiences.The Tuskegee medical experiments, where black men suffering from syphilis were deliberately left untreated in order to study the disease’s progression, have been cited as one of the abusive legacies fuelling distrust. However, studies in America found little evidence that knowledge of the Tuskegee experiments was contributing to distrust of the coronavirus vaccine.

Further complicating the picture is that statistics on uptake of other vaccines show that some ethnic minority groups are in fact more likely to get vaccinated, according to Dr Alice Forster, a UCL Research Fellow specialising in vaccine uptake.

“Hesitancy is also more complicated that it seems; vaccine hesitancy can be a confusing term. It includes anyone who has concerns about the vaccine even if they then decide to get it anyway.

“In broad terms you can subdivide people with concerns about vaccines into those who have doubts but get the vaccine anyway, those who don’t get the vaccine but who are not against the idea of vaccination per se, and a small number who will never get vaccinated. The second group is an important group to focus on, though the first group can also do with a little reassurance. The views of the third group are often developed as part of a worldview that is bigger than vaccination, and unlikely to change or be changed.”

Thankfully, Dr Forster says that the third group tends to be a small minority – people deeply tied to a conspiratorial outlook. The number of people who have refused or are thinking of refusing the vaccine but are amenable to persuasion is much bigger.

When it comes to persuading people to take the vaccine both Prof Bedford and Dr Forster offer the same advice: talk to people, understand their reasons, and have trusted figures provide reassurance about the vaccine’s safety. Health professionals are still widely trusted – even if someone isn’t sure about the vaccine- and a family doctor’s recommendation is the best method to convince people to get the vaccine.

Dr Forster’s main concern is not hesitancy but access. “While vaccine hesitancy influences uptake, vaccine access is critical. The UK is pretty good but some people can fall through the gaps. For example, if they’re paid hourly or work unusual shift hours.”

The problems of access and hesitancy appear to be linked. Those sceptical of the Tuskegee explanation for hesitancy argue that current distrust is fuelled by current failures – all too contemporary problems of poverty and unequal treatment that limit access as well as fuelling distrust. Stories of bad treatment spread.

Conversely, stories of good experiences help increase vaccine uptake – perhaps explaining the noticeable decrease in vaccine hesitancy since December. Hope has been expressed that seeing older people get the vaccine with no ill-effect will increase trust amongst younger people.

Efforts can also be made to improve access. Sadly the most effective method – mass vaccination of people when they are gathered together (children at school, for instance) – is hindered by lockdown, but others are available. Dr Forster believes that simple steps to remind people to get vaccinated can be of great help. “The best thing to do is keep good vaccination records and have good reminder systems for chasing up people who remain unvaccinated.”