Europeans have had a very tough time with the coronavirus—physically, economically, but also psychologically.
After China, Europe quickly became the hotspot of the pandemic in early 2020, and hasn’t fully recovered since. More than 43 million people in the region are confirmed to have had Covid-19—the real number is likely much higher—and 940,000 people have died. Europe’s economic recovery is lagging behind, while protests against lockdown measures are becoming more frequent and more violent.
And now, its vaccine rollout is off to a slow and messy start, with only 60 million doses of Covid-19 vaccines administered in the 30 countries of the European Economic Area, compared to 31 million just in the UK.
Europe’s vaccine program has been plagued by three different problems: Low supply, ineffective on-the-ground distribution, and vaccine hesitancy among the population. All three of these strands have converged to create a public relations and a public health crisis, one that’s centered on the vaccine made by Anglo-Swedish drugmaker AstraZeneca, in conjunction with the University of Oxford.
What’s clear is that the next frontier of the pandemic for Europe will be played out not in hospitals, but in people’s minds.
The EU has committed to buying up to 400 million doses of the AstraZeneca shot—the cheaper of the four vaccines it approved for use against Covid-19 (for comparison, three have been approved the US so far, where AstraZeneca is still undergoing trials). If we consider that children may ultimately be asked to take the vaccine, then there are more than 515 million people living in the European Economic Area who will ultimately need two doses of a vaccine (unless they are getting Johnson & Johnson’s single shot, which won’t be delivered until the second quarter of 2021).
A recent poll published by the British market research firm YouGov found that trust in the AstraZeneca vaccine has taken a hit in western Europe in recent weeks. In France, Germany, Spain, and Italy, adults polled between March 15 and 18 were more likely to see the vaccine as unsafe overall than safe, a reversal from a few weeks earlier, when they said the vaccine was broadly more safe than unsafe. (The chart below excludes Spain and Italy because the countries weren’t included in all three polls.)
The poll doesn’t ask people why there’s been a slump in trust. But as I’ve previously written, initial delays in deliveries of the AstraZeneca vaccine caused a very public brawl between EU authorities and the drugmaker. Misinformation about the jab’s effectiveness among older people, propagated not just on social media, but also by German media and French president Emmanuel Macron, scared some people off, and convinced them to wait for another vaccine while millions of doses sat unused.
And recently, many European countries halted the distribution of the vaccine out of concern that it may be linked to blood clots, even though that link has not been proven and both the WHO and the European Medicines Agency (EMA) said the benefits of the shot outweigh its risks. Now the EU and AstraZeneca are once again at odds over how many doses were promised to the bloc, as it weighs imposing export restrictions on doses made in the EU but meant for the UK and other countries.
The EU is in the middle of a third wave of coronavirus cases. Scientists don’t know what percentage of a given population needs to be vaccinated in order to reach what’s known as herd immunity, whereby enough people develop enough resistance to a virus that it can no longer spread to the part of the population that doesn’t have antibodies. (The World Health Organization cites a threshold of about 95% for measles and 80% for polio.) It’s clear that Europe doesn’t stand a chance of reaching herd immunity if it can’t use its available doses of AstraZeneca vaccines because people won’t take them.
Concerns over the AstraZeneca shot in Europe—whether valid or not—have spread to developing countries. Following the bloc’s lead, both Thailand and Indonesia temporarily stopped using the vaccine until the EMA gave the green light. That’s especially worrying because the AstraZeneca jab can be transported and refrigerated more easily and cheaply than other vaccines, and is considered crucial to tackling the pandemic in the developing world.
Public health experts know a thing or two about convincing people that an intervention—be it vaccines or seat belts—can save lives. Their suggestions could help reverse the mistrust that has built up in Europe surrounding the AstraZeneca vaccine.
Kavita Vedhara is a professor of health psychology at the University of Nottingham, where she is developing a soon-to-be launched website called covidvaxfacts.info that seeks to answer the most common questions Britons have about the vaccines. Vedhara says dealing with vaccine hesitancy should start with addressing people’s concerns respectfully. After all, “it’s completely normal that people would be more hesitant about [the AstraZeneca vaccine] in the immediate aftermath” of contradictory public health messaging and the news coverage surrounding possible ties to blood clots.
Not all concerns are born equal, Vedhara accepts. She distinguishes between what’s commonly known as anti-vaxxers, “people who have really long-standing reasons for not wanting a vaccination that may not even be specific to Covid-19,” and who “are the minority,” and people who “have very genuine questions about a treatment that has emerged out of nowhere, in less than a year, and they want to know it’s safe.”
The good news is that most people’s questions have answers. A common one centers around how the vaccine was developed so quickly. “It’s possible to point out that all of the vaccines that are currently licensed are building on decades of previous research. So, if your concern is something like that, then our hope is that our website will support you in providing the answers. If your concern is that Bill Gates has put a microchip in it, our website won’t address that, because that [theory is] probably about something much wider.”
The goal of any public health campaign shouldn’t be to convince people to take a particular vaccine, says Vedhara. Instead, it should be about “giving people the opportunity to make an informed choice.”
Outreach efforts should answer the specific questions of individual communities, especially those who are more susceptible to vaccine misinformation and are more skeptical of vaccines in general, says John Drury, a professor of social psychology at the University of Sussex. That means groups like women and minorities, for instance. “You need to have public buy-in,” he argues.
As an example, Vedhara mentions British Muslims, who may have more questions about the vaccine as Ramadan approaches. Many Islamic scholars have said that the vaccines’ ingredients are halal and that the act of receiving the vaccine wouldn’t break someone’s fast. But that information needs to be better disseminated, says Vedhara, and those communities told that “ultimately, it is a personal choice.”
Drury warns against programs of mandatory vaccination. “If we think that trust is the issue, and trust is low in certain demographics, then a change of policy whereby enforcement is involved confirms the suspicions of those groups.”
“The key factor in vaccine hesitancy is trust,” says Drury, which is why he advocates for public health authorities to work with trusted community leaders to spread the message that vaccines work and are safe. But that only works if the public health authorities themselves are “seen as being open and honest.” So, “if communication is good, ie., implies trust in the person you’re talking to and implies respect, then everything you say afterwards is listened to [and] internalized more.”
It might be tempting to cut one’s losses and move on; after all, there are plenty of people in the world, especially in poor countries, who would welcome the extra doses of the AstraZeneca vaccine. If Europeans don’t want them, why not just redistribute them? But that sends the wrong message, argues Drury. “There’s always a point to trying to convince people.” And since the world can’t fully recover from Covid-19 until most people are vaccinated, it’s in all our interest to get this right.