We need a better way to talk about vaccine hesitancy

Something good could come out of this pandemic, says one expert, if it leads to a broader conversation about health literacy.
Something good could come out of this pandemic, says one expert, if it leads to a broader conversation about health literacy.
Image: REUTERS/Emily Elconin
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In Dec. 2020, the polling company Ipsos surveyed adults in 15 countries about whether they intended to get vaccinated. In some countries, the findings were not encouraging. Only 12% of French respondents “strongly” agreed with the statement, “If a vaccine for Covid-19 were available, I would get it.” Only 40% agreed overall.

In late February Ipsos did a follow-up survey and found that among people who had not been vaccinated, the percentage of those who “strongly agreed” that they would get a jab had increased in every country by anywhere between two (Russia) and 36 percentage points (Italy). The improvement in western European countries stood out, with strong intent to vaccinate rising by 31 points in Spain, 24 in the UK, and 23 points in France.

The Covid-19 vaccine rollout in many European countries started off slowly, and vaccination intentions are still worryingly low there: While a 31 percentage point jump in Spain sounds impressive, it still means that only 57% of unvaccinated adults “strongly agree” that they will get vaccinated. But the question remains: How did these countries change so many hearts and minds?

What is vaccine hesitancy?

According to the US Centers for Disease Control and Prevention (CDC) and other global health bodies, vaccine hesitancy is a nuanced concept that describes people who, for various reasons, wait to accept or refuse to take a vaccine even when it is available to them. According to the World Health Organization (pdf, p.7), vaccine hesitancy “is complex and context specific, varying across time, place, and vaccines,” and is “influenced by factors such as complacency, convenience, and confidence.”

It’s a more malleable label than “anti-vaxxer” because it implies that people won’t take the vaccine just yet—but they might at some point, under the right circumstances.

When is someone considered an anti-vaxxer?

Scott Ratzan, co-leader of CONVINCE, a vaccine communication project, says that in the early days of the pandemic, public health authorities were too quick to label people as “anti-vaxxers” just because they didn’t immediately jump at the chance of a jab.

People’s feelings about vaccines can evolve “as they weigh the risks, benefits, and convenience of vaccination,” Ratzan wrote in a recent paper published in the New England Journal of Medicine (NEJM).

In the paper, which is based on an outside survey, Ratzan and his co-authors classify individuals’ attitudes towards vaccination on a “spectrum of vaccine ‘hesitance,’ ranging from being ‘vaccine ready’ to ‘vaccine neutral’ to ‘vaccine resistant.'” Even the people who are ready and willing to get vaccinated might not seek out a jab, preferring to wait for it to come to them.

With the benefit of hindsight, and as Covid-19 vaccine rollouts take off in some countries and stall in others, it’s clear that the issues around who is not getting vaccinated and why are more nuanced than the labels we’ve created. That’s important because different forms of vaccine hesitancy call for different public health approaches.

How to tackle vaccine hesitancy

Some US states, for example, offer lottery tickets and free beer to adults who get vaccinated. These kinds of creative incentives are unnecessary for many “vaccine ready” adults, says Ratzan, but they might help nudge vaccine receptive or vaccine neutral adults. (On the other hand, some people could be tempted to wait and see what better perks might be around the corner before getting the vaccine.) For those who are receptive to vaccines but not “avid seekers,” simply facilitating access to vaccines could do the trick. Giving more information about vaccines to the “vaccine neutral” group might help sway them—and Ratzan believes that everyone could benefit from becoming more “vaccine literate” anyways.

Once all the people who are receptive to vaccines have been inoculated, the NEJM paper makes the case that governments should go back to providing vaccines where people are used to seeing them, like doctors’ offices, because they have a better chance there of reaching people who identify as “vaccine resistant” than in baseball stadiums and theme parks.

Ratzan argues that, beyond this pandemic, public health campaigners should think of vaccine hesitancy in a more nuanced way, and design more targeted solutions to counter it: “This is a teachable moment.”