It takes longer than oprobrium and exhortation to deal with this contraction here and elsewhere. This requires tuning.
In an area where coronavirus cases are kept low – deep mistrust, ignorance and lack of urgency in government – that means Hong Kong is now struggling to vaccinate enough residents. This week, when appointments for people over the age of 30 began, thousands of us booked between Sinovac Biotech Ltd and Pfizer-Bioentech vaccines made in China. Of the 7.5 million population, many of the eligible 5.5 million are not yet there.
From political turmoil to reports of more than 160 deaths of more than 160,000 people given the Synovac shot, Hong Kong is a storm of troublesome factors, although these events are not linked to the vaccine. Even before the shots became widely available, many suggested it would be too late. But the city is not alone. Doubts and anxiety are as old as vaccines, haunting vaccine pioneer Edward Jenner and running from the backstreets of Lahore to the high-end Paris neighborhoods.
This is not a brushable problem. The hope that life will return to normal is very low, with 2.7 million people and very few conquering the virus that killed frozen economies, until enough people set foot to achieve herd immunity – perhaps up to 70%. Even a small shortage is enough to spend lives and livelihood.
The good news is that experience has taught us a lot about campaigns and resistance. Plus, despite the fact that Kovid-19 is a disaster, it is an unprecedented opportunity to change the mindset and prove the value of vaccines for visible public health hazards.
The less positive news is that the reasons for skepticism are many times and complex. Misinformation is a problem: fears from episodes such as the Nigeria polio vaccine boycott in 2003-04 or around diphtheria, pertussis and tetanus vaccine in the 1970s and 1980s. Today, social media means that the most modest anti-waxers are moving fast to conquer those who shrink through online chat rooms, sometimes by sowing doubt. A Facebook study has shown that a small subset of users is responsible for a lot of skeptical content posted. There are a lot of resources ranging from a lack of trust in the authorities to health care barriers to general racism. Episodes such as the 40-year-old Tusky Gee syphilis study that rejected blacks in the US state of Alabama diagnosis and treatment have long been a shadow.
This is a very long list for Kovid-19, where there is misinformation from the beginning, geopolitical tensions and confirmed domestic agendas seem to be in America, where President Donald Trump has minimized the threat and played conspiracy theories. In places like Turkmenistan it was completely denied, no confirmed cases were reported and Tanzania, last April, stopped publishing the data.
The rapid appearance of vaccines has not been addressed by more people, and it is unclear where time will be saved or how risks will be balanced against rewards. Europe’s suspension of the Austrogeneca Kovid-19 vaccine over blood clotting reports is a matter of caution, but real-world evidence suggests that the shots are safe. After planting, it is very difficult to remove doubts.
In a way, vaccines have led to a lot of debate. Very few people think too strongly about allergy medications or cough syrup. Heidi Larson, who runs the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine and studies the rumors, associates it with government and big business – which is largely driven by mistrust. In a recent speech, she said it was less of an information issue than a relationship. Less confidence in the authorities, like Hong Kong or Lebanon, is another dubious hotspot, meaning some people take the risk. Vaccine skepticism is very often overshadowed by poor governance and unpopular politics.
Blocking vaccine resistance information on social media platforms is clearly needed, but it is not its own solution other than making injection mandatory – an action that undermines and further validates future efforts. Closing down skeptics is a poor strategy when the exception is half the problem.
For a long time, distrust in life-saving shots seemed to me to be an emerging edge from ignorance. Then I had a kid in the autism spectrum, and he asked me very often and very openly on his vaccination schedule: Did he have a shot against measles, mumps and rubella, MMR? This is a reference to the long-discredited study of turbo-charging the vaccine resistance movement, which caused unintended harm to autism and vaccination. These are not illiterate people or conspiracy theorists, but they have questions.
That’s where we should start.
Pictures of vaccinated celebrities, basic booking procedures and basic access to injections are all important. But it is very important to listen to doubts and understand where the problems are coming from. For example, the Philippines is experiencing a dengue vaccine effect that can worsen symptoms in people who have been infected in the past. Some Hong Kong people need to be assured of the proof and safety of vaccines. Elsewhere, when other health threats are even bigger, it may be a question of explaining why this is a priority. Tailoring response topics in a way that doctors, priests or elders can provide from a locally respected source.
A U.S. public health specialist explained to me that there is a choice: focus on groups that connect with peers and try to educate them by answering questions and not teaching. His experience in Hispanic and other societies suggests that Nazarenes should be brought around when evidence comes from a friend or relative or when an acquaintance is vaccinated without adverse consequences. Behavioral science shows similar results in areas such as climate change: we are happy to change our views if someone we relate to is credible.
Such efforts are possible almost everywhere. Community negotiations do not resolve deep mistrust in government and may not reconcile everyone with science. It’s too late – the push should have started months ago. But we can still reach enough people.