Vaccine Hesitancy: should we be worried about uptake rates?

Written by Rob MacFarlane

As the production and rollout of vaccines continues to progress worldwide, there are concerns that successes may be undermined by people not taking their doses when they are called upon to do so. Vaccine hesitancy can have a host of causes among populations, the most common being associated with skepticism around vaccinations themselves. However, other reasons to bear in mind are ease of access and general complacency. On 24th May, YouTube launched a collaborative campaign with the NHS to combat vaccine hesitancy among young people in the UK. ONS data published earlier in the month found that rates of vaccine hesitancy were highest among 16-29 year olds, with almost double the national average across all other age groups at 13%. Zoë Clapp, director of YouTube marketing UK, said “YouTube is used by 98% of online 18 to 34-year-olds each month, and it is the primary platform for the NHS’s target demographic for their vaccine campaign”. The World Health Organisation has listed vaccine hesitancy as one of the top ten threats to global health.

On 11th May, Bolton had the highest Covid case rate in the UK with 255 cases per 100,000. It was found that of the people being admitted to hospital with Covid in Bolton, a majority were those who had been offered their first vaccine dose but hadn’t taken it. Boris Johnson’s spokesperson said that the government doesn’t plan to implement any new incentives for people to get vaccinations, saying “It’s really important when we’re talking about hesitancy to highlight the fact that we have one of the most enthusiastic populations for vaccine uptake in the world and that is only increased as we’ve progressed on the rollout”. As of 24th May, vaccination rates in Bolton were largely in line with the UK average, with 67.6% of adults having received their first dose. 

On 19th May, Malawi, a country with a low vaccine uptake, started incinerating unused doses of the AstraZeneca vaccine. The country had received 102,000 doses as of 19th May and has used 80% of them, however, the remaining doses had an expiry date of 13th April. Malawi’s Principal Health Secretary Dr Charles Mwansambo said that while burning the doses was a formality it also had the effect of reassuring the public that the vaccines were safe. Talking to the BBC, he said “When news spread that we had out-of-date vaccines, we noticed that people were not coming to our clinics to get immunised”. He went on, “If we don’t burn them, people will think that we are using expired vaccines in our facilities and if they don’t come, Covid-19 will hit them hard”. The AstraZeneca vaccine has a shelf life of around six months when stored in a fridge of between 2-8℃. Recently, new storage conditions for the Pfizer/BioNTech vaccine have been approved, meaning it can be stored in conventional fridge temperatures for 5 to 31 days. Previously, It could only be stored for six months at temperatures of between -80 and -60℃. 

Of course the provision of vaccine services should be considered in uptake rates, however, in the case of hesitancy a more important factor comes in the form of accessibility. A 2014 report from the SAGE Working Group on Vaccine Hesitancy described the main causes of vaccine hesitancy to be complacency, convenience and confidence. Sometimes people’s social or financial situation means they simply can’t afford to take time off work due to vaccine side effects. It doesn’t help that the severity of the post-jab effects of Covid vaccines have shown to be hugely varied person to person. This fear of the unknown also comes across in the medical language surrounding vaccinations. So while terms like ‘variant’ and ‘mutation’ are commonplace in scientific circles for instance, they can have negative connotations for the average person reading about Covid-19 vaccines. 

People’s negative perceptions of vaccines have been driven heavily by conspiracy theories and rumours, aided by online discussion during periods of lockdown. Through closed groups and discussion threads on social media, people often find themselves in echo chambers of like minded individuals. In the case of Covid and vaccines, this results in a propagation of unsubstantiated fears. A study from 12th May showed that of the 578 Covid-19 theories investigated, 83% were false and a further 10% were misleading. The study concluded, “Tracking COVID-19 vaccine misinformation in real-time and engaging with social media to disseminate correct information could help safeguard the public against misinformation”.

There is also significant cultural variance when looking at vaccine uptake. Data analysed by QResearch indicates that, for several new vaccines in the past, Black African and Caribbean groups have been far less likely to receive doses(50%) than White groups(70%). The reasons for this remain today – language barriers, lack of representation in trial groups, inconvenience, and a lack of trust in Government communications. This is doubly significant for combating the spread of Covid-19, as BAME groups are also the ones that have been hit hardest by Covid-19 in the UK. This inequality is reflected on an international scale, as African countries in particular are seeing low uptakes of vaccines. This is a result of a combination of trust issues, and a lack of infrastructure and wealth. According to data compiled by the Our World in Data project at Oxford University, just 0.3% of doses worldwide have been administered in low-income countries. 

Some aspects of religious belief don’t gel with the scientific reality of vaccines. For example, the AstraZeneca vaccine uses cell lines from aborted foetuses in its development, a fact that has created hesitancy among Christians on moral grounds in consideration of the sanctity of life. Although, this is nothing unusual in vaccine development and in December last year The House of Bishops Recovery Group issued a statement addressing hesitancy within the Church of England. “We believe that all clinically recommended vaccinations can be used with a clear conscience and that the use of such vaccines does not signify some sort of cooperation with voluntary abortion”. 

Although it still exists in the UK, vaccine hesitancy is now a relatively small issue. Research findings from 24th May reveals that over 80% of people who were reluctant to have a vaccine dose in December have now changed their mind. The Pharmaceutical Journal says the best way to combat vaccine hesitancy is to engage in open communication with vaccine hesitant groups, being sure to reinforce the factual benefits of vaccinations where possible. While the WHO says ‘Immunization is a global health and development success story’, it is still concerned about vaccine hesitancy, adding ‘In some countries, progress has stalled or even reversed, and there is a real risk that complacency will undermine past achievements’.

Featured images courtesy of Unsplash and Pixabay. No changes have been made to these images.

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