4 1GT Tuesday October 20 2020 | the times

times2health

How to

convince

people to

have the

vaccine (even

the doubters)

Not everyone wants to be immunised.

We need to change minds, the expert

Heidi Larson tells Damian Whitworth

H

eidi Larson knows

what we think about

vaccines — and it

worries her. Larson

is an American

anthropologist

who spent years in

communities around

the world studying vaccine anxieties.

A decade ago, when she set up the

Vaccine Confidence Project, she had

a mission. “I wanted to say, ‘Houston,

we’ve got a problem brewing.’ ”

The project monitors confidence

in immunisation programmes by

tracking concerns about vaccines, and

advises governments and public health

organisations on how to engage with

the public to boost favourable views

of immunisation. Research from the

project, based at the London School of

Hygiene & Tropical Medicine, showed

that, before coronavirus, confidence in

vaccines was falling in some parts of

the world, but growing in the UK and

Europe. (It took years for confidence

to recover in the UK from the damage

done by Andrew Wakefield, the

disgraced doctor who wrongly linked

the MMR vaccine to autism. “The

anxiety around MMR travelled the

rest of the world,” Larson says.)

Now, with dozens of possible

Covid-19 vaccines in round-the-clock

development, the question of public

confidence is paramount. Headlines

about vaccines providing an exit from

the global crisis have focused attention

on immunisation, and social media

has spread doubt, misinformation and

malicious conspiracy theories as fast

as you can say “monkey vaccine”.

Last week an investigation by The

Times found that a Russian campaign

was trying to undermine the Oxford

University vaccine by saying that it

could turn people into monkeys

because it uses a chimpanzee virus as

a vector. “They’re trying to undermine

that particular vaccine so that they

can make space for their own vaccine,”

Larson says. Yet she says that this is

just one of numerous efforts to

undermine trust in Covid-19 vaccines

that have created a “perfect storm”.

How sceptical are we British?

Scientists believe that between 60 and

70 per cent of the population would

need to be vaccinated to achieve herd

immunity, and some say it could

require as much as 80 per cent. A poll

conducted by Orb International last

month in the UK for the Vaccine

Confidence Project found that 71 per

cent would be willing to be vaccinated,

14 per cent would refuse it and

another 15 per cent don’t know.

Of those who say they would have

the vaccine, only 43 per cent “strongly

agree”, while others just “agree”. “They

want to know more about the vaccine,

which I think is perfectly legitimate.

I think I’d probably say I ‘tend to

agree’,” Larson says. Yet she warns

that this means it only needs a small

percentage to change their minds for

the prospect of community immunity

to look doubtful. The 14 per cent who

say they wouldn’t have the vaccine has

grown from 5 per cent in March. In

the US, just over half of people say

they would take a vaccine, down from

two thirds saying they would in May.

Larson fears the increase in the

numbers saying they wouldn’t take the

vaccine means we could be on the

verge of a “tipping point”.

“I think it’s gone up because people

are constantly weighing the risk of the

disease threat against the risk of a new

vaccine. March and early April was the

peak of Covid deaths being reported

daily in the news. Now, even though

we’re going through more waves and

more spread, we don’t see the fatality

rates as high. People are saying: ‘Wait

a minute, I can get through this.’

Dr Mark Porter

Go easy on the laxatives — they

may cause more harm than good

(eg Fybogel), but I prefer the natural

approach, using fruit and vegetables

and high-fibre cereals (eg bran).

If you need more help, the next

step would typically be adding

a macrogol (eg Movicol or Laxido),

an inert osmotic laxative that passes

through the body without being

absorbed, but which retains water

in the stool.

Basically, you take as much

as you need to get the desired

effect, but be warned: it can

be powerful. Macrogols are

often used in large quantities

to empty the bowel for medical

procedures, and if you doubt

their efficacy then

google “Billy Connolly

and colonoscopy”.

And if you still don’t

get the desired effect,

now is the time to

consider a short

course of stimulant

laxative such as senna

or bisacodyl.

One last tip.

Humans are designed

to empty their bowels

in a squatting

position, so if

you, or your child,

regularly need to

strain, consider

buying a small stool to

raise your feet off the

floor when sitting

on the loo.

These “poo

stools” may

seem like

a strange

addition

to your

bathroom, but

they do help.

on how easy it is to pass your motions

rather than how often. If you regularly

strain, but go every day, then you are

more likely to have a problem than

someone who goes every other day

but passes their motions easily.

If you are still concerned, the first

step should be to look at your diet.

Normal bowel movement requires

a soft stool, and this depends on

how much water it contains. The

easiest way to retain plenty of water

in the stool is to eat a high-fibre diet,

but you need to be well hydrated

too. If you are a bit on the dry side,

your body will pinch water back from

the stool no matter how much fibre

you eat.

Start by increasing fibre intake

and ensuring that you have an

adequate fluid intake. You can buy

fibre supplements over the counter

O

ver-the-counter

sales of some

popular laxatives

are being restricted

amid concerns that

too many people

are misusing the

drugs. From now

you will only be able to buy stimulant

types such as senna (Senokot) and

bisacodyl (Dulcolax) in small packs

from general retail outlets such as

supermarkets, with sales of larger

packs restricted to pharmacies.

The new restrictions (see panel

right for full details) follow a national

safety review this year by the

Commission on Human Medicines

highlighting misuse among teenagers

and young adults, and people with

eating disorders, some of whom

take vast quantities of stimulant

laxatives (up to 100 a day) to try

to control their weight.

Another area of concern is

prolonged use in older people where

other approaches/medication would

be more appropriate. So what is wrong

with drugs such as bisacodyl and

senna, and what are the alternatives if

you are struggling with constipation?

Stimulants work by encouraging

the muscular bowel wall to speed

everything along. Taken appropriately,

they are a safe and effective group of

medicines, but many of the 14 million

packs that are sold over the counter

every year in the UK are not used

as they should be. And if you consume

too many, or take them for long

periods, they can have worrying

side-effects.

In extreme cases, typically seen

in people with eating disorders,

high doses can be fatal. There is

a widespread misapprehension that

laxatives aid weight loss. They may

help you to shed a few pounds by

emptying your bowel, but this is

short-lived. And the more you take,

the more likely it is that you will

develop the sort of problems we see

in people with severe diarrhoea,

particularly depletion of essential

salts and dehydration. And in

someone who is in poor health

because they are underweight, these

side-effects can be life-threatening.

In older people, many of whom

depend on drugs such as senna as

their first-line treatment for

constipation, long-term use can

make the muscular bowel wall

overdependent on this artificial

stimulation, meaning they need

to take more to get the same effect.

And so starts a vicious spiral of

increasing use.

The first thing to be sure of when

considering a laxative is whether you

actually need one. We are all different

and it is important not to get fixated

on the belief that you need to open

your bowels every day to be healthy.

Food typically takes anything from

two to five days to travel from mouth

to anus, with most of the population

going to the loo somewhere between

three times a day to three times

a week. Doctors tend to focus more

6 Under the new

rules, sales of

bisacodyl, senna and

sodium picosulfate

will be restricted

to smaller packs (eg

20 normal-strength

senna) in general

retail outlets such

as supermarkets

and corner shops.

They will only be

sold to people

aged 18 or over.

6 Pharmacists will

be able to sell larger

packs for use in

adults and children

over the age of 12

(stimulant laxatives

should not be

used in younger

children unless on

medical advice).

6 If you regularly

use stimulant

laxatives as a first-

line treatment you

risk aggravating

your constipation in

the long-term and

should talk to your

pharmacist about

switching to a safer

osmotic laxative

such as macrogol.

6 Fibre and osmotic

laxatives are harder

to take — think

of drinking

flavoured watery

wallpaper paste

and you won’t

be far off — but

they are much

better for you.

6 For more

details on

the MHRA

decision visit

gov.uk

If you have a

health problem,

email drmarkporter

@thetimes.co.uk

Some people take

up to 100 a day

to try to control

their weight

The new

restrictions