The Economist - USA (2021-02-13)

22 Briefing Making vaccination work The Economist February 13th 2021

or have survived it. This all disinclines

them towards accepting the vaccines that

their employers now want them to take.

A December survey of 16,000 employ-

ees of a health system in Pennsylvania re-

vealed concerns about unknown risks and

side effects. At the nadir 45% said they ei-

ther did not want the vaccine at all or want-

ed to wait (see chart 2). One-fifth did not

trust the rushed regulatory review. Others

worried they were not actually at high

enough risk for infection or disease. Hard

refusals, though, soon began to wane. 

In general, a feeling that the govern-

ment is cutting corners seems to drive hes-

itancy up. When Donald Trump appeared

to be trying to rush approval along before

the election Americans became more hesi-

tant. Concerns have risen in Indonesia and

India at the same time as there have been

controversies about aspects of govern-

ment vaccination programmes.

Another factor in hesitancy is peer-

group sentiment transmitted through so-

cial networks. Parents who choose not to

vaccinate children have a much higher per-

centage of people in their social networks

with similar views. The same will be true of

people who intend not to get vaccinated

against covid-19.

Understanding how the hesitancy

weather changes offers ways to modify it.

Some are well known to advertisers. People

are encouraged by the sight of happy peo-

ple eagerly lining up to receive vaccines, or

by politicians, royalty and celebrities roll-

ing up their sleeves. They may also re-

spond to the notion that something is in

scarce supply. Since scares about the h1n1

flu vaccine in 2009 the French have been

very dubious about vaccination. But since

realising that their country has few doses

to offer, their opinions have been chang-

ing. To refuse is one thing; to be denied an-

other. Marine Le Pen, a right-wing nation-

alist who had previously said she would

wait and see before getting vaccinated now

says she will do so, a decision which is ex-

pected to be influential (and which will

better position her to attack Emmanuel

Macron on the issue in next year’s election

campaign).

The bad news about changing the

weather in this sort of way is that it can

quickly change back again. Vinay Nair,

boss of Lightful, a tech firm that works in

the charity sector to enhance its use of

technology, says that because vaccine sen-

timent is dynamic, so the response to it has

to be too.

It is also important to reach vaccine-

hesitant communities directly rather than

through the media. In 2017 Patricia Stinch-

field, a nurse practitioner at the Children’s

Minnesota Hospital, told Modern Health-

care, a magazine, about intervening this

way among Somali-Americans in Minnea-

polis after their under-vaccinated commu-

nitysuffereda seriousmeaslesoutbreak.

“Wespend agreatdealoftimemeeting

imamsinthecommunityandaskthemto

partnerwithus.”Evenwiththehelpofso-

cial-media campaigns aimed atyounger

parents,itisslow,painstakingwork.Butit

is effective.

Stormwarning

Unfortunately,helpthroughsocialmedia

is farfromthenorm.TheCentreforCoun-

teringDigitalHate(ccdh), a not-for-profit

group, is tracking 425 anti-vaccine ac-

counts onFacebook, Instagram, Twitter

andYouTubethatitsaysspreadcovidmis-

information; they have 59.2m followers

betweenthem,andthenumberisrising

rapidly.Theorganisationsaysthatwhilea

minorityoftheseanti-vaxxersactonthe

basis of profoundly held beliefs, about

four-fifthshavea financialmotiveaswell,

or instead. Half are entrepreneurs with

businesses that promote alternative or

oddball remedies such as homeopathic

immunisationora bleachnebuliser“with

a 100% successrate”. Theotherhalf are

conspiracistswhoprofitfromtheonline-

advertisingrevenuetheirsitesattractand

themerchandisetheysell.

Theworkofthesegroupsisa loteasier

than thatofpublic-health workers: fear

anduncertaintyareeasiertofosterthan

trustandconfidence,andinactioneasier

toencouragethanaction. InOctoberlast

yearrepresentativesoftheccdhwerepre-

sentata privateonlineconferenceheldby

influentialopponentstovaccinationwho,

it says,sawa historicopportunitytoreach

larger numbersofsupporters,anddrive

long-term vaccine hesitancy. They out-

linedthreebasictoolswithwhichtodoso:

sowdoubtabouttheseriousness ofthe

threatposedbycovid-19;spreadconcern

aboutthesafetyofthevaccines;stressthe

untrustworthinessofexperts.

These three basic messages will be

adaptedwithselectivereporting—making

sure, for example,that Brazilians know

that their president has said he will not be

vaccinated—half-truths and lies. Ethnic

minorities will be told that covid vaccines

are unsafe for them, or part of a plot or ex-

periment—somethingthatwillresonatein

communities that remember stories of

thisinthepast.Youngpeoplewillbetold

taradiddles aboutfertility. The religious

groupswillhearthatvaccinesarenothalal

orcontainfetalmaterial.(Itistruethatthe

vaccineproducedbyAstraZenecaisgrown

ina celllinederivedfrommaterialtaken

froma fetusinthe1970s;it isalsotruethat

thepopehasdeemedtheuseofsuchcell

linesmorallyacceptable.)

A recent studyin Nature using data

from 2019 createda networkmapof1,300

Facebookpagescarryingpro-andanti-vac-

cinemessagesandtheirfollowers.Anti-

vaccinepagesweremorenumerous,faster

growing and increasingly connected to

pagescontainingundecidedusers.Ifcur-

renttrendscontinue,theresearcherspre-

dicted,anti-vaccineviewswilldominate

onlinediscussionina decade.Anewpre-

printbymanyofthesameauthorsreports

thatthestrengtheningofonlinebondsthat

hasbeenseenduringthepandemichas

givenconspiracytheoriesgreateraccessto

mainstreamparentingcommunities.

OnFebruary8th,intheteethofongoing

criticism,Facebooksaiditwouldremove

falseclaimsrelatedtocovidvaccines(see

UnitedStates).Manythinkthemovehas

cometoolate—andthattoshiftthebal-

anceofpowerdecisivelywillrequirefur-

ther action. Mr Nair believes that tech

companiesneedtoamplifypositivemess-

ages,storiesandcampaigns

“A mix offactors will challenge our

planstodefeatcovid-19,fromnewvariants

tosupplyissues.Butvaccinehesitancyisa

significantthreattopopulationprotection

againstcovid-19,”saysDrLarson.Andafter

emotionalcontagionhastakenholditis

difficulttotampdown.AstheFrenchexpe-

riencewiththeh1n1vaccinehasshown,

once widespread a negative impression

abouta vaccinecanbehardtoshift.

Atthemoment,peopleareleavingvac-

cinationcentreshappily,andtweetingand

postingabouttheirgoodfortuneandsuc-

cess.Theyproudlydisplaythebadgesand

stickersthatshowtheyhavereceivedthe

vaccine.Fornow,publichealthiswinning.

Butcontinuedgoodnewscannotbetaken

forgranted;inthisstruggle,fairweather

hastobefoughtfor,notcountedon

Whether report

US,health-careworkers*,intenttotake

covid-19vaccine,%responding

*Sampleof16,000inPennsylvania

Source:“Healthcareworkerintentionstoreceivea Covid-19

vaccineandreasonsforhesitancy ”,byM.Meyeretal.

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On Monday February 15th

The Economistis launching a

new podcast, “The Jab”, devoted

to the the science, business,

policy and politics of rolling out

covid-19 vaccines around the

world. You can subscribe at

economist.com /thejab