The key to combating vaccine hesitancy? Deep listening, tailored messaging.

Julie Leask: One of the most important things when people are thinking about having a new vaccine is looking at what their peers and their family and friends are doing. Seeing that other people are having the vaccine is starting to become normalized. I think that will probably flip some of those people over who are on the fence right now and aren’t quite sure what to do about it. Of course, there are going to be some people who will not ever vaccinate. Hopefully that’s going to be a small number of people. 

Look, countries are quite varied. Australia, we have about 88 percent of people intending to have the COVID-19 vaccine — if it were recommended to them. And I know that drops a little bit if you are in the US right through to Russia and Poland, which have intentions of around 50 percent. So in Australia, where we’re a very pro-vaccination country, actually, we really defend vaccination of children very strongly with some of our policies. But naturally, there is always going to be a group of people who are a bit wary, particularly when we haven’t got the Phase 3 trial results released yet and we’re not exactly sure what we’re looking at with these vaccines. Certainly the public cannot [either]. So, confidence will build a little bit more over time in Australia and other countries. 

No, surprisingly not, because here, of course, we’re talking about a vaccine that will be initially offered to adults, health care workers, the elderly, people with chronic diseases, people working on the front line. So with adult vaccination, you see slightly lower vaccination rates. And you also see a little bit more hesitancy around adult vaccination. And the levels of hesitancy we’re seeing globally at the moment, at least in the countries that are measuring this, are sort of what you’d expect at this stage. You know, in a way, it is on a bit of a knife-edge because — depending on how this program goes, how people experience having that vaccine, how they experience side effects and make sense of them — it will have a lot of impact on how people in future cohorts approach having the vaccine and think about it and are motivated to have it. 

I’ve been an adviser for the World Health Organization, visiting countries including Serbia, Romania and Samoa. And I’ve also observed programs to address vaccine hesitancy in many countries. It always starts with understanding the communities you’re working with. We can’t second-guess people. We need to understand, in a country or a locality or a community, what are the issues that those people have with the vaccine? What are the experiences they’ve had with the vaccine program so far? Who are the community influences and what are they saying about the vaccine? The religious leaders? And that flows right over to the individual conversation a health professional or even a family member might have with someone else who is hesitant. “Tell me about your thoughts. What is concerning you right now?” Hearing them out and acknowledging them and then tailoring the information that you give them and share with them according to where they’re at — you know, that’s the core to dealing with vaccine hesitancy really well. 

These are really challenging questions because mistrust and past performance have a big impact on whether people are willing to accept technology or a prevention measure that a government is recommending that you have and that the system is recommending you have. So if there have been past injustices and bad experiences — racism, systemic racism — then people are going to be understandably wary. In the end, we have to ask those communities how it’s best to approach them. So as a white Australian woman, I’m not going to pretend I know the best way to reach African American communities who themselves will be diverse. But what I will say is that we know from past experience with vaccination hesitancy, working to tailor immunization programs in different communities, that when you use local community influencers, people who are trusted, people who reach many people in that community, that can have quite a strong impact, for better or worse. And also investing in good systems so people have a good experience with the health care service, so that questions are answered, so they are treated well, so they don’t have to question whether the color of my skin is affecting the way I’m being treated in this clinic. That means that those people will then go and share that good experience with their broader community and that will have an impact as well. 

Any person in any country is capable of having questions about whether this needle or these drops are going to be safe for me or my child. So vaccine hesitancy, i.e. the reluctance to have a vaccine because of concerns about it, is an issue globally. It tends to be quite localized, though. So there have been particular vaccine safety scares that are affecting particular countries that have their own characteristics. The Philippines, northern Nigeria, Indonesia, more recently, the US, the Northeast and of course, New York state with the various issues you’ve had there with Hasidic communities. So, yeah, it tends to be very localized and very specific to that setting. And it is not limited to just high-income countries. And in the same way that in high-income countries there are people who are poor, don’t have access to health insurance, don’t have good transport access to health services, who themselves don’t get vaccinated — not because they don’t want to, but because it’s difficult to do. So we need to think about all of the barriers to vaccination in all countries and again, using data to do that so that the solutions that we have are based on evidence, not anecdote.