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READ any journal article or mass media piece about the development of COVID-19 vaccines and there is a common thread among them. They all refer to the development process with words or phrases such as “race”, “speeding up” or “breaking record times”.
For those keeping track of the process, these words make sense, given the unprecedented funding and scientific focus on the development of the vaccines through global partnerships such as the Coalition for Epidemic Preparedness Innovations and the efforts being made by pharmaceutical companies, academic institutions and other organisations. However, for lay members in the community, these words may trigger alarm.
Concerns about whether vaccine developers are skipping steps or trial phases to get to the finish line first, coupled with concerns about the level of due diligence being given to understanding the safety profile of any new vaccine are already starting to emerge on social media sites. These concerns have the potential to undermine trust, as well as the providers delivering it, leading to misunderstanding and misapprehension.
Currently, willingness to receive a future COVID-19 vaccine has been documented to be between 60% and 75% internationally (here and here). In Australia, intended vaccine acceptance appears to be fluctuating between 76% and 86%, depending on when the data were captured and the level of perceived risk and disease severity reported (here and here). However, “willingness to vaccinate”, does not always equate to actual uptake. In 2009, “willingness” to receive the H1N1 pandemic vaccine was documented in the month prior to the vaccine release at 54%. In reality, out of the 21 million doses purchased, only 18.9% of the population actually received it. Low perceptions of personal risk coupled with beliefs that the situation did not warrant the need for vaccination and concerns about the development of the vaccine were all factors given for non-acceptance.
To optimise vaccine coverage, suggestions of making a future COVID-19 vaccine mandatory have already been put forward. While vaccines mandates play a role in some settings, it is premature to be talking about their introduction at this stage. Theoretically, a mandatory model ensures a definite level of vaccination since it removes the variability of personal attitudes and other behaviour barriers. In a health care or aged care setting, where there is the possibility of occupational risk and need to protect vulnerable patients and residents, the use of a COVID-19 vaccine requirement or mandates may be a strategy considered. However, in the community setting, we need to first focus on reaching the required levels of coverage through other means. The key is to understand how to prepare the target population, activate and engage them. To effectively engage with communities and support adoption of a future COVID-19, we need to ensure that we understand their needs, concerns and most importantly deal with issues around access, awareness and acceptability.
Planning for the introduction of a COVID-19 vaccine is multifaceted: we need to account for fair and ethical prioritisation, delivery models, surveillance of adverse events and tracking of vaccine confidence and uptake. It is critical that we start to plan how we are going to monitor real or perceived concerns about the safety of the vaccine and communicate through accessible platforms with the public to ensure ongoing demand. There may be a need to counter any antivaccination movements that arise and to support those who are hesitant, amid a background of misinformation and rumours.
It has been suggested that governments that base vaccine uptake programs solely on expert opinion are likely to be suboptimal. Instead, what is required is planning that captures the behavioural insights of the population, in terms of what they are thinking, their beliefs and needs, what they value or fear and what will support them to receive a vaccine. In capturing these insights, it is critical that we ensure that we engage with community members and with other key groups using a range of approaches to ensure that we have a rich understanding of motivation around this new vaccine.
In thinking about the key groups, we will need to move beyond our traditional groupings (parents, pregnant women, over 65-year-olds) and think about other at-risk groups (eg, health care workers, culturally and linguistically diverse persons) and individuals that we have struggled to engage during this pandemic. These may include people who are “unconcerned” (ie, young adults) or “poorly reached” (culturally and linguistically diverse or First Nations populations). All these activities require early investment in social and behavioural studies, alongside the substantial investment in research focused on developing these vaccines.
High coverage with a future COVID-19 vaccine is likely to be needed to control local transmission within Australia. To support vaccine uptake, governments cannot focus on just providing people with information or wellcrafted messages and assume that the community will make the correct decision to be vaccinated. Key to delivering a successful COVID-19 vaccine program will be understanding and engaging with the community, ensuring that communication programs are appropriately tailored and that capacity-building activities focus on providers.
The challenge is that during this pandemic, there has been an absence of communication and behavioural studies to inform our responses, even though this is our frontline defence.
Dr Holly Seale is a social scientist at the School of Population Health and Deputy Chair for the Collaboration on Social Science and Immunisation. Her research focuses on improving acceptance of immunisation across the lifespan with a particular focus on children and adults with chronic health conditions, culturally and linguistically diverse communities and among occupational groups.
Associate Professor Margie Danchin is a consultant paediatrician within the Department of Paediatrics, University of Melbourne and Murdoch Children’s Research Institute (MCRI). She is Group Leader, Vaccine Uptake at MCRI, and chair of the Collaboration on Social Science and Immunisation. Her research focuses on diagnostics for the drivers of under-vaccination, new strategies to improve vaccine uptake in different populations and high-risk groups and evaluation of vaccine policy.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Uptake would increase if people have the right incentives to get vaccinated. With there being a lot of desire for society to ‘get back to normal’, it is foreseeable that individuals could be required to provide proof of vaccination prior to attending mass gathering events, travelling interstate or overseas or engaging in any other activity that is deemed to present a risk of exposure/spread. This does not mandate the vaccine, but if people wish to be able to do the things that they want to do, then they would be required to show evidence that they have been. Perhaps a personalised card could be provided upon vaccination which could serve as proof of vaccination? There will still be some who opt not to do so, but hopefully the percentage would be so low that herd immunity could provide protection to the whole community.
Language is the first barrier to uptake. As you’ve both stated rush the vaccine, race to create the vaccine all potentially imply that the vaccine being made is the goal. It does not de spell perceived fears around safety, efficacy, side effects and other concerns of those already filled with heightened fear during a pandemic. A campaign that is educational, transparent and honest will be helpful. Comparison about development of other vaccines and their success would also encourage further understanding. Our next barrier is the anti vaccine group however small they are will use every ounce of fear to discourage any one sitting on the edge in a state of reluctance. With political parties disputing sensible actions for containing the virus we have extensive confusion, distrust and rebelliousness within our nation. The uptake of this vaccine will need a national consistent approach with equity of access to all. The risk however higher in certain groups is not to be used as a prioritiser. Our nation and its people need to feel equality in this area.
‘I agree that public information campaigns are needed – before a vaccine is released’.
Public information campaigns don’t make vaccines safe.
Public information campaigns about safe vaccines are needed.
Thanks for the article. As the authors state, there is a widespread misconception that a vaccine is being “rushed” out, in the (mistaken) sense that important steps are being omitted, or time-frames shortened, in a way that is unsafe. At the same time, others are worried that the development of a vaccine is “taking too long”.
There have also been false assumptions that the length of time taken to develop some vaccines to market is necessary for all vaccines. We really do need to get the message across that the world-wide attention, funding and multiple international teams working concurrently are reasons why this vaccine may not be as DELAYED as others with less attention or funding have been (as opposed to ‘rushed’).
I agree that public information campaigns are needed – before a vaccine is released.
Whilst I believe that mandatory vaccination is the only method of achieving protective levels of vaccine-related immunity in the community, I hope that antibody levels will be tested before and after administration of a vaccine so that the government cannot falsely claim that it was the vaccine rather than natural immunity that produced the immunity.
We just do not know how many of the population has natural immunity already!
I am nurse immuniser working on the school program and also an operating theatre RN working in a private hospital. I will not doubt be involved with the role of the Covid 19 vaccine and have been discussing this widely with colleagues and neighbors and members of the general public. I have been VERY concerned about the level of concern/distrust of this emerging vaccine both in the lay person AND in my nursing colleages. All of these people spoke english well, had a reasonable level of education and seemed quite sensible types. We need to be starting NOW with some form of education campaign to ensure everyone out there that this is a good idea and not waiting until it is time to be jabbed. It would be very sad if we had to make this vaccine mandatory to get people to come forward.