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.