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19 November 2020updated 20 Nov 2020 6:38pm

Heidi Larson interview: How to tackle Covid-19 vaccine hesitancy

The director of the Vaccine Confidence Project on why the number of anti-vaxxers has risen and how to respond. 

By Sophie McBain

Heidi Larson is a professor at the London School of Hygiene and Tropical Medicine and the founder and director of the Vaccine Confidence Project, a group that monitors public support for vaccination programmes worldwide. Since the start of the pandemic, the organisation has been tracking misinformation and public sentiment around Covid-19 restrictions and a potential vaccine. A few hours after the pharmaceutical company Pfizer announced that it had completed safety checks and found that its new Covid-19 vaccine was 95 per cent effective, Larson spoke to the New Statesman about a vital next step. Once there’s a vaccine, how do you make sure enough people take it?

How are you feeling about this afternoon’s news from Pfizer?

It’s good news. We had no idea at the beginning because the flu vaccine can be 50-60 per cent effective and measles vaccines are 98 per cent effective, so it could have been anywhere in that range. And I think if it was more like 60 per cent effective that would have been much more of a confidence-building challenge. 

In terms of vaccine confidence, what are you seeing in the UK at the moment: what indications are there that if they are offered a vaccine people will actually take it?

It’s good, but not good enough. In May, a survey by the Vaccine Confidence Project found that 7 per cent of respondents would definitely not take the vaccine. And now that’s up to 17 per cent. So there are more hardliners than there were six months ago.

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On the other hand, those surveys were asking about hypothetical vaccines. We didn’t have the data we have now.

Why do you think that proportion of anti-vaccine hardliners has gone up?

A couple of things. One is the state of the epidemic. In the beginning it was big and scary, we were witnessing the peak of fatalities, it wasn’t as clear that the majority of fatalities are in the older age group. And now there’s more fatigue, and more of a sense of ‘it’s not going to happen to me’. Yesterday [17 November] the fatality rate was high, it was close to 600 deaths in the UK. So, it’s not like the pandemic is going away, but there are some people who are feeling over-confident.

And the other side of the story is we have a lot more, not just information but misinformation circulating. The Vaccine Confidence Project has been doing a lot of social media listening, and there was much more focus initially on quarantines, isolation, lockdown, should you wear a mask, should you not wear a mask. In our social media monitoring in the UK people were also totally frustrated with NHS 111, they could never get through. So at first people were just scrambling to understand what they should do and what they shouldn’t do.

Now vaccine information has grown a lot, and unfortunately with the informational news has been the reactionary news. So there’s a lot more out there for people to get worried about in a way, which is unfortunate. And people are trying to weigh up the threat of the virus to them, versus what they are hearing about the vaccine.

What kind of impact does online misinformation have on vaccine confidence?

One thing that’s very concerning is that we recently did some research on the question of “so there’s misinformation out there, what’s the impact on the general population? Does it just impact a marginal group?” – which is what a lot of people, especially those involved in public health, would like to believe. You know, they’d like to believe these are a bunch of crazies at the fringes, and the average guy on the street isn’t going to be affected by online misinformation.

On 12 November we published an 8000-person study, with 4,000 people in the US and 4,000 in the UK, and interviewed all of them about how they’re feeling about different covid-requirements. And we asked them: “by the way, would you take a vaccine if it was proven to be safe and effective?” And then for 1,000 of them on each side of the Atlantic, we showed them straightforward, fact-based information and for the other 3,000 we showed them the five most frequently circulating pieces of misinformation here in the UK and in the US. In the UK, there was a 6.4 per cent drop in willingness to take a vaccine after seeing the misinformation.

That’s pretty significant. And it wouldn’t matter so much if our surveys were showing that, say, 80 per cent of the population would take a vaccine. This particular study showed that 54 per cent said they would take a vaccine, so a 6.4 per cent drop in confidence brings you below 50 per cent, so below herd immunity.

Having said all that, this was all done before we had this week’s news, which may or may not be boosting confidence. We will continue to monitor that because one of the things we are seeing with the Pfizer and Moderna vaccine news is a surge in misinformation.

So how should the government, and I suppose to some extent the media, be trying to communicate about the vaccine in a way that doesn’t leave people vulnerable to misinformation and rumour on the internet?

I don’t think we should just knock out misinformation without having something to put out there instead. There’s a lot of anxiety around the newness of this all. People want to know really practical stuff like: where are you going to get it? Who’s going to get it? Which vaccines are we going to get? When is my grandma going to get it? Are kids going to have to take it? People are just starved of some kind of guidance. They’re thinking: just tell us what to do and don’t change your mind the next week or the next day.

Even if you’re not in the final stage of guidance, [the government should] bring people along with the journey because we have to fill those spaces. If we leave it open, it’s just a red carpet for all of these alternatives.

But isn’t there also a risk in going public too early, whether it’s with scientific findings that haven’t been peer-reviewed and are later retracted or when, say, vaccine trials are halted because someone has fallen ill for reasons that could have nothing to do with the vaccine itself?

Normally waiting to be peer-reviewed is good. But in this case [Pfizer and Moderna’s interim results announcement] it wasn’t a bad thing to get some positive information out there. We needed a boost of something hopeful. It hasn’t been a hopeful time. We do need, as I say, to manage expectations around that hopefulness.

In terms of the Pfizer and Moderna results, these were reviewed by an independent monitoring board. So it’s not like they were being really premature. Just more premature than usual.

A lot of the response to the pandemic has become highly politicised, with those on the right often much more sceptical of things like lockdowns or mask-wearing. Are you noticing the same with anti-vaccine sentiment?

Yes, but I’m not surprised that it’s politicised because we are in a time of hyper-government control – for good public health reasons. But for people who have an antipathy to government control, of which there are many, vaccines fit right into that agenda. Unfortunately, the whole Covid situation has amplified rather than mitigated anti-vaccine sentiment. And it’s really joined the whole anti-masking, anti-lockdown, anti-quarantine groups and even a number of groups – far-right, anti-Islam and misogynist groups – that weren’t even talking about vaccines before. Anti-vaccine sentiment is one more issue that they are polarising, and these are groups that are trying to polarise or destabilise society.

How do you combat this kind of politicisation?

This is a reason we need an all-society approach, engaging very locally, at a community level, working bottom-up rather than centre-out. Of course, you’re going to need central guidance and central regulation on a number of things, but when it comes to engagement the local level is going to be key.

On the one hand, vaccines also have a history of being soft-diplomacy. When I was at UNICEF, we used to have what we called “Days of Tranquility” when warring parties would put their guns down to enable vaccination programmes for a day. You know, I hope we can have more of a peace-making role for vaccines, recognising it is for everyone’s health. I just don’t think we’re there yet.

*The interview has been edited and condensed for clarity

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