The health minister for Haryana—one amongst the many ‘celebrity’ volunteers as a part of vaccine trials—was, in all likelihood, more successful in increasing awareness about the COVID-19 vaccine and the underlying scientific process of double-blind medical trials, than anyone else. Unfortunately, he declared having tested positive for COVID-19 after receiving the first shot of two, resulting in wide-ranging scepticism. The incident highlighted an important consideration: how can we increase ‘trust’ in the vaccine and the scientific process behind it—an important factor which affects people’s decision to vaccinate (or not) and compliance to its schedule, and addresses any ‘hesitations’.
Lead by ‘Healthcare Systems’
In response to COVID-19, vaccines have been developed in a record time—some already ‘rolling-out’ in countries like the US, UK or Canada, with other countries like India soon to follow. ‘Healthcare systems’ including hospitals, health officials along with frontline health workers are preparing for this ‘roll-out’ with mechanisms for vaccine storage, delivery and implementation.
India has a proven track record of implementing programmes around vaccine-preventable diseases like the ‘Pulse Polio’ campaign, and the Universal Immunization Programme (UIP) implemented through vaccination camps by health workers, in every city or village.
These ‘systems’ will be critical to deliver any new vaccine, some of whom may not be ‘one-shot’ but given across multiple doses—with one dose giving only a degree of immunity, it increases the importance of taking follow-up doses in a timely manner. Given the complicated science behind it, and early days of COVID-19 vaccines, this may not be easy.
‘Bitter-Pills’ & ‘Vaccine Hesitancy’
A 2020 World Economic Forum/Ipsos global survey reported ‘side-effects’ as being a major concern impeding people’s confidence in any COVID-19 vaccine, despite it being completely normal for any medically safe vaccine to display some ‘side-effects’ upon administration.
To elaborate, the UIP includes a ‘Pentavalent’ vaccine which offers protection from multiple diseases like Hepatitis-B and others. It is a multi-dose vaccine given to children over a course of weeks—making adherence to its schedule important. Although a proven successful and medically safe vaccine, it may cause a slight fever in some children. This could lead to parents being hesitant in getting follow-up doses.
So what do nurses do? They use simple ‘techniques’, like warn parents upfront on known ‘side-effects’, or frame their presence as being similar to a ‘bitter-pill’—a sign that the vaccine is working. By warning parents in advance, they are not caught off-guard or frightened by ‘side-effects’. Frightened parents mean low follow-up doses, leaving children susceptible—very similar to how parents prepare their kids against actual bitter-pills, to avoid any sudden reflexes!
Public health officials in countries like the USA are also fighting ‘vaccine hesitancy’, with far-reaching consequences if many people decide to stop getting vaccinated, something also witnessed during initial Polio campaigns. For the success of vaccines, a ‘critical mass’ of people need to be vaccinated to ensure protection for all.
There is a fear that across the world, similar ‘hesitancies’ may appear with the new vaccines, especially amongst vulnerable populations and where ‘trust’ in health-systems is low. The intuition behind ‘celebrity volunteers’ during trials, or those volunteering to take first doses of COVID-19 vaccine like US presidents Obama, Clinton and Bush, is to ‘signal trust’ in the vaccines and the science behind them, leading to more people getting vaccinated.
Tackling Misinformation, Building Confidence
The spread of COVID-19, also saw the spread of misinformation, leading to stigmatisation of groups and minorities. With people set to be vaccinated, news portals and social media handles must be ready to counter such misinformation and clickbait on vaccines—ranging from myths to conspiracy theories.
Media reports of any such incident as Mr Vij’s should not fuel doubt on the vaccine but provide objective reports—a step which would serve well to repose lost ‘trust’.
Using relatable social media ‘influencers’ according to age-groups, regions or others, can be an approach of segmenting vaccine-takers.
Along with simple and factual communication to explain the complicated process of vaccine science in the media, transparency mechanisms like the public release of data, communication on the rationale behind ‘emergency-use’ approvals and their quick arrival, will be important to build confidence—and allay fears of a ‘rushed’ and ‘unbankable’ vaccine.
However, any violations of research protocols must not only be severely criticised, but met with appropriate actions by regulators—to build and maintain lasting ‘trust’ in public health systems.
With both public and private health institutions gearing to deliver vaccines, and ‘eagerness to get vaccinated’ verifying the authenticity of the ‘vaccine’ and its delivery, through ‘genuine certificates’, can avoid incidents of users falling into buying ‘counterfeit’ doses. The Interpol has already issued a warning against fake vaccines being brought into the market!
Leveraging Behavioural Insights
The World Health Organization’s Technical Advisory Group chaired by Prof. Cass Sunstein, recently released a behavioural insights framework for compliance and up-take of any COVID-19 vaccine. The pandemic has brought out the need for health policy measures dynamically adapting to political and social realities. Enter behaviour science-informed measures, which have much to offer.
For instance, one of the biases influencing vaccine behaviour is ‘present bias’ – where people forgo large future gains – like by getting vaccinated, due to present-day ‘costs’—like visiting the vaccine centre. A ‘behaviourally informed solution’ could be a simple SMS reminding people of a vaccine’s long-term health benefits!
Adoption of such a framework could crucially aid the effort to roll-out COVID-19 vaccines. For example, frontline health workers can be trained to communicate effectively on concerns around ‘side-effects’, followed up by regular informational IVRS phone calls, or 24×7 helpline numbers accessible to vaccine-takers for more information.
Such measures or ‘interventions’ can also help improve motivation in people to comply with the follow-up dosage. Reminder messages can be delivered via tools like a dedicated ‘vaccination calendar’ or timed SMS. Other digital tools may include a mobile app or ‘online games’, which would unlock ‘new levels’ on completion of every dose—nudging people to get timely vaccine doses—while making its benefits interactive.
‘Beginning of the End’
The mere presence of vaccines should not lead to a faux sense of security and ‘overconfidence’, leading to more infections. Protective measures would need to continue to be followed, like mask-wearing and social-distancing.
Given supply constraints and a large population, it may take more than a year till we reach ‘herd immunity’ through vaccines, and it becomes more important than ever to consistently maintain ‘trust’ in the health system and the science behind vaccines.
—Saksham Singh works with the Centre for Social and Behaviour Change, Ashoka University. The views expressed are personal.
