No panacea

by Frances Salt

How vaccine confidence is more than a matter of trust

A COVID-19 vaccine may be seen as a silver bullet to the pandemic, but faith in vaccination has dropped globally.1 Vaccination trends do not exist in a vacuum but are directly impacted by the sociopolitical influences of our everyday lives. To instil confidence, we need to see vaccination as a product of our underlying values and beliefs.

There can’t be many people in the world this year that have escaped discussions about vaccination. Indeed, on Sunday 15 March 2020 the term ‘vaccine’ started to really pique global interest. Of course, we were talking about a very specific inoculation by then.

However, vaccination uptake was in a precarious state even before the pandemic. Prior to COVID-19 there were concerns around the impacts of ‘vaccine hesitancy’ – the delay in acceptance or refusal of vaccines despite availability – and the re-emergence of previously controlled diseases such as measles and meningitis.

Vaccination behaviour was precarious even before the pandemic

Healthcare Practitioner administering vaccine in patients arm

Concern around side effects and efficacy are the biggest barriers to uptake

A pandemic of perpetuation

Over the summer, the WHO and UNICEF warned of the disruptive impact COVID-19 has had on the delivery and uptake of immunisation services worldwide.2 During the first three weeks of national lockdown in England, there was a 20% drop in the number of MMR vaccines administered.3 Social distancing policies and ‘stay at home’ messaging resulted in public reluctance (and/or inability) to attend vaccination appointments.

Hesitancy towards vaccines is the result of a conscious ‘cost-benefit’ analysis – although it must be said that this is often passive and subliminal. We can be aware and believe in the protective benefits of vaccination while at the same time conclude that the associated costs are far greater. Previously, these costs focused on side effects and lack of perceived need, but now include COVID-19 risk through having to travel to and enter a high-risk area, such as a GP’s surgery.4

While we can see a vaccine as the panacea to the pandemic, the lived experience and immediate reality for people doesn’t match up. The public are far more worried about the aggregate risk of the virus to the country as a whole than they are to themselves personally. Persuading people to take the vaccine will therefore also need to be about it being a pro-social act, for the good of the country, as much as for oneself. A global study on behalf of the World Economic Forum shows three in four adults globally would be likely to receive a COVID-19 vaccine once available, but the majority do not believe this will happen before 2021. Concern around side effects and efficacy are the biggest barriers to uptake.5 But this suspicion is highest among people with a wider scepticism of science and authority, and among those who rely on social media for their news.6

Did you

In August


said they’d be certain or very likely to get a COVID-19 vaccine

As we approach the end of 2020, efficacy data on COVID-19 vaccines in development is starting to emerge from fast-tracked clinical trials. The efficiency with which we have arrived at this point is impressive, but there are many more steps to overcome to produce, distribute and promote COVID-19 vaccines, all without disrupting broader vaccination programmes.

In 2021, governments and health authorities are going to have to use facts, stories and emotion in their communications programmes – rather than thinking that the ‘facts’ alone will be convincing enough for mass uptake, which has been the downfall of many expert-led campaigns in the last few years. The environment and sociopolitical context is volatile, but what our overall behaviour during the pandemic shows is that the vast majority want to do the right thing – and believe the science.

There are many more steps to overcome to produce, distribute and promote COVID-19 vaccines

Frances Salt

Frances Salt

Senior Research Executive