COVID-19 cases in India are hurtling towards the second peak at a frenetic pace. We now have vaccines, unlike during the first outbreak. At the moment, India has approved two vaccines: Covaxin, a homegrown vaccine, and Covishield, an Oxford-AstraZeneca vaccine. In order to stop the growing rates of cases, hospitalizations, and death, it is essential that vaccines be available to and accepted by all. A vaccine-hesitant population is the last thing India needs in this time of crisis. As and when the vaccine becomes available to all it is important that people do accept it and get vaccinated.
What is Vaccine Hesitancy?
Vaccine hesitancy refers to a delay in accepting or refusing vaccination despite the fact that vaccination services are readily available. Vaccine hesitancy is complicated and context-dependent, varying by time, location, and vaccine. Complacency, ease, and trust are all factors that affect it. Although vaccination is widely accepted in the majority of societies around the world, a small percentage of people reject some vaccinations but allow others, and others postpone or refuse vaccination because they are uncertain.
There is definitely a growing concern that vaccine hesitance could keep a country from achieving herd immunity and heading towards normalcy.
Examples of vaccine hesitancy
With the surge in the number of cases in India the percentage of the country's population willing to take the COVID-19 vaccine has shot up to 77% from a mere 38%. Vaccine hesitancy seems to have dropped considerably, but even with 23% of the population unwilling to take the jab the efforts of the government to curb the spread of the virus may not be effective.
26% of Americans are hesitant towards the COVID 19 vaccine and claimed that they do not want to take it. As compare to this around 6% of the citizens of the United Kingdom are hesitant towards the vaccine. A poll from last summer discovered that 75% of Americans and 71% of British people were open and willing to take a COVID vaccine if it existed and was recommended by the government. Since then, however, the hesitancy in the US has remained about the same while the UK has managed to increase vaccine acceptance. The hesitancy rate in the UK has dropped from around 29% to 6%, while the US has failed to see such a change.
Last August, Russia was the first out of the gate to approve a COVID 19 vaccine for public use. Eight months later, the country has only administered 9 million people with the first dose of the Sputnik V vaccine which is about 6% of its population. As compared to this, the United States which has a vaccine-hesitant population has vaccinated at least one-third of its population. The leading reason behind the low vaccination rates in Russia is the lack of trust that the people have in the Russian government. When the vaccine was approved for public use it had barely been tested on 100 people and the general public had no idea of the effects of the virus.
What causes vaccine hesitancy?
WG in 2012 reviewed a number of conceptual models for vaccine hesitancy determinants. A review of these models confirms the complexity of vaccine hesitancy and its determinants to the "3C's" model which was first proposed by the WHO EURO vaccine communications working group in 2011.
The model highlights three categories- complacency, convenience, and confidence
Refers to a low perceived risk of the vaccine-preventable disease, leading to the assumption that vaccines are unnecessary. Other concerns are deemed more significant. This has already been shown by so-called anti-maskers. Many people are skeptical about whether the virus is real or dangerous, so they may think they don't need a vaccine. They might also believe that the risk and side effects on their health from the vaccination are greater than that of contracting the virus. This is a determining factor in the number of people unwilling to get vaccinated especially in the US.
Confidence is defined as trust in (i) the effectiveness and safety of vaccines; (ii) the system that delivers them, including the reliability and competence of the health care services and health professionals and (iii)the motivations of policy-makers who decide on the needed vaccines. False statements and misinformation may also contribute to the issue. In certain cases, however, the lack of trust is due to historical injustice in the medical system- like the African American and Hispanic adults in the USA.
When physical availability, affordability and willingness-to-pay, geographical accessibility, ability to understand (language and health literacy), and attractiveness of immunization services affect adoption, convenience is a significant factor. One reason people are hesitant about being vaccinated is that it's a hassle. The affordability of a vaccine can be a big issue in countries like India where a large amount of the population may be unwilling to spend on a vaccine. thus, a country must strive to ensure that quality vaccination drives and services are delivered at a time and location that is culturally appropriate, relaxed, and convenient for people.
How can we learn from UK's model to keep hesitancy low?
1. Restrained reaction to bad news about vaccines
Bad news or negative news about the vaccination and the rare side-effects of it can also cause a dip in the confidence that the people have in the vaccine. For example, the Johnson and Johnson an Oxford AstraZeneca vaccine appear to have extremely rare circumstances of a neural blood clotting after it has been administered. While the UK did not put a pause on these vaccines and instead updated guidelines to recommend that the people under the age of 30 or with a predisposition to blood clots only receive the Moderna or Pfizer vaccination. While in the US the FDA and CDC paused the distribution of the Johnson and Johnson vaccine causing a slowdown in the vaccination rate. The EU had a similar response to the AstraZeneca vaccine. This immediately put a question mark on the vaccine safety and brought up concerns with the public. The action taken by these governments confused the people and not only made them distrust the vaccine but also the people in charge.
2. It’s convenient to get vaccinated in the UK
One of the main reasons why people are hesitant about getting vaccinated is that it is too much of a hassle. The centralized rollout run by NHS in the UK has been able to make the vaccination campaign clear while in places like the US and Indian vaccination drives differ from state to state making it fractured and confusing. Secondly, in the UK the system of determining eligibility is makes getting vaccinated convenient. Because the vaccine is centralized the NHS knows who is eligible to receive vaccination and they are contacted via call, text, or mail.
3. Vaccinating as many people as possible.
One way to reduce hesitancy towards the COVID-19 vaccine is to vaccinate lots of people. Hesitancy falls as more and more people get vaccinated. In order to do so, the UK delayed the second dose of the vaccine by up to 12 weeks while it distributed more first doses for the vaccine. The health officials of the UK ruled that up to 3 months delay in the second dose of the Covid 19 vaccination was acceptable. Because the UK has been able to roll out the first dose to relatively more people, it has seen a decline in the number of deaths and hospitalization. Seeing the correlation between the increasing number of vaccinated people and decreasing seriousness of COVID 19 could definitely lead to changing the minds of skeptics.
The problem with vaccine hesitancy is that it isn't a black-and-white situation where people are either vaccine-hesitant or not. Rather, it's a spectrum ranging from total acceptance to complete rejection, with many people falling somewhere in the middle. To address the hesitancy that adults have with the vaccine a collaborative effort must be made among healthcare providers, public health leaders, and legislators. Talking with patients can make a difference in complacency and can handle the misinformation that has been circulated. Healthcare providers should strongly recommend vaccine acceptance in order to put an end to this pandemic.