By Caitlin Davies
On 9th November 2020, Pfizer announced that according to early data produced by their Phase 3 clinical trials, their Covid-19 candidate vaccine is around 90% effective at preventing infection (BBC news, 2020). While this announcement was a much needed light at the end of the tunnel moment for many, it also notably sparked a discussion between other individuals about whether they would be willing to receive the vaccine if it was offered to them. In a survey conducted by Kings College London and Ipsos MORI in August 2020, they found that 53% of Britons surveyed were “certain” or “very likely” to willingly receive a COVID-19 vaccine, with a further 20% “fairly likely” (Kings College London and Ipsos Mori, 2020). However, 16% of Britons surveyed said they “definitely won’t” or were “unlikely” to willingly receive a COVID-19 vaccine. The survey also identified that individuals who “do not believe masks reduce the spread of COVID-19”, “believe that masks are bad for people’s health” and/or “say they’re very much the kind of person for whom it’s important to make their own decisions” were among those also more likely to say they were “doubtful” or “definitely won’t” willingly receive a COVID-19 vaccine if it was offered to them (Kings College London and Ipsos Mori, 2020).
Vaccine hesitancy is the term typically used to define individuals who are unsure about routine immunisation and are contemplating deviating away from or refusing the recommended immunisation schedule (McAteer, Yildirim and Chahroudi, 2020). They are seen as a target group of people who may be open to the reception of new information to help make an informed decision about vaccination whereas the term Anti-Vax carries a certain polarisation towards being completely against routine immunisation and refers to individuals who usually cannot be swayed (McAteer, Yildirim and Chahroudi, 2020). In the context of a COVID-19 vaccine, the vaccine hesitant group may be a key deciding factor in whether herd immunity against the disease can be achieved within a population via a wide-scale vaccination programme. Anderson et al estimates that if a vaccine has ~80% efficacy, then 75%-90% of the population needs to be vaccinated, however this also depends on the R number within that population and how long lived the immunity is (Anderson et al. 2020). It is therefore is important to explore the reasons behind vaccine hesitancy and methods to effectively communicate vaccine safety to the general public in order to allow them to make a reliably informed decision about receiving the vaccine and ultimately be within the chance of achieving herd immunity.
One of the main general causes of vaccine hesitancy can be attributed to the fact that “Vaccines are a victim of their own success, turning once devastating diseases into distant memories” (McAteer, Yildirim and Chahroudi, 2020). This is a plausible explanation for vaccine hesitancy towards vaccinations that protect against diseases such as Polio, MMR and Tetanus as many of us have been fortunate enough to not have experienced the tragedies caused by these diseases as a result of childhood vaccinations, however the COVID-19 pandemic is still ongoing. So what is causing COVID-19 vaccine hesitancy?
COVID-19 vaccine hesitancy may instead be caused by individuals having no personal experience of a loved one falling critically ill or tragically passing away as a result of COVID-19 infection, due to the disease having a relatively low infection-fatality rate (~0.68%) (Meyerowitz-Katz and Merone, 2020). These individuals may also believe that they themselves do not need a COVID-19 vaccination as they believe they would survive a COVID-19 infection and not become critically ill. However, it is important to note that these individuals who are infected (asymptomatically or symptomatically) but do not become critically ill can still can spread the disease to other individuals (Letizia et al., 2020) who may have underlying health conditions and are more likely to become critically ill and require hospital intervention. Following on from this, vaccination is therefore needed to relieve the pressure placed on the health system and deal with the large non COVID-19 related patient backlog caused by COVID-19 (Nagpaul, 2020). If hospitals become less overwhelmed with COVID-19 patients, there will be more space and resources available for treating non-COVID related patients (Nagpaul, 2020) . This is why also why a vaccine that was effective in reducing morbidity and mortality in high risk groups would still be beneficial even if there was little impact on transmission and herd immunity (Peiris and Leung, 2020)
Another main cause of hesitancy towards a COVID-19 vaccine is due to the speed of development. Pfizer’s announcement of early Phase 3 clinical trial data comes just under 8 months after the UK was plunged into national lockdown (BBC news, 2020). On average, vaccine development takes between 10-15 years with the current fastest vaccine development process record belonging to the mumps vaccine, but this still took 4 years (Professor James Ussher for Reader’s Digest, no date). It is therefore no surprise that the general public are concerned about the speed of production of a COVID-19 vaccine, as it is a phenomenon that has never been achieved before.
One of the main explanations for the fast tracked coronavirus vaccine candidates is due to the fact that consecutive trials are now being run simultaneously in order to save time (Wellcome Trust, 2020). However, for individuals of the general public who are unaware of the changes made to the timeline of vaccine development process, the speedy production of a coronavirus vaccine candidate is understandably worrying. Therefore, public health authorities should be highlighting that none of the usual vaccine safety assessments have been skipped but instead run simultaneously. This information about the modified vaccine development timeline should also be readily accessible and from a variety of sources to reassure the general public that safety is the main priority and this has not been compromised in order to reduce the time it takes to develop a vaccine candidate. It is also to be noted that a large amount of non-essential research has been temporarily paused in order to increase the manpower, resources and funding available for developing a COVID-19 vaccine candidate in order to facilitate the simultaneous running of trials, due to the urgency of the situation (Wellcome Trust, 2020). Typically, these resources are not available for other vaccine candidates which is why the trials are run consecutively.
Additionally, some of the recent rise in general vaccine hesitancy can be attributed to an increase in the distribution of anti-vax media on various social media platforms. This is therefore one area that should be focused on in order to increase vaccine uptake, particularly in regards to a COVID-19 vaccine. Efforts should include reducing the distribution of disinformation and instead making sure that reliable and accessible information on the all the benefits and risks of vaccinations from trusted sources is available to all individuals. However, it is to be noted that some individuals who are not trusting of the government and/or their response to the pandemic, may be averse to any government-produced media so the source of such media needs careful consideration. Following on from this, any legal attempt to control the distribution of anti-vax disinformation such as Labour’s proposed Anti-Vax emergency legislation (The Labour Party, 2020) may be interpreted negatively by some of the public, even though the legislation’s aim is to reduce the distribution of false and inaccurate information regarding vaccines, not censor the risks. Furthermore, since there is such a large amount of information available on different platforms with varying levels of moderation, it may be more productive to focus on educating the public on how to assess the authenticity and reliability of sources themselves to allow them to make more educated decisions.
To conclude, it is apparent that approaches towards tackling vaccine hesitancy in the era of COVID-19 need to be targeted and mindful of the importance of the individuals choice in whether to be vaccinated or not. Individuals need to be provided with accessible, reliable and easy to digest information that can help them make an informed decision. They need to be aware of the implications of being vaccinated or not and how this decision affects the greater population. While more work needs to be done to tackle distribution disinformation regarding vaccines, it is vital that individuals feel they are not being coerced into a decision as this can have a damaging impact on vaccine uptake. All considering, Pfizer’s announcement has provided the much needed optimism to continue fighting through the pandemic.
Anderson, R. M. et al. (2020) ‘Challenges in creating herd immunity to SARS-CoV-2 infection by mass vaccination’, The Lancet, p. S0140673620323187. doi: 10.1016/S0140-6736(20)32318-7.
BBC news (2020) ‘Covid: Who will have the Pfizer vaccine first and when can I get it?’, BBC News, 9 November. Available at: https://www.bbc.co.uk/news/explainers-54880084 (Accessed: 16 November 2020).
Kings College London and Ipsos Mori (2020) Who’s least likely to say they’ll get a COVID-19 vaccine?, Ipsos MORI. Available at: https://www.ipsos.com/ipsos-mori/en-uk/whos-least-likely-say-theyll-get-covid-19-vaccine (Accessed: 17 November 2020).
Letizia, A. G. et al. (2020) ‘SARS-CoV-2 Transmission among Marine Recruits during Quarantine’, New England Journal of Medicine, 0(0), p. null. doi: 10.1056/NEJMoa2029717.
McAteer, J., Yildirim, I. and Chahroudi, A. (2020) ‘The VACCINES Act, Deciphering Vaccine Hesitancy in the Time of COVID19’, Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. doi: 10.1093/cid/ciaa433.
Meyerowitz-Katz, G. and Merone, L. (2020) ‘A systematic review and meta-analysis of published research data on COVID-19 infection fatality rates’, International Journal of Infectious Diseases, 101, pp. 138–148. doi: 10.1016/j.ijid.2020.09.1464.
Nagpaul, C. (2020) The hidden impact of COVID-19, The British Medical Association is the trade union and professional body for doctors in the UK. Available at: https://www.bma.org.uk/news-and-opinion/the-hidden-impact-of-covid-19 (Accessed: 18 November 2020).
Peiris, M. and Leung, G. M. (2020) ‘What can we expect from first-generation COVID-19 vaccines?’, The Lancet, 396(10261), pp. 1467–1469. doi: 10.1016/S0140-6736(20)31976-0.
Professor James Ussher for Reader’s Digest (no date) Here’s what a Covid-19 scientist has to say about a vaccine – Reader’s Digest. Available at: https://www.readersdigest.co.uk/health/coronavirus/heres-what-a-covid-19-scientist-has-to-say-about-a-vaccine (Accessed: 16 November 2020).
The Labour Party (2020) Labour calls for emergency legislation to “stamp out dangerous anti-vax content”, The Labour Party. Available at: https://labour.org.uk/press/labour-calls-for-emergency-legislation-to-stamp-out-dangerous-anti-vax-content/ (Accessed: 17 November 2020).
Wellcome Trust (2020) How can we develop a COVID-19 vaccine quickly? | News | Wellcome. Available at: https://wellcome.org/news/how-can-we-develop-covid-19-vaccine-quickly (Accessed: 16 November 2020).