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Vaccine Acceptance is the Next Hurdle

This story originally appeared on the World Health Organization’s website

COVID-19 vaccines are finally within reach, with several breakthroughs on the horizon. This is good news at the end of a difficult pandemic year.

But even after we have overcome the imminent challenges of sufficient supply, efficient rollout and equitable access, vaccine hesitancy will remain a major stumbling block to achieving the herd immunity that can protect us all.

In addition to the sheer magnitude of the coming vaccination effort, the vaccines will be new and are likely to be only partially effective for a yet unknown period of time.

There may be so-called adverse events rightly or incorrectly attributed to the new vaccines, and countries will set different safety thresholds before offering the vaccines to their populations.

Given the limited supply in the short to medium term, vaccines are likely to be prioritized for health workers at high risk of acquiring or transmitting infection and older adults.

Eventually vaccination efforts will expand to target diverse populations not typically reached with immunization programs, both across and within countries.

But research has shown that it is not enough to provide information on vaccines to encourage their uptake.

The WHO Technical Advisory Group (TAG) on Behavioural Insights and Sciences for Health has published a report outlining the factors that drive people’s behavior when it comes to vaccines: an enabling environment, social influences, and motivation.

It recommends addressing those drivers to encourage communities to accept and take up vaccination.

First, we must make it easy, quick and affordable to get vaccinated, especially for the large proportion of people who are not deliberately avoiding vaccination.

What might seem to be reluctance, resistance or even opposition, might actually be a response to the burdens or inconvenience of getting vaccinated.

Immunization rollout plans need to consider factors such as the convenience of location and time, associated costs, and the quality of the experience of being vaccinated.

For instance, if the default in schools is to vaccinate all students, with the provision of allowing those who object to opt out, then vaccination rates will likely be higher than if the default is to provide vaccination only to those who opt in.

Making vaccines easily accessible in safe, familiar and convenient locations, such as “drop-in” clinics that are near where people often go, can also encourage uptake.

This should be accompanied by targeted, credible and clear communication from trusted sources demonstrating that getting vaccinated is important, beneficial, easy, quick and affordable.

Health systems must be prepared to reduce barriers to supply, service delivery and quality of services, in addition to ensuring that health care and community workers are well trained and well supported.

Second, we need to harness social influences, including from trusted community figures.

By making vaccine uptake “visible” to others, through clinics in prominent public places or by enabling ways for people to signal that they have received the vaccine – on social media, in news media or in person – can contribute to making the social norm more salient.

Showing that health professionals are being vaccinated can lead to greater acceptance and uptake by the general population.

Amplifying endorsements from trusted community members can also help.

Third, we need to increase individual motivation through open and transparent dialogue and communication about the uncertainty and risks, but also the safety and benefits of vaccination.

Some may be hesitant toward vaccination due to beliefs that they have a low risk of infection, others may have concerns about the safety of vaccines, while others may be hesitant because of religious values or lack of trust in the health system.

This pandemic has been accompanied by an overabundance of information and misinformation, an ‘infodemic’ on a global scale.

People are inevitably exposed to misinformation, rumors and false conspiracy theories, which may erode their confidence in vaccination.

Developing trusted sources, fact-checking and responding to misinformation through dedicated dashboards are some of the strategies suggested to manage infodemics.

Vaccine acceptance and uptake may also be undermined by COVID-19 vaccines being not fully effective, meaning that people will have to continue to engage in preventive behavior (e.g. mask wearing and physical distancing) even if and after they have been vaccinated.

It will be important to manage expectations and ensure that those who have been vaccinated do not stop adhering to protective behaviors and expose themselves and others to risk.

It is important to build trust in COVID-19 vaccines before people form an opinion against them.

This should involve using trusted messengers to help navigate the COVID-19 information landscape and building confidence in the vaccine development process through transparency and managing expectations.

Communicating consistently, transparently, empathetically and proactively about uncertainty, risks and vaccine availability will contribute to building trust.

This article summarizes key recommendations from the report “Behavioral considerations for Acceptance and Uptake of COVID-19 Vaccines” developed by members of the WHO Technical Advisory Group (TAG) on Behavioral Insights and Sciences for Health, chaired by Professor Cass Sunstein, with the support of Elena Altieri and Melanie Kim from the TAG secretariat.

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