We Need to Talk about Vaccine Hesitancy, Now!

By: Ram Prasad, Saransh Sharma, Anushka Ashok and Nishan Gantayat

The idea of focusing on vaccine hesitancy, in the context of huge unmet demand and shortage in supply of COVID vaccines, might seem counter intuitive. Leading epidemiologists note that wherever we think we are in a pandemic, we are two to three weeks behind. So, to be able to put a leash on the pandemic, there is a need to think and plan about the next stage of the outbreak.

Image Credit: Getty

Vaccine availability does not guarantee vaccine uptake

Vaccine hesitancy is defined as a delay in acceptance, or refusal, of vaccination despite the availability of vaccine services. Much of the current vaccination policy discussions and efforts in India are limited to supply and logistics of vaccines, while the issue of people’s confidence in vaccines and willingness to get vaccinated is not being adequately addressed. Now, the demand for vaccine seems high but it may be misleading, because eventually, people who are willing to get vaccinated will get vaccinated, and most people remaining would be those that harbor some hesitancy. This would lead to an abrupt and sharp decline in vaccination rates, as we’re already seeing in countries like the United States, where vaccination rates are slowing down. Additionally, the current surge in vaccination seekers in India may be partially attributed to heightened concern and risk perception due to the 2nd wave and this could change once this wave recedes.

What we know about vaccine hesitancy in India

The nature of vaccine hesitancy changes substantially from country to country. Final Mile, a behavioral research firm, undertook a study to understand drivers and manifestations of COVID-19 vaccine hesitancy in India and the US through in-depth interviews with end users and health care providers. Our research corroborated years of evidence indicating the Indians are largely pro-vaccination. This could potentially be attributed to the success of large-scale child immunization campaigns, such as the Polio vaccination drive. Nonetheless, we found that while general vaccine hesitancy may not be an issue in India, people are displaying some hesitancy regarding COVID vaccines. This is because the COVID pandemic is an unprecedented, unfamiliar and unpredictable situation. To cope with this, people are rapidly consuming and integrating large volumes of information from multiple sources of variable credibility, and forming new beliefs and attitudes. Therefore the immediate context has more bearing on people’s COVID related decisions than long-held beliefs and attitudes. This also means that as saliency of COVID risk varies, people’s attitudes will vary too.

Pro-vaccine attitudes in India arise from the experience of child immunization campaigns and vaccination for adults is uncommon. When people think of adult vaccines, they think of tetanus or rabies shots which are predominantly only taken post exposure, such as after a dog bite or a cut. Due to the post facto nature of these vaccines, these are perceived almost as therapeutic interventions, rather than preventive ones. This does not translate well to COVID vaccines. People with such misconceptions reason that a vaccine is not required or relevant if they have not been exposed to COVID or don’t display related symptoms.

The efficacy of COVID vaccines in India ranges from 70–80%, which means that many vaccinated individuals will (have a chance) contract COVID after vaccination. Furthermore, when the infection rates are high, many people might catch the virus just around the time they get vaccinated. Such cases fuel mistrust and doubts about the effectiveness of vaccine, given people’s misconceptions and limited understanding. Only a small portion of the population is aware that almost all COVID vaccines provide high protection against severe disease and death.

Finally, when people consider the decision of getting the COVID vaccine, they evaluate it against the status quo, which is continuing with the safety measures they’ve been following for over a year i.e. social distancing, masking, and hygiene. By now, these measures have become familiar, comfortable and habitual for people, whereas the vaccine is seen unfamiliar and the risks and rewards of it are not well understood. So, for many, vaccination comes off as a risky and unpredictable alternative given large amount of misinformation circulating about the risks of the vaccine

The forementioned factors create an array of vaccine-related attitudes and beliefs that contribute to vaccine hesitancy. This hesitancy manifests as a continuum from nervous procrastination or the ‘wait and watch’ approach to skepticism and mistrust that fuels outright refusal. The study identified different segments on the spectrum of COVID vaccine hesitancy, based on differences in causes and characteristics of hesitancy. These segments require very different approaches for building confidence in vaccine and willingness to get vaccinated.

How do we address vaccine hesitancy

Below are a few key considerations for addressing vaccine hesitancy, that must be included in India’s vaccine plan and policies.

  • A nuanced and targeted approach towards vaccine communication, not a one size fits all approach, as motivation/barriers are different for different segments of population.
  • Addressing cost and access issues so that willing people can get vaccinated at the earliest. A critical mass of vaccinated people at local level can convince the hesitant that vaccines are safe.
  • Incentives, reminders and endorsement of trusted influencers like community leaders, religious leaders and healthcare providers, to build and reinforce intent to get vaccinated.
  • Engaging with media so that vaccine related misinformation is curbed and the issue is not sensationalized. Editorial and ethical standards have to be agreed upon and enforced by media organisations.
  • Communication campaigns to pre-empt and debunk misinformation, and address misconceptions and awareness gaps.