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Much has been made of vaccine hesitancy recently. For Paul Barry on Monday’s Media Watch, it was “that new buzz phrase filling the airwaves”. Over 170 Australian news articles featured the phrase in the last week alone. The concept has been around for years, rising exponentially in academic journals in the last decade. In 2019, the World Health Organization declared vaccine hesitancy to be one of the top 10 threats to public health.
Yet hesitancy is not the sole cause of low vaccination rates. It is also unclear how much hesitancy contributes to the low uptake of the Covid-19 vaccine at present, relative to other barriers, like supply and distribution, confusion about how to get vaccinated, difficulties in accessing the online booking system, or being able to find time off work.
Hesitancy can become a tempting explanation for low vaccine coverage when governments seek to deflect attention from health system problems. For news editors, a story about a person rejecting vaccination because of their beliefs is probably more interesting than reporting a more prosaic lack of transport or inconvenient clinic hours. However, we should not paint out of the vaccination picture individuals like the two women I spoke with this week, both affected by disability and both uniquely struggling to access the Covid-19 vaccine they wanted.
Being open and curious about why vaccination take-up is low is good for public health. It starts with asking the affected community. In Romania for instance, a large measles outbreak in 2016 was thought to be caused by active refusal of vaccination. Then a survey of 520 caregivers of children with measles asked them directly. It turns out the main barriers to these children being vaccinated were long waiting times, vaccines running out and not being aware of a vaccine due. Beliefs about side effects also featured, but not as much as expected.
In Maitland in New South Wales, a team from the population health unit used the WHO Tailoring Immunization Programmes (Tip) approach to improving vaccination rates. They worked with the community to understand why coverage of vaccines for children by 12 months was low and what could be done to address the problem. Interviews showed the best approach would be tailored reminders and help to connect parents to a bulk billing GP, outreach and home visiting by child and family health nurses. The reminders were written in friendly language with the help of a community representative, in a coloured envelope with a handwritten address. They had an invitation card to take to any of a group of GPs who agreed to bulk bill children for immunisation and to fast track appointments or accept walk-ins. Tip led to an increase of vaccination in East and West Maitland by 18 percentage points in one-year-olds. Most interventions in child vaccination are lucky to see a 2-3% increase.
Behavioural scientists have reviewed studies to find the interventions with the largest impact on vaccine uptake. Those most effective include: making vaccines free and services convenient, reminders when a vaccine is due, default appointments, performance monitoring and feedback, on-site vaccination, standing orders, incentives and requirements.
Educating and informing people on its own does not usually improve uptake, except where a new campaign seeks to inform and motivate people about a new vaccine. That is why now is the right time for a Covid-19 vaccination campaign. It should engage audiences with what the target audiences value about vaccines, use language familiar to them, come from people influential to them, and tell them how to go and get a vaccine.
Provider and institutional recommendations can also be effective. It may be that strategies needed for the first 60% of the population to be vaccinated are not to those needed for the next 30% (about 10% may never be willing to vaccinate).
Australia has a major challenge ahead. We need to get at least 75% of eligible Australians vaccinated against Covid-19. That can only happen with a comprehensive suite of approaches, rather than thought bubbles from politicians.
Now is the time for government to begin to build its own national strategy backed by evidence of the relative drivers of low coverage. It should be planned collaboratively, with the states, territories, and other major stakeholders, and it should keep performance monitoring and evaluation as central, drawing on our major successes with childhood vaccination over more than two decades.
Despite early supply and safety issues and logistics problems, Australia has the capacity to do well with vaccination. If we can inform, motivate and facilitate vaccination well, then we will be in a better situation to live a Covid-adapted life into the future.
Source: The Guardian
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