Questions of hesitancy, equity and priority require drawing on many disciplines’ expertise, says Anne Kerr
With the welcome news of progress on three vaccines for Covid-19, concerns are shifting to the accessibility and uptake of immunisation.
Much media and policy attention has focused on vaccine hesitancy. But this should not overshadow other challenges to global vaccine accessibility, such as vaccine nationalism, intellectual property restrictions and the logistics of cold-chain distribution networks. If these problems are not addressed, then the hope held out by these discoveries might not be realised.
For all these problems, policymakers can draw on a wealth of expertise and learning from studies of previous vaccination and treatment initiatives by scholars in the social sciences and humanities.
So far, it is not clear that this is happening—government statements seem to imply that addressing vaccine hesitancy takes a combination of vigorous public relations, a suppression of misinformation and appeals to public spiritedness.
One major lesson of previous research is that this discussion needs to change.
Public commentary tends to lump concerns about vaccination into one kind of hesitancy and focus too much on new kinds of anti-vaxxers and their more outlandish qualities. Social media is often blamed for spreading misinformation.
Sometimes this is contrasted with what are framed as ‘genuine’ questions that must be tackled in health promotion campaigns and conversations between healthcare providers and the public.
But this framing fails to appreciate the longevity of such concerns—which are as old as vaccination itself—the drivers of more extreme anti-vaxx behaviour, and the complexity of people’s worries. Persuasive messaging and censorship will do little to address these.
Trust is a major issue here, not just in medical professionals but in governments and mainstream media. When people do not feel supported by society, they can feel a duty to take responsibility for themselves and their families. This can lead them to reject the collective responsibility and solidarity on which vaccination campaigns depend.
Rather than demonising these people, we need to think about how to win back their trust and show solidarity, not just lecture about it. This means governments and media outlets need to behave differently.
For example, government and media need to be trustworthy—open and transparent about financial and contractual arrangements, and upfront about failings in the delivery of health and wellbeing and their potential solutions. They should avoid stereotyping people who have concerns about vaccination.
Efforts to suppress misinformation can fail if they force the issue underground and intensify its appeal to people already feeling marginalised. We need empathetic and open approaches to engaging with concerns off- and on-line, rather than censure and censorship.
The social sciences and humanities can also help optimise the distribution process for vaccination. Tracking, supply chain logistics and procurement may be less charged topics than vaccine hesitancy, but without mechanisms for identifying future outbreaks, transporting and storing vaccination, coverage will not be maximised.
Again, there are lessons from past campaigns and the problems that emerge when nations and industry do not work together to maximise the public good. But Covid-19 vaccination presents new logistical challenges, which the social sciences and humanities can help to address.
One example is how to maintain trial participation for other, perhaps simpler or cheaper vaccines when more costly and complex treatments are already being rolled out. Is it ethical to continue this work when it results in some trial participants contracting and suffering from the virus?
Social scientists and humanities scholars can help to understand people’s concerns and motivations, support their participation and put in place measures to ensure that trials continue in the public interest.
Another example is how to prioritise groups for vaccination. How should this relate to vulnerabilities of location, age, ethnicity, profession, disability and social class? Social scientists and humanities scholars can assist with this planning and, most importantly, with consulting the public about their priorities and helping to make sure the programme has support.
Social scientists and humanities scholars, especially those working in traditions critical of the powerful, often complain about being ignored or marginalised by policymakers. Vaccination campaigns are no exception. Social scientific and humanities expertise can also be inaccessible and difficult to apply, because it does not always deliver the oven-ready solutions that politicians and government want.
But a number of UK public bodies, such as the Nuffield Council on Bioethics, the Royal Society and the British Academy, have been joined by social scientists from across the academy in highlighting the importance of open and informed public deliberation to a successful vaccination programme. We are ready and waiting to play our part in these efforts.
Anne Kerr is head of the School of Social and Political Sciences at the University of Glasgow, and a member of the Nuffield Council on Bioethics
A version of this article also appeared in Research Fortnight and Research Europe