Vaccinations are probably our only route out of this horrible pandemic; vaccines are a miracle of modern science and give hope to individuals and communities. That is my view, and it is the view of most people that I come across; but it is not the view of everyone.
I have been living, eating and sleeping vaccines over the last month. Our teams in the NHS are desperate to vaccinate as many of our patients as possible, as quickly as possible- we know that every extra person we vaccinate is another person we are lifting onto the life raft. This makes it hard to understand why there is hesitancy, scepticism or even hostility to the vaccine. For health professionals such as me it is tempting to be angry with those with that attitude.
That would be a mistake. It would be a mistake that could lead to alienating groups of people who would benefit greatly from being vaccinated, worsening existing inequalities in society as a result.
One of the most important lessons I have learned during my career is that it is absolutely critical to understand people, and the reasons behind their behaviour. If someone is reluctant to be vaccinated, we need to understand why this is– this can only be done by listening to them and listening properly. As health professionals if we want to fix people, we first need to understand what makes them tick. In Covid-19 world it is especially important we get this right, and don’t make the common mistakes.
From my experience and reading, I think we are looking at roughly 3 groups of people who may not want to be vaccinated. Firstly, there are those who are anxious about vaccination; they often talk about being concerned about the vaccine being ‘rushed through’, and are worried about side effects. They may prefer to wait until others have had it.
Secondly, there are groups who have little trust in the authorities and professionals and feel excluded generally from society. This group I think is bigger than we think, as we live in an unequal society.
The third group we could term ‘anti-vaxxers’ but include general sceptics and cynics as well as true believers/nutters. This is a small but vocal group, but they can pollute the understanding of the first two groups causing serious harm.
Different approaches are needed for each group, but needs to include an awareness that rational, data-based arguments are often ineffective and could be counter-productive, especially if they reduce trust. Often the reasons for reluctance are deep rooted: more emotional than rational, and more instinctive than scientific. Using simple fact-based arguments is important to generally inform and reassure, and the ‘anti-vaxx’ arguments need rebutting, but this approach alone is not sufficient.
We need to have the attitude that concerns are not to be dismissed, but to be understood so we can address them. We need to build confidence in vaccination and confidence in the people giving the message. I have found just trying to persuade people without having the ‘permission’ to have the discussion doesn’t work. But if there is a connection as a friend, family or neighbour, or indeed their doctor, there is a relationship that can be used to have a conversation about vaccination. If that person is someone they identify with and trust and have been vaccinated it is a powerful thing. Sometimes the reason for the reluctance can be unexpected but easy to address, but the person needs to have confidence to find that out without feeling they are being lectured to or pressured.
It is tempting to just think that if someone doesn’t want to be vaccinated then it is their choice, and their loss. But if large groups, particularly those vulnerable, aren’t vaccinated then their friends, family and neighbours will also be affected. Vaccination, like other public health interventions, benefit both individuals and communities. Solidarity is vital and worth nurturing.
Dr Joe McManners is an NHS GP in Oxford. He is also a Clinical Director of his ‘Primary Care Network’.
Additionally he is an Oxford City Councillor, representing the Labour Party, and has held held roles in NHS Management, as Chair of Oxfordshire CCG and NHS England Clinical Advisor.
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