How can we make sure people trust a COVID-19 vaccine once we get one?

As the COVID-19 pandemic ravages the world, there is daily talk of an imminent vaccine. Billions of dollars are being spent in hundreds of labs to find a solution to the SARS-Cov-2 virus problem.

But we know from years of experience that having a vaccine available and convincing all members of a society to utilise it are two very different things.

While the money is being spent on vaccine development and testing, significant investment is not yet engaging people and communities to understand and track how people feel about vaccines.

Similarly, there is a lack of investment to tailor communication strategies and develop education campaigns that will convince concerned citizens to be vaccinated.

Tactics like judgement, fear and mandatory programs will fail – especially if used before the vaccines are even available. This we know for sure.

There are some things we can mandate – like a license to drive a car or compulsory seat belts, for example.

But a vaccine is different – it’s a complex process and, for the average person, it can be perceived as something that goes into our body that we don’t understand.

Like painkillers, anaesthetics, or any medicine or medical procedure, vaccines have side effects and no vaccine is 100 per cent safe. When we are vaccinated, we are engaging in preventative medicine for individuals who are usually well with no symptoms.

Our entire health system (with the exception of most notably dentistry and optometry) is based on ‘repair care’ – so for many people the decision making around health prevention is foreign and perhaps more challenging.

Healthcare, in particular mental healthcare, should focus more on prevention – but that’s not the system we have. We might get there in time, but it’s a way off at this point.

Vaccination requires a person to take the same approach to their health as they would to their car or home. Vaccination is an insurance policy. You take an action right now that will protect you, and those around you, in the future.

Vaccination programs are, sadly, a victim of their own successes.

For many of diseases we are vaccinated against, there are few people alive now who remember these illnesses as being a part of life.

Polio killed up to 350 people in 1951 before vaccination was introduced a few years later in Australia and the last case of smallpox in Australia occurred in 1938.

But today, in Australia, we never see these conditions. It becomes easy to avoid getting vaccines when we erroneously feel there is no threat from the diseases they prevent.

COVID-19, unlike smallpox, is active in the here and now.

However, we know from a recent RCH National Child Health Poll that 7.6 per cent of people intend to outright refuse to vaccinate against COVID-19 and 16.7 per cent remain uncertain.

Herd immunity may require more than 80 per cent of the community to be vaccinated, so this combined total of 24.2 per cent who may opt out is concerning.

Public sentiments are also changing very rapidly at the moment, and with so much unhelpful information over recent months, many more than a quarter of people may be unwilling to have a COVID-19 vaccine.

At times, communication about the likes of masks, social distancing and lockdowns has been inconsistent and confusing. And rather than focus on channeling efforts into public engagement and trust, our leaders have tended to focus more on enforcing the rules and ensuring we stick to them.

But if we want good vaccine uptake, we need to restore trust with education and clarity.

We are entering the disturbing media phase where clinicians, politicians – or anybody with a set of vocal cords – will be commenting on the safety of this new vaccine.

Mandating vaccines is already being talked about, with the success of the ‘No Jab’ policies touted, but we are now in a very different situation with more uncertainty and fear about the COVID-19 vaccines than the routine immunisation schedule vaccine.

Some want programs mandated. Some do not.

In many cases concerns will be voiced in the public arena by specialists we should implicitly trust, but they may not have all the answers.

Unless efforts are put into building trust and engaging with all areas of the community, slowly but surely, the fear levels towards a COVID-19 vaccine will rise, especially if case numbers are dropping.

This approach is akin to giving vocal anti-vaccination groups free airtime on every major television network. We are guaranteeing that we will lose the battle before we have even arrived on the field.

Australia has a core group of immunisation specialists who have developed an approach to communicating with adults and parents to support their decision making about vaccines.

This approach has had the input of a diverse range of people with different skills sets from social scientists, paediatricians and infectious disease doctors to communication experts, political scientists and others, most belonging to the Collaboration on Social Science in Immunisation (COSSI) network.

Through regular specialist immunisation clinics in each state in Australia, workshops and online, these specialists engage with concerned parents. They manage to get more than half of vaccine-hesitant parents to fully vaccinate and the remainder to accept some vaccines and start their journey towards full vaccination.

The core principle is not to force ideas upon people, but to listen and build trust. But it is actually ‘how’ any discussion like this is approached that’s more likely to sway a fence-sitting parent than the ‘what’ of factual information imparted.

These types of conversations take time.

Many GPs and immunisation nurses simply don’t have the time to spend with a highly vaccine-hesitant or refusing parent, and so Australia’s specialty immunisation clinics are crucial.

But one of the most important characteristics that is often lost in public discourse is that science evolves.

This concept, the very core of what science is, needs to be better understood if science is to be trusted. We should never hide from these issues. In fact, when communicated with a level of sophistication they are our greatest asset in proving that we have ‘grown up’ in certain areas.

On many occasions, the negative outcomes of certain areas of science are caused, not just by the scientific work itself, but also by the way it is communicated, policy settings or funding regimes.

We are on the precipice of this error happening with the COVID-19 vaccine unless we put in the time to prepare the public for the rollout of these vaccines.

All this may seem simple and obvious, but the medical, scientific and public health communities will need to work together effectively to make sure communication is as transparent and good as it can be.

Clearly stated, the six steps to successfully preparing the public for COVID-19 vaccines are:

1. Develop a detailed communication plan and identify ambassadors to be the public face of the campaign. Choose these ambassadors based on communication excellence and trust.

2. Understand public expectations about vaccine benefits, risks and supply.

3. Earn the public’s confidence that vaccine allocation will be fair and eventually available for all.

4. Make vaccination available in safe, familiar and convenient places, such as community halls or churches, not just medical settings.

5. Communicate in meaningful, relevant and personal terms, addressing misinformation.

6. Establish state-based public oversight committees to review and report on systems that have an impact on public understanding, access and acceptance of COVID-19 vaccines.

A vaccine for COVID will not magically return us to our old lives if only 50 per cent of our community decides to use it, so we need to get this right.

No more bluster, no more campaigning. The window of opportunity is rapidly closing.

A longer version of this article was first published on Medium.

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