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How should we tackle vaccine hesitancy?

The need to tackle vaccine hesitancy

3 April 2021

9:00 AM

3 April 2021

9:00 AM

As Britain celebrates its vaccination success, we’re in danger of missing something important. A great many people have been offered the vaccine, but have turned it down — and we hear very little about them. No. 10 briefings trumpet the numbers vaccinated in the past 24 hours but are silent on the numbers who have refused. This matters, because if vaccine passports are on their way, granting access to pubs and so on, the unvaccinated will be excluded. More importantly, the unvaccinated will be vulnerable to the virus as we unlock. We need to know more about them.

Dig deep enough and rough figures are there. Let’s look at the over-seventies in England. According to data from Oxford University’s OpenSAFELY analytics platform, just 4 per cent of white people in this group are unvaccinated: a hugely impressive number, beating expectations. But among those described as ‘black African’ the proportion is almost ten times as great, at 37 per cent. From another source, those in the poorer London boroughs are seven times more likely to have declined a jab than their peers across the rest of the country. We need to get better at understanding the underlying reasons for declining the jab — and how to address these concerns.

We have achieved the phenomenal success of offering vaccinations to all of the nine ‘at risk’ groups — the over-fifties, care workers or anyone with a serious medical condition. These groups represent around 99 per cent of those who died from Covid-19 during previous waves. But the vaccines do not totally stop infection and transmission by those vaccinated: the latest American trial of the AstraZeneca jab shows 76 per cent effectiveness in this regard. This implies that, of those vaccinated, one in four remains vulnerable to getting and spreading the virus.

When shops, pubs and more reopen soon, around half of the population will still not be vaccinated. That leaves a lot of people who can be infected and transmit the virus, so we must expect a rise in infections — indeed, the latest numbers suggest this rise might already have started. Should we worry? As all of the vaccinations in use seem to be extremely good at preventing serious illness or death, it is hoped that we will decouple rising infections from hospital admissions and deaths among those ‘at risk’ groups who have been vaccinated.


But catching Covid-19 can be an unpleasant experience for anyone. Of those infected, as many as one in five will experience ‘long Covid’, and one in ten will suffer for more than three months, according to Office for National Statistics research. As we unlock, we could experience an unforgivable death rate among some of the disadvantaged, a proportion of whom are currently unvaccinated and who seemed to be more vulnerable during previous Covid-19 waves.

There are three steps we need to take now to mitigate these risks. First, we need much better data and insights on the unvaccinated, so we can find those who remain at risk. The data remains very messy; for example, the NHS dataset suggests somewhat nonsensically that 105 per cent of those aged between 75 and 79 living in the south-west have had a first jab. We also don’t have enough insights into the real reasons behind vaccine hesitancy.

Second, we need a much more systematic programme of persuasion for those who have not taken up the offer of a vaccination. We have already seen a cross-party group of black MPs and Lenny Henry launch their own campaigns. Nadhim Zahawi, the vaccine minister, has provided jabs in mosques. Community–led efforts in Bangladeshi communities are showing encouraging results.

But so far, the numbers suggest that these initiatives are nowhere close to being sufficient. Some 19 per cent of Bangladeshi over-seventies still haven’t been vaccinated, along with 22 per cent of Chinese Brits and 26 per cent of black Caribbean, according to the Oxford University data. There’s no reason why these figures can’t be as low as for those of Indian origin (11 per cent) or white British (4 per cent). We need to understand people’s concerns and develop a tailored programme to address these concerns. Vaccine passports, while controversial, could be part of this programme as they provide another reason to take the jab.

We should also learn from other national campaigns’ techniques to find different routes to persuade everyone. These include the recent push to encourage us to complete the census, which featured social media influencers, illuminated national landmarks and even the inclusion of the census in soap opera storylines. How stupid would we feel if census completion is higher than vaccination take-up among some ethnic groups?

Third, amid the excitement of the success of the vaccine, it’s easy to lose track of the other two punches: mass testing to help stop the spread of the virus, and treatments to reduce the risk of death for those who end up infected (full disclosure: I have invested in some of the innovators in these areas). The lateral flow mass tests being rolled out will allow the infectious to isolate without the significant number of unnecessary isolations seen with our previous approach of PCR testing and contact tracing.

No vaccine can ever reach 100 per cent take-up, so releasing lockdown will see an increase in hospitalisations — but deaths and serious illness can be further controlled by treatments. We have made progress with drugs such as dexamethasone and clinical interventions such as the use of the prone position. But the lack of the focused leadership and publicity for treatments that we had with the vaccine taskforce means that some of the promising next wave of clinical and pharmaceutical treatments are struggling with recruiting patients to their trials, delaying their introduction.

In the celebration of the phenomenal success of our vaccination programme, it’s easy to overlook that it will bring little benefit to those who have not participated. It’s now time to be frank about the scale of this problem and shift focus on to it. Addressing vaccine hesitancy could be the next way that our vaccination programme leads the world. Many of the steps we could end up taking, such as treatments and mass testing, could even position us well if we end up facing a vaccine-busting variant. Covid has surprised us before, and it is likely to again. If there is a new wave, there’s plenty we can still do to be ready.

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