Policy makers and other stakeholders will need to work fast to nip vaccine hesitancy in the bud
As news of side effects allergic reactions to the AstraZeneca-Oxford COVID-19 vaccine and more recently to the Pfizer-BioNtech vaccine make the headlines, the general public is confused. Are these vaccines safe? Are they better off waiting for herd immunity to build up?
The problem is, these vaccines were hyped up as ‘magic bullets’, and that’s understandable. After months of physical distancing, sanitising and mounting deaths due to COVID-19, we want to get back to normal life.
But it’s only now that there is a realisation that vaccination will be part of the process of reducing the risk from COVID-19. That it will be a gamble, a calculated, educated one but a gamble nevertheless.
Governments are striving to be more careful, even as they hasten the regulatory process. India’s DCGI asked for more information on three vaccine candidates filing for emergency use authorisations (EUAs), just as the EMA asked for more information while evaluating the marketing authorisation application for Moderna’s mRNA-1273 COVID-19 vaccine. The EMA had planned a virtual meeting on January 12 for the next evaluation round, which it has preponed to January 6, maintaining the January 12 meeting as well if needed.
The US has realised that it must have alternatives to the Pfizer-BioNtech vaccine and hence it is expected to follow up the advisory committee’s December 17 positive recommendation for Moderna’s COVID-19 vaccine with an EUA.
The moot point is that policy makers and other stakeholders will need to work fast to nip vaccine hesitancy in the bud. Two recent surveys in the general public and one of healthcare workers, might have limited use from a statistical point of view, but should be seen as warning signs of public distrust and wariness.
This trends analysed in the section below must be arrested. Regulators and companies should share more information and be as transparent as possible about adverse events and the like. It is good that the Health Ministry has proactively uploaded details FAQs on December 17 to counter some of these questions (https://www.expresshealthcare.in/covid19-updates/vaccination-of-frontline-workers-will-reduce-societal-economic-impact-by-reducing-covid-19-mortalities-health-ministry/426427/)
GOQii COVID-19 – The Way Forward survey
So let’s analyse the data from these surveys. 53 per cent of the approximately 11000 respondents to GOQii COVID-19 – The Way Forward survey are unsure about taking COVID-19 vaccine. The remainder 43 per cent are willing and actually waiting to take the vaccine.
43 per cent of the respondents are not sure and will only make a solid opinion post initial results about the effectiveness of the vaccine is revealed while 10 per cent are firmly against taking the vaccine as of now.
There could be a gender bias, with female respondents to the survey reportedly more cautious than men with 48 per cent of the male population willing to get vaccinated while the female readiness is around 42 per cent.
Expectedly, with age, the willingness to take the vaccine reduces. The Older Adults (45-60 years) and Seniors (60+ years) segments are not as ready as the younger age groups. This may be due to concerns about complications post taking it. The statement did not say how many respondents were in these age groups.
Handling the COVID-19 crisis has often seemed like a game of oneupmanship between policymakers at the Centre and the implementors at the state level. The lockdown strategy too has been debated hence the survey results on these questions are interesting for this representative sample.
According to the COVID-19 Impact – The Way Forward study, 50 per cent of the approximately 11000 respondents feel that the Central Government initiatives have been effective in curbing the spread of COVID-19 while 25 per cent of the people surveyed believe that the State Government initiatives have been effective. Only 22 per cent of citizens recognise the efforts of the local Government in terms of effectiveness.
In a sign perhaps of ‘lockdown fatigue’, 66 per cent of the population surveyed believes the current method or opening up slowly is the way forward while 34 per cent feel that a complete lockdown should be introduced again. 25 per cent have a positive opinion about the current partial lockdown and think that it should continue in a similar manner. While 31 per cent want things to return back to normal but only in a gradual way, wherein restriction will be loosened very cautiously and while monitoring the numbers. 10 per cent of people who said that there should be no restrictions and things should go back to normal.
The LocalCircles surveys
A regular social media pollster on issues of governance, public and consumer interest, LocalCircles has run at least three polls to understand attitudes towards COVID-19 vaccination over the past few months, collecting citizens’ response to the question: “The COVID-19 vaccine is likely to be available from February 2021 via private and Government channels. If that happens, what will be your approach to taking this vaccine?”
The percentage of citizens hesitant to take the vaccine was at 61 per cent in October, dropped to 59 per cent in November, and rose to 69 per cent in December 2020. A LocalCircles statement pinpoints that some of the key reasons for citizens to become hesitant are limited information about side-effects, efficacy levels and a growing belief in parts of the population that COVID-19 cannot infect them because of their high immunity levels.
The latest survey conducted over December 10-15 reportedly received more than 18,000 responses from citizens across 242 districts of India. 66 per cent respondents were men and 34 per cent were women. 55 per cent respondents were from tier 1, 26 per cent from tier 2, and 19 per cent were from tier 3, 4 and rural districts.
To understand citizen perceptions, LocalCircles asked them about their understanding of what was the primary reason the daily caseload was reducing? The question received 9,081 responses from citizens. Of them, 17 per cent said “Because we are moving towards herd immunity”, 14 per cent said “Because Indians in general have high immunity”, 8 per cent said “Because COVID virus is going away or weakening”. 15 per cent said “Cases are reducing because we are following norms for masks and social distancing”, 8 per cent said “They thought something else was the reason”. 33 per cent said “Official daily case count is significantly understated as most people are not getting tested and self-treating”, 5 per cent did not have an opinion.
As per the LocalCircles statement, one takeaway is that 39 per cent of the citizens believe India’s daily caseload is reducing because of people’s high immunity or because the virus has had its run and is now going away. While the public is no expert on the virus, the findings throw light on why vaccine hesitancy is rising. The average daily caseload from just mid-November around Diwali to mid-December has declined from 50,000 a day to 25,000 a day. This when combined with concerns around side-effects and vaccine efficacy that best explains why the hesitancy towards vaccines is rising in India.
Dr. Abdul Ghafur’s survey
A separate independent survey of healthcare professionals coordinated by Dr. Abdul Ghafur, an infectious diseases specialist in Apollo Hospitals, Chennai, himself a COVID-19 survivor, took responses from healthcare professionals across India to understand their attitude towards COVID-19 vaccination and received 1424 responses. (https://www.expresshealthcare.in/covid19-updates/make-antibody-test-precursor-to-covid-19-vaccination-localcircles-survey/426348/)
According to his survey, conducted between December 8-13, when a COVID-19 vaccine is made available 45 per cent of the healthcare workers who responded to the survey would take the vaccine, as soon as made available.
His findings highlight a vaccine hesitancy in a population that is critically to convincing the general public about the need to vaccinate. And is therefore of more concern, as Dr Ghafur cautions that this vaccine hesitancy “percolate down to the general public.”
The health ministry does address some of these concerns in in the FAQs of December 17, in a separate section addressing healthcare providers / frontline workers.
Corporates, be they pharma and vaccine manufacturers or hospitals, too need to be seen as transparent and fair.
It is also important to find role models who will walk the talk. Actor Amitabh Bachchan turned the tide in India’s battle against polio, when he campaigned to end opposition to the polio drop campaign.
It is time to try this strategy with COVID-19 vaccines as well. In the US, three former presidents of the US (Barack Obama, George W. Bush and Bill Clinton) have expressed willingness to be vaccinated on camera, when their turns come, to build confidence in the COVID-19 vaccines. President elect Joe Biden is expected to take the shot on Monday. Legendary musician Sir Paul McCartney in the UK has said he will too take the vaccine when it’s his turn. Can we have a similar movement here in India?