From Vaccine Hesitance to Acceptance – Bridging the Gap

by Dr Cheryl Jones

One section of Jackie Hinkson’s 2022 Carnival-inspired street murals ‘Game of Words.’ Used with the permission of the artist. Photo by Wesley Gibbings

 Since the COVID-19 virus continues to cause significant death and illness globally, scientists, medical professionals and political leaders worldwide must work together to stop the spread of the virus.

 The World Health Organization (WHO) states that the best way to reduce the impact of COVID-19 is for the world’s population to reach herd immunity. Herd immunity, also known as population immunity, occurs when people are protected from contracting an infected disease.

 That protection occurs by receiving a full dosage of a vaccine or previous disease infection. To limit unnecessary COVID-19 related deaths and severe illness, scientists recommend obtaining population immunity via vaccination rather than allow persons in populations to become infected. Further, the WHO suggests that population immunity will most likely occur when 70% of the world’s population has been fully vaccinated, including relevant boosters (WHO, 2021).

 To reach the target of 70% of the global population vaccinated, scientists, medical professionals, heads of governments and public health professionals, around the world, have been sharing information aimed at nudging those hesitant members of the population towards acceptance of the vaccination for themselves and/or family members.

In addition, an incremental step towards the 70% vaccine coverage was that 40% of the global population be fully vaccinated by the end of 2021. However, by late February 2022 there were 13 countries and territories in the Americas that had not attained the 2021 goal. Of those 13 countries falling short of the goal, 10 were in the Caribbean (PAHO/WHO, 2022).

 Globally, people have expressed various concerns about the COVID-19 vaccine including but not limited to the time dedicated to vaccine development and testing and short- and long-term side effects.

 To better understand these concerns and identify others, researchers developed and implemented projects in which they gathered information from people around the world. The most frequently used methods for gathering information were the conduct of surveys and reviews of social media content.  

 A few of the projects included the Caribbean in their research and some focused on select countries in the region (CARPHA, 2021; Puertas, E.B, et al., 2022; Johns Hopkins, 2021; USAID et al., 2021; UWI, 2021).

 Many of the projects that focused on or included the Caribbean were conducted in 2021 when vaccines were just becoming available in the region. In addition, most of the projects were conducted via surveys which meant people voluntarily completed a questionnaire online with the invitation provided via social media.

 For a Caribbean country to be included in these projects, there would have to be a country specific number of questionnaires completed. Since many Caribbean countries did not have enough questionnaires completed, they were not included in the project.

 Thus, there are only a few counties in which we have vaccine hesitancy information. Therefore, the results of the internet-based surveys can only be used for a few countries in the region and represent people who had access to mobile devices and utilised social media, such as Facebook and WhatsApp. Ultimately, this approach excludes a significant portion of each country’s population and ultimately a significant portion of the regional population.

 Let’s focus on a project conducted in October and November of 2021 which was funded by UNICEF and included a face-to-face survey of persons in six countries in the Eastern Caribbean: Barbados, Dominica, Grenada, Saint Lucia, St Vincent and the Grenadines and Trinidad and Tobago.

 The UNICEF-funded project stands out for two reasons. First, it was conducted in the latter quarter of 2021, and is thus timelier than the others. Second, the survey was conducted in person.

 One of the main benefits of the face-to-face survey are that the participants were able to gain clarification on questions and/or terms, and most importantly, participants who are not available via social media or internet were able to participate.

 The project sought to better understand why people in each country were hesitant to take the COVID-19 vaccine and if those hesitant could be encouraged to vaccinate. The report suggests that Barbados and Trinidad and Tobago are the least COVID-19 vaccine hesitant of the six participating countries - followed by Grenada and Dominica and Saint Lucia, and St Vincent and the Grenadines which are the most vaccine hesitant.

 Twenty-four percent (24%) of the unvaccinated populations across all countries identified that uncertainty of vaccine ingredients and the short development time are at the root of their reluctance to vaccinate.

 Further, the study identifies some topics that, if addressed, may encourage some of the unvaccinated to change their minds. However, each country was deemed unique and would require a tailored approach for addressing vaccine hesitancy. The findings from the studies seem to have been well received by ministries of health in all countries.

 The full study can be found at the link.

 However, to smoothly move from vaccine hesitant to vaccine acceptance, a different approach to understanding a more detailed WHY those who have not been vaccinated continue to stick to their guns and WHAT can be done to change their minds. Here are some things to consider:

 Question: Will conducting surveys in which you are asking populations about the reasons behind their COVID-19 vaccination decisions provide timely information?

 Answer: A survey is a snapshot of what is happening during a specified time and provides persons with a limited number of choices for their answers. The options for answering questions from a list limits the participants ability to answer fully and truthfully.

 Also, a person’s answer can change at any point after completing the survey. With the development of the Omicron variant and a relative or close friend contracting COVID-19, a person may change their mind about their vaccination intentions. The COVID-19 pandemic has changed so drastically since 2021, and survey participants’ decision-making processes and outcomes may have changed drastically.

Question: Is a survey the best way to understand WHY and HOW people make decisions about their health?

 Answer: NO. Surveys are great tools for measuring change over time, but they are not the best tool for understanding why and how people make decisions. The tools for gathering the ‘whys’ and ‘hows’ must be built on conversations held in settings that stimulate two-way, honest, communication and acknowledge the value that all participants bring to the table. 

 COVID-19 is teaching us (scientists), medical professionals, and political leaders a few hard, lessons.

 First, with our current access to information, medical professionals nor political leaders should expect that every member of the public will ACT immediately and without investigation on their advice/words.

 Second, information shared with the public is not always received in time to be acted upon, may not reach the recipient nor be relevant for real-life circumstances. For example, the COVID-19 infographics and messaging are largely word driven. There are words on paper and in audio. Have we asked if the words make sense to all audiences? Have we asked if they heard us?

 Third, communication must be seen as a two-way street, and the ‘general’ public, individuals, families, communities, and other groupings must be valued as collaborators in the fight for good health. In addition to collaborating, they must also lead in the COVID-19 and other health related fights. This means that the medical professionals and political leaders will have to redefine their role and/or position in these collaborations and communities must ‘grab the throttle’ and take on the role of pilot or co-pilot.

 

The way forward –

I saw an art exhibit, Game of Words, in St Ann’s, Trinidad & Tobago. The exhibit is shared on the walls of a neighbourhood. It is a series of murals developed by Mr Jackie Hinkson, and a part of it portrayed my view of the COVID-19 related communication from some researchers, health professionals and politicians to the public.

 In one mural, the political parties in Trinidad & Tobago depicted by their colours are with others standing on a ‘Walk Over’. I envision the others to be health professionals and researchers.  

 Below are people holding signs with various words. There is a definite gap between the people on the ‘Walk Over’ and those below holding the signs. I feel that gap represents the opportunity for true community engagement and collaboration to fight COVID-19 and all other health issues impacting our populations.

 True community engagement requires that researchers, medical professionals, and political personnel provide resources to social scientists trained to advocate for and with communities to eliminate the gap between those on the ‘Walk Over’ and the public.

 A spiral staircase needs to be built from the middle of the ‘Walk Over’ to the level below to stimulate two-way travel and communication. Of course, the goal is to eventually have everyone and everything on one level. After a while, that staircase will be too much work and the levels will become one. It’s just Growing Pains. - You know how you appreciate the single-storey home as you age.

 

About the contributor

 

Dr Cheryl Jones received her PhD in medical sociology from Howard University in Washington, DC, Master of Public Health from Morehouse School of Medicine, Atlanta, GA and Master of Business Administration from Clark Atlanta University, Atlanta, GA. 

She is an educator with a plethora of experience in research focused on social behavioural aspects of public health as well as in curriculum development and implementation.  

Over the past eight years, Dr Jones has provided technical support to the development and implementation of regional and national approaches to identify, enhance and implement evidence-based public health interventions and innovative initiatives that seek to reduce the impact of HIV/AIDS, NCDs (non-communicable diseases), vector borne diseases and public health emergencies throughout the Caribbean.

 

References

Media Institute of Caribbean