COVID vaccine uptake: how to establish trust

Even as UK citizens return to the cosy indoors of pubs and restaurants, the Indian variant of the coronavirus remains a threat across the country and more than 50 others worldwide. And in UK hotspots for the variant, like Bolton and Blackburn, there have been mixed messages from the British government about what people need to do. So what’s the problem? Are some of us refusing the vaccine, confused by the advice, or just succumbing to a potentially more transmissible variant? Stephen Reicher is a psychologist and behaviour expert from the University of St Andrews, and he gave his analysis the situation to Chris Smith...

Stephen - The simple answer is we don't know. We do know that the B.1.617.2 - the so-called Indian variant - is more transmissible, but whether that transmissibility is due to the characteristics of the virus itself or the behaviour of those who have the virus, at this stage we don't know. It's one of the key questions we need to sort out before we can be quite sure about just how dangerous or how safe this new variant is.

Chris - Well the Health Secretary Matt Hancock... he's got some thoughts, hasn't he, because he told Sky News last week that the reason is all down to vaccination...

In Bolton, where we've seen a number of people in hospital with this new Indian variant, the vast majority of them have been eligible for a jab but not taken the jab.

Stephen - Hmm. I do think that his intervention was really very unhelpful. In his statements he has, in effect, blamed people for not getting vaccinated. I think it's inaccurate - when you look at vaccination rates in for instance, Bolton, they're very, very close to the national averages...

Chris - And what is that national average?

Stephen - It's different for different age ranges. So you could look at the graphs for all the different ages and they're basically on top of each other.

Chris - And your interpretation would be: if the graphs match what they are for any part of the country, then everywhere in the country should be equivalently affected. It's not, so Matt Hancock's point that it's all down to vaccines - that can't be the whole story.

Stephen - It can't be the whole story. But the other point is - blame is a way of alienating people. Yes, it's perfectly true that some people haven't got vaccinated, but one of the things we do know is the most effective way of getting people to vaccinate is to engage with communities, which means going to communities, talking to people, trying to establish trust. And if you alienate communities, if you hector them and blame them, that's highly counterproductive.

Chris - We know that we are at that point where people who've run vaccination campaigns traditionally say you get problems - once you get north of about 70%. Now why is that? And having anticipated that it's coming, what can we do to counter it?

Stephen - This has to do with the levels of vaccination you need in order to make sure that you can't transmit within communities, leading to what's sometimes called herd immunity. One of the problems with this discussion is it talks in terms of overall vaccination rates, as if the population is homogenous. And the problem is here that in different communities you get different levels of vaccination. So even if you had a 95% vaccination rate overall, if you had pockets where there's much lower vaccination, then the danger is you can have outbreaks in those areas. That not only leads to inequality, it leads to social tension - because people start blaming those communities for those outbreaks, and you begin to see anger, conflict, even violence between communities. So one of the problems we have at the moment is that there are lower vaccination rates in certain communities. And not surprisingly they're those communities which on the whole are more marginalised, more vulnerable, have a more problematic relationship with authority and with the state - in certain ethnic minorities, particularly the black community. So as I say, talking about the overall rate doesn't help us if there are pockets where vaccination rates are lower.

Chris - Conspiracy theories abound, though, don't they. I mean, when I had my vaccine, I had a bunch of people approach me on social media and send me the circuit diagram for the microchips that have been injected into me alongside the vaccine. I actually looked up the circuit diagram - it was a wah pedal for a guitar.

Stephen - The first thing is not to deny conspiracy theories, because there are conspiracy theories - I too have seen them - and they must be taken very seriously. However it is important to respect people and not treat people as a problem. Because again, if you're trying to engage with people and you start off by presupposing that they are irrational, they're stupid, they're pre-modern, that they don't believe in science, that they believe in strange myth, it's not going to help to engage with them. And when you look at the reasons for vaccine uptake, on the whole the literature points to three factors which are critical: the three Cs. Complacency is the first. You're not going to do things unless you think there is a risk and a need to do them. The second factor is convenience. If you're asking people to go a long way away, especially people who don't have a car who might have to take two buses to get to the vaccination centre, it becomes more difficult. If you're asking them to take time off work; if they're concerned that the day or two after they get the job, they might feel a bit under the weather - not serious side effects, but actually rather common minor side effects, but enough to affect work - what's that going to do to them financially? And the third factor is confidence: belief that these things are safe. Now sometimes people have got very real and very valid concerns, very real questions. One of the problems historically with vaccines is not enough minorities, not enough black people, have been involved in the trials. So people are concerned as to whether the types of conditions that those communities have are affected by the vaccine. So again, having people go along who are qualified to talk to people, to listen to their concerns, to answer their concerns, is really important. But of course there are going to be some people who don't just have questions, who aren't hesitant, but who are opposed because they do believe that this is some sort of conspiracy. And I think that is a different kettle of fish. It's important, but it's important not to lump it together with the majority of people who I think we need to treat as sensible, reasonable, and whose questions we should embrace and answer with grace.