Why are some people vaccine hesitant?

What makes some people less likely to get vaccinated?
14 June 2021

Interview with 

Mohammed Razai, St George's Hospital, London


A healthcare worker preparing a needle.


With us is Mohammad Razai, a researcher in primary care at St George’s Hospital in London who has been looking into why some peole are vaccinated hesitant, as he told Chris Smith... 

Mohammad - The most common reasons people give, and surveys and studies have shown, is concerns about long-term effects, side effects, and unknown future effects on health. Concerns about the speed of development of COVID-19 vaccines, and concerns about vaccines incompatibility with religious beliefs. There are also concerns about practical issues, such as inconvenient vaccine delivery, time and location. Particularly amongst women they're apprehensions surrounding fertility, pregnancy, and breastfeeding. And of course we have heard quite a lot around the spread of misinformation and some people do believe in conspiracy theories, such as COVID-19 not being real or that vaccines modify DNA. Also in some ethnic minorities, such as some black ethnicities, we see a lack of trust in the pharmaceutical industry, in government, public health bodies, and just generally a low confidence in vaccines and their importance and safety and efficacy. So these are some of the concerns we are seeing consistently in published surveys and research.

Chris - Most of these though, Mohammed, sound like a communication deficit. As in that people are saying those things, are making, to them, quite rational decisions and quite sensible decisions based on a lack of information or a lack of the right sort of information or access to that information.

Mohammad - Absolutely. I mean, recognising barriers to uptake such as the ones I mentioned, it's just really crucial because it will help inform interventions to address them. And because the key with vaccine hesitancy is to build confidence in vaccines, and particularly listening to people's concerns, being respectful of different religious or cultural beliefs, and being aware of some justifiable and understandable historical mistrust among some ethnic minority communities about vaccines. And these are really crucial in vaccine communication.

Chris - Have those stumbling blocks always been there with those groups you just mentioned, snd it's just only when we come to try and vaccinate people en masse against something like coronavirus that we then disclose them, or is this a new thing for coronavirus?

Mohammad - It has been there for a very long time. We know that the key drivers of vaccine hesitancy, and in a way causes of vaccine hesitancy, are actually rooted in lower socioeconomic groups around structural upstream factors like structural racism, access barriers. And we know that lack of trust in government, for example, fear of government is a very, very pertinent, potent symbol of structural racism.

Chris - Not just a problem for the UK though, is it, because if you look at what the World Health Organisation is saying, they are putting vaccine hesitancy and anti-vax on their list of the top 10 of what they regard as global health threats going forward.

Mohammad - Absolutely. I mean, several international surveys have shown that about 40 to 50% of the world population are vaccine hesitant with really wide variations across countries. Internationally, when we look, one of the things we need to bear in mind is vaccine hesitancy is context dependent, it's variable across time, location, and different vaccines. So the same reasons don't apply to every country. What we see in other countries is again around poverty, socio economic status, and mainly access barriers. And also to do with misinformation again, and disinformation and rumours and conspiracy theories are really powerful in the international studies when we have looked and the reasons people have stated why they are vaccine hesitant

Chris - And to give people some context, what do we think the impact of the present status quo is? What sort of a cost is that having in terms of our ability to control and potentially reign in coronavirus going forward?

Mohammad - I think we have said that if you look across the population in the UK, for example, vaccine hesitancy is on the decline, at the moment it's 6%. But if you look at the granular data, we see a lot of vaccine variations across ethnic groups. We see some variation along the age groups. These are really important because it will lead to local outbreaks, and local outbreaks are not good because it drives infection, the spread of infection, and that could cause emergence of new variants as well as putting the rest of the population at risk because of these pockets of unvaccinated people. And also we need to bear in mind that vaccine hesitancy is really high amongst ethnic minorities and it will exacerbate pre-existing health inequalities and inequities in health. So these are really important. We need to address vaccine hesitancy by engaging at the population level and targeting those groups.


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