Terry Slevin
When it comes to COVID19 vaccine hesitancy, the discussion, debate and media reporting over the past fortnight or so is worrying, particularly for those in the public health community who have been monitoring the pandemic closely from the start.
One of Australia’s leading experts in this area, PHAA member Professor Julie Leask, from the University of Sydney, doesn’t mince her words. ‘This is about people’s lives, and I want to see people protected,’ she said.
‘It isn’t the case everywhere, but in many cases supply of the vaccine is now exceeding demand. We need to persuade those fence sitters, and particularly the groups less likely to get vaccinated. It is better to be protected now than to want to get that protection when an outbreak comes,’ Professor Leask added. She expanded on those comments in an interview with 3AW’s Neil Mitchell.
Many in public health might be sceptical of the motivations of airline CEOs and those in the tourism sector demanding a ramp up of the vaccination program as being in their economic interests. Clearly that is legitimate a driver for them, and others whose livelihoods have been affected by the restrictions associated with the pandemic. But there are also other motivations.
This week’s outbreak in Victoria seems to have reinforced the genuine sense of threat. One case quickly moved to five, then 15, now 26, and the count continues. It seems people who have been less motivated previously may be changing their mind. Queues for tests and for vaccines are getting longer, and more people are reassessing the value of vaccination. Others with the means to do so might be motivated by the desire to resume international travel.
Some are still apprehensive about vaccination and are relying (with a false sense of security) on our low numbers of cases to continue. There’s also talk of people holding out for an alternative to AstraZeneca, due to those reports of rare blood clots. Or perhaps because of other perceived risks. The latest data put the known but rare side effect at around 5 cases in every million. That’s the number of cases, not deaths. And for context, the rate of blood clots in people with the covid-19 virus is 43 per million. This evidence needs to be put forth clearly and consistently.
Another consideration is providing assurance in the form of insurance. For those who do undergo vaccination, if they are one of the rare cases with adverse effects, a no fault “Vaccine Injury Compensation Scheme (VICS) may help to build trust.
Whatever the motive, the fact is that people think about vaccination in varied ways, with different drivers and concerns for every group and individual. Public health campaigns therefore need to communicate the situation honestly, clearly and in light of emerging evidence.
Communicating the message
Having been involved in social marketing campaigns for over thirty years I am conscious of some of the real drivers and challenges of communicating health messages, be they about cancer screening, tobacco control, sun protection or reducing alcohol or unhealthy food consumption.
Professor David Hill, former CEO of Cancer Council Victoria and long serving stalwart of public health campaigns listed 5 big principles of driving health behaviour that should underpin good quality health campaigns. These focus on “repeated and habitual behaviour” and have relevance for influencing public engagement with vaccination programs. They focus on the extent to which a person:
- “Wants to do it” – or their motivation. A good campaign can help persuade people to be vaccinated, by presenting a cogent case for taking it based on the key motivators of being healthy, protecting others or increasing future opportunities for things like travel and employment.
- “See others doing it” – or modelling behaviour. A campaign can show people who are ’like us’ or a celebrity or community leader choosing to be vaccinated (think Dolly Parton in the US and Elton John leading the ‘get a jab’ campaign in the UK). In digital marketing terms, “influencers” might play a role here. But many people, (myself included) have expressed scepticism as to whether “influencers” really do influence, particularly on an issue like vaccination. Nonetheless, credible people leading by example is a proven strategy.
- “Has resources & self-efficacy to do it” – this is about capacity. Is it easy to make a vaccination appointment? Can I easily get to a nearby vaccination centre or GP clinic? Will I need a day or more off work? Is there an appointment available soon or will I need to wait? Making it simple, quick and easy to get, when the individual is motivated to get it. That is easy to say, but logistically very challenging when there is worldwide demand for a finite and technically complex resource. These are the practical nuts and bolts of the vaccine program.
- “Remember to do it” – this is the simple reality of everyone’s lives. I’ve been meaning to make that booking call or find that website, but the kids got sick or it got busy at work. Campaigns with a clear “call to action” and an immediate and easy step to trigger the vaccination booking are important to continue to prompt people to act on their intentions to get vaccinated.
- “Is rewarded for doing it or suffers for not doing it” – this is about reinforcement. The “positive frame” highlights the benefits of vaccination. It is good for our health and for the health of those around us. It is important when new outbreaks occur and also increases options for travel into the future and may be important when it comes to job options in the future. The “negative frame” that is the disadvantages of not vaccinating includes the opposite.
On this there appears to be a lot of debate about “fear tactics”. Some are concerned that they may lead to a backfire effect in those who see them as manipulative. However, a story about a young person living with the effects of long covid, or someone who has lost a family member to the disease, for example, may be of use. If the stories are real, consistent with the body of evidence and not overstated, this strategy should not be ruled out as a legitimate component of a successful vaccination campaign.
Challenge One: Who delivers the message?
The Federal Government is under fire. Recent and broadly derided missteps on promoting the notion of consent will not embolden a government going to the polls within the next 12 months to go out and take risks with a cutting-edge campaign that can cut through an overcrowded media landscape. So, if a key motivation is to avoid creating offence to voters, could the message be delivered by someone else? Could state and federal governments work together to run campaigns? Could campaigns be cost shared? If that happens, various (larger) state governments might be motivated to develop campaign messages. If they chose to co-operate and share their expertise and progress (including marketing misfires), the successful messages could be shared with and adopted by other states.
Challenge Two: How should the message get out there?
With the extraordinary explosion in media diversity gone are the days of a single blockbuster 30 second advert run across the major commercial TV stations reaching 60% of the population. Every advertising genius will tell you social media is the answer and that they can prove it with a modest fee to design a viral campaign. Anyone who has actually run campaigns will tell you the cheap, wide-reaching viral campaign is an overhyped promise that is as rare as unicorn droppings.
The likely solution is instead a broad diversity of messages run through a wide range of media channels which target very specific demographics, from retired sparkies to young parents.
Then, capture data on the impact and uptake of those various messages, and adapt the messages accordingly.
Challenge Three: Incentives?
I worry about this. A lot. The incentive should be the strong scientific and health case for vaccination. If we start talking about free beer, lottery tickets or discounts on car registration, we may create the unintended consequence of encouraging people who are less motivated to act, or who feel less vulnerable to the effects of the disease, to hold off on their vaccination until the incentive is big enough. If there is a perception that there is a benefit “just around the corner”, that might discourage, rather than encourage participation. We must create the sense that the time to act is sooner than later.
Conclusion
We didn’t rush through our vaccine approvals, and we didn’t start vaccinations till our systems were properly in place. That was the right strategy at the time.
We’ve played it calm, we’ve played it safe, and to date, generally and compared to much of the world, we’ve played it well. But let’s never forget, this is still a major public health emergency, and it needs to be treated as such.
Now is the time for us to get ourselves properly protected, as a nation – and every one of us has a part to play. This starts with booking in for your vaccine at the earliest convenience and spreading this simple message. I’m booked in for mine (AZ in case you are interested!).
Vaccination against COVID might well save your own life, or a member of your family. It could also save a stranger’s life – we are all in this together, after all. Not to vaccinate guarantees nothing, except uncertainty, and an ongoing risk of Australia travelling down the same path as so many nations whose death tolls have reached frighteningly high levels.
Terry Slevin is the CEO of the Public Health Association of Australia, and is also Adjunct Professor in the School of Psychology at Curtin University and Adjunct Professor in the College of Health and Medicine at the Australian National University.