Vaccine Hesitancy: Should We Be Worried?

Veronica Martinez Harris and Michelle I Jongenelis – PHAA members

Never has there been a more important time in living memory to get vaccinated, with Australia’s ability to effectively tackle the COVID-19 crisis heavily dependent on high vaccination rates. Despite this, Australia’s vaccine rollout has experienced multiple setbacks since its commencement in late February, resulting in just 14% of the population being fully vaccinated as of July.

While this poor result is at least partially due to a combination of supply side factors, such as a slow rollout and shortage of vaccinations from overseas and local producers, it is the demand side of the equation that has public health advocates worried. Have factors such as constantly changing medical advice, poor messaging, and needlessly alarming news reports contributed to increased vaccine hesitancy? Or is there a fundamental problem with vaccine access?

In recent years, the ‘anti vax movement’ has gotten louder, with high profile public figures (think Elle MacPherson, Pete Evans, and Novak Djokovic) joining this movement and giving it a platform. This, alongside scare mongering headlines around the risks of the vaccine (see below), have been a cause of concern among public health advocates.

Investigations as grandmother, 80, develops severe bruising on her body after first AstraZeneca jab

Another Australian dies after getting Covid vaccine

Woman’s death in Perth hospital ‘likely’ linked to AstraZeneca vaccine, TGA finds

But should we be worried?

While clickbait media headlines exaggerate the risks of vaccination and suggest alarming levels of vaccine hesitancy, official statistics tell a different story: Australians are lining up in record numbers to get vaccinated.

This does not mean we should ignore the potential threat of misleading media headlines and the anti-vax movement and their contribution to vaccine hesitancy.  As public health advocates, we need to continue our efforts in communicating effectively and efficiently about the COVID-19 vaccine to ensure those who are hesitant are persuaded to get vaccinated.

A key determinant of vaccine hesitancy is confidence, or lack thereof, in the safety and effectiveness of the vaccine. For example, while there is a risk of ‘thrombosis with thrombocytopenia syndrome’ or TTS associated with the AstraZeneca vaccine, the risks of clotting are rare: just 26 cases per million in those under the age of 50 and 16 cases per million in those aged 50 years and over. Thus, our work should aim to build confidence and put the risks of the vaccine into perspective.

Our work could take the form of informative and targeted public health campaigns, advocating for clearer messaging (especially to those with low health literacy levels), and one-on-one conversations with our patients. Members of the population who may require particular attention include females, those who belong to an ethnic minority group, those under the age of 65 years, and those experiencing greater levels of socioeconomic disadvantage. Research has shown that members of these populations are less likely to get vaccinated when there is a vaccine available.

While low uptake of the vaccine in these sectors of the population could in part be due to vaccine hesitancy, there are also noticeable inequities in our society that impact people’s ability to get vaccinated. These cannot be ignored.

Structural barriers to accessing vaccination, including time constraints, physical access, and geographic proximity to health clinics, disproportionality affect those of low socioeconomic status and marginalised populations. Members of these populations are typically more likely to be in casual employment.

While it is welcome news that some workplaces are offering paid annual leave to allow their workers to attend vaccination appointments, this only applies to those who are in a salaried, non-casual position. Those in casual employment are left wanting. Consequently, as COVID-19 vaccines become increasingly available, casual employees are left an impossible choice: go without pay to get vaccinated and protect the population or continue to work to support themselves and their families.

Alongside ensuring clear messaging of the risks and benefits associated with vaccination, we need to advocate for the removal of structural barriers that leave certain populations vulnerable. This may include advocating for incentives, such as paid leave, that encourage people in casual employment to get vaccinated. We need to ensure increased access to vaccination and perhaps offer the vaccine in particular workplaces, especially those with a high casual workforce. For further commentary, see the following:

Do I get time off work for my COVID shot? Can I take a sick day?

Paid vaccine leave would help vulnerable workers and cost less than future lockdowns, according to a new report

In moving forward, our job as public health professionals and advocates is not over. Whether we are addressing vaccine hesitancy or the structural barriers to accessing the vaccine, one thing is certain:

We need to lead by example and get vaccinated ourselves if we are able. 

Veronica Martinez Harris, Master of Public Health student, School of Public Health, The University of Queensland and Michelle I Jongenelis, Senior Research Fellow, Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne.