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The big threat to the vaccine rollout

Sarah Jane Goode, a nurse at Aneurin Bevan University Health Board Trust, at a vaccine hub in Newbridge, Wales - Credit: Getty Images

As Britain’s vaccine rollout gets further through the population, it’s challenges are going to mount, explains JAMES BALL.

In this long, grey, lockdown winter there is only one real hope of a sustainable way to open up during the spring: the mass rollout of coronavirus vaccines.

The comforting fact is there is a lot of good news on this front. We have multiple effective vaccines against a virus no-one knew existed just 15 months ago – an extraordinary scientific achievement.

The UK has plenty of orders of inoculations. And the early rollout is going extraordinarily well, with heartening pictures of older adults getting their jabs going viral on social networks daily.

It’s a good start, but it will be essential to keep this momentum going – and if at all possible to accelerate it – if we are to return to anything resembling normality for this summer. The next steps though, are set to be more difficult: we will need around three quarters of people (or more) to be vaccinated to get to herd immunity – and not everyone is eager to get their jab.

The UK, like most countries, has a small hardcore of dedicated anti-vaccine campaigners, made up of out-and-out conspiracy theorists who believe vaccines are some tool for sterilisation, surveillance or population control, and some alternative medicine believers taken in by alarmist and false information on the risks of vaccines – much of it fuelled by the false MMR/autism stories of the 2000s.

That group on its own would not be too much to worry about, but there is a much larger group of people who aren’t outright anti-vaxxers, but who are worried about the risks of a new vaccine, or are mistrustful of the government or medical profession more widely (sometimes stemming from justified past behaviours and inequalities).

Generally – and perhaps unsurprisingly – the groups most at risk of dying from coronavirus have the lowest rates of vaccine hesitancy: if you’re afraid of Covid-19 itself, you’re less likely to be worried about the vaccine. So vaccine hesitancy isn’t much of a problem yet (at least not across the board) but that is likely to change.

Survey evidence suggests younger adults have far higher rates of vaccine hesitancy, peaking in general among women in their 30s. This may, in part, be connected to advice suggesting women shouldn’t have the vaccine while pregnant unless they are in a high risk group – advice given not because any signs of complications have been found, but because trials generally exclude pregnant women and vaccines are generally timed so as not to need to vaccinate women while pregnant. BAME people also generally show higher reluctance to be vaccinated.

Widespread scepticism has the potential to be a real problem: not only do we need herd immunity to make sure the vaccine is as effective as it can be, black and Asian women also make up a disproportionate number of nursing and care staff, with anecdotal evidence suggesting take-up of the vaccine in those eligible groups has been slower.

Even among the ultra-high risk 80+ population, vaccination rates between different ethnic groups vary dramatically. A study carried out on behalf of NHS England on 961,000 over-80s found that by the middle of January more than 40% of white over-80s had received their first jabs. Among South Asian and mixed-race in that same cohort, the rate dropped to under 30%, and only one in five black over-80s had been vaccinated.

There is likely to be far more than just one reason why there is such a disparity in rates: it may reflect different populations being concentrated in different regions of the UK, it might reflect who is and isn’t in care homes, and numerous other reasons – but it is very likely that vaccine hesitancy is among these disparities, and that they could become even more pronounced among younger adults.

This means that both government and wider society need serious and careful action to make sure the public in general – and groups with particular concerns about the vaccine – feel they can trust the process.

Some of that is already in place: a cross-party group of politicians produced an online video endorsing the vaccine, London mayor Sadiq Khan and vaccine minister Nadhim Zahawi did a joint op-ed, and various BAME celebrities have been recruited to endorse the vaccine rollout.

The task is made much harder, though, by the huge volumes of misinformation about the vaccine allowed to spread unchecked online – despite promises by Facebook, Google and others to take action.

Research by the Bureau of Investigative Journalism (disclosure: where I work as an editor) found more than 400 pages reaching almost 45 million followers that were spreading misleading information relating to coronavirus or vaccinations – while making use of tools provided by Facebook to make money.

These included ‘donate’ buttons, shop fronts and other methods of making cash from posts and videos, many of which are supposed to pass a higher standard of verification than general Facebook posts.

The pages – which were only a snapshot of material and likely represent just a small fraction of what is on the network – included speculation coronavirus was “bio-terrorism”, claims that CEOs got a “heads up” the crisis was coming, references to “plandemic” conspiracy theories, alarmist and baseless claims about the safety of vaccines and more.

When informed by the Bureau that this material was on their site, Facebook removed some pages but allowed most to remain, claiming they did not violate their policies.

Misinformation has plagued every step of the response to coronavirus. Theories have spread online about the effectiveness of masks, the danger of lockdown, the supposed false positivity rate of PCR tests, the idea that the terrible fatality rates are explained by people who die with Covid rather than of it, and numerous other policy discussions.

Such posts and messages keep spreading long after they were contradicted: for example, complaining about a “casedemic” – a supposed situation where a rise in coronavirus cases is just the result of increased testing, rather than more sick people – is absolutely nonsensical when huge numbers of people are hospitalised and many are dying – especially when both hospitalisation and death counts in summer were low. But once messages catch, even blatant evidence disproving the theory does not stop it.

Such messaging has ended up influencing and muddying official responses to the crisis, not least because several prominent far-left or conservative commentators have lapped it up and a sizeable minority of backbench MPs have come to believe at least some of it. That has helped make government slow and indecisive exactly when they need to act quickly.

The government’s perennial ‘a day late and a dollar short’ response to coronavirus is one effect of widely spreading misinformation. Damage to the rollout of the vaccine could easily be next – at worst making it impossible to convince enough people to take it, or else slowing down the rollout because millions of people need extra persuasion to get a jab.

This leaves the government on the horns of an incredibly difficult dilemma: for all but a few key professions (such as medical jobs), compulsory vaccination seems an incredibly invasive policy which could undermine basic human rights. Introducing vaccination passports that would only allow people to access certain services if they’d had the jab is possible, but divisive and problematic – especially when scarce doses of vaccine are rationed by need.

That leaves persuading people to take the vaccine voluntarily for the sake of their friends, families and neighbours as the only remaining option. Unless the tech giants can be made to actually take action against misinformation, though, that’s a task that will take a lot more than a few celebrities and a YouTube clip with a few politicians in it.

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