I love a proverb. There is a reason that they survive as they do. And one of the oldest in the English language is “you can lead a horse to water but you can’t make him drink”. And this particular saying could not be more apt for our times. Because, indeed, we cannot force people to drink, or accept a Covid-19 vaccine. With the first vaccination due to be given in Northern Ireland on Tuesday, our focus is firmly shifting from vaccines to vaccinations.
There will be those who say we can and should mandate vaccination. They may even be loud voices in the coming debate. Where people feel threatened, as they have done by Covid, they are likely to resort to these more authoritarian solutions. But mandatory vaccination is not the answer. The New Zealand Medical Association found that though mandatory vaccination programmes may result in slightly more vaccinations, they didn’t eradicate disease and they came at a high social cost. In particular, mandatory programmes often marginalise groups already on the periphery of society giving rise to disease hotspots that are hard to locate and eradicate.
We need to think about two issues as we proceed. The practical barriers and the psychological ones. Practical barriers to vaccine uptake will include any cost associated with it, and the practical difficulties people encounter making it to vaccination centres. Because vaccination requires a double dose, a family of two adults and three children will have 10 visits to manage. That is plenty of logistical and monetary effort in these arrangements for the average, busy family with multiple demands on their time.
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Psychological barriers
And there will also be psychological barriers. People will have safety concerns. Some are likely to be less enthusiastic than others about getting the jab. The decision on whether to accept a vaccination is profoundly about trust. Most of us, despite our newfound expertise on all things pandemic, do not understand the finer elements of the science behind vaccinations. Most of us don’t have the time or the skills to read and digest the research ourselves. We try to make sensible choices and mostly we do this by trusting in parties such as the World Health Organisation, medics or scientists.
But there are those who have limited confidence in the health system and those who may profoundly mistrust new medical offerings, medicine, pharma or the healthcare system. Even a cursory search of history offers up problematic vaccination programmes. And we don’t have to look hard for failings in our pharma or healthcare system. So concerns around safety are reasonable and they are likely to be amplified in groups that feel they have not been served well by the system in the past.
How do we counter any emerging mistrust? First we offer people comprehensive and comprehensible information about the efficacy of the vaccine. Uncertainty and confusion about results as appeared to occur with regard to the results of the AztraZenaca Oxford vaccine are for example not helpful. It is really essential that a narrative that illustrates the process to demonstrate the value of the vaccine, warts and all, is available to everyone.
Collective approach
If the Covid crisis has taught us anything, it has taught us that health behaviour is shaped by both individual and collective forces. Health campaigns have emphasised the importance of what we each do to protect ourselves, but the collective national response has been equally important. Restrictions on restaurants, pubs, visiting others’ homes, travelling beyond 5km and our county and offering education online have facilitated a systemic and collective approach to flattening the curve.
A community-led support programme could serve a second purpose: a horse led to water is far more likely to drink in the company of his friends
Rather than trying to pressgang people into taking a vaccine, we need to harness collective forces that will improve uptake of the vaccine. We need to remove the monetary costs to vaccination. We need to support people with their own logistics so that they can make vaccination appointments. Particular support needs to be in place for example for those who manage the care of others, have no access to personal transport or are geographically isolated. Perhaps it is time for another community-led initiative to support those needing to make multiple appointments?
And winning hearts and minds is as important as these logistics. To be effective, vaccination programmes need a minimum proportion of the population to engage to achieve so-called herd immunity. So we need lots of people to get past any hesitancy they feel. As the programme rolls out, individuals’ vaccination news, posts and pictures will provide a strong normative sense that vaccination is the thing to do. Those our own age and gender, in our own network, or those we trust implicitly are most likely to influence the decision to vaccinate. And so a community-led support programme could serve a second purpose: a horse led to water is far more likely to drink in the company of his friends.
Orla Muldoon is professor of psychology at University of Limerick