For over a decade, Heidi Larson, Professor of Anthropology, Risk and Decision Science at the London School of Hygiene & Tropical Medicine, has been leading global efforts to monitor public confidence in immunisation programmes. As COVID-19 vaccination programmes are rolled out across the EU, this is a key moment to build trust in countries and socio-economic groups with relatively low confidence in vaccines.
How did the Vaccine Confidence Project come about?
Heidi Larson: The idea formed whilst working at UNICEF between 2000-2005 where I was leading the communications strategy for new vaccines. I found myself doing more and more crisis communications because of drops in public confidence in vaccines.
This trend was worrying and I felt we really needed to understand what was going on. I went back to academia planning to focus my research on it, but I soon realised this was a much bigger issue than one individual can take on. I put together the proposal for the Vaccine Confidence Project and it was launched in January 2010 with seed money from The Bill and Melinda Gates Foundation. The research we have carried out over the past decade means we are well positioned to shift our focus to COVID-19 and anticipate some of the issues around COVID-19 vaccine confidence on a global scale.
We have a core team of 12 based in London and we are building a strong presence all over the world with research collaborations with the University of Antwerp (Belgium), the National University of Singapore, the University of Washington, Seattle (USA), and Africa Centres for Disease Control and Prevention (Africa CDC). Through our global network we are building local capacity to be more alert to emerging signals of drops in vaccine confidence and be better prepared.
What changes in vaccine confidence have you seen over the past decade?
Heidi Larson: Initially, when I tried to bring some attention to what seemed to be a growing amount of questioning and concerns around vaccines, public health colleagues felt that it was very much a fringe issue, not fact-based, and that we should keep our focus on positive messaging. However, in 2012-2013 after a number of countries started contacting WHO and UNICEF for help, there was a shift in the attitude of the global health and immunisation community and a recognition that there indeed was a growing problem. Between 2013-2015 we started to see initiatives to investigate vaccine hesitancy. This coincided with the launch of our Vaccine Confidence Index™ (VCI) as a tool for mapping confidence globally.
We recently published a study that maps our VCI data across 149 countries between 2015 and 2019. The general trend is that vaccine confidence is getting better, partly because there has been an increase in investment and attention to this issue. Encouragingly, there are signs that vaccine confidence is increasing in much of Europe, including France, which we identified as being the country with the lowest vaccine confidence in the world in 2015.
However, at the same time, we are also seeing more extreme, highly-organised activity against vaccines, and finding areas in which vaccine confidence is declining, such as francophone Africa. Because these sentiments are quite volatile – they can go up and down, we can’t afford to rest on our laurels.
What are you finding in regard to people’s attitude to COVID-19 measures and vaccines?
Heidi Larson: In the context of COVID-19, our ability to identify countries with sudden decreases in confidence, signalling where more trust building is needed, is particularly important.
One of the things we’ve learned over the years is that confidence in vaccines is associated with confidence in the government. When COVID-19 first hit, we shifted our attention to looking at how accepting (or not) people were to COVID-19 measures because we thought that would be an important predictor of confidence in a future vaccine. Since then, we have carried out more specific polling on vaccination intent.
There was a higher willingness to take a COVID-19 vaccine in June than in September 2020, but since then we have seen an increase possibly due to the high effectiveness of the vaccine and new waves of infection.
However, we are likely to encounter challenges in a few months as the pandemic wanes and people who do not perceive themselves at high risk of contracting the disease may be hesitant to get vaccinated. We should be using the time between now and then to engage with communities and groups that are less trusting to understand what the issues are and address them.
What are the main issues surrounding acceptance of the COVID-19 vaccines?
Heidi Larson: There will be some people who are not going to take it, no matter what. The issues are varied. Some people are concerned about the newness of the approach (mRNA vaccines) and safety. Millions of people have been vaccinated now, so if there were any common serious effects we would likely know by now.
Others won’t take a COVID-19 vaccine (or any other for that matter) because of ideological reasons or because they don’t think they need it. For example, young adults who don’t think they are vulnerable or at high risk of severe illness. There is also the continuing challenge of misinformation and disinformation. In a recent study, we investigated the impact of misinformation on people’s willingness to accept a COVID-19 vaccine and, in the UK, we found that exposure to misinformation triggered a decline in intention to vaccinate from 54% to 47.6% after exposure to misinformation.
What can be done to improve COVID-19 vaccine acceptance?
Heidi Larson: We need to make every effort to listen to people’s concerns. There are some concerns, such as whether the mRNA vaccine interferes with DNA, that we will be able to explain [it does not affect a person’s DNA] and offer assurance. Concerns related to mistrust in the motives of governments or global funders are harder to address. In those cases we should be actively engaging with communities trying to understand their issues on their terms and recruiting local champions.
In the US, the Black Coalition Against COVID-19 – a network of black doctors and community leaders – is bringing down the rates of people saying that they would not take a COVID-19 vaccine from 60% to 30% thanks to proactive engagement. You can change people’s minds, but it needs to involve people in the community who are trusted and respected.
What will be your next steps?
Heidi Larson: The part of our research that is growing the fastest is our digital analytics. We are working closely with social media platforms and engineering departments to look at ways to engage and understand public sentiment and trends over time and place. My latest book, Stuck. How Vaccine Rumors Start – and Why They Don’t Go Away, examines how rumours, anxieties and emotions can spread like ‘digital wildfires‘ disrupting vaccination efforts. The insights we are generating aim to inform policies and communication strategies, making them more relevant to people’s felt needs and concerns.
The principles of what we are doing can be relevant to a number of areas such as climate science and environmental work, which are facing denialism and the lack of public trust in science.
• State of Vaccine Confidence in the EU and the UK (2020)