VACCINE HESITANCY WILL INCREASE AS WE EXTEND BEYOND THE HIGH-RISK GROUPS, WRITES TERRY MAGUIRE

Medical scientists are more positive than they have been for months. If the science is right — and we trust it is — 21 days after 95 per cent of the most vulnerable have had their first Covid-19 vaccine, they should have 70 per cent protection against the virus and then there should be a sharp fall in the numbers hospitalised and ending up in ICU. Mission accomplished in protecting the NHS, and this should be happening mid-March.

The Covid-19 virus will of course still be with us and will continue to kill, but these numbers too will fall. As a society, we are now implicitly agreeing what represents an acceptable level of Covid-19 deaths and we must maturely negotiate this cost toward opening up our economy. There’s nothing unusual in this. In some years, the UK might have 20,000 additional deaths due to flu and we hardly blink an eye.

Vaccination will deliver a return to a more normal life so, where not contraindicated, everyone must take up the vaccine as full population cover, assuming we have sufficient vaccine, which will deliver the greatest reduction in risk. There is currently little resistance or hesitancy in uptake in the first vaccine cohorts. This positivity will of course not last. When we begin to work our way down from the highrisk groups — mainly the ‘Silent Generation’ who did as they were told — and we move through the Baby Boomers and start to vaccinate the Millennials and Generations X, it is likely vaccine resistance will become more pronounced as anti-vaxxers find more courage, and potentially more adherents, to publicly oppose this vaccination programme.

There are two main groups of concern: The anti-vaxxers and the vaccine hesitants. The anti-vaxxers are ideological in their view and mostly lost to reason and logic and if given room, will infect the vaccine hesitants; and those who have real and genuine concerns and just need clarification and reassurance. We need to act
at this time to actively disrupt the myths and conspiracies rather than, as is too often the case in public health, passively allow misinformation to be spread and cults to form. If misinformation is unchecked, we will find vaccine hesitants becoming acolytes of the anti-vaxxers and very soon we have a bigger public health problem than we should.

History shows us how this works and how, in more recent times, it is catalysed by social media. Already, we are seeing individuals in minor leadership roles posting messages on the dangers of the Covid-19 vaccines, which range from a way to insert microchips, a cause of infertility and more recently, from a Rabbi in Israel,
making us gay. My worry early on was that Donald Trump, someone who has anti-vaxxer credentials, might become the Anti-Vaxxerin-Chief but was delighted when he opted to take full credit for the US vaccine programme and is likely to keep to this line in his retirement.

A good first step would be for government to have a grown-up conversation with the public on vaccine safety

Andrew Wakefield, the discredited doctor and medical researcher, is the most famous anti-vaxxer of recent times. His story, told in a 2019 book by journalist John Deer (https://www.amazon.co.uk/ Doctor-Who-Fooled-World-Wakefields/ dp/191161780X), identifies an individual who craves publicity and adulation and, in spite of clear evidence and facts to the contrary, still maintains to his adoring fans that MMR is the cause of autism. It was relatively easy for Wakefield in the late 1990s to manipulate vulnerable parents desperate for answers to why their children developed autism. This complex, and for the parents, tragic story, shows how easily our minds can catch onto a belief and once inculcated, is almost impossible to change.

Human minds are not rational; rather, they are rationalising and this, of course, is the basis of Leon Festinger’s theory of cognitive dissonance, formulated in the 1950s (https://en.wikipedia.org/wiki/ Cognitive_dissonance). Once we believe, it’s very difficult to unbelieve and when the facts contradict our world view rather than change our minds, we employ strategies such as confirmation bias to keep to our original belief. The media played too great a part in highlighting Wakefield’s view and bringing it to a wider audience in early 2000.

Then when the fraud was unmasked, he skilfully assumed the victim role, which played well with his fans who
were not really interested in the science. We must not make this mistake again and certainly not with the Covid-19 vaccine. For those who attempt to defame any of the licensed vaccines, their claims should be brought into the light and robustly challenged.

A good first step would be for government to have a grownup conversation with the public on vaccine safety.
A safe vaccine is not a harmless vaccine, it never was, and it will never be but the facts are clear, millions are alive today because of vaccination programmes and many more lives will be saved by the vaccines which have just been licensed for Covid-19 and for that, along with the medical scientists, we should all be more positive.

Terry Maguire
Terry Maguire

Terry Maguire owns two pharmacies in Belfast. He is an honorary senior lecturer at the School of Pharmacy, Queen’s University of Belfast. His research interests include the contribution of community pharmacy to improving public health