Public health experts don’t have a surefire answer. And that worries them.
Britain is planning to launch a mass education campaign, appealing both to the population’s altruism and self-interest. “Influencers” will be deployed to tout the jab.
And so all eyes are on the 94-year-old queen.
One of the people who got the Pfizer shot first was Prue Leith, 80, a judge on the popular “Great British Bake Off” — or “Great British Baking Show” on American television. The BBC was there for the big moment. And after, Leith tweeted a photo of herself at her local doctor’s office asking, “Who wouldn’t want immunity from #Covid19 with a painless jab??”
Her post was quickly retweeted by Prime Minister Boris Johnson. “Great news Prue!” he exclaimed. “Wonderful to see so many in the UK getting vaccinated. Many thanks to the health workers who are working tirelessly to get this vaccine to people up and down the country.”
Other experts suspect there will need to be some carrots and sticks.
The British government has suggested that those who get tested for antibodies to the coronavirus might in future more easily attend sporting events or board airplanes. The government could pivot and insist instead on vaccinations, though at present Johnson and his scientific advisers say jabs will not be mandatory.
Countries may require travelers to show proof of coronavirus vaccination upon arrival. Many already demand polio or yellow fever vaccination. To make a pilgrimage to Mecca, Saudi Arabia requires vaccination against meningitis.
Employers may require workers to get vaccinated, too, especially in settings where social distancing is difficult, such as food processing plants or auto assembly lines. British businesses are currently seeking advice from the government on whether they can or should go beyond merely encouraging immunization.
Hospitals and nursing homes could insist that health-care workers and support staff are inoculated, as they require seasonal flu shots now.
British schools, alongside those in many countries, already require that students have their childhood vaccinations to attend classes. They could add coronavirus jabs to the list.
Governments could make vaccination mandatory for those who want social benefits, as Australia does. Prisoners could be required to take the jab.
A few experts in Britain have floated an incentive: paying people to get vaccinated.
Julian Savulescu, a philosophy professor at the University of Oxford, argues that given the risks or perceived risks of taking a novel-coronavirus vaccine, it would be “be practically and perhaps ethically problematic to introduce a mandatory policy, at least initially, when uncertainty around safety will be greater.”
“But paying people is not coercive,” he said. “It is simply an option. Take it or don’t.”
Savulescu said reliance on the altruism of the British public — or any nationality — may be overly optimistic. “The reality is that people aren’t angels. They need incentives and laws,” he said. “They need a nudge.”
The philosopher points out that the British government has so far spent $300 billion propping up the economy during the pandemic. He proposed: “A payment model could also be very cheap, compared with the alternatives.”
Health officials say broad vaccine uptake is crucial to stopping the pandemic. Infectious-disease experts say that population-wide, or herd, immunity may require at least 70 percent of people to be protected, either by past infection or vaccination.
It’s not the small, zealous group of anti-vaxxers that most concerns public health officials. It’s the “vaccine-hesitant,” those who are concerned the testing and approval was rushed; those who note that messenger RNA vaccines are new and are concerned about long-term side effects; those who’d prefer to wait and see.
Scott Anderson, 29, a civil engineer from Inverness, is among those not planning to get the vaccine.
“I’m not anti-vaxx in any way, shape or form. I’ve had many vaccines. It’s just this one is rushed, in my opinion. It’s not a conspiracy theory, it’s genuine concerns,” he said, noting that “you still can’t truly know long-term effects 10 years down the line.”
Anderson is worried about the talk of people needing “vaccine passports” if they want to travel to see family or go to soccer matches.
He launched a petition, titled “Prevent any restrictions on those who refuse a covid-19 vaccination,” which attracted over 320,000 signatures on the British Parliament’s website and was debated by lawmakers on Monday.
Surveys show that the vaccine-hesitant are a sizable minority, both in Britain and around the world, for both the coronavirus vaccines and others to fight measles and mumps.
Daniel Freeman, a professor of clinical psychology at the University of Oxford, and his colleagues conducted extensive surveys of 5,114 adults in Britain, representative of the population by age, gender, ethnicity, income and religion.
The good news for public health officials: 72 percent were willing to be vaccinated. But 16 percent were very unsure and 12 percent were likely to delay or avoid getting the vaccine.
One in 5 people thought vaccine safety and efficacy data could be fabricated. One in 20 described themselves as anti-vaccination for covid-19.
Freeman said vaccine hesitancy was observed across all of society, rich and poor, men and women.
“If we are seeing 25 percent willing to sit on the fence, we may be getting close to a tipping point when suspicion of vaccines becomes mainstream,” Freeman said.
Medical experts are appearing on morning news programs and at news conferences in an attempt to reassure the public.
Jonathan Van-Tam, England’s deputy chief medical officer, said he’s told his mum, who is in her late 70s, to “make sure when you’re called, you’re ready.”
The next stage in the publicity campaign could include high-profile figures. The royals, potentially, but also soccer stars and others.
Stephen Mawdsley, a historian who has looked at the role of Elvis Presley in encouraging teenagers to get polio vaccines, said officials today could likewise “identify groups that are hesitant and then say, ‘Let’s work with you, let’s understand your concerns, let’s educate you.’ ”
He added that it would be “difficult to find a universal celebrity like Elvis, so you’d need to identify groups that are concerned and find figures that resonate with each group.”
In the United States, three former presidents — Barack Obama, George W. Bush and Bill Clinton — have all said they would get a shot publicly. Scottish leader Nicola Sturgeon said she’d do it on live television.
Johnson’s spokeswoman, Allegra Stratton, told reporters that the prime minister — known for his showmanship — might consider it as well.
“We all know the character of the prime minister. I don’t think it would be something that he would rule out,” she said.
“But what we also know is that he wouldn’t want to take a jab that should be for somebody who is extremely vulnerable, clinically vulnerable, and who should be getting it before him.”
He also may feel less urgency, since he already had the virus in the spring and reinfection has been rare.
It could be that the most effective figures aren’t celebrities or royals or politicians, but everyday people, like Martin Kenyon, a 91-year-old Briton who spoke to CNN shortly after he got his shot.
“It didn’t hurt at all,” Kenyon said. “I hope I’m not going to have the bloody bug now. I don’t intend to have it, because I have granddaughters and I want to live a long time to enjoy their lives.”
The interview went viral.
Richard Horton, editor of the Lancet, the prestigious British medical journal, told The Washington Post there was a large group of concerned citizens who want to do the right thing, “but they’re scared. They see the debate and don’t fully know what to make of it.”
He said it wasn’t helpful to call anti-vaxxers “nuts,” as the British prime minister has.
To win them over, “We need to be as transparent and honest as possible about the evidence. We need to put every vaccine through the correct safety and effectiveness testing. We don’t cut corners, and we listen to what people are saying. We don’t call them crazy or nuts or any other epithet. Our task should be to build confidence by giving information and answering legitimate questions,” he said.
Vaccine hesitancy is nothing new.
In the 19th century, smallpox was killing hundreds of thousands across Europe, and was the No. 1 cause of death. And yet there was strong resistance to the first vaccines, prompting the British government to make it mandatory, punishable by fines and jail time.
Kent Woods, a professor at the University of Leicester and former head of the Medicines and Healthcare products Regulatory Agency, said misinformation and scare stories can travel fast and “are themselves a public health problem.”
“It’s really important, too, that we get across the message that standing back from vaccinations is not really an acceptable option,” he said.
Woods said he worries that most people have been shielded from the scenes of covid-19 patients on ventilators in crowded ICUs. “There’s the problem that for most vaccines, because they are so good and so effective, people just don’t see the disease that the vaccines are being used to prevent. Nobody is seeing whooping cough or polio or tetanus and, therefore, we tend to minimize the consequences of not having the vaccine,” he said.
Penny Ward, a pharmaceutical researcher at King’s College London, said officials weren’t yet blitzing the population with a PR campaign, in part because of the supply. In the first weeks, Britain will have only enough Pfizer-BioNTech jabs to reach 400,000 people.
“It’s a balancing act,” Ward said. “On one hand, you want to send reassuring notes. On the other, you don’t want people queuing up at vaccine centers when you don’t have enough stock.”
But she said authorities would be planning for that day. “I know my mother would do anything the queen did,” she said.