Since the COVID-19 pandemic first hit Wuhan, China, in December 2019, scientists have been racing against time to develop and test novel vaccines to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The speed of scientific discovery related to COVID-19 is unprecedented and even the most ardent optimist might not have expected to have a highly effective vaccine against a new virus less than a year after its genome was sequenced.
As positive results emerge at last, we pose the question: Are Pakistanis ready to roll up their sleeves and give the shots a shot? Somewhere between 60 and 90 percent of adults and children must be vaccinated or have antibodies resulting from infection in order to arrive at the safe harbour known as herd immunity, where the whole community is protected. Identifying, understanding and addressing vaccine acceptance and hesitance/resistance is therefore a potentially important step to ensure the rapid and requisite uptake of an eventual vaccine rollout.
Existing literature points towards a number of psychological dispositions that construct personality, emotion, trust, beliefs, and socio-political attitudes that differentiate those who are accepting of a COVID-19 vaccine from those who are hesitant. For example, altruistic beliefs, personality traits, locus of control, and cognitive reflection have each been shown, in some way, to influence vaccine acceptance/hesitancy. Vaccine hesitancy has also been associated with conspiratorial, religious, and paranoid beliefs while mistrust of authoritative members of society, such as government officials, scientists and healthcare professionals, has also been linked to negative attitudes towards vaccinations.
In the context of Pakistan, the joy that has greeted the shots’ arrival is already being muted by worries. Punjab Health Minister Dr Yasmin Rashid recently advised people to vaccinate at their “own risk”, saying there were side effects related to the COVID-19 vaccine, which she also claimed caused “deaths in some countries.” Such careless statements by public officials generate fear, confusion, and mistrust—amplifying the belief that a vaccine may be unnecessary, ineffective, or unsafe (and perhaps all three). Already, powerful anti-western sentiments around vaccinations are abundant, powered by conspiracy theories advocated by intransigent religious groups and spread across social media. The mistrust goes deep, with health workers seen as foreign agents and the ingredients going into vaccines being questioned. Consider the challenges faced by front line health workers in vaccinating against polio, for instance.
Although the finishing line seems to be in sight, there is still much difficult terrain to cross. To build confidence in vaccination, we urge the government to take targeted actions and communication strategies that speak to the specific concerns of each group to move them toward accepting the new vaccine. As we work to strengthen the supply-side challenges to procuring and deploying vaccines, we would do well not to ignore the demand-side. In this regard, we suggest a few possible policy interventions that can address COVID vaccine hesitancy and increased take-up.
First, trust is a fundamental component of the successful uptake of a COVID-19 vaccine. To build confidence in vaccination, government, scientists and medical professionals must engage with open discussion, ensure transparency and publish data. This kind of transparency and the option for the open airing of concerns about data is the need of the hour.
Second, the vaccine’s level of effectiveness, the time needed for protection and the importance of population-wide coverage to achieve community immunity needs to be clearly and consistently communicated by government officials. Credible and culturally informed health communication is vital in influencing positive health behaviours. This includes preparing the leaders of civic and religious organisations that are respected within various divisions of society and local communities, as well as the private sector, for a mass vaccination programme with credible spokespeople, correct information, technological support, and local engagement.
Third, public health messaging targeted at vaccine-hesitant people should be clear, direct, repeated, and positively orientated. ‘Traditional’ sources (i.e. newspapers, television, and radio) along with social media have the potential to allay vaccine concerns and improve inoculation rates. Policymakers should aim for imaginative and compelling communication, including storytelling, appeals to empathy and altruism, as well as memes to convey key information in engaging ways. This requires context-specific assessment to identify communication preferences and language needs that would also help in combating misinformation. Knowledge of the psychological and sociodemographic profiles of vaccine-hesitant individuals, combined with an understanding of what information sources they access and trust can deliver significant information for the government to successfully design and deliver public health messages.
Fourth, elected representatives—at the provincial and federal level—should reach out and speak to their constituents. They should address questions about the vaccines and dispense their constitutional obligation.
Finally, while this might be far-fetched, it would serve the national cause if the government were to reach across the aisle and get the Opposition to support the vaccine drive. This would be a win-win for Pakistan—it would display much needed political maturity and also revive the citizenry’s confidence in Parliament, as the mudslinging would temporarily have to halt.
With vaccination of people aged 65 years and above to begin from March, Pakistan should aim to introduce policy interventions that draw on “behavioural insights” that address the causes of hesitancy and ensure vaccine registration for as many people as possible.
Dr Izza Aftab and Sadaf Akbar
Dr Izza Aftab is the Chairperson of the Economics Department at Information Technology University, Lahore. She has a PhD in Economics from The New School University. She tweets @izzaaftab.
