“I’m just not keen to be a subject in a trial. They haven’t had the time to do long-term studies so of course there’s zero long-term studies, and that’s a concern in itself. I’m not comfortable with being a subject in essentially the third phase of human trials, that’s what we are part of now.”
Sarah* doesn’t consider herself anti-vax. Before the COVID-19 pandemic, she claims she didn’t have strong feelings about vaccines either way. But the way these COVID-19 vaccines have been developed, tested, and trialled has given her serious concerns.
She says the only reason she would get a vaccine is if the government forced her into it. Outside of that, she says she would wait between three and five years before feeling that the long-term effects had been better understood.
Globally, over three million people have now died from the coronavirus while 930 million vaccines have been administered. However, across Australia and the would, vaccine hesitancy is on the rise. 11% of Aussies are currently reporting that they would not get the vaccine while a further 24% say they’re not sure if they would get it. That’s 35% of the country who might not get a vaccine – some 8.3 million people.
For herd immunity to be achieved with COVID-19 – that’s the number of people vaccinated that would stop the spread of the virus within society – an estimated 60 – 70% of people need to be vaccinated. Vaccine hesitancy could be a serious issue with getting back to pre-pandemic normality. That’s if such a thing even exists.
We spoke with Sarah to find out more about why people might be hesitant to get a COVID-19 vaccine and what can be done about it.
Why Would Anyone Turn the Vaccine Down?
Like many, Sarah has had negative experiences when it comes to the medical industry. Her mother has had long-term chronic health conditions and Sarah has seen her struggle to get accurate diagnoses, put on serious medical treatments that turned out to be inappropriate, and believes that there is much missed when medical professionals deal with patients.
Despite that, she’s had vaccines in the past and would get them again – just not these ones.
“I’m not anti-other vaccines,” she explains, “I’m just hesitant to put something into my body that hasn’t been trialled and tested.
“I mean, I come from a science background, I did chemistry at university until PhD level. One of the things that really stuck with me was when we got taught about thalidomide.
I am aware that things can go wrong, that things can be missed.”
Thalidomide is a medication used to treat immune disorders that was famously given to pregnant women in the late 1950s to help with morning sickness. As a result of improper testing, 10,000 women experienced complications in pregnancies which led to many children dying or being born with severe defects.
It’s a case study brought up a lot in anti-vax and vaccine-hesitant circles as a prime example of how badly things can go wrong.
“The issue was when I started to research about these new like novel technology vaccines, particularly Pfizer’s and Moderna’s, which involves inserting mRNA.”
“I’m just a bit worried with this new novel mechanism, having never been done in humans before. This is not the same thing as other vaccines. It does not produce the same immune response in your body. It’s a completely different thing.”
mRNA is a string of genetic code that gives instructions to cells. The vaccines using mRNA to generate an immune response, namely the Moderna and Pfizer vaccines, basically teach your cells how to create defences against the spike-proteins of the coronavirus, thereby stopping it from infecting your cells. They don’t use parts of the original virus as most vaccines do.
The worry for some is that it affects DNA, potentially having unknown genetic or immune effects later down the line. The Australian government are aware of the claim and have clarified the issue, stating that this is not the case.
Unfortunately, government websites are not considered reliable sources of information for those who believe that something sinister is going on and that experts with contrary views are being silenced.
For those like Sarah, the vaccines themselves are tainted by the coercion that they feel to get them. Starting on a sceptical footing, bolstered by accidents and difficulties on the path to vaccine roll-outs, the idea of injecting a foreign body that they believe is not properly understood is a frightening concept.
“I think everything should be questioned,” Sarah says.
“If you’re going to roll something out across the whole world’s population, it needs to be looked at so hard and questioned. Not something that’s rushed.”
Feeling the Pressure
Pressure to get a vaccine might not seem like a big factor here in Australia, but in the UK and the US, where the vaccine roll-out is well underway, social media accounts are reporting the difficulties that are being experienced by those who don’t want one.
Instagram accounts – which we won’t link to here – with upwards of 35,000 followers, drive the fear and scepticism, even if the information isn’t always clear. A key part of the narrative is that the truth about COVID is being silenced and that the vaccines are more harmful than the media is reporting.
“I’m also part of like private Facebook groups for victims of COVID-19 vaccines. There are posts every day in these groups of distressed people, with things happening to their family members or their friends.”
Sarah admits the information is anecdotal – and impossible to verify – but it adds to the sense of unease that something is not right when these incidents go unreported. When they are reported, however, they further add to the narrative. It’s something of a self-fulfilling prophecy when the absence of evidence is also considered evidence.
“I just see adverts for vaccines everywhere. There are interviews, there are celebrities trying to push it. I don’t see anything in the news that talks about vitamins or just natural things that help your immune system.”
“All this fear-mongering and, from what I’ve read, the vaccine doesn’t even stop transmission. If it doesn’t stop transmission then isn’t it my prerogative whether I want to risk getting it?
“As a young person, if I’m not going to hurt anyone else in my decision, then why is it being forced upon me? It seems that’s the way we’re going now with COVID passports which is just terrifying and will cause a two-tier system in society.”
With the vast majority of people who have died from COVID being in the older age bracket, having pre-existing conditions, or co-morbidities like obesity, young and relatively fit people like Sarah wonder what the purpose of the vaccine is.
The question around transmission is unclear. While there are reports from AstraZeneca that their vaccine does stop transmission, the others have no definitive answers. While stopping the spread is crucial, the main purpose of vaccines is to stop you getting sick or dying. Stopping the virus from entering your body at all is another challenge altogether, and one that might not currently be possible.
The answer is that we don’t know definitively whether or not the vaccines do prevent the spread. We do know however that in places with high rates of vaccination, the pandemic appears to be winding down. Israel has completely scrapped its mask mandate as almost the whole population has now been vaccinated. The UK, having now given 44 million people their first shot, has seen a rapid decline in the death rate of elderly populations first in line for the vaccine and most at risk.
For Sarah, it’s the impossibility of rational debate or conversation about these topics that have frustrated her the most.
“I don’t like the way I’m being treated because I’m hesitant about this vaccine, like I’m a nut job. I don’t think I’m like completely crazy just for questioning things.”
“I don’t believe in QAnon,” Sarah says, and she thinks the idea of Bill gates putting microchips in the vaccines is “hilarious”, but does consider getting the jab a risk she’s not willing to take. Having that decision over her own bodily autonomy threatened is what seems wrong.
“I’m not going to risk getting a potential autoimmune disease for the rest of my life for the convenience of going to the pub. I’m just a very open person. I want people to be able to feel comfortable enough to talk about anything they want to talk about without being attacked.”
What Can Be Done About It?
The concerns are not completely invalid and governments and health bodies around the world will have to deal with them on a personal, rational, individual level if they hope to increase the rate of vaccinations.
Professor Mary-Louise McLaws is an epidemiologist and expert in infectious diseases control. She is a member of the World Health Organization’s Health Emergencies Program Experts Advisory Panel for Infection Prevention and Control Preparedness, Readiness and Response to COVID-19 and member of the NSW Clinical Excellence Commission COVID Infection Prevention and Control taskforce.
“It’s quite natural for people to be a little hesitant,” McLaws says, “And then they come on board.”
Through her work with patient safety, she understands that society is structured into groups who tend to follow each other when it comes to social norms.
“There are innovators, then there are early adopters because of the innovator, then there are later adopters because the early adopters have shown them it’s not life-threatening or it’s a good idea or it’s not going to cost them money, and then you have those that are just never going to budge.”
McLaws believes that once we start seeing large-scale roll-out of the vaccine, those in the “maybe not” category or the “late adopters”, will generally come around. That would leave around 10% of the the population in the “no” category, enough to achieve herd immunity if the rest of the population are vaccinated. And that’s if they adamantly refuse to change their minds, which not all will.
“Rather than bully them into it, you either help them into it by showing them the benefits or you give them an alternative, and that alternative is rapid testing.”
The reality of vaccine passports is uncertain but it is being considered for international travel. In the UK, there has been huge debate around the concept as several European countries look to implement them, most likely for international travel, but they could also be used to stop people entering venues and other spaces. This is the fear of the “two-tier” society that Sarah spoke about. Rapid testing could be a good solution to vaccine transmission without a vaccine.
As to the prevalence of “conspiracy theories” around vaccines and the pandemic, McLaws believes it’s up to the government to combat these ideas with greater transparency and rigour.
“Australia is fairly transparent, however, there needs to be much more transparency when it comes to data sharing,” she explains. “One way to get around conspiracy theories is for governments to show overtly what they’ve got and what’s happening. It really does help to build confidence and they’ve got nothing to hide.”
When it comes to taking a vaccine, it’s about weighing up the risks. You are much more likely to suffer complications and death from COVID-19 than you are from a vaccine. For a healthy young person, the risk of COVID complications is much lower. Add that to the fact that, in Australia, you are extremely unlikely at the present moment to catch COVID, and the risks of the vaccine looks more pronounced on balance.
That’s why the government has decided not to give the AstraZeneca vaccine to those under the age of 50. Risk mitigation and comparison is baked into our strategy and evolving as we learn more. While it may take longer to have the bulk of the population vaccinated because of this decision, our relatively safe position allows us to wait and do things with a higher degree of risk aversion than other countries.
“Australians are very good at understanding risk,” McLaws says. “You get into the ocean, this is the risk of a blue bottle, this is what you do when you have it. This is the risk of shark attack and this is how we’ve tried to reduce it. So, talk to them like adults, Australians that live with risk all the time.”
Ultimately for McLaws, the concern around vaccine hesitancy is overblown and she does not believe that those currently worried about the vaccine will have a big impact on the roll-out once it gets going.
“I don’t think that we should be focusing on them. We’re giving them far too much oxygen by focusing on the ‘what if?’. What we should be doing is focusing on the positive and that is Australians are so ready to be vaccinated that they’re ringing up their GPS and hassling them about when can they get vaccinated. I mean, that is just stunning.”
“Australians are not perfect in public health, but the way they’ve responded to this outbreak is just remarkable.”
As our vaccine strategy evolves and develops based on the new information that presents itself, including the alarming rise of vaccine hesitancy, state bodies, NGOs and public health officials will step in to assess the risk and assuage fears. That means giving people clear information about their concerns in a manner that is open and can be trusted.
People like Sarah may never be moved to get the vaccine and the 8.3 million of us with concerns about them should not immediately be written off as conspiracy theorists. Instead, they must be provided with the information they need so as to avoid feeling coerced, marginalised, and isolated. It’s a huge problem, but not one that we are unable to solve.
*Name has been changed to protect identity.