In a first edition of Edward Jenner’s 1798 book Vaccination Against Smallpox, where the English physician described the science behind the vaccine that would eventually eradicate the disease, a sceptical reader had scrawled, “Bah Humbug!!”
Vaccine hesitancy is nothing new. It predates the internet’s conspiracy-amplifying powers. And it certainly predates the technical, regulatory and political blunders that have undermined confidence in the Oxford/AstraZeneca Covid-19 vaccine in Europe and elsewhere. Mistrust more than misunderstanding stokes vaccine fear. The idea that confidence can be restored through “education” misses what we all know about trust: it is hard to gain and easy to lose.
The rollout of the AstraZeneca jab has appeared designed to shake faith in what is, almost certainly, an excellent vaccine. That is a calamity, especially for the developing world where — cheap, scaleable and easy to store — it was expected to be a global workhorse.
Cameroon and the Democratic Republic of Congo suspended its rollout after European governments raised the possibility of a link with rare blood clots. In Nigeria, politicians who were to receive doses in front of television cameras backed out. If the public also loses faith there will be little to fall back on, warns Dr Ayoade Alakija, co-chair of the Africa Vaccine Delivery Alliance, which is co-ordinating the distribution.
AstraZeneca bears much of the responsibility for the situation. Mistakes in the way it has conducted trials and presented data have raised the suspicion of regulators in Europe and the US. Anthony Fauci, the US president’s chief medical adviser, called its fumbled presentation an “unforced error” that undermined confidence.
Politicians are guilty too. In February, without any evidence, French president Emmanuel Macron declared the AstraZeneca vaccine was “almost ineffective” in the over-65s. Then France and several other European countries put rollouts on hold because of concerns about possible side-effects. Finally, France reversed its earlier position and authorised the vaccine for use only in the over-55s.
It is hardly surprising that confidence has nosedived. A YouGov poll this week showed that 61 per cent of French people considered the jab unsafe. In Poland, where Covid-19 infection rates are surging, fewer than half of people were turning up for their vaccination appointments. In Ethiopia, people were asking, if the Europeans were too scared to get the AstraZeneca jab, why should they have it?
In her book Stuck, Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, argues for an anthropological approach to combat fears that does not treat vaccine sceptics as unscientific idiots. Instead, rumours should be seen as what she calls “collective problem solving”.
Anti-vaccine movements sprang up in the 1850s, soon after Britain made smallpox vaccination mandatory. It took nearly 200 years from Jenner’s invention before, in 1979, smallpox was finally eradicated. In the words of Daniel Salmon of Johns Hopkins Bloomberg School of Public Health, vaccinations, not vaccines, save lives.
Vaccines are unlike most medicines, which are given to a select group of sick people who accept that the benefits are likely to outweigh the risk of their illness. Vaccinations, by contrast, are administered to healthy people in massive numbers to combat hypothetical risk.
They are also social, an intravenous equivalent of fluoridated water. People are vaccinated not only to protect themselves but to protect others as well. A healthy 20-year-old gets a Covid jab at least partly to protect more vulnerable members of society. A healthy 20-year-old in Ghana, particularly if he regards Covid-19 as primarily a rich-country disease, might wonder who he is getting vaccinated for.
Suspicion of vaccines is often a proxy for lack of trust in government, a profit-driven pharmaceutical industry or a scientific motive. It does not help that governments can be untrustworthy, that pharma companies are sometimes rapacious and that scientists have occasionally conducted unethical experiments. In badly run countries, where people are not used to receiving much from government, the fact that vaccines are free can cause suspicion.
It will be an uphill battle to restore faith in the AstraZeneca vaccine, and must be fought hardest in poorer countries, where the vaccine is needed most. This should have been a glory moment for AstraZeneca, which alone is offering its vaccine at cost. Instead, a jab that is safe and effective is fighting for its life.
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