Never mind what antivaxxers say — just watch what they do
Will people actually get vaccinated against Covid-19? The city where I live, Paris, currently a pit of grey misery, hopes to start vaccinating the over-65s and other vulnerable groups in January. That is, if people will accept the vaccine. Scarily, 43-50 per cent of the French say in recent polls that they will probably or certainly refuse it. Many believe Big Pharma is in league with Emmanuel Macron to profit from a dangerous vaccine.
France was the most vaccine-sceptical of 140 countries surveyed by the Wellcome Trust in 2018. But “vaccine hesitancy” has been growing across the developed world. The proportion of self-avowed Covid-19 vaccine refuseniks in the US is similar to France. (People in poorer countries, who have often seen loved ones die of infectious disease, tend to wish for more access to vaccines.)
Antivax talk is worrying. However, it is only talk. Social media has made this the wordiest era in history. Sharing conspiracy theories online is excitingly subversive, making people feel they have taken the “red pill” and seen the truth. More telling, though, is their behaviour. In real life, when things get serious, almost everyone chooses vaccination. “If Covid-19 vaccines are found to be efficacious and safe and widely available, my guess is that a very large proportion of people will ultimately take them,” says Vish Viswanath of Harvard’s School of Public Health.
Even French behaviour is reassuring. Vaccination rates here have been rising: 98.6 per cent of babies born in early 2018 received the “hexavalent” vaccine that protects against six illnesses, including hepatitis B and tetanus. True, it’s compulsory, but parents still have to bring in their kids. Even in the US, where parents can more easily refuse vaccinations, only about 7 per cent or fewer adamantly oppose them, depending on the vaccine, says Viswanath. He adds: “This small group gets a disproportionate share of attention.”
There is slippage in some countries: Britons’ take-up of the MMR vaccine for children has fallen for five years running. But most people only refuse vaccines when refusal feels low-cost. Paradoxically, the measles vaccine worked so well that parents grew blasé about the disease. And since almost all other children get vaccinated, unvaccinated kids can usually freeride on herd immunity, except in places such as Hackney in London where antivaxxers cluster and epidemics erupt. Even then, there were no reported deaths from measles in Britain (and only one in western Europe) between July 2019 and June 2020.
Most American adults don’t get the flu jab but, again, refusal is low-cost: the jab is only about 50 per cent effective, and flu is very rarely lethal. Similarly, many Republicans felt that refusing masks was low-risk, because health authorities said wearing one mostly protected other people, and we all tend to take medical advice more seriously when it seems to concern our own safety. Meanwhile Donald Trump, the Republicans’ spiritual leader, denied that masks protected at all.
A Covid-19 vaccine will pose a much stiffer test of antivax resolve. This is the deadliest infectious disease in the west in decades. The vaccine probably won’t be mandatory — few governments today would dare try that — but getting it will set you free. In coming months, you may have to show proof of vaccination when entering a workplace, plane, university, church, hospital, theatre, stadium and possibly even a restaurant. However sceptical you claim to feel on social media, the jab might ease your worries about killing grandpa (or yourself).
And you’d be injected not by a grinning president Macron or the boss of Big Pharma but by a nurse, doctor or possibly a pharmacist. Health professionals tend to rank as the most trusted people in society, notes Heidi Larson of the London School of Hygiene & Tropical Medicine, who leads the Vaccine Confidence Project.
Some people understandably will want to wait and see whether a vaccine approved at such speed is safe. But the elderly will be vaccinated first and studies show they are the least hesitant cohort. Once vaccinations start without adverse effects, momentum will build, predicts Larson.
A small minority will refuse the vaccine. But coronavirus is less infectious than measles, so vaccinating just 50 to 70 per cent of the population could be enough to create herd immunity.
Moreover, in the past decade, health researchers have begun thinking harder about how to persuade the vaccine-hesitant. Larson recommends telling people that their vaccination will protect others. Viswanath says authorities must be ready to communicate about incidents that could feed conspiracy theories, such as somebody coincidentally having a heart attack the day after getting vaccinated. Trump will probably spread antivax propaganda, but his megaphone has shrunk.
In short, the antivaxxers’ bark is worse than their bite. There’s a broader truth here: our society sounds wilder than it is. There were threats of violence before the US election, but none materialised despite Trump’s accusations of vote-rigging. There is plenty of anti-lockdown talk, but the vast majority of people follow most rules even in conspiratorial, low-trust countries such as France and Italy. People rant against “science”, but get treatment for cancer. Often, conspiracy theories are mere performance.
Follow Simon on Twitter @KuperSimon and email him at simon.kuper@ft.com
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