The waiting game: Why are so many people hesitant about COVID-19 vaccines?

In late April, doctors and vaccine researchers reported a “significant” rise in hesitancy among older Australians regarding the AstraZeneca vaccine.

This is because the vaccine – which is what most Australians will get – has been linked to a rare blood-clotting side-effect.

“Rare” is the key word here – it’s one chance in 350,000. But perception is important in the world of vaccines, and the perception is that it might be dodgy for some people.

To date, nearly 2.5 million Australians have been vaccinated against COVID-19, which is far fewer than originally planned, and a potential obstacle to eventual herd immunity.

People aged over 50 can now be jabbed, as well as adult Aboriginal and Torres Strait Islanders. It’s fair to say supply and also uptake has faced serious challenges.

The problem – or potential problem, because no one knows yet for sure – is that concerns regarding specific COVID-19 vaccines could (or already have) merge with wider vaccine concerns in the community.

Read more: Shot in the arm: All you need to know about the COVID-19 vaccines, and their rollout

Monash University social scientist Dr Tomas Rozbroj researches vaccine hesitancy, and says vaccine controversies can fuel concerns for quite some time.

He says it would be wrong to assume the AstraZeneca clotting news will become a lasting part of broader vaccine concerns, but notes that “if the AZ blood clot link and subsequent changes to vaccine rollouts do impact confidence, we shouldn’t assume that the impact will only happen at one point in time, or in one fixed way”.

Public sentiment about how COVID-19 vaccine concerns impact broader vaccine concerns – as of now – is hard to measure, he says.

“Vaccine beliefs and movements are constantly evolving, but at the moment they’re evolving at a much faster rate, so it’s difficult to keep up,” he says. “I dare say nobody in this space feels they’re really on top of public sentiment.”

Many Australians ‘undecided’

So, we’re chasing to understand vaccine hesitancy in the COVID era.

A University of Western Australia study published in January this year found large numbers of “undecided” Australians.

“The significant number of people who remain undecided about whether or not to get a COVID-19 vaccine, despite the ongoing devastating consequences of the virus for individuals, communities, and economies, is concerning,” the study concluded.

According to Dr Rozbroj, confidence in the AstraZeneca vaccine will “of course” be impacted by the rare blood clotting issue. But, “it is not a given that it will increase overall vaccine hesitancy, or even broader COVID vaccine hesitancy”, he says, “and it will be a while before we know”.

“People in vaccine-refusal movements also tend to overestimate how common distrust in vaccination is, including overestimating the extent to which experts question vaccination.”

“We know that beliefs about specific vaccines interact with broader beliefs, including broader vaccine attitudes and also other attitudes, like trust in government,” he says. “So, you’d expect some interaction between the news about the rare AZ blood-clotting side-effects and vaccine confidence more broadly.

“The tricky thing is that we don’t have much data about that interaction yet. It’s unwise to look at past vaccine controversies and assume they’ll apply to COVID vaccine rollouts.

“We are seeing such a unique vaccine rollout for COVID vaccines that people perceive it differently to other vaccines.

“The rollout is occurring in an unprecedented public health situation. And it’s also occurring in a rapidly changing society, where the ways in which we consume and experience health information, interact with ideas about health, have all evolved quite a lot over just a few years.

“It’s messy,” he says, “and we don’t yet know how broader vaccine confidence will be affected in Australia,” he says. “We probably won’t have a good picture even of how it affected COVID vaccine confidence until those vaccines are more widely available, when we can see how different groups in our population engage with the vaccination programs.”

Various reasons for vaccine refusal

A person who says no to a specific vaccine – such as for COVID-19 or childhood vaccines, for example – is often not “anti-vax”. People refuse vaccines for many different reasons, and only some identify themselves with the vaccine-refusal movement.

Many people may just be fence-sitting about the COVID vaccine, or have specific concerns about some vaccines while accepting others.

“People are saying, ‘I need more data, I want to see how the rollout goes’. People might say, ‘I will get a vaccine, but I don’t want to be the first to have it; I want to see what happens to the other millions of people before I commit to it’.

“It’s also plausible to think that people who have had other vaccines would refuse a COVID vaccine because they’re scared of things like how quickly they were developed, concerns about new [genetic] mRNA vaccines, or different perceptions of COVID-19 relative to other diseases against which we vaccinate.”

Read more: COVID vaccination campaign: Massaging the message to appeal to Australia’s diverse population

Then there’s a group of people who refuse all vaccines, and they’re unlikely to take a COVID one, too.

According to Dr Rozbroj, the anti-vax movement has been associated with the “natural” movement of health, wellness, and a natural lifestyle.

Mothers who refuse vaccination for their children often display high-labour, high-intensity parenting. They’re hyper-vigilant about what to put in their babies’ bodies, and think they’re doing best for their kids when they refuse vaccines.

Distrust encompasses wider beliefs

But he says vaccine-refusal groups are increasingly connected to a wider set of belief systems encompassing politics, conspiracy theories and fear.

“In order to justify thinking that all vaccines are dangerous, you need to account for why so many people, including scientists, healthcare workers, policymakers, promote them.

“You might think that the government is putting profit above public health, and the scientists are somehow corrupt or ignorant or suppressed. It would mean that a really large group of people is involved in hiding the facts, while the vaccinating public is ignorant about the ‘truth’, and you have some special knowledge about the ‘real truth’ that others are not seeing or are covering up.

“People in vaccine-refusal movements also tend to overestimate how common distrust in vaccination is, including overestimating the extent to which experts question vaccination.

“Healthcare professionals want patients to be involved in healthcare decisions, and it’s right that the public are thinking about the risks and benefits of the vaccinations against COVID-19,” he says.

“But people who strongly oppose vaccination are often doing it through a problematic lens that leads them to overestimate their risks and negate their benefits.”