COVID Vaccine Hesitancy: Where Are Health Systems We Can Trust?

If there are no injections & no early prospect of them, then a reluctance to be jabbed is hardly the biggest issue.

Image used for representational purposes.

(Image: Erum Gour/The Quint)

What do Kazakhstan, Gabon, Hungary, Jordan and Jamaica have in common? Well, let me not leave you in suspense. They have some of the highest vaccine hesitancy rates in the world.

According to a recently published Gallup world survey, fewer than one-in-three of the adults in these countries would agree to be vaccinated against COVID, even if the injections are available at no cost. It's an unsettling indication of the extent of suspicion of scientific and medical orthodoxy.

Even more striking is the other end of the table — those nations where the willingness to be jabbed to protect against the virus is highest. Asia is the continent with the greatest agreement to be vaccinated, and within Asia, India is distinctly more pro-vaccine than most.

The Bigger Problem: Vaccine Availability, Not Hesitancy

82 percent of Indian respondents said they were up for a COVID vaccine, compared to 75 percent in Britain, 53 percent in the US and just 37 percent in Russia. China — you may not be surprised to learn — wasn't covered in the survey.

OK, there's an almost tragic aspect to these findings. For much of India, and indeed the world, the issue is not vaccine hesitancy but availability. If there are no injections on offer, and no early prospect of them, then a reluctance to be jabbed is hardly the most pressing problem.

And these global polls, often conducted over many months, are not always reliable when it comes to attitudes rather than experiences — what people think rather than what they have done.

There are striking anomalies too: the survey suggests that just 61 percent of adult Israelis are OK to be vaccinated, but the take up rate there is already much above that. So, the survey offers talking points, issues for consideration, rather than hard facts.

But vaccine hesitancy really does matter. To achieve what's called ‘herd immunity’ — the threshold at which the pandemic recedes — then at least 70 percent of the population needs to gain immunity, either through vaccination or past exposure to the virus.

That’s a mountain to climb, particularly where vaccines are in short supply and public health infrastructure is weak.

Barriers to Mass Vaccination

In Britain, the mass roll-out of the vaccination programme is going well: all aged 30 and over as well as high risk groups and key workers are now able to have a vaccination free of charge. Take up has been high, but not uniformly so. In London in particular, a truly global city where the recent contest for mayor was between a centre-left incumbent whose parents came from Pakistan and a centre-right challenger of Jamaican heritage, there's some reluctance to get vaccinated among older people from ethnic minority communities.

This may be about marginalisation, social isolation, and perhaps an attitude which is either fatalist or in some measure messianic: ‘it’s God’s will’, ‘what will be will be’ or ‘my faith will protect me’.

There's also sometimes hostility to a system, an establishment, which has ignored them: ‘they've never shown any concern for me — why should I trust them now’.

Class Divide & Vaccine Hesitancy

In the United States, where vaccine hesitancy is a much bigger concern, polling by the Kaiser Family Foundation has drilled down into the underlying reasons. It's partly about political outlook — with hard right Trump-style Republicans harbouring deep scepticism of government and science. It's also about ethnicity — the outcome of systemically inadequate medical care for many Black and Hispanic Americans.

More than anything, it’s about class. The big divide in attitude is between college graduates and those who never got a college degree. That holds for all racial groups, and for Democrats and Republicans. The poorer and less well educated you are, the more hesitant you are likely to be about getting vaccinated.

Asian Americans have on average higher incomes than Black, Hispanic or white Americans — and a higher, much higher, vaccination rate. In New York State, two-thirds of Asian Americans have been vaccinated — compared to 46 percent of white Americans, 35 percent of Hispanic Americans, and 29 percent of Black Americans.

Why Trust in Public Health Systems Matters

But why is vaccine hesitancy so much more pronounced in the US than on the other side of the Atlantic, in the United Kingdom? It's all about trust — there is no public health without public trust.

Not so much trust in government — there's a deep scepticism in Britain about politicians, in and out of power. Nor trust in the news media — though people do broadly believe what is reported particularly by the public broadcaster (and my former employer) the BBC. It's about trust in those with a professional responsibility for safeguarding public health.

And in the State-funded National Health Service (NHS) which provides medical care — from routine consultations to heart surgery, and including vaccinations — to everyone. Free.

As with so many large institutions, the NHS is sometimes insensitive and inefficient. But it is revered in Britain across the political spectrum. Everyone knows someone whose life has been saved by the NHS. And the medical professionals who work in it are held in much higher public esteem than politicians, or civil servants, or journalists.

So, the first requirement of tackling a pandemic is having a public health system which has earned people’s confidence.

A service which has the capacity to respond to a health emergency — and which, when it says 'get vaccinated', enjoys the authority and trust to persuade people to do just that.

(Andrew Whitehead is an honorary professor at the University of Nottingham in England and a former BBC India Correspondent. This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)