
There should be no doubt about it: covid 19 vaccines save lives. Consider some recent statistics from the UK.
In a study of over 200,000 people, almost all participants developed antibodies to the virus within two weeks of their second dose. And despite initial fears that current vaccines may be less effective against the Delta variant, analyzes suggest that AstraZeneca and Pfizer-BioNTech vaccines are reducing hospitalization rates by 92 to 96 percent. As many healthcare professionals have reiterated, the risks of serious side effects from a vaccine are tiny compared to the risk of the disease itself.
However, a significant number of people are still hesitant to be vaccinated. According to a recent report by the International Monetary Fund, this reluctance ranges from 10-20% in the UK to around 50% in Japan and 60% in France, and the result is becoming a kind of culture war on the media. social, with many online commentators claiming vaccine-hesitant are simply ignorant or selfish. But psychologists specializing in medical decision-making say these choices are often the result of many complicating factors that must be approached sensitively if we are to have any hope of achieving population-level immunity.
The 5Cs
First of all, a few distinctions. While it's tempting to assume that anyone who refuses a vaccine holds the same beliefs, the fears of most people who are reluctant to get the vaccine should not be confused with the bizarre theories of die-hard anti-vaxists.
"They are very vocal and have a strong presence online and offline," says Mohammad Razai, of the Population Health Research Institute, St George's, University of London, who has written on the various psychological and social factors that may influence the decision. vaccine decision making. "But they are a very small minority."
The vast majority of people who are reluctant to be vaccinated have no political agenda and are not committed to an anti-scientific cause: they are simply undecided about their choice to receive the injection.
The good news is that many initially hesitant people are changing their minds.
"But even a delay is considered a health threat, because viral infections spread very quickly," says Razai.
It would have been problematic if we were still dealing with the old variants of the virus, but the greater transmissibility of the new Delta variant has increased the urgency of reaching as many people as possible as quickly as possible. Fortunately, scientists began studying vaccine reluctance long before Sars-Cov-2 was first identified in Wuhan in December 2019, and they have explored various models that attempt to capture the differences in the behavior of people in health. One of the most promising is known as the 5Cs model, which takes into account the following psychological factors:
Confidence: the individual's confidence in the efficacy and safety of vaccines, in the health services that offer them and in the political decision-makers who decide on their deployment.
Complacency: does the person consider the disease itself to be a serious risk to their health or not?
Computation: the engagement of the individual in an in-depth information search to weigh the costs and benefits.
Constraints (or convenience): ease of access to the vaccine for the person in question
collective responsibility: the will to protect others from infection through one's own vaccination.
In 2018, Cornelia Betsch, from the University of Erfurt in Germany, and her colleagues asked participants to rate a series of statements measuring each of the 5Cs, then compared the results with their actual adoption of relevant procedures, such as influenza vaccine or HPV vaccine. They found that the 5Cs could account for much of the variation in people's decisions, and that they consistently performed better than many other potential predictors, such as quizzes that focused more exclusively on trust issues without holding onto trust issues. other factors into account. In as yet unpublished research, Ms Betsch recently used the model to predict popular uptake of Covid-19 vaccines.
The results she has obtained so far suggest that the 5C model may explain the majority of variations in people's decisions. There will of course be other contributing factors. A recent study from the University of Oxford suggests that fear of needles is a major obstacle for around 10% of the population. But the 5C approach seems to capture the most common reasons for reluctance to get vaccinated.
Confirmation bias
When considering these different factors and how they can influence people's behavior, it is also useful to look at the different cognitive biases known to influence our perceptions.
Consider the first two Cs: confidence in the vaccine and complacency with the dangers of the disease itself.
Jessica Saleska, of the University of California, Los Angeles, points out that humans have two seemingly contradictory tendencies - a "negativity bias" and a "optimism bias" - each of which can distort risk assessment and advantages. Negative bias is about how you assess events that are beyond your control.
“When you are presented with negative information, it tends to stick in your mind,” says Saleska.
Optimism bias, on the other hand, relates to the beliefs you have about yourself about whether you think you are fitter and healthier than the average person. These biases can work independently of each other, meaning you can focus on the dangerous side effects of vaccines while believing that you are less likely to suffer from the disease, a combination that would reduce confidence and increase complacency. Then there is the notorious confirmation bias, which can also distort the risk perception of the virus due to the availability of false information from questionable sources that exaggerates the risks of vaccines.
This reliance on deceptive resources means that people who score high on the "calculation" measure of the 5C scale - people who actively research data - are often more hesitant about vaccines than people who have a lower score. If you already think that vaccination may be risky and you type "Is this vaccination dangerous?" You will only find information that supports your previous opinion, "says Betsch. Remember that these psychological tendencies are extremely common. Even if you accepted the vaccine, they probably influenced your own decision-making in many areas of life. Ignoring them, and assuming that people who are reluctant to get vaccinated are somehow willfully ignorant, is in itself a foolish position.
Also, one should not forget the many social factors that can influence the uptake of the vaccine by people - the "constraint / convenience" factor of 5Cs. Quite simply, the impression that a vaccine is difficult to access will only discourage people who are already hesitant. During our interview, Ms Betsch suggested that this may have slowed the uptake of the vaccine in Germany, which has a very complex system for identifying people who can receive the vaccine at any time. According to her, people would react much faster if they received automatic notifications.
Ms Razai agrees that we need to take into account the issue of convenience, especially for people in poorer communities who may struggle to find the time and money to go to a vaccination center.
“Getting to and from the vaccination center can be a huge problem for most people on minimum wage or unemployment benefits,” he says.
For this reason, it is often preferable for vaccines to be administered at local community centers. "I think there is anecdotal evidence that he is more successful in places of worship, mosques, gurdwaras and churches."
Finally, we need to be aware of the context of people's decisions, he says - such as structural racism that may have led some ethnic groups to have lower overall trust in medical authorities. It's easy to dismiss someone else's decisions if you don't understand the challenges they face in their daily life.
Open a dialogue
So what can we do?
There are no easy fixes, but health authorities can continue to provide accurate, easy-to-understand information to address key concerns. According to a recent report by the Institute of Global Health Innovation (IGHI) at Imperial College London, the main obstacles remain patient concerns about side effects and fears that vaccines have not been sufficiently tested. For the former, graphs showing the relative risks of vaccines, compared to the actual disease, may provide some context. Regarding the second, Mr. Razai suggests that we need to know more about the history of vaccine development.
The use of mRNA in vaccines has been studied for decades, for example, and lengthy trials have verified its safety. This means that the technique could be quickly adapted to the pandemic.
"None of the technologies used would be harmful in any way, because we have used these technologies in other areas of health care and research," says Razai.
Sarah Jones, a doctoral researcher who co-edited the IGHI report, suggests that a focused approach will be needed.
"I call on governments to stop thinking that they can reach mass niches with one mass vaccine message, and to work more creatively with many effective communication partners," she says.
This could involve closer collaborations with influencer models within each community, who can provide "consistent and accurate information" about the risks and benefits of vaccines Regardless of how they choose to convey information, health services should make it clear that they are engaging in open dialogue, says Razai, rather than dismissing it outright.
"We have to listen to people's concerns, recognize them and give them information so that they can make an informed decision."
In Vietnam, a new hybrid variant of the Covid worrie, Saleska agrees that it's essential to start a two-way conversation - and it's something we could all learn by discussing these issues with our friends and family.
“Being respectful and acknowledging their concerns - I think that might actually be more important than just spitting out the facts or the statistics,” she says. "Often the personal connection is more important than the information you provide."
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