At the outset of the pandemic, there were fears that finding a vaccine for SARS-CoV-2 might turn out to be like the so far fruitless quest for a vaccine for HIV.
There are now many effective vaccines. Today’s big challenge is getting them into enough arms to stop the pandemic. Even the best resourced nations seem to be falling short of the 60 to 70 percent vaccination rate thought necessary for herd immunity and a promised safe return to the carefree days of 2019.
Publicity about a rare, but sometimes fatal blood clotting disorder seems responsible for the stop-start rollout of the AstraZenica vaccine in Australia. There is a procession of scientists talking heads urging us to place these deaths in the context of the much greater risk of death or disability from an unvaccinated encounter with SARS-CoV-2. Many of us are paying attention. But there are enough hold-outs to nudge herd immunity frustratingly out of reach.
A recent piece in the New Yorker covered the work of the anthropologist Professor Heidi Larson on the phenomenon of vaccine hesitancy. Professor Larson found that, unexpectedly, the lowest levels of confidence in vaccines were not in poor countries, some of which have had a bad experience with historical vaccination efforts, but in “countries with the highest education levels and the best health-care systems; seven of the 10 most vaccine-hesitant countries were within the European Union (France ranked first).” The richest and most technologically advanced nations seem like the ancient Greek mythological character Tantalus, doomed to endlessly grasp at the just out-of-reach fruit of herd immunity.
Since the reasons for vaccine hesitancy are not rational—vaccines demonstrably work—they cannot be addressed by merely reiterating impressive statistics. It’s time to explore other factors making people reluctant to accept vaccines proven safe and effective.
Why Ebola really gets so much attention
In his recent book Plague Year, Lawrence Wright contrasts America’s lacklustre response to COVID-19 with the urgency of its response to the 2014 outbreak of the viral haemorrhagic disease Ebola. According to Wright, Ebola arrived in the United States “banging pots and pans”. The disease benefited from marketing supplied by Robert Preston’s 1994 bestseller on viral haemorrhagic fevers, The Hot Zone. Ebola, as described by Preston, is the stuff of horror movies. He presented Ebola victims with eyes “the colour of rubies” violently vomiting “red and black liquid”. Experts doubt the accuracy of some of the reporting in The Hot Zone, but its horror-movie presentation of the hitherto unappreciated disease seems partly responsible for America’s aggressive response to the 2014 outbreak. There were only two Ebola deaths in the US and no one who contracted the disease there died from it. A stark contrast with the experience of COVID-19.
Compared with Ebola’s fatalities, deaths from COVID-19 aren’t especially Hollywood. The deaths inflicted by the coronavirus tend to involve inert bodies being artificially ventilated and eventually suffering multi-organ failure. COVID-19 is something young people, known to be among the most resistant to public health messages, back their immune systems to fight off. It’s unlikely young unmasked partiers would be so cavalier if menaced by Ebola’s red and black vomit.
One way to coax the vaccine hesitant might be to make deaths from the coronavirus seem more frightening. Something like that worked in the public health campaign against smoking, a habit previously viewed as healthy—“More Doctors Smoke Camels Than Any Other Cigarette”. But I suspect another strategy is likely to be more successful in coaxing the hesitant to vaccinate.
Addressing our emotional natures
We should acknowledge that a reluctance to vaccinate may trace back more to our emotional than our rational natures. Psychologists have explored a variety of non-rational responses to substances and activities. We tend to avoid activities and substances we find yucky—these include encounters with other people’s bodily fluids. According to one explanation, this is rooted in our need to avoid disease. Contact with another person’s blood or snot may expose you to their diseases.
Ebola is the stuff of horror movies. But so is the image of a uniformed health professional brandishing a large needle. As with our revulsion at other people’s bodily fluids, we fear those who menace us with large needles. Suppose I were to approach you with a suspicious substance and offer you the choice of sniffing it, touching it, tasting it, or having it injected directly into your body, I suspect few would choose the last option.
When I tell people I’m a type 1 diabetic, I’m surprised how many of them fixate on the needles. Injections are a regular part of my daily routine; if I hadn’t gotten over any needle phobia I’d be long dead. My needle conditioning made me entirely unfazed by my coronavirus vaccination.
In our search for herd immunity, the best focus is on modes of delivery less likely to provoke these anxieties. A recent piece in the Wall Street Journal discusses a variety of needle-free possibilities, including “dissolving implants, microneedle patches, electrical-pulse systems, nasal sprays and even pills”.
Perhaps some of these alternative modes of vaccine delivery will fail to match the efficacy of injected vaccines. But if the obstacle to herd immunity is a widespread but irrational fear of needles, the trade-off may be warranted.
Nicholas Agar is an Adjunct Professor of Ethics in the Philosophy programme at Te Herenga Waka—Victoria University of Wellington and a Distinguished Visiting Professor at Carnegie Mellon University in Australia.
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