2021 will be the year of vaccines and #vaccine #hesitancy. Let me share a few thoughts about vaccine hesitancy, to help shape a year of debate. A thread: 1/
Vaccine hesitancy is not the same as anti-vaxx. Not even close. One can be hesitant towards something and still accept it. One can be hesitant and delay acceptance. One can be hesitant for various reasons and to various degrees. 2/
The following questions are worth asking (other too of course): Why would people be hesitant, about vaccination in general, and why about Covid19 vaccines in particular? To what extent is vaccine hesitation a global or a local phenomenon? What can be done about it? 3/
What should be done about it, and by whom? And perhaps most importantly: how, and with whom, should we talk about this? 4/
Let us start with the last one and ask who might be a legitimate expert on vaccine hesitancy. Clearly NOT a virologist. At the top of our list should be the hesitant themselves. They offer legitimate views on the social, political & moral dynamic underpinning their hesitation. 5/
In other words: the vaccine hesitant have legitimate expertise on vaccine hesitancy. We should not talk about them, but with them, and accept that expertise. 6/
For the larger, structuralist perspective, and the role of vaccine hesitancy in societies, we can seek out more formal expertise. Again, we do not find this with virologists. Rather, we need expertise on social, political and moral structures in our societies. 7/
Psychologists, sociologists, social theorists, philosophers, ethicists, anthropologists and historians would be a good starting point. Vaccine hesitancy is - and we'll get to that below - more about values than it is about facts. We need experts who can handle that. 8/
So why do people hesitate about vaccination? The term "vaccine hesitancy" links the hesitation to the material vaccine. In some places in our world, legitimate doubt about the identity, efficacy and provenance of a vaccine is quite understandable. 9/
In China, for instance, a series of vaccine scandals (counterfeit, expired, and ineffective vaccines) severely affected public trust in vaccines, vaccine producers and the health professionals distributing them: mdpi.com/2076-393X/8/4/… & mdpi.com/2076-393X/8/1/2 10/
It wasn't only the vaccine itself though, but also the way in which the medical profession was pushed to vaccinate as many as possible. This resulted in an inability to object, or ask questions, and more. Hesitance is not just about vaccines, but also about vaccination. 11/
Vaccination practices are about policies, laws, logistics and trust in systems and institutions, but also about local interactions and trust in the relationships between health professionals and (parents of) the soon-to-be vaccinated. 12/
Chinese vaccination practices differ from Dutch vaccination practices when it comes to the political context. Yet in NL too, the (technocratic) assumption that one will accept the vaccine lowers the time available to health professionals to engage in an actual conversation. 13/
Colleagues have studied local vaccination practices in NL, and found that willingness to vaccinate is high, but hesitancy emerged and is amplified in settings where compliance is assumed and questions are considered a distraction: sciencedirect.com/science/articl… 14/
This has a clear consequence for what we can do about vaccine hesitancy: explaining the safety and efficacy of the vaccine better, is not going to help. It is not a deficit of knowledge that is the problem. 15/
This way of approaching the public understanding of science is called "the deficit model". We're having some trouble moving away from that model:
https://twitter.com/scheufele/status/1342875720222187523?s=1916/
An important reason why this is so difficult is that we often resort to ideas about the role of science in society in which science deals with known facts only, and managing uncertainties, and dealing with values, is left to others. 17/
The problems we face as a society do not neatly work that way. Values and facts are not easily separated, especially when we have *do* something: decide, inform, educate, solve, improve, and more. 18/
A lot of the animosity towards science and scientists (in climate science, food science, vaccination, and so much more) stems from a disagreement with dominant values - not the facts. Plurality in science also means that there are always multiple facts to choose from. 19/
Values inform that choice. When it comes to vaccination, our values inform us about when something is safe enough, who gets to have priority, how we organise vaccination practices, how we communicate about vaccination and who we grant voice. 20/
Those are not scientific decisions & we should not pretend that they are. They are, however, decisions that will help shape public trust in the #covid19 #vaccination #campaigns & how we reach those decisions, who was involved, and how we account for them, co-shape that trust. 21/
In order to get a population vaccinated, we first have to work on the willingness of the population to be vaccinated. That process will have to look differently at different places across the globe - with different actors and values involved. 22/
We need to seek out local expertise, both formal and informal. National outbreak management teams now face a new task, that requires different expertise (which, to be honest, they needed before as well), new members and new strategies. 23/
Vaccine hesitancy CANNOT be managed by "explaining things better" or "educating the public". Vaccine hesitancy asks for value-sensitive, sufficiently inclusive, and timely decision making, communication and innovation. 24/
Poor communication around the vaccine trial, unclear government involvement in those trials, and the irresponsible amplification of technocratic voices (including an overreliance on natural & life sciences as the answer to all problems) already kickstarted vaccine hesitancy. 25/
Time to change course. 26/26
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