With a COVID-19 vaccine here, governments are scrambling to meet the financial and logistical challenge of immunizing their populations in a short space of time. Hopes for a pickup in global economic growth next year depend on it.
But the bigger challenge may end up being psychological: How to convince people to actually take the shot. Achieving herd immunity may mean at least 80% of people will need the vaccine, leaving little room for error.
Polls suggest it’s France, the birthplace of vaccine pioneer Louis Pasteur, that will be the country to watch. A recent Ipsos survey found that only 54% of French adults would be willing to get a COVID-19 vaccine when it’s available, the lowest score of 15 countries. (The U.S. was second-to-last.)
While France has its share of anti-vaxxers, the main reasons for skepticism are questions about efficacy and a fear of side effects, rather than outright opposition. France is also vulnerable for other reasons: It’s a highly-medicalized society where antibiotics have tended to be over-prescribed, pushing people toward natural remedies. Even 26% of French doctors think some recommended vaccines are useless. Vaccine hesitancy isn’t new, but it’s complex.
We don’t know how the holdouts will really react when immunization campaigns begin, but it’d be reckless to assume they’ll automatically get in line. France’s child vaccination coverage is above 90%, like many rich countries, but that’s largely because 11 of them are required by law and conditional for access to schooling. There’s little appetite to make a COVID-19 vaccine No. 12 on the list in case it fuels a backlash. So people will have the power to refuse it, and a likely need for a two-shot course raises the risk of dropouts.
Communication will be key. Fear of side effects runs deep among the vaccine-hesitant and it’s very hard to dislodge misinformation. When Gerard Araud, a former French ambassador to the U.S., recently tweeted his support for vaccination, he was flooded with so many anti-vaxx responses that it became impossible to answer them all. It’s the social media equivalent of “Gish Gallop.”
President Emmanuel Macron hopes creating a committee of scientists to focus on vaccine take-up and recruiting members of the public to spread the word will help. But support should also be enlisted from the medical community at large. Family doctors are the “last mile” of vaccination, and they need to be advocates. That’s made a big difference in uptake of the human papillomavirus (HPV) vaccine that protects against cervical and other forms of cancer. Even something as simple as an HPV fact sheet was enough to increase intent to vaccinate from 49% to 70% in one group, according to research cited in Jonathan M. Berman’s book “Anti-Vaxxers.”
The most effective nudges will be community-based. Rather than lecture skeptics and risk hardening their opposition, it’s better to focus on positive kinds of peer pressure: The altruism of saving others, the benefits of not being ill and the role modeling parents can do by getting vaccinated themselves. Australia’s 2014 “I Immunize” campaign is one successful example, with a study finding it resonated positively with a third of parents who had refused or doubted vaccines.
Similar to what’s done in AIDS or breast cancer awareness campaigns, researchers Coralie Chevallier and Hugo Mercier have proposed distributing blue ribbons people can wear to signify they’ve been vaccinated against the coronavirus. The effort could start with the tens of thousands of people taking part in vaccine trials.
If that all fails, there could be room for tougher measures, possibly with companies taking matters into their own hands. Airline Qantas could require international travelers to have a COVID-19 vaccination, for example. But it’s pretty unrealistic to think that bars, restaurants or cab drivers could do similar and start enforcing such a policy on their own.
There is a glimmer of hope that take-up could surprise us all. Voluntary influenza vaccination is booming in France this year after a widespread campaign calling it a necessity to protect the elderly, vulnerable and medical workers in the midst of this pandemic. The almost 10.7 million doses given in the past month have exceeded last year’s total. Sometimes a nudge can make a difference.
Lionel Laurent is a Bloomberg Opinion columnist covering the European Union and France.
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