Australians must be prepared to see the Covid vaccination uptake curve start to flatten in coming months, a leading vaccine communication expert has warned, due to the rate of hesitancy.
But she is calling for health policy to reach this group in order to stop their lives becoming too difficult or to drive them away from healthcare.
The latest data from Melbourne Institute’s Covid-19 Vaccine Hesitancy Tracker suggests 20.3% of Australians are either unsure about or unwilling when it comes to vaccination.
In the fortnight to 20 August, the proportion of people self-described as “unwilling” to be vaccinated in New South Wales, where the Delta outbreak is most pressing, rose from 9.2% to 11.8%.
However, the proportion of people unsure about vaccination in the state who said they “don’t know” whether they will get the jab reduced slightly, from 8.1% to 6.2%.
Prof Julie Leask said a balance must be struck between freedoms for the fully-vaccinated and not making life overly onerous for those who choose not to vaccinate.
Leask, who is also a visiting fellow with the National Centre for Immunisation Research and Surveillance, said she understood the anger and frustration some people living in Victoria and NSW in particular were expressing towards those choosing not to vaccinate.
“What those people who choose not to vaccinate represent to us right now is a resistance to escaping from hardship, and from escaping a whole lot of things like lockdown,” Leask said.
But she said it was important to remember people who were vaccine hesitant “are humans, they’re citizens”.
“They’re not just the ratbag lockdown protesters, they’re often reasonable people with genuine fears about vaccination, and for many of them, those fears may reduce and shift over time,” she said.
Nationally, the percentage of people unwilling to vaccinate remained stable compared to the previous fortnight, at 11.7%, according to the latest figures. The proportion of unsure people feel slightly from 9.8% to 8.6% in the same period.
The survey is conducted every two weeks, and each survey wave includes responses from 1,200 people aged 18 years and over. The sample is stratified by gender, age and location to be representative of the Australian population.
Australia’s national plan requires 80% of eligible Australians to be fully vaccinated before widespread lockdowns end and caps on returning vaccinated Australians are abolished.
For those staunchly unwilling to vaccinate, sophisticated communication strategies would be needed if Australia wanted to reach high vaccination coverage of 90%, Leask said.
“The solutions that work with the remainder of unvaccinated people will be different to the ones that were needed for getting the first 60-80% of the population vaccinated. And they’ll need to be tailored based on a solid understanding of why people aren’t vaccinating and what they need to support their decision-making.”
That was where trained professionals skilled at interviewing people about their vaccine concerns, and home-visits from these health workers to vaccine refusers, would prove essential, she said. Language such as calling those people “selfish” or “traitors” might feel therapeutic but would not help change their views.
“I’m quite concerned about these people who will choose to remain unvaccinated because life will be harder for them.”
Leask said it might be justifiable to require mandatory vaccination among health care staff to protect elderly or vulnerable people, or for remote Aboriginal communities to require proof of full vaccination before allowing visitors.
“But there are situations where the risks are not as high and less restrictive options, such as requiring unvaccinated people to get tested and then allowing them to travel if they show a negative test, might be available instead of banning them altogether.
“The evidence shows that if you require something inconvenient, such as producing a negative test, which is inconvenient to get, that can actually produce quite high vaccination rates in and of itself. People get sick of it after a while and it’s easier to get vaccinated.”
Leask said she was already receiving emails from people saying they would quit their job if their employer required them to vaccinate, and she feared what unemployment would mean for them and their families.
“There are people like this in the workforce, and governments and employers also need to think about planning for the loss of those people.”
But Leask was confident Australia could aim high with its Covid-19 vaccination coverage and reach up to 90% vaccination.
“We won’t see it until next year if we do reach that level,” she said. “But to reach those high goals we need to look to the evidence for what works to reach people. And over time we should be prepared that the remaining group of unvaccinated will be harder to reach or more reluctant.
“These hardcore vaccine refusers will always think Covid is not severe, or not around, or it’s being misdiagnosed, or it’s a conspiracy to make people vaccinate. That’s why you can’t have conversations with them because you don’t even share the same fundamental assumptions about what’s happening.”
While this group might be small enough that overall vaccination coverage could still reach high levels, Leask said, this would only be the case if those for whom access to vaccines were an issue, or who were on the fence about vaccination, were well-targeted.
She said it was becoming clear that incentives such as entry into lotteries as a reward for vaccinating, as trialled in US states like Ohio, did not work when it came to significantly boosting vaccination rates in this group of people in particular.
“Incentives don’t overcome barriers to access of vaccines in remote areas,” Leask said. “They don’t overcome difficulties with booking appointments through complex online systems, they don’t overcome the need for a Medicare card when you make an appointment, or overcome concerns about vaccination safety.”
Prof Anthony Scott, a health economist with the Melbourne Institute who leads the Vaccine Hesitancy Tracker, said researchers periodically asked people about their reasons for hesitancy or refusal as part of the survey.
“We have found that it is mostly about safety and effectiveness of vaccines and potential side effects that people are most worried about,” he said.
Hesitancy was coming down as more information was being communicated about vaccine safety, along with the importance of vaccination during outbreaks, Scott said.
“Some people who may have been unwilling might have changed to just being unsure as more information has come out,” he said.
“When you look at childhood vaccination and those not willing to get kids vaccinated, they are a very hard, immovable group, but I think with Covid we are seeing at the moment more of an ability to change people’s attitudes.”