The complicated case of vaccine and hesitancy

By Indira Laisram
Dr Raj Khillan and Prof Jaya Dantas

Thirty-two-year-old *Vikas, a chef here in Melbourne, says he does not remember taking a vaccine in his life. In the 13 years that he has been in Australia, he has suffered from chicken pox once. Yet he says he is not sure whether he will ever take the COVID-19 vaccine. But if it becomes compulsory at some point, he says he will take the jab.

A doctor in regional Victoria, who does not want to be named, says she herself was hesitant about getting vaccinated because, “Firstly, there are no cases here. Second, everything is so new. But it’s like being in the army for us, if you are asked to fight you have to do it. I’d have preferred Pfizer though,” she says.

While there can be no single explanation for vaccine hesitancy, it is popular opinion that the Australian government’s vaccine roll-out program has been quite a disaster adding to vaccine hesitancy. Then there is, of course, the attitudes of people prompted by an intricate mix of hearsay, social media platforms and some facts on the ground.

“What we know is that currently there is a lot of misinformation that goes out. And because of social media explosion—people are part of WhatsApp, Facebook groups—you have this misinformation of vaccine myths that are being circulated. In many countries this is what is happening, sometimes it can be religious groups or anti-vaccination movements that can influence this. So, people get mixed messages and there is hesitancy. They then say, ‘Oh I am not going to take the vaccine now, I will wait and watch and see what happens’,” explains Prof Jaya Dantas, currently Deputy Chair of the Curtin Academic Board, Professor in the School of Population Health and Dean International in the Faculty of Health Sciences.

Philosopher Maya Goldenberg in her book Vaccine Hesitancy: Public Trust, Expertise, and the War on Science, frames the ‘war on science’ as ‘a crisis of trust’.

“What we know is that currently there is a lot of misinformation that goes out. And because of social media explosion—people are part of WhatsApp, Facebook groups—you have this misinformation of vaccine myths that are being circulated”
— Prof Jaya Dantas

In Australia’s so called bungled Covid vaccination plan, trust is an issue. Dr. Raj Khillan, Director and Pediatrician at Western Specialist Centre, and someone who has worked to create awareness in multicultural community about health-related-issues, believes the government’s messaging right from the beginning including those by the Australian Technical Advisory Group on Immunisation (ATAGI) was ‘unthoughtful and negative”.

“The whole vaccine program is messed up unfortunately. I am sorry to say it is more of a political agenda than a public health agenda. Being a medical professional, we are stuck in between the public end versus the political end, but the hesitancy is created by political mess up. It’s a bit of a shame when mixed messages come from top authority, it’s not a right message for the public,” says Khillan.

If one calculates the risks of dying from, say, road accidents or paracetamol poisoning or food poisoning, it is much more than the vaccination, says Khillan, adding, “Nobody mentions how many die of alcohol abuse every year or that more than 10 times young people die in Australia from suicide, higher than Covid-induced death rate.”

Khillan also says that the two recent advertisements released by the government will lead to more distrust. He says, “The message itself is wrong and will further incense young people who are not eligible to have vaccination. If you have motivated, say, 20 million youth and 4 million are lined up, do you have the vaccines? You are disengaging and annoying the youth and run the risk of losing further trust.”

Instead of spending 41 million on an ad campaign and using an unrelatable army officer, Khillan thinks engaging community and indigenous leaders would be more effective. He also believes using incentives for people to get people vaccinated along the lines of the United States would enhance vaccination programs.

Photo by CDC on Unsplash

Ethnicity Data

In countries like the UK, Canada and the US, ethnicity data is collected to understand vaccine uptake and hesitancy, says Prof Jaya Dantas.

So, when a person actually goes to get a vaccine and enters into the health system, they collect data to ascertain the background – whether the person is indigenous, South Asian, South East Asian or European and so on. In the South Asian community this data can be broken down further.

“What it has shown in the UK is that there are higher rates of vaccine hesitancy among the Pakistani and the Bangladeshi population. You are talking about 18-23 per cent not wanting to take the vaccine at this stage. That’s problematic and they need to find out why or the need to encourage those population groups with community leaders to increase their vaccine uptake. Also in the US, they found that among the African American community, younger people had more vaccine hesitancy and they are trying to address that. In Canada, there was vaccine hesitancy among certain groups like the Punjabis in Brampton in Ontario. These are examples that have been documented,” says Dantas.

In Australia, Victoria is the only state that captures some form of ethnicity data. So we are missing that gap in formation and unable to understand why certain communities have vaccine hesitancy, says Dantas.

However, there are public health researchers who are looking at this aspect, who have tried to pilot this with the Federation of Ethnic Communities Councils of Australia with other studies that they are doing to capture ethnicity data, says Dantas.

In Western Australia, where she is based, Dantas says she will be talking to the Officer of Multicultural Interest to see how this can be captured within the health data that they collect.

Not just Covid, an accurate ethnicity data will help with all sorts of health data, will help with health literacy and other community programs that could be implemented, she adds.

Agrees Khillan, “Ethnicity data will be very helpful because vaccine acceptance varies based on your background, language, etc., and how the message is being conveyed.”

Taking his own example where he has motivated his clients to get vaccinated in the languages he is fluent in such as Hindi, Punjabi, Urdu and Arabic, Khillan says it is the relatability factor that enables trust to be bestowed. Hence the need for local ethnic community leaders who work with the community and have the power to influence.

With the Delta strain ripping through, Dantas says, we need to get our vaccination rates higher. “At this stage we need to capture ethnicity data and work with our ethnic community councils and with our Office of Multicultural Interests which will help not just in the roll out of the vaccine but in the roll out of other interventions and programs.”

“We don’t know whether the virus started infecting more children or whether there is a true age shift, it could be that we have more vaccinated groups among adults and elderly groups. So maybe the data is skewed now and showing that more children are affected”
— Dr Raj Khillan

Why is Delta worrying

People have to fear the Delta variant, says Khillan.

Delta has more spikes and it is more contagious than the virus that came out of Wuhan or the Alpha strain. The Delta variant can be very easily transmitted from one person to another and when it attacks the cells it can get inside the cells. If the Wuhan virus can infect four people, Alpha can transmit to eight people and Delta 12. That’s how rapidly it is spreading, explains Khillan.

The second reason for fear is that the symptom has become slightly different than the previous ones. Runny nose, headache and sore throat were the three top symptoms of the earlier viruses. Now, it starts with a bad headache, then a runny nose, then sore throat and temperature. So these changes in symptoms started confusing people.

Third, the age shift is happening with children and young people are being easily affected, says Khillan. “We don’t know whether the virus started infecting more children or whether there is a true age shift, it could be that we have more vaccinated groups among adults and elderly groups. So maybe the data is skewed now and showing that more children are affected.”

The fact remains, Delta is more deadlier than all the others. “But does it have more chances of killing the people affected? We don’t know. We do see the mortality rate over time has dropped down as compared to last year, but is it because we have become more knowledgeable in terms of understanding the virus and managing it? We don’t know.”

The message from experts is that vaccination is the only way to get out of the pandemic. “Nobody is safe, no country is safe till everyone is safe,” sums up Khillan.

*Name changed

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