Trust, not bribes, key in vax rollout

Vaccination researcher Dr Katie Attwell argues blanket mandatory COVID-19 vaccination or big financial incentives are not necessarily the best way forward. 

Australia’s COVID-19 vaccination rollout has been humbling. In a few short months, we have gone from being the envy of the world to having to manage outbreaks of the Delta variant in our largely unvaccinated population.

Dr Katie Attwell

As Europe and North America emerge from lockdowns and restrictions, many Australians have been placed back into them. We are left asking what it will take for us to resume our lives. 

However, part of the problem might be that life has been too good already, especially in Western Australia. Within our hard border – aside from a few short, sharp lockdowns – we have been able to attend work, school, and participate in social life. Naturally, some people feel that they can wait a bit longer to be vaccinated, or can wait for the brand of vaccine they prefer.

Facing this situation, it is easy to assume that the community is not pulling its weight, and that mandates or incentives are needed. However, apart from key occupations where workers can infect vulnerable patients or transmit disease from active cases, it is much too early for mandates. 

Our problem has been less about complacency or hesitancy, and much more about supply.  

Outside of NSW, the only people who have been able to easily and quickly access a vaccine are the over-60s. AstraZeneca uptake among over-60s is not complete, but more large-scale and targeted government communications can support and encourage the older population to access their first dose or complete their second. 

When it comes to those under 60, there has been a significant lack of Pfizer, and barriers for younger people who are happy to consent to receiving AZ. These barriers include the advice of experts and doctors. To say it’s complicated would be an understatement.

Meanwhile, non-English speakers have not been engaged through targeted programs. Those who come from countries where they have been abused by the state need supportive and empathic engagement in their language through trusted messengers. There is an urgent need for appropriate government communications to address hesitancy and misinformation. 

It’s enormously hard work to make all of these things happen, and so the quick fix appears alluring. 

Incentives have been the latest buzz in political and media circles, with the ALP suggesting vaccine recipients receive $300. Purpose-built incentives have been used in Australian immunisation policy before, but as part of our long-term and stable childhood vaccination program. 

Non-vaccinators were also able to access these incentives using conscientious objection forms. (This kind of exemption was abolished by 2016’s No Jab, No Pay policy.) It is highly unlikely that there would be any personal belief exemptions for COVID-19 vaccine incentives. 

Our ‘Coronavax’ social research project indicated that small incentives would be palatable, but large incentives would feel like bribery. Compared to the previous maternity immunisation allowance, there is a big difference between locking in behaviour that is already the social norm (and helping people to vaccinate on time) and paying people to accept a pandemic vaccine. 

There is also the issue of undermining pro-social behaviour and people’s intrinstic motivation to contribute to Australia’s COVID-19 exit strategy. And how would people feel if they had already been vaccinated and missed out on the money? This could have a very negative impact on trust in government and social solidarity.

That said, additional payments to support the vaccine access (and any recovery time) of casual or low-paid workers and welfare recipients would be an equitable way of helping vulnerable individuals to play their part.     

Vaccine passports for events and venues are another hot topic. These strategies are being used overseas, making it easier to learn from their successes and replicate them. The devil always lies in the detail, including whether the policy is tightly enforced and what happens to those who won’t or can’t be vaccinated. 

Requiring a recent negative COVID-19 test is a sensible opt-out from a behavioural perspective. It is more difficult and annoying than getting a vaccine, but not impossible, meaning that people still have a choice. However, if vaccine passports are required for a long time, the resources required for frequent testing may be costly for government or individuals.

My research on the development of childhood vaccine mandates in Australia, Italy, France and the US state of California shows that there is complexity to these policies. Governments often reach for mandates before they have exhausted other approaches, including tailored and effective communication campaigns or the provision of behavioural-science-informed resources for medical providers to use when talking with families. 

When vaccines become (more) mandatory, health professionals may be placed in difficult situations with patients who are uncertain or unwilling. That said, one of the reasons that French authorities made more childhood vaccines mandatory in 2017 was to help doctors have more straightforward conversations with patients.

I feel for medical professionals in the current environment. Nobody wanted our vaccine rollout to be this complicated. The Prime Minister’s instruction for younger people to access AstraZeneca through their doctors has placed both these parties – younger Australians and their doctors – with a heavy weight of responsibility. 

There are difficult conversations to be had about risk, safety, fear and consequences. While this is the bread and butter of individual clinical encounters, this time the stakes are high for all of us.

I take heart from knowing that the public have great trust in their doctors. The recommendation and advice of trusted medical professionals recurs as a key factor in vaccine acceptance across the world. 

The saying goes that “we are all in this together” – and we are. But some of us play a very big role in helping us get from “this” to “that”. As a vaccination social scientist, I take my hat off to the medical professionals who are so integral to our rollout. You are trusted, and you are appreciated. Thank you. 

ED: Dr Attwell is a senior lecturer and academic researcher at UWA’s School of Social Sciences.