Vaccine hesitancy and the place of empathetic communication

After several prevention, management and control methods deployed globally in the past 12-14 months, since the first announcement of the COVID-19 outbreak, scientists and researchers have taken one major leap that is leading to a big change in the lives of mankind. We have a vaccine!

In simple terms, as seat belts help prevent us from road accidents, vaccines prevent us, in the first instance, from getting sick from a disease. A vaccine is a biological substance containing the dead or weakened form of the disease-causing microorganism, which when administered to the body, provides protection (immunity) against that disease. When one receives a vaccine, the immune system responds in three steps:

Recognition: The immune system recognizes the invading or disease-causing organism
Antibody Production: The immune system naturally produces “warriors” called antibodies. Antibodies are proteins whose function is to fight disease.
Immune Memory: The immune system does not forget. It remembers the disease once you are exposed to them in the future and quickly destroys it, before you become unwell. In such cases, it’s like a lock-and-key effect. The antibody fits perfectly into the antigen and eats or kills it.

However, a knowledge of how vaccines work is not enough to make the world open to this preventative option, for diverse reasons including vaccine hesitancy.
Described as a delay in the acceptance or refusal of vaccines despite the availability of vaccine services, vaccine hesitancy is a challenge worldwide. Globally, racism and other health inequalities have contributed to major public health concerns over the years. These concerns are hinged on views of the anti-vax communities, a distrust in the public health systems, the amplification of disinformation through the digital media, ill-equipped healthcare workers who have inadequate health communication skills to empower patients and the public, amongst others.

Locally, a 2020-study published by The Nigerian Journal of General Practice, shows that context-specific factors contributing to vaccine hesitancy in Nigeria is largely dependent on its multi-ethnic and multi-religious diversity across the various geographical regions. Other influencing factors like educational and socio-economic status also contribute to the uptake of vaccines. Vaccine hesitancy in the early 2000s, contributed to the heightened cases of polio in Northern Nigeria. In some religious contexts, all deaths, including those from vaccine-preventable diseases, are ascribed to, as the will of God. There are also those who see vaccines as the western agenda to depopulate people of African origin. More specific to COVID-19 is the misinformation and assumption by most Nigerians that the disease is simply non-existent, or at most a type of malaria, for which the government is using to plunge into the national economy.

We cannot ignore these concerns as we begin the COVID-19 vaccination in Nigeria. Since vaccination from vaccine-preventable diseases offer the fastest route to herd immunity, concerns that influence a people’s disposition to it must first be understood and addressed using context-specific strategies. What, then, is the place of empathetic communication in vaccine administration?

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The first and most important step is for the government to join forces with allies: healthcare workers, scientists, researchers, religious, community, social, political influencers at all levels who are strong advocates of vaccination as a launchpad to health security. These forces at various levels must imbibe empathy in reaching out to and engaging with individuals and communities who, verbally or not, express these concerns. For a win-win engagement:

Seek to listen, understand and acknowledge the concerns of the individuals or groups. This step is non-negotiable, as we cannot talk about behavioural change communication if we do not pay attention to the people. Acknowledge by showing that their fears, worries, complacency, or cautiousness are valid. A community where everyone is heard is one where we see a surge in transparency and trust for health workers and public health systems.
Give and receive feedback without blame. The best approach to empathetic, change-driven communication is not to ask people to roll up their sleeves and get the COVID-19 vaccine because it is what we think best for them. Our approach should reflect that we care more about them, what they represent, their dreams, liberty and safety, amongst others. Feedback given in the way that these audiences can understand, and gain the support or endorsement of influencers from these communities present a win – win situation.

Most times, these underlying causes reflect an unfamiliarity with the content of the vaccine, a deficit of information by experts, or even a lack of trust in information shared by non-experts. This is where we address issues around misinformation using sound, relevant and easy-to understand communication methods. Massive health education, especially in local languages, could simplify complexities like the content of the vaccine, how it works, why it is safe and long-term benefits of getting vaccinated.
Identifying and engaging with audience segments like parents and household leaders, whose decisions are key in vaccinating against COVID-19 and other vaccine-preventable diseases are key. This can be achieved through town hall meetings in communities and religious groups. Knowing that these people often have the final say, we need to be honest without coming off as insulting.

Addressing these vaccine hesitancy in the most humane way is neither a one-time campaign nor is it dependent on a single type of intervention. Most times, it is a long journey. However, the multiple interrelated determinants underlying this behaviour can be addressed per time. It is a continuous loop of listening, understanding, acknowledging concern and giving timely, relevant feedback in a way that is memorable and shareable within these communities. In the long run engagement strategies suited to a local context will do more to reduce vaccine hesitancy and amplify the uptake of COVID-19 vaccination.

Chidindu Mmadu-Okoli is a health writer and licensed medical laboratory scientist, who is passionate about telling purposeful and persuasive health stories that promote patient-provider interactions, patient-centered care and inspires healthy living.
She is a 2019 #PreventEpidemicsNaija Fellow with the Nigeria Health Watch where she lends her voice towards advocating for the need for sustainable funding for disease prevention. She is a 2019 Science Communications Fellow of the Africa Science Literary Network, a TEDx Speaker whose talk advocates for patient-centred storytelling as the future of healthcare and a member of the Society for Health Communications, USA.
Chidindu currently hosts The Vital Signs Podcast show for humanizing healthcare, and has contributed through her various communications roles to write, create and design health awareness, education and promotion materials for vulnerable patient populations, the public and policymakers.