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Vaccine hesitancy is climbing in Australia, as it decreases in the rest of the world. At the same time, the government has outsourced its health campaign to private consultancies instead of engaging experts. By Justine Landis-Hanley.

Experts raise concerns about vaccine messaging

Professor Julie Leask, founding chair of the Collaboration on Social Science and Immunisation.
Credit: Louise Kennerley

Julie Leask heard the government’s Covid-19 vaccines commercial three weeks ago. She was on a podcast and the hosts played it to her, wanting her response as an expert in risk communication and vaccine hesitancy.

“They played the commercial to me for me to critique live,” she says. “… I heard the bureaucratic language and the sentence structure and I had less and less hope that the campaign messaging was taking on what we had learnt over so many years of research. My hope started to fade.”

Professor Leask already knew that the government had not engaged the country’s leading experts on vaccine hesitancy. They had not spoken to her, or to her colleagues in the field. The country’s world-leading research collective, the Collaboration on Social Science and Immunisation (COSSI), of which Leask is the founding chair, was not directly consulted.

Instead, according to tender documents, the federal government has outsourced the Covid-19 campaign planning to several private marketing companies and consulting firms. These include contracts with consulting firm McKinsey for strategic planning around the Covid-19 vaccine, The Lote Agency for public relations to support the vaccine’s rollout, and market research agencies such as Quantum Market Research, FiftyFive5 and Hall & Partners to monitor public vaccine sentiment and evaluate communications strategy.

At the same time, hesitancy about Covid-19 vaccines is rising in Australia. A recent global survey from the Imperial College London’s Institute of Global Health Innovation, in collaboration with market research firm YouGov, found that 40 per cent of Australian respondents said they were unsure about taking the vaccine or wouldn’t take it at all. Overseas, the opposite is happening: the willingness to be vaccinated is going up and up.

Almost all European countries surveyed reported a double-digit percentage-point increase in coronavirus vaccine acceptance rates between November 2020 and January this year. In Australia, the figure has dropped seven points.

In the context of these figures, Leask is struck by the government’s lack of engagement with experts.

“We have this network of researchers who do vaccine acceptance research, and I’m not seeing evidence that expertise is being used, expertise that taxpayers have invested in,” she said.

“We want to help Australia do this well. It’s more crucial than ever.”

In November, COSSI released a working paper with a six-point strategy for supporting Covid-19 vaccination uptake among Australians. Recommendations included developing a central repository of Covid-19 vaccine resources tailored to different groups, developing a risk management strategy for addressing vaccination crises if they arise, and conducting behavioural research on the barriers and drivers of immunisations.

While Leask knows the document reached government advisers, she says she’s seen “no evidence that these recommendations have been put into practice in the campaign planning”.

COSSI’s chair, Associate Professor Margie Danchin, confirmed that while the federal government has received advice from the group through the working paper, the Coalition has “not directly accessed the research, knowledge and expertise within the group to develop the content of the Covid-19 vaccination campaign”.

“A close partnership between academia and government would enable leading social and behavioural science around vaccine acceptance and uptake to be used to inform the Covid vaccination campaign. This would maximise its success,” Danchin said.

So why has hesitancy around the Covid-19 vaccine grown in Australia, while in other countries willingness has soared?

Leask, who also co-chairs the World Health Organization working group that contributed to the design of the YouGov survey, says it could be because Australians have enjoyed living in a country relatively unscathed by the virus.

“It’s possible that what we are seeing here is a strong relationship between disease risk perception and vaccine acceptance,” she says.

“A lot of medical treatment is to treat something you already have. A vaccine requires people to take a risk, to put a lot of faith in a system and take a biological product for something they don’t have yet.

“And most Australians haven’t seen anyone with Covid.”

Leask’s hypothesis is backed up by the YouGov survey, which found that as vaccine hesitancy went up, the number of Australians worried about getting Covid-19 went down.

Hesitancy around taking the vaccine is particularly notable among young people. Guardian Australia reported in January that women aged 30-39 are the most vaccine-hesitant group in the Australian population, according to Health Department research.

Danchin, a vaccinologist and group leader in vaccine acceptance, uptake and policy at the Murdoch Children’s Research Institute, says it may be because women are “thinking about vaccines, say, more than other age groups”.

“I think younger women have children who are being vaccinated and going through the childhood vaccination schedule, so vaccine decision-making is more a part of their life.

“But I also think captured in that age group are pregnant women, and then another big group are breastfeeding women.

“You know, we actually have no trial data to support the vaccine in pregnancy or breastfeeding at the moment; we are having to go off data from other similar inactivated vaccines used in pregnancy. So the recommendation at the moment is for pregnant women to discuss whether they should have a Covid-19 vaccine with their healthcare provider who can help them to assess the risk from the disease compared to the vaccine for them personally.”

Leask predicts that Australians’ attitudes will begin to shift once the vaccine is rolled out here, as it has in Europe, because “when people come to approach crunch time with a vaccine decision, they tend to move towards vaccination, rather than away from it”.

But she believes that the government should be using the experts and research available to improve vaccine uptake, to “meet our very ambitious target of having 80 per cent of Australians vaccinated by October”.

The University of Western Australia’s Dr Katie Attwell, who is working with the WA government to research community readiness for the Covid-19 vaccine, warns that the companies winning the government tenders for consultancy may be able to measure attitudes but may not be able to interpret them.

“Can they extrapolate what the data shows, drawing from other fields of research like childhood vaccinations or adult influenza?” she asks.

“It would be great if vaccination social scientists had more opportunity to draw on our significant expertise, working directly on research design and analysing and interpreting results.”

A spokesperson for the Department of Health confirmed that the department’s public information branch is responsible for research and implementation of vaccine communications, but did not respond to The Saturday Paper’s questions about who sits on the team.

Researchers say they have also struggled to get funding to investigate the barriers to Australia’s vaccine acceptance and ways to overcome them, and that the underinvestment is showing now.

Last year’s federal budget committed $95.2 million to the Medical Research Future Fund to support “diagnostics, vaccine development, antiviral development, clinical trials, digital health research infrastructure and research into the human immune response to the Covid-19 infection”. Only $600,000 – less than 0.01 per cent of the pool – was made available in grants for research projects focusing on behavioural communications research to “improve community engagement and responsiveness to information and advice about pandemics”.

Some infectious disease social scientists, such as University of New South Wales associate professor Holly Seale, have taken it upon themselves to use their own time to conduct what they consider to be necessary stakeholder research.

“I’ve spent my last three weeks interviewing stakeholders who work with and provide support to people from culturally and linguistically diverse communities and hearing about a wide range of activities that have occurred during the pandemic so far, because there is no way that these [large] surveys are going to hear their concerns,” Seale told The Saturday Paper.

“And that’s why I’ve done it off my own bat with no funding. I’ve literally used my own time to do these interviews because I want to hear from the people on the ground who will be the ones driving localised communication.

“I have another colleague who is doing surveys in a range of different languages, again unfunded – just using the resources that she has, because she knows it is so critical to understand the motivators [for taking a vaccine] within these communities.”

But hope for strong vaccine acceptance is not lost. Leask says she doesn’t think the rise in Covid-19 vaccine hesitancy, captured in the YouGov study, is a major issue.

She warns, though, that “if we continue to see information gaps on the very real questions people have now, if we don’t see more rapid, responsive and transparent communication around the vaccine, if we continue to see messages from homogenous spokespeople or hesitancy from healthcare workers because their questions aren’t being answered, I will get worried”.

This article was first published in the print edition of The Saturday Paper on Feb 13, 2021 as "Vaccine but not heard".

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Justine Landis-Hanley is a Melbourne-based journalist. Her work has appeared in The New York Times, The Sydney Morning Herald and The Age.