Getting to 80 per cent vaccinated against coronavirus — and beating the anti-vaxxers

Here’s the problem. To get back to normal, we need to get 80 per cent of the population vaccinated. But in a recent poll only 45 per cent of the population say they are certain to get the vaccination (just 35 per cent of those aged 35–44) with 18 per cent saying they definitely or probably would not.

Let’s assume that a vaccine is proved to work, and the government can manage the rollout (a big assumption, given the concerns already expressed about the volume of cold storage and the staff required). How are we going to get to 80 per cent?

The answer is (1) a programme explicitly designed to get to 80 per cent and (2) a world class campaign to get people to get the jabs.

A programme designed to get to 80 per cent vaccination rate can’t just work for middle England, or what Caroline Criado Perez calls “the default male”.

We know the ways public policy fails in the UK. Rollouts are slow and bumpy. Some disadvantaged groups are always left with less access. People on low incomes always find it harder to exercise their rights. Private companies cream money off the top that could be better spent.

So we need inclusive programme design rooted in the diverse communities of the UK, with transparent decision-making and procurement. The government needs to actively involve regional and local government, which is closer to people’s lives and expert in their local communities. Too often in the pandemic response public policy has made assumptions about people’s lives which have undermined the effectiveness of the policy. We can’t make the same mistakes — not least as some aspects of programme design have a major impact on demand — above all the practical barriers of getting a slot in people’s busy lives.

The core thing is this: it must be as easy as possible to get vaccinated. Vaccination should be available nearby, at times convenient for those getting vaccinated (including evenings and weekends). Employers should be required to give paid time off to get vaccinated.

And the government must set out transparently some of the trade-offs and assumptions guiding the programme, to help build trust. A key issue will be helping people understand the rationale for the order in which groups of the population get vaccinated. Given that the vaccine has been talked about as the golden ticket out of the pandemic, the order and pace of universal rollout may leave some disappointed as their slot comes perhaps months after the start of the programme.

We should also trial ways of structurally encouraging people to get vaccinated (“nudges”, ugh).

A weakness of our vaccination system in the UK is the expectation that individuals (and parents) will know their eligibility, understand vaccination schedules and themselves manage the process of making appointments. My experience as a new parent was that it was hard to understand which vaccination came when, and harder to schedule appointments at overstretched GP practices. It would be worth the NHS experimenting with telling eligible people when and where to attend for their vaccination, creating the expectation that they will get vaccinated.

The other nudge centres on the range of benefits and sanctions related to vaccination status. We have seen the Test and Trace programme fail to balance these — with heavy fines for those failing to self-isolate but non-existent financial support for most of those who remain at home but can’t work.

A range of personal freedoms could, in time, be opened up to those who have been vaccinated. Allowing access to pubs and restaurants, live performances and sport, and foreign travel upon proof of their status may be a powerful driver of pro-vaccination behaviour, as people realise that not getting vaccinated will mean their leisure activities remain limited.

The other side of the coin is restricting access to employment or public services on the basis of vaccination status. But although it may drive some pro-vaccination behaviour, the social justice implications of eg not allowing children to attend school without being vaccinated or employers coercing decisions that impact people’s livelihoods are indefensible.

Once we have an inclusive programme with the right balance of nudges, we need a world-class communication campaign to create demand for the vaccine. That’s the subject of my next blog.

I’m neither a scientist, a medic nor a health promotion professional. What I am is a campaigner who desperately wants the potential of a coronavirus vaccine to be realised. I make no claims to expertise — and would love to read others’ thoughts on how we get this done.

Part 2 — the comms campaign we need

Part 3 — what individuals can do