Want to Restore Trust in the AstraZeneca Vaccine? Start Here.

https://www.nytimes.com/2021/03/22/opinion/astrazeneca-vaccine-trst.html

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The European Medicines Agency, Europe’s top drug regulator, confirmed last Thursday that the Oxford-AstraZeneca Covid-19 vaccine is safe. And on Monday, results from a large clinical trial in the U.S. found that the vaccine is 79 percent effective with no serious side effects. In some ways, this shouldn’t be news: It had previously received approval by the E.M.A. and some 20 million people in Europe have already received doses, largely without issues. But earlier in the week, several European countries temporarily halted inoculations out of concern that it caused blood clots.

Now that regulators have reaffirmed the AstraZeneca vaccine’s safety, we need to address the next key challenge: confidence and trust in it. Although the vaccine has been given the official green light, the reported risks and the temporary suspensions have heightened anxieties and increased hesitancy.

Among the 20 million people who have received the AstraZeneca vaccine in Europe, 25 people developed blood clots following vaccination. The rate of blood clots that would normally occur among unvaccinated people is in fact much higher. But given the newness of the vaccine, every reported side effect is being carefully considered. This is a good thing. Instead of being scared, we should be reassured that the safety system is working.

That isn’t how last week’s developments were received, though.

When multiple European countries temporarily suspended distribution, it triggered anxieties around the world. A poll published last week found that only 20 percent of people in France — a country with a high rate of vaccine hesitancy to begin with — trust the AstraZeneca vaccine. Thailand and Indonesia temporarily suspended its use while the E.M.A. investigated the reported side effects. The Democratic Republic of Congo postponed its rollout of the AstraZeneca vaccine because of concerns about the reported blood clots. Cameroon also suspended its intention to use the AstraZeneca vaccine, even after the E.M.A. endorsed its safety.

This is bad news. The AstraZeneca vaccine will be crucial for putting Europe, which is now facing a third wave of coronavirus infections, on the road to recovery. It is also crucial for Covax, the global facility that aims to ensure access to Covid-19 vaccines for low and middle-income countries. AstraZeneca and its partnering Serum Institute of India are the biggest providers of vaccines for the initial Covax rollout, aiming to reach 142 countries. But delivery will not be enough if these vaccines aren’t trusted.

We are just at the beginning of multiple new rollouts to millions of people. It is almost inevitable that among those millions, new risks will emerge. In our hyper-connected, anxious and uncertain world, a perceived risk in one place can easily be amplified with potentially fatal consequences halfway around the world. This is what is now happening.

What is to be done?

The truth is, there’s no easy path here. Vaccine confidence has many layers. Those who have low confidence in vaccines have their reasons. Some stem from historical distrust, based on lack of transparency or unethical processes in previous medical trials. (See, for example, the Trovan case in Nigeria or the well-known Tuskegee study in Alabama.) Meanwhile, some people have simply felt judged or mistreated at clinic visits, or have heard about a vaccine reaction that led them to be cautious. Sometimes the distrust is not even directly related to the vaccine, but caused by a lack of faith in local authorities or global institutions. Headlines about side effects and suspensions of inoculations will only redouble the doubts of the skeptical.

As the world deals with brand-new vaccines, trust issues like the ones that have arisen in the past week are inevitable. But we must be prepared to reassure people that they can have faith in the process.

The E.M.A.’s report of its findings has been transparent and the rationale for continuing vaccination is clear. What is needed is equally vigilant safety monitoring globally, with rapid responses to assure people that each new Covid-19 vaccine is treated with serious attention and that there are no shortcuts on safety.

But public confidence is not just about trust in vaccine safety, it is about trust in those who fund, produce and deliver the vaccines, and in governments and international bodies that regulate, approve and recommend them. Trust is often defined by two factors: trust in the ability or competence of an individual or institution to do what they promise and trust in their motive. We need to build the public’s confidence in both.

This month, the World Bank issued a report on countries’ Covid-19 vaccine readiness. The findings were concerning when it comes to the human side of vaccination: In the 128 countries reviewed, only 30 percent had plans to train the vaccinators needed to administer the new vaccines and only 27 percent had developed public engagement and social mobilization strategies to motivate people to get vaccinated.

This is a shocking finding, given how long we have known that these new vaccines were on the way. Planning for — and investment in — communication and engagement should have started the day governments began making advance purchases.

Training vaccinators and building their confidence is essential. They are the ones interacting directly with the public, calming anxieties and answering questions. Their training needs to go beyond the logistics of how to administer the shot and prepare them for questions, including ones about the vaccines’ safety.

While a wider coherence is needed in getting the up-to-date facts about Covid-19 vaccines, there need to be opportunities for people to ask their questions and get prompt answers. The opportunity to talk to someone — even if online — is crucial. We cannot forget the isolation that many have felt, and the opportunity to just talk through vaccine questions and be reassured can be invaluable, especially in light of uncertainties like those that emerged last week.

Few countries have coherent national strategies, but they are necessary. These strategies need to involve the public, not only as vaccine recipients, but as actors in the process. Covid vaccines cannot be seen as something taken because the government says so, but because they have meaning in people’s lives.

Communication and engagement strategies need to take into account local histories, engaging groups where there is known hesitancy, and supporting local leaders and trusted figures from within those communities to build confidence. Creative media — offline as well as online — that is engaging, empathetic, and touches social and personal emotions, while conveying facts about the vaccines, is important, but it needs to be part of a wider effort with not just a goal of getting everyone vaccinated, but opening up society.

In our scientific rush to develop, manufacture and deliver vaccines more rapidly than ever in history, countries around the world have failed to engage the public. We need to restart immediately and bring vaccine confidence into the heart of our global Covid-19 recovery efforts. This is a global crisis at multiple levels.

This article has been updated to reflect news developments.

Heidi J. Larson is the director of The Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine and the author of “Stuck: How Vaccine Rumors Start — and Why They Don’t Go Away.”

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