1 July 2021

What works best for vaccine hesitancy?

Clinical COVID-19 Vaccination

Although vaccines are our clearest path out of the worst of this pandemic, reluctance appears to be entrenching itself in parts of the community.

While much of the hesitancy is specific to covid and distinct from hardline across-the-board anti-vaxxerism, there are lessons in previous policy efforts to increase vaccine uptake.

Dr Katie Attwell, a mandatory vaccination policy researcher at the University of Western Australia, delivered a series of presentations at the 2021 National Immunisation Conference this week looking at which government-sponsored tactics worked best for encouraging vaccination.

In a study looking directly at the effects of two punitive financial interventions known as No Jab/No Pay and No Jab/No Play, Dr Attwell and team found that despite the high profile of the interventions, they were virtually ineffectual.

The No Jab/No Pay policy, which began in 2016, is a federal initiative which prevents parents from accessing certain rebates such as the Child Care Rebate if they choose not to vaccinate their child for non-medical reasons.

Although this policy existed prior to 2016, payments were still available to parents who identified as conscientious objectors, meaning parents who chose not to vaccinate could still claim the money.

The No Jab/No Play policy, on the other hand, has been progressively introduced on state levels since 2014, and limits access to childcare centres and early childhood education for unvaccinated children.

The study, published in Paediatrics late last year, found that Australia’s childhood vaccination rates had indeed increased – but appeared unaffected by the policy implementation.

“There was no statistically significant change brought about by the policy change,” Dr Attwell said.

“Basically, things were going in the right direction before and after the policy.”

The research itself was a time-series analysis which measured the number of children unvaccinated at 12 months.

In the target population of vaccine-hesitant parents, the policies don’t appear to have made a dent.

“We also found no significant difference in areas of high, medium or low conscientious objection, so the policies don’t seem to have contributed to a bunch of unvaccinated people living in a cluster going out and getting vaccinated,” Dr Attwell said.

According to Dr Atwell these results essentially mean that Australia’s increasing vaccination rate should not be put down to financial interventions, and suggested other factors held greater weight.

These include the mandatory childhood vaccination policy which was already in place prior to the financial policies, the fact that vaccines in Australia are free and the idea that the punitive policies, which were widely publicised, could have contributed to heightened public discourse around vaccination.

Investigating these factors further, Dr Attwell also presented research findings on the interaction between vaccine mandates and communication campaigns.

Published in Frontiers in Communication earlier this year, the paper compared public information campaigns promoting vaccination in Australia and France in 2017-2018.

If the No Jab/No Pay policy was the federal government’s ‘stick’, funding for communications campaigns which would educate the public on the benefits of vaccines were the ‘carrot’ – accordingly,  in late 2017, the federal government launched Get the Facts.

Get the Facts was a multi-tiered campaign, outsourced to a private media company and run for a total of six years using a variety of media channels, with the website component still accessible today.

In France, the government followed up a change in mandatory vaccination laws with Vaccine Information Service, an initiative involving social media influencers, videos and a website.

There are several key differences between Vaccine Information Service and the Australian campaign.

In France the campaign was created by the health department – not outsourced – and was largely static, with the website essentially staying the same from the day it was released, where Get the Facts had a tiered rollout.

Although there was no clear data on attitudes toward vaccination pre- and post-campaign for either country, Dr Attwell identified multiple issues with both.

“There was no attempt to record public sentiment toward a vaccination mandate prior to its implementation in Australia, and, in France, differences in study methodology makes it difficult to diagnose evolution,” the authors wrote in Frontiers in Communication.

Get the Facts operated on an emotional level and was apparently rather light on actual facts; a large section of the website is dedicated to video testimony from parents whose children died of vaccine-preventable illnesses.

The French website, however, treated the population as homogenous and did not address any social or ethnic subgroups in the population, which meant it missed the nuance which the Australian website contained.

“In France, the scientists have actually put their stamp all over this thing, which is why it’s not very accessible, and in Australia it’s private companies who have expertise in communication who have designed the campaign [but left out relevant facts],” she said.

Attitudes aside, however, the Australian campaign appeared to have a greater positive effect on vaccine rates.

“It is possible that the higher support for the mandate in Australia means that Get the Facts and the associated public communications proved more successful in manufacturing consent for the mandate than the exhaustive and transparent French approach,” the researchers wrote in Frontiers in Communication.

Dr Attwell’s research suggests that in light of the ongoing covid vaccine rollout woes, perhaps it is time to break out the carrots with reluctant patients – as tempting as the stick might be.

Paediatrics 2020, December 1

Frontiers in Communication 2021, February 23

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