Can a rise in vaccination motivation spur take-up beyond hotspots?

Jolyon Attwooll

17/08/2021 5:29:12 PM

The Delta threat has coincided with a surge in Australian vaccination numbers but experts say other factors, including access and socioeconomic status, could be even more important.

People lining up for a COVID vaccine.
People in hotspot areas – particularly Sydney – are presenting for vaccines in unprecedented numbers. (Image: AAP)

The urge for people to get vaccinated is rising fast, with people in hotspot areas – particularly Sydney – turning up for vaccines in unprecedented numbers.
But while motivation is high, social scientists believe other factors affecting the uptake are not as widely appreciated and that it is too early to gauge the effect on vaccine hesitancy.
Professor Julie Leask, a social scientist specialising in immunisation at the University of Sydney’s School of Nursing and Midwifery, stresses there are a variety of factors at play beyond motivation.
She says the outbreaks have prompted people to get vaccinated sooner, but cites access related to socioeconomic status as the biggest determinant – a practical issue also affected by outbreaks.
‘The well-resourced are getting vaccinated sooner, and the poor are getting vaccinated later. At this stage that’s the biggest driver of vaccination uptake,’ she told newsGP.
‘Outbreaks trigger a whole lot of things that make vaccination easier: more convenient services, the drop-in clinics, the Medicare free clinics for those who are poorly reached.
‘So it’s not just about tweaking individual motivation. I can say after 24 years of researching that if you want to improve uptake, change upstream policies, make vaccines convenient and stop confusing people with different recommendations.
‘That will have a bigger impact than changing the way that you feel.’
According to surveys released by the Department of Health (DoH) this month, rising concern about COVID has resulted in more people planning to get vaccinated.
The surveys, which were carried out by Melbourne-based Quantum Market Research, also suggest the outbreaks have spurred more people to consider AstraZeneca, but do not include any breakdown of the respondents’ age, location, ethnicity, or socioeconomic background.
While Professor Julie Leask says the surveys only reveal a small part of the picture, she says they reflect a more positive trend in sentiment towards vaccination than she anticipated.
‘I predicted at the beginning of the year that we’d get 60% national coverage by the end of the year if we were lucky,’ she said.
‘But I didn’t predict that we’d have such a big Delta outbreak that started seeding around the country. And I think that spurred things along.
‘If we’re just looking at motivational issues, then outbreaks can definitely influence willingness to vaccinate.
‘They can tip some people over the line when they’ve been planning to vaccinate and haven’t gotten around to it yet. That can really be the nudge for a decent amount of people.’
Influence of outbreaks
The ripple effect of the outbreaks is being felt well beyond the hotspots. Based in Kununurra in far north Western Australia – an area that currently has the lowest COVID vaccination rates in the country – Dr Catherine Engelke is part of a team that successfully bucked the regional trend.
In Warmun, an Aboriginal community of around 300 people in the East Kimberley where Dr Engelke has been a familiar face for 10 years, more than 80% of eligible residents have received at least one vaccination.
However, like Professor Leask, she believes the outbreaks are mostly a spur to those who had already planned to get vaccinated anyway and that uptake is primarily generated by substantial preparation work.
‘[The community] knows that there are outbreaks, and that causes them certainly to be fearful. But I don’t think that fear necessarily generates more to be vaccinated,’ Dr Engelke told newsGP.
‘It will get those that are interested in vaccine or don’t have a huge issue with being vaccinated and tend to promote them to come along earlier.
‘We started the vaccination program before there were huge outbreaks in the east. A few more have come along, but there is still that concern and anxiety in the Aboriginal community.’

Professor Holly Seale says community leaders play a key role in reducing vaccine hesitancy.
As well as being spurred by outbreaks, different communities will have varying motivations beyond reducing the chances of severe disease, Professor Holly Seale, a University of New South Wales infectious disease social scientist believes.
She says it is important to determine what those nuances are, be it reducing border restrictions and seeing friends and family, to kickstarting small businesses back into action.
Professor Seale also highlighted that the DoH surveys revealed that a lack of certainty over the long-term impacts was significantly above all the other vaccination concerns among those polled.
However, she believes that while the COVID vaccines are at a disadvantage compared to more established vaccines, those concerns could still be addressed with better messaging and cites articles talking about the long-term evolution of mRNA technology as an example.
‘This whole notion that magically within a year they had this [vaccine] up and running, actually, it’s not entirely true,’ she told newsGP.
‘I think that could be used more to support confidence and break down this kind of sentiment around things being rushed.’
Having run workshops talking about vaccine communication, Professor Seale also stresses the key role of community leaders in the decision-making process.
‘I am especially focused on Aboriginal and Torres Strait Islander communities,’ she said. ‘Those local leaders are going to be the most influential voice out there, talking to community and I’ve certainly been hearing great things about people having those conversations.’
Again, however, Professor Seale raises the key issue of access, which she says needs to be an urgent priority even in places that have not seen any COVID-19 cases so far.
‘Are we taking the vaccine out into the community? Are we setting up the workplace vaccine programs?’ she said.
‘All of this is relevant wherever we are right now in Australia. It’s not just about the big hubs.’
The unclear role of hesitancy
Questions over the relative influence of hesitancy, motivation and access remain, Professor Leask believes.
‘It’s as much about practical factors and confidence,’ she said. ‘And to what extent? We don’t know for sure. That needs to be measured really well, and in Australia, we don’t measure it that well.’
Assessments on attitudes towards the vaccine have been carried out by the Australian Bureau of Statistics – most notably the Household Impacts of COVID-19 Survey, which began in autumn last year as the pandemic took hold.
The latest study, from this June, suggested antipathy towards the vaccine was falling. In April, 13.4% of respondents disagreed with the statement they would take an available, recommended COVID-19 vaccine. In June, that had fallen to 11.4%. However, that survey has now been discontinued – and there are no plans to pick it up again.
Professor Leask says hesitancy is sometimes conflated with those who intend to refuse to have the vaccine – and stresses that it is those on the fence who are the most important to target, alongside people with access issues.
‘Those who are unsure about whether to vaccinate or not, those people who could well be brought to vaccinating with the right approaches or simply having more time to be more comfortable with the idea of having a new vaccine, we know we really do need to focus on those,’ she said.
And the size of that task is not for a moment lost on Dr Engelke.
‘We are still nowhere near out of the woods yet,’ she said.
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