Last week, I spent time in a remote community in South Australia. Whilst completing some aged care client assessments, I asked people what their intention was regarding getting the COVID vaccination once it was available to them.
It was both interesting and disturbing to note that whilst the older non-Indigenous clients in the town were eager to access the vaccine as soon as it was available, their Indigenous counterparts were hesitant.
This is not the first time I have noted a high level of vaccine hesitancy amongst older Aboriginal clients or the Aboriginal staff who care for them, and other people working in these remote areas report the same issue.
This is very concerning because Aboriginal people living in remote communities are some of the most vulnerable in our Australian population. Many aged care clients have health conditions that result in compromised immune systems. Because of these comorbidities, plus environmental factors that encourage the spread of infectious diseases like seasonal Influenza, most people in these communities line up each year to get the flu shot. They understand that this immunisation practice minimises the risk of an adverse outcome if there is a flu outbreak in the community.
So why is getting the COVID vaccine so different? After all, over 85% of deaths from COVID occur in those aged over 65 years, and in those people who have health conditions commonly seen on remote communities, such as kidney disease, COPD, diabetes and heart conditions.
What are the reasons people are COVID vaccine hesitant?
Apart from concerns around Western medicine generally, there are concerns around the speed that the vaccines have been developed and an adverse outcome from vaccination, like a blood clot, as reported in an extremely low number of people who have received the AstraZeneca vaccine.
Some concerning trends are appearing from as far north as the Torres Strait and down to central desert community people. In some of these communities where there are strong links to a religious affiliation, people have been influenced by messages coming either from overseas religious programs, or leadership who don’t believe in vaccination, believing that ‘God will protect them’ from contracting the disease.
Other people have become complacent; as one older man told me, “we don’t have that disease here, that's a city problem.” This was despite living in a small town that is experiencing an extremely high level of tourism currently, where those tourists use the one small fuel stop/general store that the community people also use on a daily basis.
Why do people hold these beliefs?
Some people living in very remote Indigenous communities in Australia have low English literacy. This results in a dependence on news headlines, oral messaging and social media for information.
This reliance on sensationalised reporting, half-truths and personal opinions results in an ill-informed group who are at the mercy of anti-vaccination groups and conspiracy theorists, or just mistaken information. They are unable to discern the difference between hyped-up reporting and scientific studies, plus they don’t have access to medical and scientific journals or the ability to fact check as we do.
Many may also be wary of the information disseminated by government entities, not knowing if the information provided can be trusted.
Real vs Perceived Risk
We have a problem when people don’t recognise, or confuse, real risk as opposed to perceived risk. How do we communicate the very real ‘risk’ that COVID-19 presents?
Many Australians don’t recognise the impact that the virus can have on our vulnerable populations. We haven’t experienced the high number of deaths that other countries have and still are experiencing. We don’t personally know many people who have caught the virus and who are currently living with the long-term effects of COVID.
Here in Australia, as of June 2021, more than 900 Australians have died from COVID complications from the approximately 32,000 known infections. On the other hand, we have had two people die of complications from blood clots arising from the more than 5 million vaccinated.
While the untimely death of a person is tragic, are we, as a population, over-emphasising the risk of clotting due to the vaccine and overlooking the very real risk of an adverse outcome from the virus should it gain a foothold in the community?
Perhaps our problem is that we believe we have the luxury of over-emphasising the risk of clotting, because we have such low community transmission risk currently. But the price of vaccine hesitancy is closed international borders, ongoing lockdowns, ongoing COVID safe practices such as limitations on venue numbers, empty or almost empty sporting stadiums, and restrictions on travel for business and pleasure, all of which impact on jobs, our economy and our mental health.
As we move into winter and the cold weather in our southern states, we are more likely to come into close contact with other people as we spend longer periods of time in shops and cafes with decreased ventilation. As shown in other colder climates, this period is more likely to increase the chance of coming into contact with a COVID carrier and catching the virus. We are also more likely to be fighting off other seasonal infections, such as the flu.
The cold hard truth about COVID
The cold hard reality is that we will very likely live with COVID forever. We might be an island nation, and while we might strive for COVID zero, at some point we need to open our borders and that means we open ourselves up to the risk of the virus being imported into the country.
Experts advise that we need around 75-80% of the population immunised to achieve herd immunity. At this level, the virus has less ability to freely circulate and affect those more vulnerable to the virus who may be unable to be vaccinated.
How do we address this issue?
The Government has compiled resources that have been reviewed and fact-checked by the scientific and medical community. Use these resources to assist you in understanding COVID and immunisation.
Don't circulate dubious or sensational information.
It’s very easy to hit the share button on Facebook or forward a video or email to friends and family, but is the information correct? Take a minute to do some fact-checking against the science. Also, think about how others might view the information. You might follow through and realise that a viewpoint or piece of information is incorrect, but what about your family and friends who only read the headlines?
Get vaccinated yourself.
As soon as you are able to do so, get vaccinated. You’re not only doing this for yourself, you're supporting the safety of those around you. Additionally, the more people who get vaccinated, the more others will begin to know someone who has successfully and safely been vaccinated.
( A number of our team here at CDCS have been able to access a vaccine and are happy to report only minor side effects such as headaches or mild flu-like symptoms for a day or so. Due to the age range of the team we’ve accessed both the AstraZeneca and Pfizer vaccines.)
Meet people where they are at.
Sometimes you need to speak people’s ‘language’ to help them to understand the value of the vaccine. I don't necessarily mean their spoken language, although an interpreter can be a great asset when explaining the vaccine to those whose first language is not English.
What I mean is recognise their fears. A care worker may be worried about getting a vaccine if it might mean that if something goes wrong she leaves behind young children. Acknowledge the fear and let them know about the Pfizer vaccine, which is currently recommended for people under the age of 50.
If you are discussing the vaccine with someone who is adamant that ‘God will protect them’, discuss the concept that ‘God’, or their particular deity, is also integral in having a role in providing scientists and doctors who develop ways to protect people, and that Christian leaders of the past, such as Martin Luther (1483-1546), founder of the Lutheran Church who experienced the black plague in his time, who also advocated the concept of human responsibility.
Use practical examples.
Someone commented that the speed of the COVID vaccine development was fast and they were concerned about this issue making the vaccine unsafe.
While I could discuss the science around the timing, how the technology of gene sequencing and mRNA vaccines has been developed over many years, how sharing scientific information across the globe on COVID findings, combined with the vast sums of money that many governments contributed created the perfect environment for the development of suitable vaccines in a shorter period of time, perhaps using an analogy such as building a new model car might help some people visualise this better.
When a car manufacturer wants to build a new model, they don’t start from scratch, they build on existing infrastructure, templates and knowledge. This saves them time and money. If they went back to the drawing board every time they designed a new car, it would take forever to come up with new model vehicles. Instead, by building on what they already have, they can focus on tweaking things to make the vehicle look and perform better, meeting the needs of consumers and being more responsive to the market. That's essentially what has been done in developing these vaccines, building on existing information.
Help people join the dots.
Sometimes people don’t quite see the big picture. Like the elder I mentioned at the start of this article who didn’t recognise the risk of a passing tourist bringing the infection to his town, you may need to help him join the dots.
If you are working with people who have an issue with literacy, then try drawing the problem or using resources like maps to emphasise how the virus can be spread and how they might inadvertently pick it up.
CDCS worked with the Aged Care Quality and Safety Commission in 2020 to develop some storyboards that might be useful when explaining this. You can find downloadable copies of the storyboards on the Commission's website.
Hopefully this post has helped you to understand vaccine hesitancy better. If you can think of someone else who might benefit from this article, send them a link. We’d appreciate it! And if you’re looking for more helpful resources, why not check out our Total Quality Package resource hub? We have culturally appropriate, tailored resources that are designed to make your job simpler and help you provide quality care to your clients. Click here to find out more.