This is the postscript from the last article that showed how our vaccine authorities and science communicators have not performed very well promoting trust and confidence in a potential COVID-19 vaccine. When vaccines become available, there is a risk we may not have a wide enough public uptake to promote herd immunity. This is not due to naturopath uncertainty campaigns against vaccination or conspiracy theories but to the authorities’ failure to communicate trust. I often wonder whether there is a sound vaccine uptake strategy (outside of just trying to get social media companies to censor or remove anti-vaxx pages). People see vaccination rates going down, they hear concerns about an accelerated coronavirus vaccine development process, but they continue making the same mistakes rather than putting forward remedial actions.

Here are twelve communications ideas I feel are worth considering to improve our COVID-19 vaccine uptake strategy.

1. Stand up for science: Scientists should stay out of politics, but science needs to stand up to politics. I get that a particular person running for re-election is hanging his hopes on a vaccine before November 3, but each time he makes that promise, the scientific regulators need the backbone to stand up and say: “The vaccine will be ready when it’s ready and not a day before.” I don’t see that courage at the moment.
2. Create choice: There are many vaccines in the Phase 3 testing stage and there should be a wide variety of vaccine choices on the market. Assuming they all pass safety protocols and are effective, I would rather see people debating which vaccine to get (eg, number of jabs, dose levels, age-related advantages…) than worrying if any vaccine is safe or not. And competition will encourage further developments and iterations.
3. Open access: Publish all data and information on the research, development, trials, ingredients and production of the vaccines. One of the common (and successful) tricks anti-vaxxers use is to claim industry and the complicit regulators are not telling the truth. Eroding trust is easy when you can claim someone has something to hide. Only with full transparency can those susceptible to conspiracy theories think twice about Bill Gates trying to insert some sort of chip inside of us.
4. Publish a set of safeguards and approval protocols: To avoid the perception that a COVID-19 vaccine is rushed through the approval process or that corners had been cut, regulatory agencies should publish the different stages of the process and walk the public through each step when the vaccine candidates are being evaluated. Trust is gained with public engagement and buy-in; it is lost when people feel decisions are made behind closed doors.
5. Free access: One of the more curious tactics I have heard is the mathematical proposal to pay people to get the COVID-19 vaccine (up to $1000 per jab in the US, which is fine I suppose since we have got over our inhibition to print and give away trillions without scrutiny). I don’t think people should associate a societal responsibility with lucrative gain but since money is no issue, then the vaccine should be freely and conveniently available. Often people get their flu vaccine in the office, but as many are working from home, creativity is needed here. Those most vulnerable need to have the vaccine brought to them, freely, easily and voluntarily.
6. Communicate on quality: In many developing countries, people are hesitant about vaccines and other pharmaceutical products out of a belief (not entirely unfounded) that the high-quality products are reserved for affluent nations. The highest quality in production, distribution, management and administration has to be guaranteed for everyone, everywhere.
7. Strengthen the lifestyle and historical narrative: Anti-vaxxers portray themselves as leading health-conscious lives full of virtue and commitment (contrasted to the “sheeple” who are misled by evil chemical-pharmaceutical industries colluding with corrupt governments … and Bill Gates). There isn’t a positive name for people who vaccinate (OK, maybe “responsible”, but aren’t we all supposed to be so?), no honouring of the great vaccine research achievements, no chapter in school history books… It was not until the recent increased media coverage that the public learnt there was a field called “virology”.
   Getting a vaccine should be a celebration of how science has conquered some of the greatest threats of nature. Instead the naturopaths have framed it, like everything else science and technology has achieved, as diabolical.
8. Get spokespeople to speak up: I can think of a dozen Hollywood celebrities feted for their anti-vaxx position; I can’t think of any celebrity or influencer standing up and campaigning in favour of vaccines. These anti-vaxx celebrities tell heart-wrenching stories of vaccine victims (and stories always speak louder than facts). I get that public health authorities don’t have those budgets, but this needs to be run like a marketing campaign. (Like everything else in our community-driven world, vaccine perception is a marketing campaign.) If I were given this “campaign account”, I would get family members of COVID-19 victims to share stories of their departed loved ones, and end with a simple message: Don’t let this happen to your dearest and nearest!
9. Provide positive voluntary benefits / entitlements: Telling a parent that little Johnny cannot go to school unless he is vaccinated is an invitation for outrage. Rather than penalising people for not vaccinating (or worse, force vaccinating), why not create positive incentives? Perhaps offer a reduction in health-care costs (since money is no longer an issue), a QR code with access to public spaces, large events… Carrots always work much better than sticks.
10. Avoid publicly expressing scepticism: The scientific method is sceptical by design but the public does not understand that. When scientists disagree in public debates, the message we receive is: uncertainty, fear and loss of trust. The media loves to play up disagreement … as the BBC did claiming the “science was divided on vaccines” when one discredited physician questioned the safety of the MMR triple jab. The public perceive all scientists on the same level and expect consensus. So when there is news of Russian or Chinese vaccine developments, explain how you are cautiously looking into it (rather than rejecting it outright).
11. Lower expectations: While it is important to not be too publicly critical or negative, we should also avoid being overly positive. I have a sense that many people expect that once a vaccine is approved, the COVID-19 coronavirus will immediately “melt away”. Authenticity (a key element of trust) is when experience meets expectation. So science communicators have to learn to lower public expectations, be more sober and less exuberant. The public needs to know that beating the coronavirus will take some time and while a vaccine will improve the situation, the virus won’t just go away.
12. Focus on safer, not safe: Nothing is 100% safe and risk-free and while the precautionary-based docilian mindset demands these emotional reassurances of total safety, the public needs to understand that a vaccine is part of an immunity-building strategy that reduces risk of illness but is not perfect. Otherwise the first case of a vaccinated person contracting the coronavirus, or the first bad vaccine side-effect, will be met with a firestorm of fear and disappointment. I hold these precautionistas, with their zero-risk demand, as the main reason for the rise of anti-vaxxers. It is sad to see how some vaccine authorities willingly go down the “safe” rabbit-hole, raising public expectations that will never be delivered. We desperately need to return to risk management (continously making our world safer) and abandoning this reckless two-decade precaution-based experiment (demanding 100% safe).

These are some simple ideas (there are many more, I’m sure) to try to resuscitate trust in the COVID-19 vaccine uptake strategy. As long as the market and politicians are leading the discussions and framing the narrative, we can expect further public pushback (not just from anti-vaxxers). The present strategy of more of the same risk communications failures and censoring those who challenge them is not only an admission that the anti-vaxxers are winning, it guarantees it.

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