Representative image. Photo: Reuters/Hannibal Hanschke/File Photo
Even as the novel coronavirus spreads anew through the world’s populations, governments have been trying to quicken the pace at which they’re delivering vaccines against COVID-19. In this scenario, vaccine hesitancy has become a significant problem in many countries, including India, Europe and the US.
In India at least, potential vaccine recipients were put off by the national drug regulator’s summary approval for Covaxin, by controversies surrounding the AstraZeneca shot in Europe, and now by suspicions that the government is suppressing news of inconvenient side-effects.
This throws up some interesting, if quite concerning, questions about why people hesitate to take vaccines and why public institutes advocate their use despite not knowing all there is to be known. Are the institutes behaving responsibly?
On the other hand, would the people be justified in avoiding them on the thin possibility of adverse effects?
The public institutions administering the vaccines need to calculate the pros and cons of administering a vaccine. Pros include saving contraction and spread of disease, lowering pressure on healthcare infrastructure, lessening the negative impact on the economy and saving lives. Preliminary studies have shown that vaccines could also help reduce transmission of the virus.
There are some cons, even if they are very unlikely. For example, around one in 600,000 AstraZeneca shot recipients in the UK reported developing rare blood clots.
From the broader society’s point of view, the AstraZeneca shot’s efficacy of 76% or so means its benefits vastly outweigh its risks (one in 6 lakh amounts to 0.0017%). So it is rational for public institutions to recommend vaccination, at least until they find a definitive causal link.
Consider this same calculus from an individual’s point of view. A person might hesitate to receive a vaccine due to doubts about threats that it may pose. From their vantage point, two outcomes are possible: debilitating and non-debilitating side-effects. A non-debilitating side-effect may not be very off-putting; however, it’s tricky when a side-effect is very rare but, if it happens, can considerably worsen one’s quality of life.
In 1968, American economist Thomas Schelling advanced a distinction between two kinds of biological entities embodied in the consideration above. Statistical lives, he said, refers to people who could be saved by a public health programme like a vaccination drive, but who will remain unidentifiable before and often after the illness. The individual life is one’s own life or that of a distinct person whose wellbeing we are familiar with.
From one’s own perspective, an identified life is more valuable than the statistical life. So an individual’s decision to not vaccinate themselves or other family members may seem rational. Amos Tversky and Daniel Kahneman have also shown in their work that people tend to be risk-averse even if a risky choice can lead to gains. So people would rather avoid being vaccinated fearing a rare but serious adverse effect instead of protecting themselves from contracting COVID-19.
Vaccine hesitancy is likely to decline only when the number of people taking vaccines increases. For this, vaccination as a standard public health behaviour needs to be institutionalised, by getting more and more people vaccinated.
It is important that public authorities understand the people’s perspective instead of brushing away their concerns as insignificant, irrational or unscientific. For example, India can emulate the Australian government, whose department of health has said that it is investigating adverse effects, has admitted the existence of certain risks, and has published warning signs that people can look out for being vaccinated. Such initiatives will help the people retain faith in the public institutions tasked with protecting them – and make the vaccination drive smoother, even if it slows down a bit in the short run.
Indranil De is an associate professor at the Institute of Rural Management, Anand. The views expressed are the author’s own.