Covid–19 vaccines, their effectiveness and their risks are a hot topic of conversation. A growing number of vaccines are becoming available, pharmaceutical companies have developed them in record time, producing in a number of months what ordinarily would take several years. Following an initial scrum from countries to get hold of vaccines, roll out has begun at varying rates across the globe. 

 In Northern Ireland one in three of the population has received a first dose and the team behind the rollout of the programme are to be commended. But for vaccination programmes to be successful in populations gaining control of the pandemic, uptake must be almost universal. And it is not. Whilst the majority of people embrace vaccination as the way forward and keenly await their turn for the jab, there is a sizeable minority who are hesitant and will resist being injected. These people are not the bellicose anti–vax cohort who are unlikely ever to be persuaded of an argument in favour of vaccination but rather people who need to be convinced of the safety, effectiveness and morality of being inoculated. These people lack trust.

As any good communicator will know, building trust is imperative in shifting attitudes and behaviours. In terms of the vaccine there is a lack of trust across a number of areas on a number of grounds and building it will take a co–ordinated effort that occurs at different levels. Getting the communication right about vaccination will be crucial in coming months. And to be frank, we are off to quite a shaky start in this regard. ‘Big Pharma’ has had trust issues for years with some very prominent incidences remaining clear in the mind. 

 An example of this is the controversy in Ireland over the price being charged by the makers of a drug to treat cystic fibrosis Orkambi, that then Taoiseach Enda Kenny described as “grossly excessive”. The fallout was very damaging not just the reputation of the drugs maker but to the sector as a whole. In 2019, as noted by business site Raconteur, “the Edelman Trust Barometer found only 57 per cent of the UK public had faith and trust in the sector while more recently, a survey of UK consumers by medication review site Drugs Disclosed, revealed 93 per cent of patients are mistrustful of information about their medication, with 84 per cent believing the pharma industry influences prescription decisions.” Those are pretty heady figures to contemplate and the pharmaceutical sector must not only contemplate but act on them. In truth, if it gets right, Big Pharma can have a Covid moment and can, through persuasive vaccine communications, rehabilitate its reputation across the board for the future. It can do this by demonstrating collaboration and openness and by activating the supportive voices of medical academic commentary. In short, science backed data is the way forward.

In the UK, distrust in the health system is most prevalent amongst BAME (Black, Asian and Minority Ethnic) communities. The research statistics on this are stark and in an article appearing in the BMJ at the end of February this year, BMJ 2021;372:n513, Mohammad S Razai, academic clinical fellow in primary care explains the rationale behind the statistics; “the most common reasons for hesitancy [around vaccines] are concerns about side effects and the long term effects on health, and lack of trust in vaccines, particularly among black respondents. Some have capitalised on these concerns to spread misinformation, adding to the historical mistrust of government and public health bodies that runs deep in some ethnic minority groups.” However, the author also says that, in addition to funding of community health services at local level, good grassroots communications can overcome this hesitancy by building trust “Engaging community groups, champions, and faith leaders, and resourcing targeted, culturally competent interventions would also help reduce vaccine hesitancy.”

Notable in the above quote is the reference to faith leaders. In the last week mainstream media in the US has carried a story which was widely picked up in the UK and which did the rounds of social media; New Orleans Archdiocese warns Catholics against Johnson & Johnson vaccine ran the headline in many outlets. The Archdiocese claims that the Johnson & Johnson vaccine is morally compromised due to its link to an ‘abortion–derived cell line’. 

The story it appears, garnered far more column inches and social posts than the Vatican’s guidance on vaccines issued in December that said, “All vaccinations recognized as clinically safe and effective can be used in good conscience with the certain knowledge that the use of such vaccines does not constitute formal cooperation with the abortion from which the cells used in production of the vaccines derive.” And certainly, more than this author has seen on the Pope’s belief that people have a moral obligation to get vaccinated as stated in an interview on Italy’s TG5 news programme in January. The impact of the Archdiocese veto remains to be seen but the power of such controversial communication from religious leaders of any persuasion is all too well documented.

For the optimism around vaccines felt by the majority to translate into successful roll out across the world an army of advocates working at grassroots, local and global level must organise, aligning scientific data and moral argument to win over the hearts and minds of the uncertain public and give reassurance to all.