Throughout the pandemic, a lot dialogue about COVID-19 transmission targeted on individual-level choices, making it simple guilty the unvaccinated. (Pixabay)
The time period “vaccine hesitancy” was in extensive use years earlier than the World Health Organization (WHO) declared COVID-19 a pandemic. The time period focuses on individual-level attitudes towards vaccines. Throughout the pandemic, a lot well-liked and scholarly dialogue about COVID-19 transmission targeted on individual-level choices, making it simple guilty the unvaccinated.
By specializing in particular person choices, it’s simple to miss different causes for suboptimal vaccine uptake. These embrace politicization, mistrust of the well being system attributable to systemic racism, social inequities, and boundaries to entry and acceptance.
The perspective that well being is the results of solely particular person behaviours falsely disconnects well-being from essential elements like systemic social inequities, group well-being and environmental well being (comparable to One Health). The give attention to particular person choices additionally reinforces widespread social norms and sanctions (such because the stigmatization of the unvaccinated), which make people personally chargeable for conserving themselves wholesome, together with getting vaccinated to guard others.
Although there have been efforts throughout Canada to enhance COVID-19 vaccine accessibility and acceptability amongst underserved populations, the success of those efforts is remoted to particular communities and ongoing efforts are wanted to cut back inequities. As a end result, many people who’re blamed for being unvaccinated are sometimes additionally denied equal entry to well being care and vaccination companies, and credible details about vaccines from trusted sources.
We are a gaggle of researchers whose work explores inequities in vaccination intentions, entry and uptake amongst underserved populations, in addition to public well being communications and inequities ensuing from pandemic responses. We additionally analysis vaccine hesitancy, public well being communications and using vaccine info and misinformation to point out how social inequities form vaccine uptake.
What is vaccine hesitancy?
Convenience of vaccination contains availability, location accessibility and affordability of vaccination, understandability of vaccine info and attraction of vaccine companies.
THE CANADIAN PRESS/Jeff McIntosh
The Strategic Advisory Group of Experts (SAGE) on Immunization on the WHO defines vaccine hesitancy as a “delay in acceptance or refusal of vaccination regardless of availability of vaccine companies” for varied causes, together with comfort. Convenience refers back to the absence of boundaries to accessing and accepting vaccines. This contains availability, location accessibility, affordability of vaccination, understandability of vaccine info and attraction of vaccine companies.
Systemic social points have an effect on vaccine entry and acceptability. Yet, the time period vaccine hesitancy typically overlooks these, and reduces the a number of elements that have an effect on vaccine uptake to individual-level choices. Researchers have additionally critiqued the give attention to vaccine hesitancy as a result of it distracts from the accountability of presidency establishments to make sure vaccines are accessible and acceptable to the inhabitants.
Social inequities create boundaries to vaccination
Pre-pandemic analysis exhibits substantial boundaries to getting vaccinated exist, particularly for sure populations. These embrace racialized and Indigenous Peoples, individuals with disabilities, individuals residing in rural and distant areas, and people with low earnings. For instance, a latest evaluation of research about boundaries to grownup vaccination listed entry among the many most regularly reported boundaries.
In Canada and internationally, the uptake of COVID-19 vaccines has been a lot larger than for different pandemic and routine vaccines. Yet, it has been tougher for these with fewer assets to get vaccinated.
Participants in our analysis recognized many boundaries to getting vaccinated in Spring 2021 when COVID-19 vaccines first grew to become broadly obtainable throughout Canada. These boundaries embrace expertise entry, language necessities, accessible transportation and childcare, gaps in lodging for incapacity or well being circumstances, inflexible work schedules and feeling unsafe.
Uptake of COVID-19 vaccines has been a lot larger than for routine vaccines or different pandemic vaccines (comparable to H1N1 flu).
THE CANADIAN PRESS/Justin Tang
Similar boundaries have been beforehand acknowledged with routine childhood vaccines, grownup vaccines and seasonal vaccines.
For racialized and Indigenous populations, whom Canada’s National Advisory Committee on Immunization recognized as being at elevated danger of extreme sickness from COVID-19 illness, main boundaries to accepting COVID-19 vaccines additionally embrace up to date and historic medical racism, disregard and mistreatment.
Improving vaccine entry and acceptance
Throughout the pandemic, native non-profit, group and Indigenous organizations tailor-made vaccine rollouts for the individuals they serve.
For instance, city Indigenous well being service suppliers sought to enhance the accessibility of culturally applicable look after First Nations, Métis and Inuit communities, together with individuals with out shelter. However, some nonetheless famous decrease uptake than in non-Indigenous populations.
Across Canada, First Nations, Métis, Inuit and Indigenous-led initiatives supplied culturally and linguistically applicable clinics, info and wellness assist.
Similarly, native organizations labored to enhance vaccine accessibility for various peoples, together with newcomers, racialized populations and folks with disabilities.
Provincial well being authorities additionally labored to diversify vaccination companies, offering cell, walk-in, drive-through and pop-up clinics. Federal, provincial and territorial governments additionally supplied pandemic and vaccine info in a number of languages to enhance accessibility.
However, many of those efforts had been initiated after mass vaccine clinics opened to most people. This made it tougher for populations that had been really useful for vaccination early in rollouts to entry the primary obtainable doses of COVID-19 vaccines.
People stroll previous a vaccine clinic throughout the COVID-19 pandemic in Mississauga, Ont. in April 2022.
THE CANADIAN PRESS/Nathan Denette
Although these initiatives improved vaccination accessibility for some underserved communities later within the rollout, boundaries to vaccination remained excessive for a lot of all through the preliminary rollout, even for individuals who needed to be vaccinated.
Addressing boundaries
The overemphasis of analysis and public dialogue on vaccine hesitancy makes systemic boundaries to getting vaccinated invisible to the general public. Instead, people are blamed for not getting vaccinated, even when entry to vaccines just isn’t equitable.
Without resolving boundaries to vaccine entry and acceptability, efforts solely targeted on lowering vaccine hesitancy is not going to optimize vaccine uptake. Vaccine packages have to be deliberately designed for these with the best boundaries, beginning with the preliminary rollout.
To enhance vaccine entry and belief, rollouts should happen in a contextualized manner and in partnership with organizations which have group belief and expertise working to enhance entry to well being care and social justice. As modelled by native non-profit, group and Indigenous organizations, vaccine packages have to be embedded in wider efforts to enhance social equality and entry to well being care.
Terra Manca at present receives funding from the Social Sciences and Humanities Research Council within the type of an Insight Development Grant for a examine into how accountability for danger mitigation, parenting, and household caregiving was assigned throughout the pandemic. She has beforehand obtained funding from IWK Health and the Canadian Immunization Research Network for analysis into how feelings and gender form understandings of vaccination in being pregnant.
Shannon MacDonald has obtained analysis working funds from the Canadian Institutes of Health Research (CIHR), the Canadian Immunization Research Network (CIRN), and the Alberta Ministry of Health. All funds are directed towards analysis actions, with Dr. MacDonald receiving no monetary remuneration.
S. Michelle Driedger receives funding from the Canadian Institutes of Health Research for 2 COVID-19 tasks. One undertaking focuses on public understanding of the pandemic by way of public well being communication in regards to the virus, and protecting behaviours that folks can undertake to remain secure, together with attitudes towards COVID-19 vaccines. The different undertaking focuses particularly on Red River Métis experiences with the pandemic, together with insurance policies in Manitoba that excluded early entry to COVID-19 vaccines within the first few months of the rollout and the way this will likely have influenced vaccine uptake in that inhabitants group. She additionally obtained funding from the Canadian Immunization Research Network to conduct an analysis of public well being web-based communication with residents in British Columbia, Manitoba and Ontario.
Emmanuel Akwasi Marfo and Laura Aylsworth don’t work for, seek the advice of, personal shares in or obtain funding from any firm or group that may profit from this text, and have disclosed no related affiliations past their educational appointment.
