Jennifer O’Connell: Monstering the unvaccinated is satisfying but not helpful

Around the world, people are gunning for the unvaccinated. "You have a right to choose," Australian senator Jacqui Lambie said in a rousing speech that went viral and inspired a TikTok craze recently. "You choose to put other people's lives at risk, and you will be held accountable for that choice . . . Being held accountable for your own actions isn't called discrimination. It's called being," she roared, her voice rising into a furious crescendo appropriate for someone who spent 10 years in the army, "a goddamn bloody adult."

Angela Merkel's husband Joachim Sauer, a quantum chemist, is generally less fond of publicity than Lambie. But his fury at the unvaccinated recently got too much to hold in. "It is astonishing that a third of the population does not follow scientific findings. In part, this is due to a certain laziness and complacency of Germans," he told an Italian newspaper.

The unvaccinated are "causing a lot of trouble", Tánaiste Leo Varadkar tutted on CNN.

There is a certain logical appeal to these arguments. You have a right to bodily integrity, but so do other people. You have a right not to get vaccinated, but you don’t have the right to risk someone else’s health.

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According to the latest data from our hospitals, the unvaccinated – who represent only 7 per cent of the adult population – account for 46 per cent of those in hospital with Covid, and over half the Covid patients in ICU.

You have a right not to get vaccinated, but you don't have the right to risk someone else's health

Inevitably, the unvaccinated are serving as lightning rods for growing frustrations about a health service in danger of collapse, fears about the new variant, worries about restrictions or dismay at the prospect of small children in masks all day.

But research about the vaccine-hesitant suggests they are unlikely to have their minds changed by being shouted at by politicians or anyone else. Monstering the unvaccinated may be satisfying, but it isn’t helpful.

Complex reality

Beyond the caricature of selfish individuals who see themselves as invincible, or who are too lazy to get the jab, the reality is more complex. Sure, there are some lazy and feckless people out there. There are others who are never going to believe the Tony Holohans or Luke O'Neills over the Aislings on Instagram. There are some who wouldn't dream of risking their bodily integrity with a rigorously tested vaccine backed by science and governments around the world – not when they can compromise it instead with a box of so-called homeopathic pills of indeterminate origin that they picked up in a health food shop.

But then there are the ones you don’t hear about so much: those who end up in ICU due to genuine fear or because of a failure of our public health messaging.

Among them are the 35 young, pregnant women who have ended up in ICU this year, none of whom were fully vaccinated, Health Protection Surveillance Centre figures show. Among them, too, are individuals from countries where English is not their first language. In the population generally, vaccine uptake rates among those from Central and Eastern Europe is low, averaging about 44 per cent in October. Twenty-eight per cent of those in ICU in September and October were not born in Ireland; 90 per cent of them were not vaccinated. Many come, as one senior doctor put it to me recently, from cultures where there is a suspicion of anything that is state-sponsored.

Twenty-eight per cent of those in ICU in September and October were not born in Ireland; 90 per cent of them were not vaccinated

A Eurobarometer study of 28,000 people in March 2019 about attitudes to vaccination found that only two in three Romanians and Latvians agreed with the statement that "vaccines are rigorously tested before being authorised for use", the lowest proportion across the EU. A qualitative study of medical students in Romania in 2019, which dived into the country's low MMR uptake during a significant measles outbreak, found that some of the factors influencing decision making, even among aspiring doctors, were an active anti-vaccination lobby and loss of trust in public health authorities.

Changing minds

As tempting as it may be to stereotype, stubbornness and stupidity aren’t what’s driving the unvaccinated. Other factors include misplaced fear, a generalised distrust of authority and our public health authorities’ failure to reassure them. The Health Service Executive pointed out to journalists recently that its vaccine-related material is available in 27 languages, and it runs frequent ads aimed at Polish, Lithuanian and Russian communities in Ireland. “We’re probably doing better at reaching our migrant populations than other countries,” a spokesperson told RTÉ’s Prime Time. The figures from ICU suggest otherwise. Just translating messaging tailored for an Irish audience, who are generally more trusting of vaccines, may not be enough.

Even this far into the pandemic, people’s minds can be changed. An oncologist in the Mater, Prof John McCaffrey, told me how he is still seeing patients with cancer who “shockingly aren’t vaccinated”, often because of what they have been exposed to on social media. He’ll talk to them about chemotherapy drugs and they don’t even want to hear the evidence, they just want the treatment. They’ll happily take the influenza vaccine, “and yet the same person can then say, but I’m not having the Covid vaccine because I don’t think the evidence is there”.

There is still an opportunity to persuade these people – he knows because he has done it. “I find myself trying to control myself in terms of being exasperated” and focus on the science. “I spend a lot of time on those people. And you do convince them. It’s worth it.”

The challenge for our public health authorities is to scale up what McCaffrey and others in our hospitals are doing every day. This means a targeted, impactful and culturally sensitive campaign that reaches the unvaccinated on the platforms where they are. It’s more boring, much harder and way less satisfying than shouting at them in newspapers or demonising them on social media. But if the goal is to get the numbers who end up in ICU down, it’s a lot more effective.