Vaccine rollout: As clotting fears recede, hesitancy falls

She might be labelled vaccine-hesitant, but there was nothing hesitant about the way Jane avoided being immunised with the AstraZeneca vaccine.

"I got the offer of the vaccine I didn't want. I asked for a new appointment and waited for another offer. Same again, so I cancelled again. Finally, they offered me Pfizer. "

John took the wait-and-see approach. “I’m not in any hurry. I just don’t want a vaccine that might cause clots. So I have held off registering for now.”

Neither Jane nor John (not their real names) is anti-vaccine, they say. While anxious not to be identified, they say they will be happy to roll up their sleeves, once they can take the jab of their choice.

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But in spite of extensive focus on vaccine refusal and hesitancy, the real story of the Covid-19 vaccine rollout in Ireland is the size of the uptake.

Throughout this year, support for vaccination has remained consistently high among those not yet vaccinated. This group is becoming younger all the time, as older people are immunised, so in reality support is actually growing in the overall population.

Roughly four out of five of those yet to be vaccinated say they intend to get it, according to polling by the Economic and Social Research Institute (ESRI). Its social activity measure has been tracking vaccine intentions since Christmas, along with other pandemic-related sentiment.

Despite the ups and downs of the vaccine rollout and the fortunes of individual products, the tracker paints a mostly stable picture. The proportion of people saying they would get vaccinated dropped to a low of 72.3 per cent at the end of April, possibly due to delays in the programme and the clotting-related issues linked to the AstraZeneca vaccine. Since then it has recovered to 79.4 per cent.

Conversely, those who are unsure about the vaccine – the Johns and Janes out there – dropped from 18 per cent to 13.2 per cent between April and May. All this year, the proportion who say they definitely will not get the vaccine has remained small, at 6.3-8.8 per cent.

"There's more than a hint in the data that more people were pushed into the 'not sure' category after the blood clots issue emerged," says psychologist Prof Pete Lunn of the ESRI, "but the effect was never more than a few percentage points".

A large majority believe most people close to them will take the vaccine, and most would recommend the vaccine to friends or family members who are unsure. Just 10 per cent would not do so.

Vaccine hesitancy is highest among the thirtysomethings, the polling shows, and particularly among women

So far, uptake rates back up this polling data. According to the HSE, more than 90 per cent of the over-70s have been immunised. Almost 90 per cent of those in their 60s have registered for the vaccine, despite some grumbling over being allocated AstraZeneca. Last week’s cyber attack has interrupted data collection but vaccination of those in the 50s and 40s age groups is proceeding apace.

Progress could become stickier from now on, though. Vaccine hesitancy is highest among the thirtysomethings, the polling shows, and particularly among women.

In Ireland, half the expecting mothers at the Rotunda hospital declined the offer of a vaccine during the first week of the rollout to this cohort, The Irish Times reported earlier this month.

This reluctance is presumed to be linked to worries about possible effects on the unborn baby. Covid-19 vaccines were not tested on pregnant women during clinical trials, but have been administered to hundreds of thousands of pregnant women without any safety concerns being raised for the women or their babies.

Monaghan GP Dr Illona Duffy says there has been "some reluctance" among her pregnant patients to be vaccinated and, in some cases, this has been influenced by healthcare workers advising the woman to hold off.

“It shows the need for all of us doctors and nurses to be singing off the same hymn sheet about this.”

Lunn says: “It’s easy to exaggerate the higher acceptance rate among older people relative to others. Among 18-25 year-olds, three-quarters say they will take it; even among women in their 30s, that figure is two-thirds.

“Further, the majority who are not saying yes are saying they’re unsure. Yet in the older age cohort there were lots of unsures, but they still got the vaccine.”

Some of those vaccinated in recent weeks have reported being called at short notice, indicating they were filling a slot originally intended for someone else. Some have taken this as evidence of a growing reluctance to be inoculated.

But while there have been no-shows at mass vaccination centres, this is not always due to vaccine hesitancy. Earlier this month, one-fifth of people called for vaccination on one day in Drogheda failed to appear, but this seems to have been because they had received calls from other vaccination centres.

Something similar happened at the start of April, when a large number of no-shows were reported at the Citywest vaccination centre due to double bookings. In the earlier stages of vaccine rollout, double bookings occurred for older patients between GP surgeries and mass vaccination centres.

The HSE says the centre in Drogheda was relatively new at the time of its no-shows, which had dropped to 10 per cent the following day.

Beset by the disruption caused by the cyber attack on its IT systems, the HSE is struggling to provide even basic data about the vaccine rollout. Anecdotally, AstraZeneca is associated with the highest proportion of DNAs (did not attend), officials say, while Johnson & Johnson has the lowest DNA figures. This may be because it is a one-shot vaccine, and thus more attractive to people planning to travel abroad in the summer.

Duffy says some of her sixtysomething patients were “cheesed off” over the 12-week interval between AstraZeneca shots, which leaves them without full protection unlike younger, less vulnerable people who got other vaccines. “It has meant them having to isolate longer than might have been needed. But, at the time, supply was erratic and planning was often taking place on the hoof.”

Officials say the reticence expressed about AstraZeneca in some quarters is moot now, given our remaining supplies of this vaccine are being used as second doses for people vaccinated in the spring.

If you are unsure but you see millions around the world taking vaccines without consequences, you'll respond to what you see and come onboard

Covid-19 is predominantly an older and vulnerable person’s disease, with younger people extremely unlikely to suffer serious consequences unless they have an underlying condition. With time, too, the general threat posed by the virus is receding as more and more people get immunised.

So as the rollout reaches ever younger groups, does the messaging need to change? Rather than appealing to people’s self-interest – in protecting themselves against Covid illness – should we be appealing to a sense of social solidarity?

Lunn doesn’t think so, based on the general receptivity to vaccines among younger people as measured by tracking surveys.

Young people need to be clear about the risks posed by long Covid and to understand they could still pass on the virus to older relatives even though these have been vaccinated, he says.

Overall, he believes people are underestimating the degree to which vaccination is suppressing the disease: “This is working. We’d be in terrible trouble without it.

“The psychology is straightforward. If you are unsure but you see millions around the world taking vaccines without consequences, you’ll respond to what you see and come onboard.”