When anthropologist Heidi Larson secured the seed funding to establish the Vaccine Confidence Project a decade ago, it was a humble set-up housed in a corner of the venerable London School of Hygiene and Tropical Medicine in Bloomsbury.
Now, in a global pandemic, her expertise as one of the world’s foremost authorities on anti-vaccine sentiment and the rumours, misinformation and emotions that shape our perception of vaccines means that Professor Larson is in serious demand.
In the past fortnight she has delivered the John Maddox Lecture at the Hay Festival, collected the prestigious Edinburgh Medal for her work to understand and tackle popular misconceptions of vaccines and joined UK health minister Matt Hancock and WHO chief Tedros Adhanom Ghebreyesus at a Science Museum summit to explore ways to boost confidence in the Covid-19 vaccine.
“It’s been a busy time,” she says, sitting on a bench in a north London park. Gently spoken, she doesn’t relish the limelight but is committed to sharing her insights into how to build public trust in vaccinations.
The answer, she says, is to listen. “We need to get out to communities and hear their concerns and spend time addressing their concerns. We need to listen as much as send messages.”
Misinformation, amplified by social media, have stoked anxiety and mistrust. Prof Larson’s team monitors news coverage, social-media posts across the world, tracking trends, rumours and falsehoods that might undermine faith in life-saving inoculations, from the seasoned polio vaccine to straight-from-the-lab batches of Covid-19 jabs.
As attention turns to accelerating the vaccine rollout in Africa, where just 2 per cent of the population has received a first dose of the Covid-19 shot, building confidence will be as crucial as ensuring adequate supplies.
“In Europe and the West it is a slow burn erosion of trust, but in Africa a rumour can explode in one day and become viral. The medium of social media can have a mimic effect across great distances which creates a shock impact and reduces confidence,” Prof Larson explains.
In Nigeria and in Madagascar, viral rumours that soldiers were coming to forcibly vaccinate children against monkeypox and plague quickly drew angry parents to the school gates to pull their children out of class, even though neither vaccine exists and no armies were coming, she says.
“I spent a lot of time engaging in meetings and discussions with some of the tech companies, Facebook, Google and WhatsApp, YouTube. Trying to particularly understand where do you draw the line. Because a lot of the questioning addresses itself as questions and doubt and you cannot delete doubt,” Prof Larson says.
Lessons can be learned from previous epidemics, like the Ebola outbreak in West Africa when local listeners were deployed in communities to hear and answer people’s concerns over the vaccine trials. The approach was successful and trials were heavily subscribed.
“It’s important to have positive local influencers, and they must have grounded knowledge to be able to challenge wrong information and wild rumours,” Prof Larson says.
Suspicions rise if teams of strangers roll into villages to administer vaccines, especially to children, with no warning, no explanation.
“As one woman said to me, I’ll believe it when someone who looks like me and talks like me tells me. Somebody in my community. Somebody who speaks my language. And not just the literal language, but someone who understands where I’m coming from,” she says.
Prof Larson, 64, has lived and worked in the West Bank, Nepal and the South Pacific; she has travelled extensively in Africa. She leads a multi-national team of more than a dozen staff at the Vaccine Confidence Project and refuses to condemn the views of so-called “anti-vaxxers” - a term she shuns as she regards vaccine reluctance as a spectrum of beliefs and attitudes.
“People have very different reasons for being worried about the vaccine. There is misinformation (and we need to do) the checking and fact checking. I think it’s really important, but it doesn’t end there… A lot of anger, emotions and alternative beliefs that will not be fixed by ending misinformation,” she says.
She decries a “desert” of communication around the Covid-19 vaccine in Africa, just as the WHO warns the continent is facing a last-ditch battle against a third wave of infections. Supplies of the jab to the continent have ground to a near halt after a devastating surge of infections in India diverted supplies from the Serum Institute for domestic use.
The stop-start in deliveries, combined with doubts cast on the safety and efficacy of the AstraZeneca vaccine – the so-called workhorse of Africa’s rollout – has dented faith in the jab. “When the situation is complex like that there are a lot of rumours going around,” says Larson.
In a survey in Nigeria in May 2020, 49 per cent of respondents strongly believed an approved Covid-19 vaccine would be safe. In a follow up sample taken in March this year, at the height of fears in Europe over rare blood clots linked to the AstraZeneca shot, confidence slumped to 24 per cent.
“What happened in India could be just around the corner in Africa. This work (to build trust) needs to happen now, not wait until vaccines are sitting in boxes in the heat,” says Larson.
“National immunisation programmes, local organisations, professional networks and healthcare workers need to be ready and need to prepare their populations for those vaccines.”
But a blinkered focus on simply knocking down the wildest of rumours is not the answer. A survey of attitudes across Africa unearthed genuine concerns that were not being addressed.
“It normally takes 15 years to manufacture a vaccine so how can a new vaccine be manufactured in just a year?” asked one in the Democratic Republic of Congo. “I don’t believe there is Corona as I have not seen it,” queried another respondent in Nigeria.
“I talk about building confidence to convince,” says Prof Larson. “So that people can convince themselves. At the end of the day you might convince someone for the short term. But unless they’re convinced by themselves, for themselves, it’s not going to be sustainable. What I try to do is listen to people, try to understand.”