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Australia What could convince someone worried about the COVID-19 vaccine to get the jab?

22:26  01 august  2021
22:26  01 august  2021 Source:   abc.net.au

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When massage therapist Vashti Eastern arrived on the NSW north coast 30 years ago, the debate over vaccination was already in full swing.

The lush, coastal region is now known as Australia's anti-vaxxer heartland, but even in the '90s, Vashti says, everyone was questioning the safety of vaccines. It was in this environment that she decided not to vaccinate her son because she believed the "diseases weren't around".

This rationale took a hit when her son contracted whooping cough at five years old. "I became aware that the disease was around, [that] if my boy was a baby he probably would have died," the now 57-year-old says. "I thought then that if I had another child, I might have chosen to vaccinate."

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When another child didn't come along, the question of vaccination was pushed to the back of her mind. While Vashti wouldn't describe herself as a "rabid anti-vaxxer", she adds: "I definitely wasn't into vaccines for a very long time". That is until coronavirus came along.

More than a year and a half into a pandemic, with Greater Sydney in the midst of a nine-week lockdown, the need for people to — as Prime Minister Scott Morrison put it this week — "go for gold" and get the jab has never been greater.

But as health authorities move to ramp up the delivery, protesters holding signs declaring "I believe in Jesus not the vaccine" and "don't believe the COVID-19 hoax pandemic" are popping up on city streets.

If Australia is to vaccinate 80 per cent of its population — the percentage required to return to achieve herd immunity, according to epidemiologists — vaccine hesitancy needs to be quashed. But what pushes people who are unsure about the vaccine over the line?

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For Vashti, it was a desire to see her family overseas and the nature of her job that led her to get her first AstraZeneca dose a few weeks ago, just days before the Australian Technical Advisory Group on Immunisation (ATAGI) changed its advice to recommend Pfizer for under 60s, unless you've already received your first dose.

"I could just see the writing was on the wall," she says. "The only way I can see the whole world getting out of this thing is through vaccinations."

In Sydney, all adults are now being urged to "strongly consider" getting either of the two vaccines in the face of a growing Delta outbreak. For those outside Sydney, ATAGI's advice is that Pfizer is still the preferred vaccine for under 60s.

She's now approaching her second dose and says she's feeling anxious, despite official health advice stating anyone who recieved their first dose of AZ should get their second.

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Vashti say she has been forced to tell her friends to avoid the subject when they speak to her  because her "nerves are shot".

"I find that anytime anyone says anything anti-vaccine to me, I get really confused again, what to do, and how I feel about it all," she says.

Libby Rann, also from northern NSW, says it was the fear of her chronically ill husband contracting the disease that pushed her to "put her big girl pants on" and get the Pfizer jab, despite her lingering concerns about its safety.

"I was walking on a bit of a line there, it could have gone either way," she says, the day before she is scheduled to get her second Pfizer dose. "It's the lesser of two evils here. I really don't want COVID … so let's roll up my sleeve and do what I have to do."

The 56-year-old says she is not a vaccine objector, or sceptic, but considers herself a "purist" about what she puts in her body.

"If I have a headache, I'll take Panadol, but the idea of sticking a needle into me of something that was relatively new in the scheme of things with chemicals that I didn't really know much about did freak me out a bit," she says.

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"Ultimately, I'm just trusting, trusting that it's the right thing to do."

A range of motivations

Julie Leask, a professor at the University of Sydney's nursing and midwifery school and a member of the World Health Organization's vaccination working group, says there are a range of reasons someone who is hesitant about the vaccine will choose to get it.

The biggest influence are recommendations from healthcare professionals, she says, followed by convenience of vaccine delivery — "where you don't have to think much about it, you just do it" — seeing your peers get vaccinated, and having your questions and concerns met with tailored, two-way communication.

In a focus group hosted by the Washington Post earlier this year,  formerly vaccine hesitant people were asked why they decided to get the jab. Their answers were varied and unique to the person's personality and context.

For one 60-year-old Illinois woman, it was a video by a John Hopkins University doctor explaining why vaccines were safe that led her to the jab, while a 39-year-old New Jersey woman said her decision came about when she realised being vaccinated would make it easier for her family to attend New York Yankees games.

"In Australia what we might see is the people who are very hesitant, towards the 'I'm not going to vaccinate' group, be swayed by exemptions for the vaccinated," Leask says, "because suddenly the positives of vaccinating are further weighted by social, and sometimes even economic benefits."

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Practical considerations like these are behind Sydney resident Hannah Blencowe's decision to get the vaccine, even though she says it doesn't "align with her values".

"I'm very mindful about everything I put in my body," she says, "I would probably never get the flu vaccine, or get vaccinated as an adult, unless it's something like COVID, which even then I've been really hesitant about it."

The 24-year-old has booked in to receive her first Pfizer jab in November because she believes she won't be able to travel internationally without it.

"The secondary reason is being mindful … that even though I might be able to get COVID and be fine, I then could become a carrier and pass it on to somebody who would get a lot more sick that me," she says.

Overall she describes her position as "conflicted"; she says weighing up her concerns about whether the vaccine was rushed against her trust in Australia's high health standards.

"But, I think, regardless, I'm going to get it," she says. "If you trust your body to handle COVID, then equally, can you not trust your body to handle any ill effects of the vaccine? That's what I tell myself."

The vaccine attitude spectrum

While "anti-vax" is often used as a catch-all term for people either not planning to vaccinate or those who are unsure, Leask says it's important to differentiate between the different states of vaccine refusal or delay.

Vaccine hesitant, she says, refers to people who are conflicted about vaccinations, or in other words "are not sure, or are doubtful about vaccination, or have a lot of questions and concerns [they] want addressed". The term does not include people who are planning not to vaccinate — referred to as vaccine refusal or objection — or anti-vaccination activists who seek to broadcast their beliefs and sway debate.

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Despite the high visibility of anti-vax activists in the media, they are very much the minority. An Australian Bureau of Statistics survey, released earlier this month, found 73 per cent of Australians said they would get a COVID-19 vaccine when it is available and recommended for them.

By comparison, 11 per cent — or one in nine people — said they would not be getting a COVID-19 vaccine, while 14 per cent fell into the hesitant category.

This distrust or fear over the COVID-19 vaccines is a separate issue to the wider anti-vaccination movement, says Dr Katie Attwell, a vaccination social scientist at the University of Western Australia.

"The hesitancy around these vaccines is occurring among people who are routinely vaccinating their kids, or have themselves been vaccinated," Attwell says. "People are afraid of the new ... that's what makes it really challenging to roll out new vaccines in a pandemic scenario."

While people who are vaccine hesitant may be swayed by their peers' behaviour or convenience, as detailed by Leask above, different approaches are needed for people who have already made up their mind.

One method called "motivational interviewing" involves listening out for people's concerns, such as "I'm worried about my mum" or "I want to be able to travel", and amplifying them.

"So you say, 'I think you're right to be worried about that, and one option for you is to vaccinate, what would be the biggest barriers for you to do that'," Leask says.

In the United States — where large parts of the population have experienced COVID-19 first-hand — a number of high-profile figures who sowed scepticism over vaccination have since come out in support of the jab.

Among them is conservative radio host Phil Valentine who, after contracting COVID-19, released a statement urging his audience to "PLEASE GET VACCINATED". "Phil would like for his listeners to know that while he has never been an 'anti-vaxxer' he regrets not being more vehemently 'pro-vaccine'," the statement, released by his family, said.

Others who have changed their minds are taking to social media and blogs in the hopes of encouraging others to take the leap.

Among them is self-described former "viral anti-vaccine influencer" Heather Simpson, who co-founded Back to the Vax, a group aimed at countering vaccine misinformation.

Years earlier, the mother-of-three had posted a photo of herself covered in red spots alongside the caption, "Was trying to think of the least scary thing I could be for Halloween … so I became the measles", attracting thousands of new social media followers.

In a recent blog post, she wrote that what ultimately changed her mind was "having people reach out, listen to my fears and talk to me".

"When friends calmly and patiently explained the science to me, showing they cared more about me than about changing my mind, my mind started to open up to the fact that I could be wrong," she said.

Both Vashti and Libby say one of the hardest parts of their decision has been filtering out the often loud opinions of others.

Libby says she is distressed by the level of divisiveness in her community.

"I do have a couple of close friends who are pretty rabid anti-vaxxers and that's been really difficult," Libby says. "[But] if I'm going to listen to anyone it's going to be a virologist, or an epidemiologist, or a researcher who's been doing this for 25 to 30 years."

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