Confidence, complacency and convenience: part three
It's all about trust (8 minute read)
A little over a month ago, I bumped into a friend on a Khandallah street. In the course of that brief conversation, she mentioned that she’d just had her Covid-19 vaccination.
“I just got it done at the church,” she said, pointing to a sign announcing that the local Presbyterian church was a Covid-19 vaccination centre.
“It’s very easy,” she added. “You just call up the phone number.”
I’d seen the advertisements on television, but I hadn’t paid much attention, since my age group wasn’t yet eligible. But I noted the location. The church is just across the road from the supermarket that I go to regularly – very convenient.
About a week later, I received a text from my mother, just after 6 am. The text reminded me that Covid-19 vaccine bookings were now open for over 40s. Since by that time I’d already had breakfast and was working on my computer, I checked the online booking system. I was able to select the vaccination centre my friend had pointed out to me and I booked both my first and second shots.
I’m not in the least bit uncertain about getting vaccinated, but those little reminders from friends and family were still helpful. I’m the kind of person who doesn’t get around to things when I’ve got a lot on my mind. Knowing where the vaccination centre was, and a reminder to book as soon as I was eligible, made things easier for me.
And, just as those little prompts helped me, I was able to help someone else. One of my neighbours hadn’t been vaccinated, despite being in a priority group. She didn’t say that she wouldn’t get vaccinated, just that she intended to do so “sometime this year”. So, from the website, I noted down the phone number for booking a vaccination. I gave her the phone number. I told her that she could get it done at the church over the road from the supermarket.
In the end, giving her the phone number turned out to be unnecessary. She just turned up at the vaccination centre when she next went to the supermarket, and they gave her the shot then and there.
These anecdotes illustrate a wider truth about vaccination – the conversations you have with friends and family are important. Nearly 60% of Americans who had been vaccinated said that conversations with family and friends had influenced their decision.
But these conversations aren’t always easy. I’ll be honest, I’ve felt a little overwhelmed by the flood of misinformation out there. I worry that I’ll get something wrong. I wonder if the conversations are worth the stress, since conversations about vaccination, especially online, can become heated and acrimonious.
But I also know that if I have doubts, I’m probably not alone. If I’m uncertain about my ability to have difficult conversations about vaccines, others will be too. If I learn something about how to have better conversations, it is probably useful to others.
I also have a head start when it comes to conversations about vaccines, because of my work as a public servant, something I’ve done for more than 20 years. If I were to describe my work in a single phrase, it would be this – I’ve helped people to make decisions based on evidence. I understand the importance of science in making good decisions, but I also understand that science doesn’t give absolute answers.
One of the lessons I learned early, and learned well, was the importance of trust. When I advised someone, they seldom knew about my qualifications, my knowledge or my experience. Usually, the most they knew was my job title. People had to decide whether to listen to me or not without much evidence that I knew what I was talking about.
Quite early in my career, I realised that people tended to trust me because I cared. I was, and still am, passionate about New Zealand’s native plants and animals. But it was more than that. I often needed to explain to people why the Department of Conservation and local councils wanted to kill attractive-looking plants in parks and reserves, usually with herbicide. Many people had the false impression that this was because the plants were exotic, and that we wanted to kill all the exotic plants. So it helped that I loved gardening and exotic plants too.
I’ve also had harder times in my work, times when it was difficult to get people to listen to me. There were many reasons for that, but a crucial one was the perception that I didn’t care about the same things as the people I was advising. Until they knew I cared, nobody wanted my advice.
The importance of caring shows why talking about vaccination with family and friends is important. I want my family and friends to get vaccinated because I don’t want them to get sick – and I’m sure that’s the same with you. Our words carry more weight when we talk to our family and friends, because they know we care.
Trust is a part of interpersonal conversations, but it’s also part of the bigger picture for vaccination. Interviewed on the BBC World Service’s Newshour1, Stephen Reicher of the University of St Andrews, said:
“trust is critical, because the reason why people are hesitant a lot of the time, the reason they are doubtful about the information they are given isn’t because they’re stupid, that they don’t understand science, it’s because they lack trust in the sources of that information.”
There is no better illustration of the role of trust in vaccine hesitancy than the boycott of the polio vaccine in northern Nigeria in 2003. As Heidi Larson explained in the TED talk I shared on Monday, the people of northern Nigeria had many good reasons to trust neither the central government nor drug companies. So, when health officials turned up offering something for nothing, people were suspicious. The environment of mistrust allowed rumours to spread and magnify, until state governors openly forbade vaccines for their citizens.
We are seeing the same kind of situation in the USA, with the convergence of beliefs that the 2020 US presidential election was “stolen” with beliefs that Covid-19 vaccines are unsafe. There’s little that we, personally, can do about the flood of online disinformation contributing to that problem, apart from reporting such content when we see it on social media. There’s also not much that we can do to restore people’s trust in governments, pharmaceutical companies, scientists and medical professionals, unless we are one of those.
But there’s another problem contributing to the lack of trust some people have in vaccines. Like the flood of anti-vaccine disinformation, the problem is particularly prevalent online, but it also affects our interactions in person. Unlike anti-vaccine disinformation, it’s a problem that I, personally, have contributed to in the past, and maybe you have too.
The problem is the attitude of people who support vaccines towards those who are uncertain or opposed. As the quote from Reicher implies, people who doubt vaccines are sometimes portrayed as stupid and unable to understand science. Earlier this week, I shared an article from a mother who had chosen not to vaccinate her children because of her fear of side effects, but changed her mind this year. She referred to people being attacked and judged for not vaccinating their children.
This attitude isn’t just an anecdotal observation. A study of pro- and anti-vaccine online messages found that pro-vaccine messages were often sarcastic in tone. There’s another article about these messages here, and it gives a few examples showing anti-vaccine mothers portrayed as stupid.
I know that I’ve seen those kinds of messages on social media and I admit that I’ve thought they were funny. In my own mind, I’ve tended to dismiss people who oppose vaccination as irrational, and it’s possible that this attitude has crept into my interactions with people. But that makes me part of the problem, because implying that someone is irrational won’t convince them to listen to us.
A big part of overcoming our own attitude problem is understanding how people can get drawn in to views that run counter to overwhelming scientific evidence. The formerly anti-vaccine mother I referred to earlier was drawn in as an anxious new mother, desperate to make the best decision for her child. In hindsight, she now says that the anti-vaccine movement preyed on her fears, but at the time she felt as if they offered her reassurance. Fear also plays a part in how people get drawn into other conspiracy theories, like Covid-19 denial.
If fear is the way people are drawn in, that doesn’t mean that reassurance is the way out. As I learned from Peter Sandman’s book many years ago, reassuring people about a risk doesn’t make them less afraid. Instead, it makes them worry that you aren’t taking that risk seriously.
Perhaps the best concise summary of how to have a good conversation with someone concerned about Covid-19 vaccination comes from the USA Centres for Disease Control. Right at the start, it talks about the importance of listening to people’s fears. Sharing accurate information is important, but that comes later, not until after you have listened and asked questions to help you understand. It’s a reminder of a quote, attributed to Theodore Roosevelt, that “nobody cares how much you know until they know how much you care”.
Here’s a summary of the information from the USA Centres for Disease Control:
Listen to their questions with empathy
Recognise that it’s perfectly reasonable to have questions, and acknowledge their emotions to show that they’ve been heard
Ask open-ended questions to explore their concerns
Let them talk and help you understand what they are concerned about and why
Ask for permission to share information
They are more likely to listen if they don’t feel as if information is being pushed on them
Help them find their own reason to get vaccinated
Once you’ve listened and responded with empathy, you can begin to turn the conversation from “why not” to “why”
Help them make vaccination happen
See if you can provide practical help – access can be a real barrier
The interview starts at around 14 minutes
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