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Understanding vaccine hesitancy is important, but it is vital that we go about it in the right way

South Africa – and the world – is still in the grip of a frightening and deadly pandemic. We have tools at our disposal to mitigate the effects of this, and unquestionably the most robust are the Covid-19 vaccines. While our vaccine programme was initially slow to get started, it is now picking up steam, and as of 7 August, 8.5-million doses had been administered, with 8.9% of adults fully vaccinated.

One of the major barriers to the programme is vaccine hesitancy and understanding why people are vaccine hesitant is important. Publishing a piece justifying this hesitancy is not, however, and is a classic example of “false equivalence”. Sadly, this is exactly what happened with Angelo Ryan’s recent article in the Mail & Guardian, Vaccine hesitancy: a non-religious defence. What could have been an opportunity to explore the mindset of the hesitant instead turned into a litany of poor reasoning, false claims, and scientific misinformation. 

The article begins fairly enough, with Ryan arguing that to win people over, you must understand them. He writes that calling people with doubts or concerns names, and insulting them, is counterproductive. On this, I completely agree. Very few people change their minds when they feel belittled. Ryan, however, wants to make it seem like choosing not to get vaccinated is a scientifically valid and reasonable choice, and it’s here that things fall apart. 

Ryan believes pharmaceutical companies are unethical. In many ways, I agree. But the leap from “some pharma companies have done some dodgy things in the past”  to “therefore we cannot trust any of these vaccines”s is simply throwing the baby out with the bath water. By this rationale, Ryan would not trust any new medication coming from any of these companies; in his eyes, they are irrevocably tainted. But looking at the issue dispassionately, there is no evidence of unethical behaviour in the development of any of the current Covid-19 vaccines. Their creation has been monitored and scrutinised more closely than perhaps any medication in human history. While the funding for their development came partially from Big Pharma, the researchers involved include many of the finest, most ethical, minds of their generation. To tarnish all these scientists and developers with the same tainted brush because the people who sponsored them have done questionable things many years ago, is both unfair and unjustified. 

In addition, the approval of these vaccines comes from independent regulators (such as the South African Health Products Regulatory Authority — SAHPRA), who interrogate the evidence extremely closely. If there was any hint of impropriety, they would not have granted approval. 

Ryan claims science has a replication crisis, and for some aspects of research, this may be true. But when it comes to Covid-19 vaccines, he couldn’t be more wrong. Studies demonstrating the efficacy of the vaccines have been replicated over and over, including against the newer variants of concern. Put simply, there is no replication crisis when it comes to these vaccines, and the evidence is clear and unambiguous: apart from some exceedingly rare severe side effects, they are effective, and they are safe. Furthermore, with billions of doses now administered, some over a year ago, there have been no safety flags for long-term side effects (in contrast to Covid-19, which leaves up to 25% of sufferers with chronic symptoms).

Ryan then criticises the US Food and Drug Administration (FDA) and Centre for Disease Control (CDC), calling them “incompetent”. But his examples are strange. He lists medications that have either not been approved for over 40 years (DES and quaaludes), or he significantly overstates the harm they caused (Cylert, which caused liver failure in a total of 13 patients over 20 years). No one would accuse the FDA and CDC of being perfect, and they consist of people who are fallible like the rest of us. But cherry picking a few examples where, many years ago, they may have erred, without demonstrating why you think they may have erred in this instance, is simply an example of poisoning the well. Like everyone else, these agencies work with the best available information they have. Sometimes, this information changes, which causes them to change their recommendations. This is good science, not evidence of ineptitude, as Ryan thinks. In the case of Covid-19 vaccines, the evidence of benefit is robust and overwhelming. (On a side note, his claim about the recommendation for vaccines during hurricanes is uncited and irrelevant). 

Ryan begrudgingly concedes that the vaccines are effective at preventing ICU admissions and death due to Covid-19. But that is literally their raison d’etre, with reducing transmission a happy bonus. He claims that their effectiveness at this is “indeterminate,” (and, oddly, links to a website that unequivocally supports vaccination) but again, this is simply untrue. The recent HEROES-RECOVER study demonstrated 40% lower viral replication in the noses of those who were vaccinated, while a pre-print of a study in Israel demonstrated a four-fold decrease in viral load after vaccination. While these numbers aren’t perfect, they provide compelling data that the vaccinated are not only protecting themselves, but they are also providing a degree of protection to those around them. Whether herd-immunity (a term Ryan misunderstands as being “viral elimination”) is reachable or not, it is certain that unchecked spread of a virus, particularly in the unvaccinated, has devastating consequences.

Finally, he claims that those who are vaccinated shouldn’t worry about those who are unvaccinated, which neglects three crucial points. Firstly: there are many immunocompromised people and children who cannot get vaccinated and rely on the rest of us to protect them. Secondly: the vaccines are not 100% effective, so unvaccinated people do still pose a risk to the vaccinated, and thirdly: ongoing viral replication in the unvaccinated is likely to produce more variants, which put us all at risk. Quite simply, vaccination is a public health issue, and not simply individual choice. 

Ryan concludes by stating that he likes some vaccines, just not the Covid-19 vaccine. That’s fine, and his prerogative, but the reasoning he uses to justify this position is specious and flawed. The M&G, by giving his opinion a platform, has done a grave disservice to its readers. As the adage goes, if one man says it’s raining and another says it’s sunny, the journalist’s job is not to publish both opinions but instead to open the window, look outside, and tell the truth. In this case, that truth is crystal clear: the Covid-19 vaccines, while not perfect, are safe and effective. They protect us and those around us. They are the best weapon we have to deal with this pandemic. I respectfully submit that the M&G publish fewer anti-vaccine opinion pieces and open even more windows.

 

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Alastair McAlpine
Alastair McAlpine is a paediatrician who has specialised in infectious diseases. He has no conflicts of interest to declare.

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