COVID-19 vaccine development and deployment
In the face of societal challenges that are unprecedented in recent history, the development of effective vaccines against SARS-CoV-2 is a landmark achievement in health sciences. This is not only because of the highly accelerated cycle of product development, clinical trials and mass deployment, but also because of the extent to which these novel vaccines have been accepted by the public in countries that have provided broad and free access. By 31 August 2021, around 80 per cent of over 16-year-olds in the UK had been fully vaccinated with two doses of a COVID-19 vaccine (89 per cent with at least one dose). However, there is no equity of access to vaccines for many low- and middle-income countries (LMICs), with less than 2 per cent of people in low-income countries having been vaccinated with at least one dose of any vaccine. Scarcity of vaccines in LMICs means that equity within populations will also be low; for instance, with social elites and wealthier, urban populations potentially being prioritised.
Why social science is vital for vaccine deployment
Vaccine hesitancy and misinformation about vaccines have emerged as prominent topics in the news and have been major focus points amongst public health officials concerned with COVID-19. Too often, however, these discussions have relied on simplistic assumptions about people’s relationship to vaccines, emphasising for example a lack of knowledge rather than engaging with drivers of mistrust. In practice, building confidence in vaccines is far from straightforward and effective efforts to encourage vaccination in communities and amongst individuals requires holistic and evidence-based approaches. To begin with, the extent to which hesitancy has influenced uptake of COVID-19 vaccines among people in LMICs is unclear—questions of supply and accessibility are also important. Secondly, social science research shows that vaccine hesitancy is both complex and context-specific, and heavily influenced by historical, social and political factors. It is thus imperative to take these into account to avoid poorly informed approaches to tackling vaccine hesitancy.
Our brief ‘Social Science Research for Vaccine Deployment for Epidemics Outbreaks’ argues that social science is vital for effective vaccine trials and introduces social science methods that can be used to explore contextual factors that are important to vaccine deployment. These methods include qualitative interviews and focus group discussions, social media analysis, ethnographic methods, and community consultations. Our ongoing social science work related to COVID-19 vaccines involves four studies based in the UK, Sierra Leone and DRC, which shine a light on these complexities, using these social science methods.
The first study collects rapid social science data on a range of issues related to the current pandemic in the UK and Sierra Leone. We have developed and deployed a survey, online in the UK and in person in Sierra Leone, which includes both quantitative and qualitative questions that are relevant to the COVID-19 pandemic, including questions on COVID-19 vaccines.
We found that, in the UK, COVID-19 vaccine hesitancy is driven by specific concerns with the vaccine development process, political leadership and individual political views, whilst vaccine acceptance is driven by prior behaviours and transparency of the scientific process of vaccine development. The Sierra Leone survey also revealed positive attitudes towards vaccination as a means to protecting oneself and community. Similar to the UK, concerns in Sierra Leone were mostly linked to questions of safety, wishing to wait until others are vaccinated, and whether COVID-19 is really a risk to Sierra Leoneans, particularly during the first wave when relatively fewer cases and deaths were recorded.
The second study examined the experience of healthcare workers in Sierra Leone and DRC during the COVID-19 pandemic, as well as local debates and perceptions surrounding COVID-19 vaccinations.
The Health Workers Impact project found that the COVID-19 pandemic impacts on trust in the health system – COVID-19 is seen as a ‘business’ to replace ‘Ebola business’. Meanwhile, healthcare workers have reported feeling vulnerable to infection, especially due to lack of funding and resources, such as PPE. We also found that, in both countries, the potential of COVID-19 vaccination trials in Africa reignited criticism of Western-led clinical research on the continent. COVID-19 vaccines are described as a tool of Western pharmacapitalism for profit. Distrust was heightened by the perception that COVID-19 was not a priority in these countries, or even present at all in the early months of the pandemic.
The third study trained community health workers to collect data on vaccine confidence and, more recently, on rumours and concerns about the COVID-19 pandemic, a recent Ebola outbreak in neighbouring Guinea, and perceptions of emergency vaccine deployment for both diseases in Sierra Leone.
This study revealed the multifaceted nature of vaccine confidence in border areas, highlighting how prior interactions with healthcare workers had eroded confidence, how vaccination campaigns often do not consider local livelihoods, and two-way dialogue with the publics that allows these political, social and economic concerns to be voiced.
In both countries, vaccine trials were established in a context of an Ebola epidemic and historical conflict and tensions with the state. Thus, vaccine development is situated in broader political and social realities, concerns are rooted in mistrust of government and international actors, as well as historical legacies of colonialism. These complex state-society relations and the contentious political economy of aid are therefore central to shaping debates about the trials. The trials themselves have allowed citizens to articulate long-standing grievances about governance, political economy, and social justice, and continued influence of outsiders and their priorities.
What have we found?
Our research confirms the importance of addressing historical, social and political factors in vaccine confidence. Trust is particularly important, and community engagement is essential for vaccine deployment. For it to be effective, there are two key issues that need to be considered:
- We must understand how political and economic factors can influence trust in medical research and science more generally. Understanding local power dynamics to identify trusted community leaders can enhance trust and legitimacy.
- We need to gather community views about vaccine acceptance, concerns, equitable access, misunderstandings and fears through deliberative approaches. Vaccine inequalities also need to be addressed for marginalised populations through active involvement in discussions about fair distribution. Scheinerman and McCoy (2021) provide a helpful approach to public engagement that involves transparency, ethical reasoning, formal and informal deliberations that can be adapted for different contexts.
However, the impact of vaccine inequity within and across contexts is also emerging in our research. And whilst focusing on vaccine confidence is important, this must be understood in relation to vaccine supply. Here, a more global engagement is needed to acknowledge this as a social justice issue and demand for the expansion of access to COVID-19 vaccines and the scaling-up of technology transfers from the Global North to the Global South.
This blog post is one of a series, providing insights and reflections from the SSHAP ‘Social Science and Epidemics’ collection. The collection reviews different aspects of past disease outbreaks to identify social science ‘entry points’ for emergency interventions and preparedness activities.