How stumbles for AstraZeneca and Johnson & Johnson open those ‘doors of mistrust’

John Downing

Analysis

A nurse prepares to give the AstraZeneca vaccine. Photo: Leon Farrell/Photocall Ireland

April 14 2021 02:30 AM

If you ever succumbed in an idle moment to reading the information leaflet inside a box of headache remedy tablets, you probably quickly realised it was a mistake. It takes no leap of imagination to visualise horrific side effects of the simplest medicine.

But, for the most part, the vast bulk of us when stricken by injury or illness will take the recommended medicine on grounds that the benefits will vastly outweigh the risks. A vaccine is, however, a different class of medicine.

It is proffered mainly to healthy people to protect them against a hypothetical risk. It is also crucially a proxy test for our level of faith in our health experts, and in our political leaders whom those experts inform.

A tranche of the population opposed to the principle and practice of vaccination dates right back to the late 1700s and Edward Jenner’s breakthrough with smallpox. Some minority religions have vaccine opposition as an important tenet of their beliefs.

Trust is the central word. Here, trust relates to public acceptance of the truth of a situation without a real ability or facility to get to grips with all the complex technical research details.

We know trust is usually hard to build and often too easily undermined. Two antonyms of trust are those close first cousins: mistrust and distrust. Language savants will argue at length about the difference between the “mis” and “dis”, which, at all events, is slight.

But this writer has always used “mistrust” to mean the impairment of faith based on a vibe or personal suspicion rather than on hard empirical evidence. I take “distrust” to be more definitive in its rejection and more often based on hard evidence. If you have similar language pedant tendencies, you very probably disagree.

But the main point is that, over the past year, the “anti-vaxxers” were not an issue in Ireland. Of all the problems the authorities faced, so-called “vaccine hesitancy” was not a major worry. Anti-vaxxers’ internet activities were monitored – but the issue paled into insignificance when it came to vaccine supply shortfalls and gripes about distribution problems.

But watch the word “mistrust” in this writer’s understanding of it. The real danger now lies in the growth of suspicion. That is often a good opening for those operating quietly on the fringes hoping to sow doubts.

In contrast to other developed countries, various surveys showed that up to eight out of 10 Irish people were prepared to take a Covid-19 vaccine. The first concerns leading to a temporary halt of AstraZeneca vaccines in Ireland and across the EU last month did not much change that.

A big survey by Ipsos-MRBI for the Irish Pharmaceutical Health Care Association at the start of this year showed that, overall, 75pc of Irish people would take the vaccine, with higher numbers in older age groups. Fewer than one in five were unsure, and less than one in 10 ruled it out entirely. Similar polls showed much the same findings.

This latest AstraZeneca precautionary reverse – with Irish experts restricting it to the over-60s – followed by a voluntary move by Johnson & Johnson to suspend its EU vaccine roll-out, raises the risk of “vaccine hesitancy” becoming a force. It has already dogged France’s efforts, compounding its vaccine roll-out problems.

France, a prosperous G7 economy which has made more than its share of contributions to science and health care excellence, is a very interesting study in this regard. Vaccine hesitancy has run at up to 70pc of the population, a rate buoyed up by ethnic minorities and less well-off sections of the community where there is an inbuilt mistrust of the authorities.

We should at this point stress that “hesitancy” does not mean out-and-out opposition, but rather shows the uphill battle to convince the hesitant. Rumblings such as this latest one concerning AstraZeneca are no help, and neither are the less well thought-out comments of political leaders.

In February President Macron stated, with little hard evidence, that he believed AstraZeneca was “almost ineffective” for the over-65s. By late March one poll for YouGov showed six out of 10 French people would not take the AstraZeneca vaccine. The latest turn-up has shown that assessments of that vaccine raise doubts about its use in the younger population, contrasting with a high recommendation for the over-65s.

The more urgent issues raised by serious reverses on these two vaccines remain supply and logistics. But the authorities have now also to watch the question of trust.