The COVID-19 pandemic forced us to revise our methods of preventing the diseases spreading, but we also faced a serious problem of medical disinformation. In an age of disinformation and questioning of medical authority, how can we convince patients of the effectiveness of vaccinations?
Dr. Paweł Grzesiowski: First, we need to understand where disinformation comes from and what mechanisms we can use to combat this phenomenon. Only then can we reflect on more specific proposals regarding the vaccination programme.
Disinformation about health or medical problems have not originated from the pandemic. During the pandemic, it has increased rapidly, but we can recall the actions of anti-vaxxers before 2020 to realise that vaccine-based disinformation is not a new phenomenon.
Even before the pandemic, a whole lot of very strange and unbelievable information appeared on the web, which internet users read, in which they partially believe, and in a situation of danger to health or life, they even rely on them. The pandemic led to the spread of this type of behaviour, which was a consequence of the rising popularity of medical and health message.
Never before has any issue related to medicine attracted such attention from the traditional media, such as television, radio and the press, but also social media. Due to the pandemic, health issues are discussed in the media all over the world, and this in turn facilitated the occurrence of various pathological phenomena, such as hatred of doctors or scientists, trolling, or the deliberate dissemination of erroneous and false information.
Unfortunately - and it pains me to admit this - many actors make huge money promoting anti-scientific content. It is not just about vaccines, but it is an attack on medical knowledge, on science as such. Media are also partially responsible for that. By supporting anti-scientific movements, giving them a platform to speak out, they help them to boost their popularity. In addition, they earn a lot of money on this-anti-scientific and anti-vaccine revelations, which usually bring great interest of the recipients.
Not everyone who has not been vaccinated is a follower of conspiracy theories. There are also people who have simply been effectively frightened by anti-vaccine content. To discourage someone who is not vaccinated, it is enough to sow uncertainty in him, to ask the question "What if...?" and hide all the scientific answers to them under a layer of lies and screaming chaotic fake news. How should scientists, journalists, and local governments communicate the safety and effectiveness of vaccinations so as to encourage those who are frightened to do so?
As I see it, education is a fundamental issue. I work as a consultant in the vaccination center, which is the place where patients with doubts go - the patients that do not want to get vaccinated because of their fears. I've been working there for years.
The first basic principle is to listen to the patient. You should try to understand what the patient is afraid of or why they do not want to get vaccinated. I agree that it is absolutely impossible to call all the people who have not been vaccinated anti-vaxxers.
A lot of people have doubts and questions that have never been answered. These people should be able to go to consultation points, where they can meet with an expert. We have a few, sometimes a dozen conversations a week, and after a lot of these conversations, the parents - because they are usually the parents - usually come out with a somewhat changed point of view.
I don't mean that everyone agrees to vaccinate a child right away. However, in many cases, informed patients will get vaccinated sooner or later. There's nothing worse than being left with your doubts, with no answers.
So the first rule is to listen and understand the patient. The second rule is not to promote vaccination aggressively. I think that the vaccination campaign in Poland has failed miserably. This is the result, among other things, of a kind of propaganda campaign or posters that treat people in a rather primitive way. It is as if the actor's presence at the show was enough to encourage people to get vaccinated. That's not the way to decide health issues. It's not selling washing powder that's at stake here, it's our health. Each of us has confidence in certain sources of information, and these sources of information should be used to promote vaccination.
I think that the fact that the Polish Catholic Church did not take a clear position on vaccination and pandemics may have had a significant impact on the low vaccination rate in many regions, especially where the church enjoys great confidence and authority. It was not uncommon to hear negative statements about vaccines from priests in Polish churches, even if the Vatican is positive about vaccinations.
The vaccination programme should therefore be prepared on the basis of appropriate authorities and not on the basis of propaganda. Those do not even need to be medical authorities, because it makes no sense for doctors to cite data which people do not even understand. Everyone should have access to the authorities they trust.
The message must also be tailored to different groups. One example is 70+ people. Many of the people from this age group who came to vaccination points asked why vaccinations were not mandatory. These people still remember terrible epidemics of smallpox or polio, and for them mandatory vaccination is something obvious. They were brought up when vaccination was compulsory and I think most of them would not mind if the vaccination against COVID-19 was compulsory.
Of course, we approach young people differently. Among the young people, the virus also has a different virulence. For younger generations, more liberal rules could therefore be introduced. So it is very important to tailor actions and strategies to specific demographic groups.
There are countries where vaccination against COVID-19 has actually been made compulsory. In the United States, for example, unvaccinated workers in certain sectors are being laid off. What do you think of such a strict approach to the problem of vaccine hesitancy?
I believe that in "socially engaged" professions, such as doctors, nurses, teachers, educators and public transport drivers, vaccination should be compulsory. If someone works with other people, they should get vaccinated, because this prevents the spread of the virus among the people with whom they come into contact at work. Of course, top-down duty is the ultimate solution to the problem. It would be much better to reach agreement on health and vaccination with trade unions and local authorities.
In Poland, almost 90 percent. doctors support vaccinations. Nine out of ten representatives of medical workers were vaccinated despite the absence of the mandate. Of course, this 10-per cent margin remained and it is necessary to somehow persuade these people to change their minds.
But how to do it? By force, by imposing duty and absolute rigor or by lay-offs? Or maybe it would be enough to increase significantly the liability insurance premium for the unvaccinated? Or to otherwise make the decision not to vaccinate costly to the worker? Perhaps it would be a good solution to set up a special fund in the workplace, which would be mandatory for unvaccinated people, and from which compensation would be paid in the event of an outbreak of the epidemic?
In my opinion, these are better solutions than coercion on the principle of "who does not get vaccinated, you will lose your job". Of course, such an option is ultimately acceptable, but it should be accepted in advance by employees, and therefore also by local governments and trade unions. Otherwise, it would be a form of external pressure that would not have the desired effect.
Already today, some local medical authorities have opposed the plans to punish unvaccinated people. Local governments do not want to participate in this penalisation campaign. This approach is fundamentally wrong, because if the local government does not accept that a worker has to be vaccinated, it is a signal to the workers that they really do not need to get a shot.
The provisions on vaccination obligations, if they are to come into force, must be well prepared, planned and be a result of negotiations. The message should not be that the "bad government" imposes vaccinations, and the "good self-government" defends its employees from this kind of aggression.
Let's try to move to the other side of the barricade for a moment. As an employee of a vaccination information point, you probably have contact with people who have encountered vaccine-related disinformation on the internet, for example, heard the statements of anti-vaccination leaders, which at first glance sound reasonable to the ear. What do you think is the most persuasive argument that anti-vaxxers use and how to effectively argue with it?
There are many such seemingly reasonable arguments. I think a lot of people refuse to get their shot because they're afraid. If I'm afraid to go down to the basement in the dark, I'll be open to all kinds of concepts that explain my fear.
If someone tells me someone's been murdered in some basement, I don't think I'm going to go there anymore because I'm afraid I'm going to suffer a similar fate. Someone else can say that in the basement of the block there are rats that can bite a person and infect him with some kind of disease. Also in this situation, I will not go down to the basement, because I will be afraid of a bite and illness. Someone else will say that in a poorly lit basement I can break my leg, and then no one will help me and I will stay in this basement forever.
Each of us looks for excuses to avoid what frightens us - all the more so if there is a lof of allegations and false information about the subject. It's normal that a man should look for reasons not to do something or give up something that he fears.
The internet provides lots of anti-vaccine content that makes people afraid to get a jab themselves and vaccinate their children. Each of us has certain health concerns. Anti-vaxxers are well aware of this and are taking advantage of it. They are hitting very sensitive areas of the collective medical consciousness, e.g. saying that vaccines can make people infertile.
For a human, apart from his or her health an ability to have children also matters a lot, so he reacts with fear if somebody says that he or she can lose his or her fertility.
Another way to sow doubts on vaccination, especially among the people for whom the Catholic Church is the authority, is to spread the information that vaccines are produced from aborted foetal cells. Few people, of course, clarified that these fetal tissues come from the 50's from a single collection. Currently, these cells are maintained in culture.
Vaccine production has nothing to do with abortion, but the message is that one-cells used for production, and therefore vaccines themselves, are unethical. Therefore, we should not use them, because it is a sin for believing people. Such arguments referring to religion can be an insurmountable barrier, even though the Pontifical Academy of Sciences has said that vaccines are as ethical as possible and save lives.
Some other people believe all sorts of conspiracy theories. Many believe that the SARS-CoV-2 virus was created by scientists for nefarious purposes, to mention just one theory. So there is a part of society that is susceptible to conspiracy theories. The internet feeds our fears, and they only grow as a result. Then we don't want to get vaccinated.
The most important thing is to reach those people who read these conspiratorial contents. Then you have to ask them, one by one: what are you afraid of? And then explain these issues. You have to explain the whole matter to those who are afraid to show them that there is no reason to fear. This can only be done in direct conversations. Sometimes, perhaps, these conversations should also involve psychologists, not just a doctor or nurse. Besides, maybe we should also think about support groups for people who are so reluctant to vaccinate. There are so many solutions, and yet, in my opinion, this issue has been neglected in Poland.
There are entire large anti-vaccination groups and communities that support each other in their attitude towards vaccination. On the other hand, people who are vaccinated do not form the kind of groups that would give positive support. There are no such actions here, because vaccinators take it for granted and will not try to persuade their friends to vaccinate as hard as an anti-vaccinator will encourage non-vaccination. I think that this communication of the pro-vaccine part of society is a little lacking, because it makes the undecided fall into some kind of busy society.
And are you concerned that the lack of confidence in COVID-19 vaccinations could affect the effectiveness of vaccination against far more virulent diseases? Those against which vaccinations are mandatory?
The pandemic has already done us harm. As regards the implementation of the vaccination calendar, there have been many delays due to the pandemic-I mean that they have been hindered at some point. Visits to doctors were impossible, because clinics were closed for some time. This caused a shift in the implementation of the vaccination calendar. Some people involved in anti-vaccine theories can actually effectively discourage parents from getting their children vaccinated, not just against COVID-19.
On the other hand, 2019 was the best year for calendar vaccination implementation in the last 10 years. That year the number of people who refused to vaccinate their children was the lowest. For 10 years we have developed the children vaccination in Poland, bringing it to a good level. Unfortunately, the pandemic has destroyed this achievement. In the future, it may indeed happen that confidence in vaccination in general, or in doctors and medical professionals, will be lower. Rebuilding that trust will take time.
However, conditions in Poland before the pandemic were noteworthy. Approximately every two years, Polish Public Opinion Research Center (CBOS) conducts surveys concerning confidence in mandatory vaccines. Only 10 per cent of respondents said that they do not trust vaccines. On the other hand, only about 20 per cent of people regularly get jabbed against influenza. 20 proc. badanych.
So it turns out that Poles trust mandatory vaccines, but do not trust seasonal vaccinations. Still I hope that the positive trend will continue and the pandemic will not result in much higher reluctance to vaccinate on a calendar basis. .
Apart from the COVID-19, we currently have vaccinations against pneumococci (PCV) and rotaviruses (RV). In Poland, they are free of charge, which is a very important from the point of view of their availability. I hear no protest against these new vaccines that have been introduced into the children's mandatory vaccination calendar.
Should COVID-19 vaccines be advertised in this way, could it have some impact on the level of trust?
As I see it, it would only do harm.There have been attempts to promote vaccination with advert spots on television and the internet, but this has had a similar effect to the poster campaign. In my view, Polish people on the one hand take their health very seriously - for instance, many tend to make medical decisions only after consultation with relatives or other people they trust.
On the other hand, dietary supplements are actually very popular. People think: "I'll take it, it will not hurt me, but it can help." Therefore, many people take handfuls of supplements and spend a lot of money on it.They feel they do something for their health, and this is quite simple, because you just need to go to the pharmacy, buy pills and take them.
The decision to vaccinate is much more serious, because we have to go get stung. It's some kind of procedure. There's a qualification to this procedure. It is much more engaging, requires more time and commitment. I would absolutely not see a place for this kind of TV promotion.
I believe in education. People should be taught about public health by all possible means, including through all media. They need to know what immunity is, what viruses are, how vaccines work. Why do I get vaccinated, what will result from the vaccination, why will I have a headache after vaccination or will I have a fever?
No such information is provided. This is about building awareness and readiness for the vaccine. You can't make marketing videos about vaccinations. But you can create educational content that should be widely available.
In my opinion, there are no such information and consultation points in Poland, where the patient could call and consult there, whether to get vaccinated or not. At many vaccination points, there are only nurses, pharmacists or paramedics. For obvious reasons, they will not answer complex medical questions. We have a lot of people who are taking various medications; they are chronically ill. These people have doubts, often justified, about whether to get a shot or not. Such question cannot be answered at the vaccination point, since only doctors have the qualifications to answer them.
Some say the pandemic is coming to an end. In many Western European countries, in which the percentage of the vaccinated population is much higher, politicians consider abolishing the pandemic-related restrictions altogether. Do you think that the vaccination campaign in Poland has failed? What can be done to encourage the unvaccinated to get a jab?
It is never too late for education or promotion of care of your own health. Every day I see new patients who decide to get vaccinated. There are very few of them, but the fact that every day someone appears at the vaccination point means that the program to combat covid is not dead yet.
We have two goals. The first one is to vaccinate as many people at risk as possible with the third dose, because here we know that vaccination saves life and health. The second goal is to slowly but consistently encourage younger generations to vaccination. I believe that we also need to break out of the information bubble, according to which in Poland there is an anti-vaccination hatred everywhere, and people are negative about vaccination, and therefore it makes no sense to take any actions related to public health.
I don't agree with that. I take part in various training courses in workplaces, where we train several hundred people at one meeting. Among these people, there are still those who ask specific questions, for example: "if I had a food allergy, can I get vaccinated?”. If such people's doubts are met and dispelled, the chances are higher that a person decides to get a jab.
The same applies to the third dose. There are numerous people who had been vaccinated with two doses last Spring, and in the fall they nevertheless went down with COVID-19. Some of these people don't need to get the third dose now, it just needs to be recorded in the system that yes, they didn't take the third dose, but they have high levels of antibodies, so they do not to take another jab as soon as now.
There are a lot of such patients got over COVID-19 late 2021 even if they had previously been vaccinated. These people do not necessarily need to be vaccinated immediately with a third dose. They will be able to do this when their level of antibodies fall, so that those people are again exposed to a severe course of the disease.
The interview was conducted by Euractiv Poland, one of the IMMUNION partner.