According to an article entitled ‘Vaccination and trust’ released by the World Health Organisation (WHO), research shows that the key determinants of trust are how people perceive given issues.
Competence: people need to feel that the authorities and spokespersons possess knowledge and expertise.
Objectivity: people need to feel that the information provided and the actions taken are not influenced by stakeholders with an agenda.
Fairness: people need to feel that all relevant opinions were included.
Consistency: people need to feel that messages and actions are predictable and aligned.
Sincerity: people need to feel that the authorities and spokespersons are transparent, honest and open – showing transparency or empathy through actions here is more important than declaring.
Faith: people need to feel that the authorities and spokespersons possess empathy, listen to them, understand them and sincerely want the best for them.
Considering the above factors, clarification by the international and local authorities and spokespersons on lingering issues surrounding the COVID-19 vaccines is likely to allay confusion, distrust and misconceptions among the public. Moreover, it is bound to facilitate an informed opinion among those who are hesitant about taking the vaccine.
The prime minister’s reported assertion that he wants Malta to be back to business as usual by May, filled with tourists next summer, with people travelling again, flies in the face of the declaration by WHO chief scientist Soumya Swaminathan. When, at the end of December 2020, she was asked whether international travel without quarantine would be possible after mass coronavirus vaccinations, she replied: “I don’t believe we have the evidence on any of the vaccines to be confident that it’s going to prevent people from actually getting the infection and, therefore, being able to pass it on.”
More recently, she warned: “We are not going to achieve any high levels of population immunity or herd immunity in 2021.” She stressed the need to maintain physical distancing, hand washing and mask wearing.
People need to feel that the information provided and the actions taken are not influenced by stakeholders with an agenda and that they are not in conflict with the advice being given by the international scientific community.
No robust evidence exists that the Pfizer vaccine would be adequately protective if the second dose was given more than 21 days after the first. On the one hand, WHO’s Strategic Advisory Group of Experts on Immunisation said the second dose could be delayed in order to allow more people to maximise the number of individuals from benefitting from the first dose.
It is unwise to open our borders too early as this would jeopardise our success with the vaccination- Frank Muscat
Pfizer is reported to have warned that no “data” exists in support of plans to delay the second dose of the vaccine with the aim of reaching as many people as possible with limited supplies.
The US Food and Drugs Administration (FDA) clearly stated that the vaccination programme should not be changed without a clinical trial. Some scientists have warned that extending the interval between the first and second dose could increase the risk of vaccine-resistant mutations if the virus is then transmitted between millions of people who are partially but not fully protected against the infection.
The Medical Association of Malta is right in saying that the vaccination process needs to be more transparent and that the government should be more efficient in its distribution process. I venture to add that, should the government declare the two vaccine doses be given to the public according to Pfizer’s protocol, the uptake of the vaccine would be significantly higher.
The vaccines from Pfizer and Moderna seem to be remarkably good at preventing serious illness and death from the virus but it is unclear how well they will curb the spread of the virus. If vaccinated people are silent spreaders of the virus, it stands to reason that they may keep it circulating in their communities, thereby putting unvaccinated people at risk.
Moreover, according to a healthline publication, even after getting the vaccines it may take several weeks for the body to start building immunity. What this means is that someone could get sick with the virus just before or even just after receiving the vaccination.
It is unwise to open our borders too early as this would jeopardise our success with the vaccination and the achieving of herd immunity. However, I do understand that public health should not be the government’s only consideration. Other factors need to be considered. People may be alive but destitute.
No data exists about the number of vaccinated people who have been infected by the virus and yet have no symptoms. It is unclear how long immunity from the Pfizer vaccine lasts. It is too early to know whether vaccinated people can have rare side effects which could be detected in long-term trials with millions of participants. The extent of the role children play as silent spreaders in the community is unknown. No assurance has been provided about whether the vaccine offers protection against variants that originated in the UK, South Africa and Brazil.
If the objective of the international and local authorities is to ensure high levels of vaccine acceptance by the public, it is imperative they abide by the determinants of trust as delineated earlier.
If vaccine uptake is high enough and transmission is reduced, our collective immunity, also known as herd immunity, can be used as a firewall.
Abraham Lincoln’s assertion holds true at this time of the pandemic: “I am a firm believer in the people. If given the truth, they can be depended upon to meet any national crisis.”
Frank Muscat is Retired Guardian ad Litem and Reporting Officer (UK).