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Rapid response to:


Cultural competence in covid-19 vaccine rollout

BMJ 2020; 371 doi: (Published 18 December 2020) Cite this as: BMJ 2020;371:m4845

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Rapid Response:

Re: Cultural competence in covid-19 vaccine rollout - The importance of social media use to maximise vaccine confidence and uptake

Dear Editor,

We share the same concerns highlighted in this Editorial that certain communities, such as minority ethnic groups and those of lower socioeconomic standing may be left behind in the UK’s vaccination programme. We propose that social media may play a key role in ensuring that this does not happen.

In the modern age of the internet and social media, information can be shared at the click of a button and instantly accessed by millions of people around the world. Unfortunately, the same is also true for misinformation and the COVID-19 pandemic has provided the vast numbers of trolls, snake oil salesmen and conspiracy theorists with the perfect platform from which they can share their pseudoscience and ‘fake news’ to achieve their 15 minutes of fame. Misinformation on social media has plagued the scientific community throughout the course of the pandemic, ranging from initial rumours that the SARS-CoV-2 virus was ‘lab engineered’ to PCR testing ‘false positives’ and ‘casedemic’ claims. Unsurprisingly, as the UK rolled out the first wave of its COVID-19 vaccination programme, social media was awash with false information regarding the safety of the vaccine(s) [1] and public concern was, and still is, clearly evident.

Is it recognised that vaccination of a large proportion of the population would be required to achieve herd immunity to SARS-CoV-2 [2]. Therefore, in the absence of mandatory vaccination or a payment for risk scheme [3], it is paramount that the general public make an informed choice to actively accept vaccination when offered. Presently, the public is faced with making this choice influenced largely by the vast amount of information/misinformation they encounter on the internet and social media. Nevertheless, recent studies have estimated that potential UK acceptance rates for vaccination are promisingly high (79-90%) [4],[5],[6]; however, these studies openly identify that their participants are not fully representative of the population in general, with individuals of lower education and lower socioeconomic standing, and BAME communities vastly under-represented. Therefore, the extrapolation of the results of these studies should be undertaken with caution. Preliminary data from our own ongoing study (>4200 participants recruited on Facebook) and, more anecdotally, our personal experiences on social media, both indicate the potential for a higher prevalence of vaccine hesitancy and negativity than is being reported in the published studies. Indeed, this was particularly evident following the reports of anaphylactoid reactions to the Pfizer/BioNTech vaccine in 2 vaccinated NHS staff [7].

Vaccination misinformation on the internet [8] and vaccine hesitancy [9] are not new phenomena; however, on the background of a global pandemic, their consequences could be significantly magnified. A recent study indicates that exposure to COVID-19 vaccine misinformation on social media even has the potential to dissuade those who would otherwise ‘definitely’ vaccinate [10]. Throughout the duration of the COVID-19 pandemic, the UK Government has repeatedly missed the mark with their blatant disregard of their own policies and recommendations, gimmicky slogans and sub-standard presentation of scientific information. Therefore, it is unsurprising that trust in the UK Government is at an all time low [11] and the general public have every right to be hesitant in their belief of Governmental advice and information with regards to vaccination. Therefore, we believe that a coordinated and concerted effort from the medical and scientific communities is required to provide more accessible and effective science communication of the COVID-19 vaccine(s), in order to build confidence in the general public as to the benefits and safety of vaccination. To reach the demographics which are least likely to actively research the validity of information they encounter on the internet and engage with scientific information from reputable sources, social media is the perfect platform from which to disseminate factual evidence. Learned societies, such as the British Society of Immunology (BSI), have now recognised the importance of this and are actively encouraging their members to act as vaccine advocates by engaging with families and friends on social media and disseminating clear and concise educational materials [12]. On a more personal level, we have recently written our own COVID-19 vaccines science communication article designed to be shared on social media [13], which has received an average of ~250 views/day since publication on the 14th December 2020. Preliminary feedback on this has suggested that the majority of people engaging with it have found it very informative and useful in their understanding of the COVID-19 vaccine(s) and the importance of vaccination.

We propose that, via targeted use of social media, a collective effort from medical and scientific professionals can harness the potential to accurately inform the public of vaccine benefit and safety in a timely and accessible way. Through this, informed decisions can be made with confidence to ultimately maximise the uptake of the COVID-19 vaccine(s) in the UK.

Daniel Patten is a Postdoctoral Research Fellow in the Institute for Immunology and Immunotherapy, University of Birmingham, UK

Adelle Green is a Final Year Student (BSc in Education with Biological Science) at University Campus North Lincolnshire, UK

Daniel Bown is Programme Leader at University Campus North Lincolnshire, UK

Craig Russell is Lecturer in Pharmaceutical Sciences at Aston University, UK

2. Anderson, R.M., Vegvari, C., Truscott, J. and Collyer, B.S., 2020. Challenges in creating herd immunity to SARS-CoV-2 infection by mass vaccination. The Lancet, 396(10263), pp.1614-1616.
3. Savulescu, J., 2020. Good reasons to vaccinate: mandatory or payment for risk?. Journal of Medical Ethics. doi: 10.1136/medethics-2020-106821
4. Bell, S., Clarke, R., Mounier-Jack, S., Walker, J.L. and Paterson, P., 2020. Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England. Vaccine, 38(49), pp.7789-7798.
5. Neumann-Böhme, S., Varghese, N.E., Sabat, I., Barros, P.P., Brouwer, W., van Exel, J., Schreyögg, J. and Stargardt, T., 2020. Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19.
7. Mahase, E., 2020. Covid-19: People with history of significant allergic reactions should not receive Pfizer vaccine, says regulator. BMJ 2020;371:m4780
8. Kata, A., 2010. A postmodern Pandora's box: anti-vaccination misinformation on the Internet. Vaccine, 28(7), pp.1709-1716.
9. Dubé, E., Laberge, C., Guay, M., Bramadat, P., Roy, R. and Bettinger, J.A., 2013. Vaccine hesitancy: an overview. Human vaccines & immunotherapeutics, 9(8), pp.1763-1773.
10. Loomba, S., de Figueiredo, A., Piatek, S., de Graaf, K. and Larson, H.J., 2020. Measuring the Impact of Exposure to COVID-19 Vaccine Misinformation on Vaccine Intent in the UK and US. medRxiv.

Competing interests: No competing interests

10 January 2021
Daniel Patten
Postdoctoral Research Fellow
Adelle Green, Daniel Bown and Craig Russell
University of Birmingham
Institute for Immunology and Immunotherapy, University of Birmingham, Birmingham, UK