Vaccine hesitant workers - to jab, or not to jab?

Employers have an obligation to provide healthy and safe workplaces, but it's a struggle balancing workplace safety with individual choice. Mandatory vaccines help employers (both government and business) acquit their obligation in an open COVID-19 economy.

The Victorian Premier, Daniel Andrews, has been resolute.

We’re going to have a vaccinated economy, and we’re going to lock some people out, because that is far better than locking everybody down. That’s the decision we’ve made.

Recent polls show that at least 62% of Australians are comfortable with mandatory vaccines across a range of employment and leisure settings, and support is particularly strong for health and disability care workers, airline travellers, and teachers. In many workplaces, including here at Griffith University, an open and respectful discussion is underway on how best to approach the idea of vaccine mandates. However, across sectors, there are many workers that are steadfast in their opposition to mandatory vaccines without having medical exceptions, even though it may cost them their livelihood.

Refusing vaccines is not new and started back in the early 1800s with the smallpox vaccine. Opposition is usually on religious, medical risk perception, and mistrust (of science/ pharmaceutical companies/government) grounds.

The decisions of these workers to forfeit their livelihoods seems puzzling. While we must be sensitive to the individual's rights to choose, especially for something that is injected into your body, if this cohort become more permanently unemployed, would the Government choose to impose vaccine mandates on JobSeeker payments to reduce the budget burden, similar to Family Assistance Payments?

What are they thinking?

Behavioural insights can help shed some light on cognitive biases that contribute to vaccine hesitancy. A recently published open access article in BMC Health investigated different cognitive biases in individual vaccine decision-making. The research looked at individuals that were undecided about getting vaccines and those refusing to get vaccines in the 2011 to 2018 period using the US Vaccine Adverse Event Reporting System.

The following cognitive biases were detected in the undecided group:

• Omission bias is the tendency to consider the outcome of not doing something as less severe than doing it, i.e. the side effects of the vaccination are worse than the side effects of the disease. Wanting to avoid the regret of getting the vaccine if adverse side effects were to occur and the recency of news regarding adverse side effects can exacerbate this bias.
• Ambiguity aversion is the tendency to take a known risk over an unknown risk, regardless of the outcome, i.e. individuals question vaccine testing to justify their stance on preferencing the known disease risks versus the less known vaccine risk.
• Loss aversion is the tendency to put greater weight on avoiding losses than achieving comparable gains. Research shows that people feel the pain of a loss 2.5 times more than they feel the joy of a gain, and they take risks in order to avoid the loss. Individuals may focus on the very small chance of having an adverse side effect (for example, 1%) over the base rate (99% chance of no adverse side effect).
• Optimism bias is the tendency for someone to believe that they have a lower health risk than other people.

The following cognitive bias was detected in the refusal group:

• Confirmation bias is the tendency to search for and value more highly the information that confirms our existing beliefs. If an individual believes content that challenges the efficacy of vaccines (safety and effectiveness, alternative medicine, civil liberties, conspiracy theories, morality, religion and ideology) it becomes very difficult to believe contradictory information. When more time and energy is spent sharing information that is familiar, particularly through social media echo chambers, individuals have a tendency to overestimate the extent to which the general population share the same belief. This tendency is reinforced by the higher instances of vaccine hesitant people engaging in communication about the issue, while people that support vaccines do not.

It is important to identify the biases so they can be counteracted. For example, communication about risks of adverse effects of getting the vaccine versus getting the disease needs to be simpler and displayed side by side to counter omission and ambiguity bias. The media and health professionals need to explain very low probabilities in terms that people can understand. Very low probabilities are the flipside of very large numbers which people cannot mentally calibrate. i.e. people respond to a one in a million chance of an event in the same way as they respond to a one in a thousand event. Optimism bias may also be countered by reframing the health messaging to be considerate of others and taking the focus off oneself.

Confirmation bias is a little more difficult to counter, because of the deeply held beliefs and echo chambers these individuals engage in. It is important that vaccine accepters contribute to the discourse to provide balance. Unfortunately, the decision for an individual not to vaccinate affects large numbers of people and can lead to the re-emergence of infectious (and potentially deadly) diseases.

The good news in Queensland (which was slow initially in vaccine take up) is that we observed a surge in vaccinations ahead of the new rules for non-vaccinated people being implemented on December 17.  A report published on ABC Online shows that vaccine hesitant people have been motivated to get the vaccine because they ‘didn’t want to cause anymore problems’, ‘felt left out’, ‘want to enjoy life’, ‘want to go overseas’, ‘don’t want to be selfish’, ‘want to do family stuff’, and ‘want to keep my job’. The prior beliefs people held are being overcome by the powerful force of ‘loss aversion’, the idea that the pain of losing family time, holidays and income is not worth persisting with vaccine refusal. Many businesses and households that will be impacted financially from lost workers and incomes will be hoping that this trend continues. While we are yet to see how 2022 evolves in terms of borders and restrictions, talking to vaccine-hesitant people about future financial goals and plans (and missing out on them) will rest uncomfortably in their emotions and might help them break existing thinking patterns.