So I got my Astra Zeneca jab on Thursday morning. After a tough Thursday evening with 38.8 fever and a headache, a missed flight and feeling tired on Friday, I feel much better today even though I still try to be careful. The possibility for a fever was explained in the information sheet I got together with the vaccine and it’s an indication my immune system has responded to the vaccine. So no big surprises there even though of course I would have preferred not to feel the vaccine at all, which has been the case with many people I talked to.
In fact, it was the night before taking the vaccine that was tough for me. I didn’t sleep at all and it is this night that I want to reflect on in the current post which is to some extent auto-ethnography but is also the result of my long interest in disinformation, which I have studied mostly when it comes to politics. Of course, I had followed publications discussing the role of social media in spreading disinformation that in turn fuels vaccine hesitancy. A big N-study recently came out that analysed “the effect of social media and online foreign disinformation campaigns on vaccination rates and attitudes towards vaccine safety”. To do that the study used among others geolocated Tweets, polling data on whether people find vaccines unsafe, actual vaccination rates, as well as own survey data on foreign disinfo and extent of using online media to mobilize.
Yet, being familiar with these studies is one thing, and taking the personal decision to get vaccinated is a completely different thing. All the discussions after I took this decision (I immediately agreed when it was offered to me) convinced me that vaccine hesitancy cannot be explained away with online disinfo alone. I want to discuss in this post four key points that I think are often overlooked: 1) differences in national media discourses 2) the still existing lack of sufficient empirical information 3) the importance of general trust in fellow citizens and in the government; 4) geopolitical games.
The importance of national media discourses
Several caveats before I begin: I am Bulgarian, I had taught a short elective course in Sofia University last year and I was in Sofia now to deal with an insurance I could not postpone anymore. Two days before I had to leave, I got a call from the University that I was eligible for vaccination and I could get the vaccine the next day – it was a ‘now or never’ choice. It was amazing luck so I quickly said yes. And that’s when the drama began. In the evening before I got vaccinated I received 2 phone calls – one from my aunt whom I deeply respect (I am named after her), the second – from a doctor friend who has a PhD in neuroscience. The doctor was very skeptical and my aunt directly urged me not to vaccinate. Both calls made me so worried I couldn’t sleep. So what was going on there?
Taking the vaccine seemed completely obvious to me when I agreed. My Dutch biologist boyfriend told me I am extremely lucky and so did a German and a Czech friend, one of whom even suggested I should reject the vaccine out of generational solidarity. Yet the only reason why I and other younger people were offered the vaccine was because a lot of elderly professors had refused to get it. No wonder. The media discourse in Bulgaria when it comes to vaccination has been highly contradictory. Rather than contributing to a coordinated push for vaccination, most mainstream media have emphasized doubts and uncertainties about the vaccine. Just before I started writing this piece, the Bulgarian National Television BNT (the Bulgarian equivalent to the BBC) organized a debate on whether to get the vaccine, with one of the participants insisting a person gets much better immunity if they actually get sick.
Bulgarian media’s obsession with ‘balanced reporting’ and listening to all possible opinions explains also why for months after the start of the pandemic all key Bulgarian mainstream media invited doctors who insisted that the virus is a simple flu, masks don’t help, we need to reach herd immunity, etc. This was further made possible by the fact that the government established two competing expert bodies in the beginning of the pandemic. As we argued with my journalist colleague Georgi Hristov in a piece for Euractiv, it has been Bulgarian mainstream media and the government itself that were the key to blame for disinfo in the first months of the pandemic. Of course, social media matters. But my aunt Julia (who due to her job had to deal with the earliest computers in the late 1980s) hates computers and never goes online. Instead, she follows extremely carefully all debates on national TV and in print media. That is why when she learned I am going to get vaccinated, she called me to actively discourage me claiming that the long term consequences of this new vaccine are unknown, the Covid risk for a younger person like me is small, and that the vaccine had been developed extremely quickly.
Of course, all this is to some extent true. But in countries such as Britain the media coverage does emphasize not uncertainties but the big benefits of vaccinating as many people as possible, starting from the most vulnerable groups. This is being emphasized by mainstream media and crucially also in the tabloid press. It is unclear whether the tabloids with their huge reach would have been so supportive of the campaign had their been a Labour government. But dealing with counter-factuals is never productive. The fact now is that the main discussions in the UK context have to do with how quickly the vaccines are administered, who can get a vaccine, etc. For people coming from such a context the very doubt whether one should take the vaccine sounds ridiculous. But in a media context such as the Bulgarian one where the uncertainties surrounding these new vaccines are consistently discussed, skepticism (rather than outright disinfo such as conspiracy theories) is prevalent and contributes significantly to vaccine hesitancy. As of February 2nd, 43 % of Bulgarians didn’t want to get vaccinated. Which brings us to the second important factor contributing to vaccine hesitancy. The fact that indeed we lack some empirical data.
Lack of Empirical Data
Lack of empirical data is particularly important when it comes to people above 65 but also when it comes to pregnant women and people with autoimmune diseases. The uncertainty about people above 65 is not the case for all vaccines. Notoriously, the data was not sufficient to make a certain assessment of the efficacy of Astra Zeneca vaccine. This does not mean the vaccine does not provide immunity for people above 65 but simply that we don’t know whether it does. Still, the insufficient data so far was a reason enough for several countries to adopt a cautious approach: Germany, Austria, Sweden, Norway, Denmark, Netherlands, Spain and Poland only recommend it for people under 65, and Italy and Belgium for those under 55. And in an unexpected recent development French President Emanuel Macron – European liberals’ sweetheart – caused a stir with his claim the vaccine was “quasi-ineffective” for people above 65.
This wrong claim was rebuffed by Boris Johnson, the prime minister of the UK, where more than 10 million people have been vaccinated with Astra Zeneca. The World Health Organization also defended Astra Zeneca claiming it can be used for people above 65. Furthermore the WHO argued that the recent study showing that Astra Zeneca was not effective against the South African strain had a very small sample and was not peer reviewed. Still, the reputation of the vaccine has suffered a strong blow. Italy’s main teachers union even protested against receiving Astra Zeneca. Rather than online disinfo what we have here is insufficient (yet) empirical information which was misinterpreted by Macron. The lack of information can be approached with caution, as in the German case, or, with some good faith, considered non-problematic, as we see in the UK. In fact, there have been voices that not recommending Astra Zeneca for the elderly is unethical and risks the lives of the most vulnerable.
The situation is even more complicated when it comes to the long-term consequences of mRNA vaccines where we simply need to wait and see. One does not receive much comfort from reading Moderna’s press releases on their vaccine containing sentences such as the following: “The forward-looking statements in this press release are neither promises nor guarantees, and you should not place undue reliance on these forward-looking statements because they involve known and unknown risks, uncertainties, and other factors, many of which are beyond Moderna’s control and which could cause actual results to differ materially from those expressed or implied by these forward-looking statements.”
Ultimately, science is based on empirical data and when there is not enough data, science cannot say things with certainty. When new data is available, scientists are ready to correct previous errors thus incrementing knowledge. Science has never been about absolute certainty. Nor has it pretended to be. That is its strength. But this does not sound very reassuring when one needs to take a personal decision affecting one’s own health. ‘Do you want to become a lab mouse?’ – my aunt asked me during our phone call that left me so distressed. This is not a nice question to be confronted with. Ultimately, the personal decision about the vaccines in the current stage is a decision based on weighing different personal risks – what is my chance of getting unknown long-term side effects from the vaccine Vs what is my chance of getting Covid soon vs. what is my chance of dying from Covid. But crucially the decision about the vaccine also has a societal dimension: if taking the vaccine can help stop the pandemic, I can also protect other people – thus it also involves weighing risks about society and affecting other people. But do other people also think of their fellow citizens?
In a country with a well-established immunization cycle such as Bulgaria, a lot of Bulgarians who don’t get currently want to get vaccinated with any vaccine against Covid are not anti-vaxers. They just want to ‘wait and see’. That means they want to wait and see what will happen to other people who do take the vaccine. This is a personally rational choice (provided they don’t get sick with Covid while waiting) — but societally a completely irrational one since the pandemic still rages, people lose their lives and the economy has taken a big hit.
Not trusting the government nor one’s fellow citizens is in fact a final important factor for being hesitant about the vaccine regardless of whether one uses social media or not. A qualitative study from Bradford found that “The more confused, distressed and mistrusting participants felt about their social worlds during the pandemic, the less positive they were about a vaccine“. While my aunt was calling me on the phone, the electricity of the whole region where she was at the moment was cut off due to a storm. This was not the first time this happened. After a year of protests against the government embroiled in a series of corruption and rule of law scandals, it’s not a big surprise Bulgarian citizens are not overly inclined to trust any government campaign or their fellow citizens. Many people also question why Bulgaria has imported much larger quantities of Astra Zeneca compared to the Moderna and Pfizer ones. A potential doubt is related to the fact that the representative of Astra Zeneca for Bulgaria is the mother of an MEP from the ruling party. The Ministry of Health has denied these rumours citing the lower price of the vaccine as a main consideration, which sounds reasonable enough. Still, doubts persist. People could ignore vaccine skepticism and uncertainty if they trusted the government. But those who don’t, have one reason less to put their doubts aside.
Lack of trust also plays out on a general more geopolitical level. Ultimately, developing a vaccine has a particular prestige to it. As late as December 10 2020, the Council of Foreign Relations blog published an article claiming that Russian state information promoting the Sputnik vaccine was “foreign disinformation”. The blog contained statements such as “Putin is front-and-center in the disinformation campaign because his cult of personality helps quell dissent from the scientific community.” While at the time of writing the CFR blog, the Russian vaccine had indeed not passed Phase III trials, the problem with such coverage was the complete lack of good faith. Similar Sputnik-skeptical reports could be found in British media, which, unsurprisingly, have been readier to show good faith for Astra Zeneca (and rightly so considering the dimensions of the current pandemic). After the results of the Phase III trials of the Russian vaccine became available, Western media dramatically shifted their discourse with regard to Sputnik: on February 8, Fortune claimed that ‘Countries are lining up for Russia’s once-scorned Sputnik vaccine after strong efficacy results ‘ and the Washington Post asked ‘Did we underestimate Russia’s vaccine’.
What all this comes to show is that vaccines did become politicized by both liberals who first decried supposed Russian disinformation about the vaccine (all too readily) and then by populist provocateurs such as Victor Orban who did order and approve first in the EU the Russian vaccine out of practical concerns but certainly also as a political gesture. In Bulgaria, the far right Alpha TV which stared a campaign against vaccination suspiciously remained silent about the Russian vaccine. Thus, a fraction of the Bulgarian far right seems adamant to wait for Sputnik. What we see here, both on the liberal side ad the far right side, has been a prime example of politicization and involving Cold War rhetoric and fears.
Such politicization has been observed even among close European allies with Macron having to explain “he is not a sore loser on the vaccine race with the UK” and commentators suggesting on the EU Confidential podcast that Brexit might have been a good decision considering the problems the EU Commission has faced in delivering the vaccine. Developing and administering the vaccine has become a game of prestige and international status competition.
So what is my conclusion from all this? Despite my sleepless night I took the vaccine and I am happy to have done so even though after one dose I will continue observing all measures since I can still get infected. On a personal level, I realized that digital disinformation on vaccination, as important as it is, should not be overestimated when trying to address vaccine hesitancy. As a scholar of disinfo, I have been particularly careful when encountering online information on vaccines. Yet much of the conflicting information I was faced with and the ensuing hesitancy for one sleepless night can be explained only if we take a more complex approach to hesitancy.
First of all, we need to take into account that digital disinfo thrives or doesn’t thrive depending on how it is embedded in broader media ecologies. Mainstream media play a huge role in all vaccine discussions. Furthermore, it matters whether people have a good understanding of how science works. Ultimately, in the absence of good empirical data (still), we need to weigh personal and societal risks and do what’s best for us and for everyone. This of course is easier if we live in a context where we believe other people will do the same and the government wishes us best. It’s much more difficult to trust the government on vaccines if we don’t trust it on other issues. Finally, in a situation in which the vaccine race has become very political, both mainstream and alternative media, liberal and far right, have to different extent fallen prey to Cold War discourses and nationalist competition narratives. In a situation when there are so few vaccines still, leaders and think tanks pitting ‘our vaccine’ against ‘their vaccine’ unsurprisingly invite considerations about the vaccines different form the purely scientific ones.
Ultimately, I had all these considerations only after I was vaccinated. I will not pretend I rationally went through the whole thought process recorded in this blog. When I was called, I made a quick emotional decision and stuck to it despite my ensuing sleepless night. Still, I am amazed to know there are contexts in which people don’t even think for a second whether to get vaccinated and no one tries to dissuade them after they have decided. For other contexts, such as mine, we need more complex models to explain what’s going on rather than simply blaming social media disinfo. It’s not simply a matter of ‘the rational us’ Vs ‘the irrational them – the conspiracy theory anti-vaxers from Q-Anon’. Understanding better what drives vaccines hesitancy is crucial. I hope this post helps at least a bit for this.
With the risk of sounding stylistically like a certain company’s press releases, I must note that everything I wrote here is my own personal opinion and has nothing to do with any official position or the position of anyone else associated with the blog. I was just thinking aloud on a matter that is very important to me and many other people and would love to hear your opinion as well.