Confidence

At a time when mistrust is rife in so many ways, the arrival of vaccination against Covid raises complex issues.  Whether people buy in to anti-vax narratives, mistrust big pharma, or simply wonder about the robustness of the evidence for safety from what have been the fastest trials in history, there are real challenges to securing sufficient take-up. We have been surprised about how many intelligent people are not seeing the announcement of vaccine success as the good news it clearly is.  A sustained, open, clear and properly targeted approach to addressing scepticism and anxiety is vital.

There have been sensible suggestions about such a campaign. News channels have been addressing the questions and doubts, with some down-to-earth, realistic and knowledgeable scientists engaging with the big questions. Ideas have been floated for involving public figures and celebrities likely to be trusted by various social groups in a communications strategy.  Intelligent discussion has emerged about how to engage with anti-vaxxers – respectfully, taking doubts and questions seriously, and trying to help rather than to defeat.  Lessons about the lack of reach into various communities – cultural, ethnic, age and economic – of earlier communications about the virus and measures to manage it are there to be learned and applied. 

Given that vaccination is likely to begin very soon, though, I’d like to see more signs of these and other threads being properly and determinedly drawn together into a more active, prominent, strategy for engagement with public opinion.

My confidence in such a strategy emerging is not, I have to admit, high. The childish and irresponsible behaviour of (at least) two members of the cabinet – Messrs Hancock and Williamson – who have chosen to twist a vital dialogue about the safety of vaccination into a competitive playground game, is more than alarming.  Making frankly untrue, politically gauche comments, indeed baseless boasts, rather than maturely engaging with legitimate questions and doubts, is expressly not the way to build confidence. Blurring the issue by introducing nationalistic jibes and Brexit posturing into the dialogue is provocative and dangerous, and directly generates mistrust.  In my days in local government and the NHS, staff members who behaved like this as we tried seriously to engage service users, or communities, in a complicated, vital, high risk strategy, would have been disciplined for unprofessional and destructive behaviour.

Then there is yet another U-turn in the strategy for implementation. Once again healthcare workers come off badly, suddenly demoted from the first phase of vaccination.  Friends who are clinicians tell us how deflated they felt when their appointments to have the vaccine before Christmas were suddenly cancelled with no explanation. These are people who come home from work and spend half an hour scrubbing themselves in the shower, so anxious are they not to pass on the virus to their families; people who have lost beloved colleagues to the virus. What is the rationale for this decision? Surely everyone knows the advice to parents in an aeroplane in crisis, is to look after oneself so one can be in a fit state to look after the baby? There have been months to plan for this situation, plenty of time to engage the people with the right expertise in the discussion, to ensure prioritisation is rational, ethical and efficient. If this conversation happened at all, it seems very likely that it was overturned at the last minute for political reasons, or because of incompetence in planning and delivery, or both.  Let’s put aside (as if we can) the shock and damage to morale in a workforce, many of whom are on their knees with exhaustion – partly because workers are covering for colleagues compelled to isolate in the absence of a vaccine. It is the inability to make, and stick to, a sensible, doable, plan and to put it into action that will further eat into public confidence. 

Of course, this event simply adds to the list of headline grabbing assertions that fail to reach anything like reality, with consequent erosion of public trust.  Take the much vaunted rapid testing regime: Operation Moonshot. It has been promoted by the government despite ministers being fully aware of research showing the test produces worryingly inaccurate results. It has been promoted for mass testing against the advice of the WHO and even the manufacturers’ instructions. Alongside the dysfunctional ‘test and trace’ system and the antibody test (confusingly also referred to as ‘project moonshot’) such developments are costing the tax payer billions, whilst cheaper and better evidenced projects have been side-lined.  The National Audit Office, reviewing contracts worth £18bn in the first wave, describes a lack of a transparent procurement practice – and the Public Accounts Committee suggest that this NAO report as just the tip of the iceberg. In the same vein, the British Medical Journal’s editorial last week cited a litany of government failures concluding that ‘perhaps the gravest error is an arrogant disregard for scrutiny’. The public are not children, nor are we stupid: we witness all this behaviour, and, however much we understand how complicated and urgent the situation is, our trust suffers badly.   And all this is happening in the context of wider anger, mistrust and even rebellion about the way the government has managed its lockdown strategy – amongst believers in, sceptics about, or frank enemies of such an approach.

In my previous post, I tried to highlight how readily a conspiracy theory can be generated and reinforced when a consistent blind eye is turned to harmful realities, or when behaviours by those in power appear to be self-serving, unaccountable, even corrupt.    Potential benefits of the new vaccines depend on public trust.  The government must stop  hiding its head in the sand about the scale of mistrust, and its likely consequences, not just for vaccine uptake, but for continued sensible behaviour to minimise infection. Making vaguely virtuous, mechanically empathic, parental or optimistic statements as if this mistrust is not there will be next to pointless.  Constant over-promising or posturing, combined with clumsy implementation, is a recipe for cynicism, despair and non-engagement.

The prospect of vaccination is tremendously encouraging. If trust is high among the public, and delivery well-targeted and efficient, we will be able to move into a safer world, and rebuild lives, communities, culture and workplaces. But gaining buy-in to vaccination is not a separate task from wider confidence-building. A responsible, competent government needs determinedly to acknowledge and address the many fault-lines in public solidarity and trust.  To earn our confidence, they must display integrity, honesty about failures and contradictions, careful restraint of wild promises or triumphalism, and mature engagement with criticism or scepticism.  Since our trust depends, in the end, on what actually happens, we need to see realistic, informed planning, and logistical intelligence in implementation – of vaccines, of testing, of financial support, of anything really.  Against such a background, successful engagement of enough of the public with a vaccination programme will be much more likely. I fear there is some way to go before we can be truly confident that such a change is going to come. But please let’s start.

John