Staying alive: Leveraging storytelling to tackle vaccine hesitancy

EUSEBIUS MCKAISER

We should start telling stories about the value of preventing yourself from falling ill by choosing to get vaccinated. The science may be technical, but the public health challenge is fundamentally a communicative one. Let us better leverage the power of stories to ensure we survive this pandemic.

It feels as if death is hanging in the air like a nasty stench. That is the existential dread that the third wave of Covid-19 has saddled us with.

Every time my phone rings, I wonder if I will get yet another call about a friend, relative or colleague who is gasping for air. I found myself almost behaving mechanically yesterday as I typed the words “My deepest condolences…” on WhatsApp in response to a friend’s loss that had been sponsored by Covid-19.

With the real death toll associated with Covid-19 probably more than 176,000 by now (a figure based on a weekly analysis of excess deaths by the Medical Research Council), the impact of this pandemic on our lives is deeper than official numbers would have us believe. And this is not to include our neglected psychosocial well-being. If there was a way to measure what is happening to the population in terms of mental health, many of us would not only be physically precarious but also psychologically stretched.

So why, given these sociological and psychological realities, are many citizens thinking twice about getting vaccinated?

Sceptics

I have been trying to convince my dad to get vaccinated. It struck me that the power of stories needs to be understood and leveraged in our response to any vaccine hesitancy. Misinformation campaigns piggyback on the power of storytelling. When someone at gym told me, “That Jabu guy was vaccinated and he still died, so what is the point of vaccines?!”, I knew that a discussion I had had with my friend, fellow author and broadcaster Redi Tlhabi, had been on point.

We had expected the worst in terms of the impact of a story about the death of former Eskom board chairperson Jabu Mabuza. We had heard that he had been vaccinated a few days before falling ill. I don’t know if that is true or not. But we instinctively knew that a sceptic would reason poorly about this fact if it were a fact. Scientifically, you do not have optimal immunity that soon after being vaccinated. The death of someone who had recently been vaccinated is not evidence of the ineffectiveness of vaccines. But my friend would have none of it when I pointed out these facts to him. Even while accepting that I am lucky to have privileged access to some of our country’s best medical scientists who work on these issues, he persisted in asserting a right to cynicism.

My dad, who is well-read, well-informed and very intelligent, also stumped me with his hesitancy.

Wait and see

In his case, he cited stories of people developing blood clots as a reason to “wait and see”. He did not want to say to me that he is unwilling to get the jab, but framed it as a decision that can be delayed until some degree of research certainty that he has in mind, had been achieved, about his safety concerns. I obviously rehearsed what doctors and scientists in the main have said about the odds of getting clots versus the upsides of getting vaccinated, but I was responded to with silence, and a change in subject.

A friend of mine’s mother, who is a nurse, has similar views to my dad’s, even though she works on a daily basis with patients who are gasping for air, and many who have died because of Covid-19.

In each of these cases, people who matter to me or to my friends have heard stories, found the stories gripping and compelling, and internalised the stories as scientific truth, and therefore as a basis for what they will or will not do. In some cases, the stories lead to vaccine cynicism.

Single story

Chimamanda Adichie had seemed to be making an obvious and pseudo-profound point when she went viral for a TED Talk in which she warned of the dangers of a single story. In that context, her message obviously was that we should debunk naked and tired stereotypes by arresting the tendency of assuming you know the full, complex set of truths about someone just by knowing, for example, that they were born “in Africa”. But her point is painfully powerful in the context of the deadly consequences that a single story we are told can have on the decisions we make about our health and wellbeing. Many single stories contain some truths, but invariably only partial truths.

Someone can be vaccinated but not yet have both jabs (depending on which vaccine was administered), and fall ill. Someone may already be very ill, but not presenting as such, when they get vaccinated, and be in the ICU within a day or two anyway. Someone might have many difficult comorbidities or other illnesses unrelated to Covid-19 that complicate their overall health when they are diagnosed with Covid-19, even a few days after being vaccinated.

This is why it is so important for us to take seriously what scientific research tells us. Precisely because the psychological pull of a story can be stronger than a pie chart or a spreadsheet with dizzying numbers on it, is it necessary for the public health messaging to leverage the same toolkit that peddlers of falsehoods leverage, and a key tool in the toolkit is storytelling. We need a multiplicity of stories of the benefits of science and of preventive medicine in particular.

History

Last, we should, of course, as communications specialists, be mindful here of the history of scientific racism.

Richard Pithouse had written powerfully in recent months about the real memory that black people have of being used as inputs in scientific experiments. It is not mere paranoia on the part of black people to be wary of the possibility of being scientific guinea pigs. At a sociological level, we carry stories within our population of not being the friends of scientists at all times in history, but sometimes being the objects of study of those who render us less than human.

Now, obviously, Covid-19 has and is affecting the whole world. But we are not logic machines. For those population groups who have specific strands of medical histories that are morally odious, the strategies and tactics that we use to bring about behaviour change, and encouraging, in particular, opting into vaccination programmes, need to tell stories of why and how doing so is good and safe for us, mindful of our medical histories in our parts of the world.

Accountability

It can be done, but it requires not condescending to those who are hesitant, like my dad and my gym friend, but rather making sense of the internal logic that explains their position, and then working out what stories that engage their logic have some chance of getting them to change their mind. The worst strategy would be to moralise and simply label anyone who is not keen on being jabbed as stupid or irresponsible. I had to check myself in that regard, and we all should, even as we are anxious about loved ones who are thinking twice of trusting scientific orthodoxy.

Obviously we cannot even, as yet, say that we do have a vaccine hesitancy problem because we do not have enough vaccines available for us to test for hesitancy (as explained in this experiential research by Kate Alexander and Bongani Xezwi). Many deaths during this third wave have been preventable deaths. If the government’s vaccine acquisition, roll-out and administering process had been as decent and as effective as it ought to have been, our excess deaths would have been lower.

So, before we blame South African citizens, we need to hold the state morally and politically accountable. Nevertheless, even as we do that, we should start telling stories about the value of preventing yourself from falling ill by choosing to get vaccinated. The science may be technical, but the public health challenge is fundamentally a communicative one.

Let us better leverage the power of stories to ensure we survive this pandemic. In the meantime, know that you are only being a good democrat rather than a contrarian irritant when you ask tough questions of the government about the availability of vaccines.

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