BY OSAMU TSUKIMORI
As the nation’s COVID-19 booster rollout begins to wind down and as the government considers a second booster shot starting as early as May, vaccine hesitancy remains an issue that can impede uptake in the vaccines and hurt the country’s chances of emerging from the pandemic in the near future.
Almost 80% of people in Japan have received at least two COVID-19 doses, but that doesn’t mean all are planning to get additional shots. Decisions on boosters can depend on people’s circumstances and the pandemic situation, warns Takayuki Harada, a psychology professor at the University of Tsukuba. The rollout of third shots began on Dec. 1, but the booster vaccination rate remains a little above 40%.
“Vaccinations were progressing smoothly last September, but at that time the delta variant was prevalent and the risk of serious illness was said to be extremely high,” he said. “I think it was fortunate that the timing of the vaccine rollout in Japan coincided with the outbreak of delta.”
A study by the university has shown that being in the presence of people getting the vaccine or recommending the shot can have a significant effect on a person’s attitude toward the vaccine.
Harada’s findings serve as a cautionary tale for the government, highlighting the need to keep the public informed on an ongoing basis about the importance of booster shots to protect themselves and others.
The booster rollout is progressing at a far slower pace than the initial rollout of shots last year. Government data shows that the number of total daily shots administered, also including first and second shots, exceeded 1 million on some days in February, but that pales in comparison to the more than 1.6 million shots a day seen during the peak of the initial rollout, when then-vaccine minister Taro Kono was making regular appearances on news programs.
“Now some people don’t even know the names of the vaccine rollout minister or the health minister,” he said. “Under such circumstances, the government’s messaging is extremely weak. And given some people think the omicron variant causes mostly minor symptoms like a cold for most people,” many may opt not to get booster jabs.
Worries over adverse side reactions can also put a significant brake on the rollout, Harada continued, and so can a wait-and-see attitude among people who believe that most cases will likely not lead to serious illness despite the increase in overall infections.
Harada conducted a poll of 1,000 people in Japan last April, when the initial COVID-19 vaccinations for the general public began, and again last September, by which point about half of the public had received two doses.
The findings were clear: Last April, people were equally split between vaccine hesitancy and generally positive attitudes toward vaccines, but last September, positive sentiments jumped to 85.5%, while vaccine hesitancy plunged to 8.9%. Among those who were hesitant last September, about 42% believed false rumors about the shots — a finding that Harada plans to announce in an upcoming study.
What those people who avoided COVID-19 vaccinations tended to have in common was that they had lower anxiety about the coronavirus and perceived they had a lower risk of being infected. In addition, they had an anti-scientific attitude and a strong belief in pseudo-science. Such tendencies did not have a strong correlation with gender or educational background, he added.
Factors such as getting the influenza jab and attending annual health checkups have been also shown to be highly correlated with whether a person receives a COVID-19 shot, Harada said.
Those who spread false information online are not limited to regular people, with even some doctors using their clinics’ websites to propagate misleading views and disinformation. One doctor based in Sendai, for example, blasted then-vaccine chief Kono for a lack of scientific rigor after Kono said there is no scientific evidence behind the claim that the COVID-19 jab can cause infertility.
“It’s not true to say that all doctors are excellent scientists, and as in any profession, there are a certain number of people who say nonsensical things,” Harada said.
“I am not an expert on vaccines, so I still believe what the experts say about the effectiveness of vaccines. … I don’t know what the doctor is basing his argument on, but at the very least, I think it is completely different from the consensus of the scientific community, which is based on evidence that has been properly documented.”
In general, only a limited number of people who believe misinformation eventually change their minds and come around to accept the scientific consensus, experts say.
“I think it might be a bit of an overstatement if I say that we should leave those who believe in misinformation alone, but it is very difficult to change their minds,” Harada said. “So rather than spending the effort on them, it would be more important to devote particular focus on others,” such as fully vaccinated people who are undecided on whether to get a booster.
Source of the problem
So who are the culprits for the spread of vaccine misinformation? That is the question that Fujio Toriumi, professor at the University of Tokyo’s Graduate School of Engineering, wanted to answer with his research.
Toriumi led a study that scrupulously analyzed nearly 100 million tweets and retweets posted in 2021 that included the keyword “vaccine” in Japanese. He found that just eight Twitter accounts were responsible for about half of the anti-COVID-19 vaccine disinformation in Japanese that spread on the social media platform last year.
In all, 79 messages were sent by those accounts, which were then retweeted by other users about 50,000 times. Those accounts — which claim to be a legitimate news source or experts in the field, among other things — tweeted disinformation, some of it sourced from overseas, that fanned radical anti-vaccine conspiracy theories, he said.
Most vaccine-related tweets gave general information on COVID-19 vaccines, followed by political discourse on the shots. Posts related to the anti-vaccine movement were the third most common type of post, accounting for about 4% of the total tweets. Those included messages that link the vaccines to infertility or inaccurate claims that thousands of people died after receiving one of the shots.
“Many of those who send those tweets developed anti-vaccine attitudes as a result of listening to seemingly scientific things,” he said. “They mention, for example, the fact that 1,700 people have died in the U.S. after being vaccinated. But those people could have died from natural causes. They should take into account whether there is a statistically significant difference between the possibility of dying without vaccination and the probability of dying after receiving the vaccine. But sadly that’s not something that most of us think about.”
Overall, the number of tweets that include the word “vaccine” had started declining by the August-September period last year — by the end of that time frame, the majority of residents in Japan were fully vaccinated, with many people likely losing interest in the issue after receiving their shots. But anti-vaccine messages continued at a robust pace and were propagated by people of all political backgrounds, Toriumi said.
“People who are anti-vaccine want to keep talking about it, as they have a passionate desire to oppose vaccines because they think they are bad,” he said. “People generally believe what the government and the media say, but some people think that the media is lying and that the government is not telling the truth. So when they hear spurious things from some unknown person, they will think that they have found the truth that no one else knows.”
Meanwhile, it’s important to note that this misinformation has been effectively addressed by those who spread the scientific consensus, Toriumi said. About half of the tweets countering those misleading messages have been disseminated by roughly equal numbers of individuals and groups — including Kono, the health ministry and three doctors who were particularly active on social media — who have tried to spread the authoritative scientific consensus, he added.
“These people deny the hoax and say that vaccines do not cause infertility in women, for example,” Toriumi said. “The spread of countering information is greater than the spread of misinformation, and they are roughly twice as widespread as misinformation. And that’s one important point.”
To dispel false rumors or conspiracy theories, a group of volunteer doctors has set up the online platform Cov-Navi to provide accurate information on COVID-19 and its vaccines. What the group feared was a repeat of the vaccine hesitancy seen over the human papillomavirus (HPV) vaccine across Japan, which seemed unavoidable unless accurate scientific information was presented to the public, said the head of the group, Dr. Reona Okada.
After a spate of vaccine side effects were reported in the media, the government in 2013 stopped actively recommending the HPV vaccine, and the vaccination rate among eligible women plummeted, which is estimated to lead to a substantial increase in deaths from cervical cancer over the coming decades. The health ministry has only in recent months decided to restore the active recommendation of the vaccine, starting from April.
“COVID-19 vaccinations began in Japan in February 2021 and large clinical trials had shown high efficacy and safety of the messenger RNA vaccines,” said Okada, who also serves as a specially appointed professor at Chiba University Hospital’s Center for Next Generation of Community Health.
“But there were a series of baseless reports in the media and on social media in Japan, and that seemed to dissuade people from getting the vaccine. Many doctors were concerned that the same thing that occurred with the HPV vaccine could happen again. That’s why we got together on a voluntary basis and decided to launch Cov-Navi to get the correct message out.”
Since early last year, Cov-Navi doctors have hosted discussions more than 160 times on the audio-based social media platforms Clubhouse and Twitter Spaces to answer questions about COVID-19. Cov-Navi also conducted a crowdfunding campaign last year and published a guidebook titled “What We Should Know About COVID-19 Vaccines” to convey accurate information in simple terms. Around 45,000 copies have been distributed so far.
Okada says that the group’s activities have helped some people overcome their misconceptions.
“Some of the comments we received on social media said that they were initially leaning toward skipping the vaccine, but our message has helped them change their mind and get vaccinated,” he said. “Some people who had previously been spreading conspiracy theories online also said they have come to our side due to our efforts.”
Cov-Navi’s main aim is not focused on direct “battles” with those spreading misinformation or conspiracy theories, Okada added.
“We try not to directly fight against false rumors or conspiracy theories,” he said. “Our basic stance is to present scientifically correct information so that people can decide whether to get vaccinated or not for themselves.”