By now most of us will have seen risk comparisons like the one below coursing through social media. The message is that, yes, there are risks of clotting from the AstraZeneca vaccine, but they are almost homeopathically small when compared with other blood clotting risks from things that millions do every day (take oral contraceptives, smoke) and especially if any of us were to acquire COVID19.

The idea is that rational people will compare these risks and suddenly any vaccination hesitancy will evaporate when it dawns on the anxious that they are being ridiculously risk averse.   

If only it were so simple. The trouble is, that risk perception and communication researchers have long known that such comparisons do little to assuage anxious people’s concerns. Instead, people unconsciously reach for a variety of heuristics  or mental shortcuts that ease the cognitive load of making decisions about issues where we often lack any scientific detailed and relevant knowledge. We all use these rules of thumb to interpret and make sense of risks in everyday life.

The traditional approach to assessing environmental risks has been to characterise the hazard, quantify the frequency, duration and magnitude of exposure, and to evaluate the risks in a rigorous model with estimation expressed as a probability of an adverse health consequence.  This is the classic scientific approach to assessing environmental risks, but it differs radically from the approach taken by ordinary people when reacting to or ignoring risky situations. The public does not generally assess risky situations using scientific methods, but reacts to specific perceptual components of hazards that are often poorly correlated with their consequences for health.

Rutgers University’s Peter Sandman has probably done more than anyone else to deconstruct how  this applies to a large range of health scares. He argues that the idea of risk needs to be reconceptualised to take account of the relationship between the risky situation or agent (which he names the “hazard”) and the strength of people’s responses to these situations. These responses are mediated by the extent to which these agents or situations “outrage” communities. Risk is thus a product of the actual hazard plus a community’s outrage at their perception of that hazard. He argues: 

Experts focus on hazard and ignore outrage. They therefore systematically overestimate the risk when the hazard is high, and underestimate it when the hazard is low. The public focuses on outrage and ignores hazard, and thus overestimates the risk when the outrage is high, and underestimates it when the outrage is low. Hazard and outrage are quite independent concepts, poorly correlated, which share a name: risk.

Building on the work of others including Paul Slovic, Sandman has delineated principal outrage components that influence whether or not a situation is perceived as acceptably safe or unacceptably risky. No problem will tick all of the boxes shown in the tables below, but all will tick some of them which will go a  long way to helping understand the real causes of people being anxious and upset.

In 1997, with a colleague, the late Sonia Wutzke, I applied Sandman’s outrage matrix to claims which were being made at the time  about the dire consequences ahead for us all that would occur with the rollout of mobile phone transmission towers. Despite the radio frequency radiation from the towers being barely detectable by nearby monitoring equipment, some people were having none of it. Here’s a TV newsreel from the time showing  local anxiety in Harbord, on Sydney’s northern beaches, with the local MP Tony Abbott milking it hard. Our paper in the Australian and New Zealand Journal of Public Health, had the two tables below where we applied the factors in Sandman’s model to the case of mobile phone transmission towers.

It is rare today to encounter any concerns about mobile phone towers like this woman is expressing here. This is largely because none of the dire predictions made by electrophobic activists have come to pass. While mobile phones and WiFi have been ubiquitous for decades, the incidence of brain cancer (the disease most often mentioned) has flatlined across the same time. The same has happened with the non-disease of wind turbine syndrome where complaints across Australia have now dwindled to a trickle, mostly coming from anxious people in areas where wind farms have not even been built, but are just being discussed.

Sandman has recently featured in a podcast talking about how such an analysis can be applied to COVID vaccine hesitancy. It is well worth a listen and should be mandatory for those in the government’s communication divisions who are briefing spokespeople and advising on public messaging.

He makes a point I made in my most recent blog that it is elementary that those being vaccinated should be given something to display to others:

I got vaccinated a couple of days ago and I was very surprised that they didn’t give me a pin. They didn’t give me a button. They didn’t give me an armband. They gave me nothing that I could wear or put on a doorpost or something to signal that I got vaccinated and whey oy can, you should too. Because that’s the  kind of bandwagon we should be encouraging. I would pay far more attention to the people who want to be vaccinated than to the people who don’t yet.

Looking over the tables above, several factors seem very obvious in the way they are influencing those hesitating to get vaccinated”. Here are just a few

  • COVID19 is still an unfamiliar disease, unlike the other more familiar vaccine preventable disease
  • Some may feel they are being almost socially coerced into being vaccinated, rather than doing it entirely voluntarily
  • The consequences (potentially fatal blood clots) are probably perceived as catastrophic, and not a mild adverse effect
  • With disrespect for politicians being rampant, they and those working for governments may be seen as untrustworthy. Big pharmaceutical companies, likewise.
  • Lots of media coverage about the adverse reactions

The table below shows vaccination rates in Australia today for children at 12 months for diseases that compared to COVID, have “been around” for a long time.

Like clotting with the AstraZeneca COVID19 vaccine, each of the above produce rare adverse reactions in a tiny number of people who receive these vaccines.  This report on measles vaccination for example, shows 11 children had allergic reaction; 1 anaphylaxis; 1 encephalopathy; and 4 seizures. Yet 94.91% of children are fully immunized in Australia today and all of these diseases are as a result very uncommon.

Sandman’s website has rich pickings on risk perception, communication and how to reduce outrage in ways that may be highly relevant accelerating vaccine uptake in Australia and around the world. Highly recommended.