Polarised views or ambivalence? Vaccines through teenage eyes

Note: Header image (figure 1 below) was created from self-portraits contributed by UK secondary school students taking part in the Infecting Minds project. Used with permission.

During the COVID pandemic, vaccination has become a mainstream topic, with information – and misinformation – rapidly disseminated through communities and populations, influenced by mainstream and social media [1–3]. Mass immunisation campaigns have delivered huge success, but new vaccines understandably raise concerns and questions. The pandemic has amplified long-standing inequalities based on deprivation, race and geographical setting [4–6], and offered a feeding ground for conspiracy theorists. COVID lockdowns have interrupted existing health interventions and delayed access to routine vaccinations. Evidence of disruption to normal patterns of population immunity and seasonal infection has surfaced [7], with outbreaks of severe acute hepatitis [8,9], chickenpox [10], monkeypox [11,12], and a resurgence of cases of paralytic polio [13].

As COVID vaccines were rolled out into younger age groups, the opinions and narratives of children and teenagers have become progressively relevant and important. This group may be strongly influenced by their parents and other family members, but also receive and disseminate ideas and information in different ways, including high on-line connectivity ​​with social media platforms such as Tik Tok, and have the potential to become influencers themselves. Yet young people are less heard in public discourse, and poorly represented by opinion polls, policy development and strategy design. 

We developed dialogue with around 180 Year 8 students (age 12-13y) in an ethnically diverse city-centre secondary school in Oxford, located in the lowest sociodemographic quintile of the UK (based on Index of Multiple Deprivation by postcode [14]). We gathered feedback as anonymous sound-bites, asking students to share opinions and experiences about vaccination (using post-it notes and artwork), and inviting questions for follow-up (Figure 1 above) [15]. Polarised views are striking, with voices in favour counterbalanced by a group expressing negative sentiment. However, it is noteworthy that the largest group – representing nearly half of all students –  adopt ‘active ambivalence’, stating they have no opinion (Figure 2 below). These students are likely to be under-represented in any existing data, because they are highly likely not to express an opinion or to engage in dialogue. Identifying this group disrupts the common narrative that people are either ‘pro’ or ‘anti’ vaccine – in this case, the dominant group is undecided and students express a lack of interest.

Figure 2

As society gets back onto its feet after the complex damage and disruptions inflicted by the pandemic, we need to be mindful of the prevailing mindsets in our young people. Which of these groups could be influenced and educated, with careful provision of appropriate and accessible information to support those who have reasonable grounds for hesitancy? Among those with more polarised anti-vaccine views, what potential is there for reach or influence, and what strategies should we apply? How will negative ideas persist over their lifetimes and be relevant to their own children in due course? How might opinions vary in different settings depending on the experiences of individuals and communities during the pandemic?

Especially careful consideration of the dominant ‘ambivalent’ group is important: we must invest in understanding why and how young people adopt this perspective. Vaccination is a topic covered by the UK Health National Curriculum [16], but is not referred to in the Science National Curriculum from Early Years to the end of Key Stage 3 (Up to School Year 9), and is only implicit in Key Stage 4 (School Years 10-11). As the topic falls under the Health statutory guidance, teaching may not be delivered by teachers with specialist Science expertise. The students interviewed here will thus have encountered minimal teaching about vaccines. Furthermore, their interaction with formal childhood vaccine programmes is limited during primary school (Years 1-6), so vaccination may not seem a relevant priority. Ambivalence about COVID vaccines may also be linked to ‘pandemic fatigue’ and the mental health impact of coping with the challenges of the COVID era [17], alongside the influences of political upheaval, a cost-of-living crisis, and climate change, that pervade the media and can make futures feel uncertain. Lack of engagement may reflect conflicting personal and social priorities, a desire to move on from the pandemic, or genuine disinterest and lack of motivation linked to disengagement from school and from authority figures.

Work is needed to understand how the views of our teenagers might be associated with ethnicity and sociodemographic status [18], such that appropriate resources can be focused on those who are most at risk of declining vaccination [19]. ​​There may be a positive role for social media and peer role models in engagement and influence. If the majority of young people lack an opinion on vaccines, we should approach this as an active opportunity, recognising the potential for positive influence to inform the future, developing approaches to provide appropriate, accessible information, and improving engagement. In contrast, complacency risks ‘avoidable and unnecessary outbreaks’ for many vaccine preventable infections [20].

Addressing these issues is complex and multifaceted, but there is no doubt that we must invest in our teenage populations, providing continuing threads of support, education and engagement, so that we leave no-one behind and offer the best health outcomes – both for them as individuals and for our society as a whole.

Authors

Elizabeth Burns is a science-based artist, following a doctorate and research fellowship in cancer research in the University of Oxford. Twitter: @DrLizzieBurns

Tamara Ingamells is Science Key Stage 3 Lead at The Oxford Academy.

Sally Frampton is a historian of medicine and healthcare. As Humanities and Healthcare Fellow at the University of Oxford she works on fostering greater interdisciplinary collaboration between humanities and medical researchers. Twitter: @DrSallyFrampton

Philippa Matthews is a consultant in clinical infection and group leader at the Francis Crick Institute, London. Twitter: @pippa_matt

Acknowledgements and funding

We are grateful to the staff and students at The Oxford Academy.

This work was done by the Infecting Minds project, https://infectingminds.web.ox.ac.uk/home, funded by the Oxford University Wellcome Institutional Strategic Support Fund (https://wellcome.org/grant-funding/funded-people-and-projects/institutional-strategic-support-fund) and The University of Oxford John Fell Fund (https://researchsupport.admin.ox.ac.uk/funding/internal/jff).

PCM receives funding from the Wellcome Trust, NIHR BRC, and the Francis Crick Institute, and supervises a PhD student cofunded by GSK.

References:

Elizabeth Burns¹, Tamara Ingamells², Sally Frampton³, Philippa C Matthews^4,5,6*

¹ Department of Oncology, University College London Hospital, 235 Euston Rd, London NW1 2BU, UK

² The Oxford Academy, Sandy Lane West, Littlemore, Oxford OX4 6JZ, UK

³ Faculty of History, Oxford University, George Street, Oxford OX2 6GG, UK

⁴ The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK

⁵ Division of Infection and Immunity, University College London, Gower St, London WC1E 6BT, UK

⁶ Department of Infection, University College London Hospital, 235 Euston Rd, London NW1 2BU, UK