 Good morning. I'm Mustafa Al-Rawi, Assistant Editor-in-Chief at The National. Thank you for joining us for this session titled Boosting Vaccine Confidence. It's an exclusive expert panel. We're going to do a briefing on the global implications of the COVID-19 crisis and the road ahead. We are on the cusp of an era of mass COVID-19 inoculation. The deployment of vaccines by drug makers such as Pfizer-BioNTech, AstraZeneca, Moderna, Sinopharm and the Gamalaya Center promises to put the pandemic behind us. Justifiably, there's been plenty of optimism about a return to a more normal arc of life. However, it may not be a straight line to global herd immunity. Surveys indicate that only 73% of people would get a COVID-19 vaccine if available with a number as low as 40% in some countries. It would seem that there is a lot more work to be done to help people feel comfortable enough to get a jab. So we're going to discuss the various aspects of this about confidence with our experts, as I said. With us is Heidi Larson, Professor of Anthropology, Risk and Decision Science at the London School of Hygiene and Tropical Medicine. She's also the Director of the Vaccine Confidence Project. We also have from Singapore, Professor Chao Chuan Tan, he's Executive Director of the Office for Healthcare Transformation at the Ministry of Health there. He's also Singapore's first Chief Health Scientist. Welcome to both of you. Professor Larson, perhaps I could start with you. Good morning, first of all, and also to say that you recently published a book called Stuck that discusses the issues of trust and distrust around vaccines. How do we work on building the trust that's needed to get enough people to come forward and take the vaccine so that we can get to that sort of magical herd immunity that we've been talking about? Well, trust is all about relationships. I mean, it's very relational. And I think that in general, most of trust is generally defined most deeply in the philosophical literature, and it's two things. It's about trust in the ability. If you believe your doctor or your politician or your healthcare local healthcare worker or system is competent. And the other domain of it is motive. And I think what's particularly concerning in some of the challenges that we face now is that a lot of people don't trust by default, rather than by, I mean, I grew up with trust as the default. But the world is not like that in many settings. So it's really, and I think what's happened in the context of COVID is it's thrown even more uncertainty. And you trust us, we all know the old adage goes, it takes a long time to build and you can lose it pretty quickly. So I think that and this is the COVID and the pandemic is no longer quick. It's been a long haul already. And we've got this very mixed news of vaccines coming down the pipeline, but then this whole new portfolio of variants, which is adding more uncertainty. And we have a lot of supply issues. And as anyone who's read the news, and then we'll talk about it, a very uneven landscape of public confidence. Can I just pick up on that point that we're in an atmosphere of kind of beginning from the point of not having trust. Is this a new phenomenon? How long has it been that we, when did we exactly move from starting from a basis of trust to moving to where we are now? Well, it's interesting. I think his human kind has gone through eras and histories of it. I think if you go back to even the terms misinformation, go back to the first and second World War. We have old etchings in the Welcome Trust here in the archives that go back to the very early days of vaccines, but in the context of wars, in particular, the notion of fake news to send the enemy in the wrong direction is very old. But I think we're back there in one of the low points in history. And certainly, WEF has been monitoring with the Edelman trust barometer for years. And I think last year was the lowest in the period that they've been monitoring. And we see that in the vaccine confidence index. It's very correlated with trust or lack of trust to government. I hope I see COVID as a huge opportunity for governments to rebuild trust because it's highly related. I mean, if we can come out of this with publics having a different appreciation of their governments, we could shift the whole trust landscape. If they feel like they've been let down and betrayed, broken, it's going to be we're going to have to start from scratch again. And Mustafa, I don't know whether I can just jump in here. Please. Say that the situation is variegated across the globe. And if you look at some of the countries in East Asia, for example, there is the indications that I think trust levels there in public health authorities in government may be higher. And this, I think, is somewhat correlated with the ability of the society to respond to the pandemic. And I think as Heidi says, trust is something that needs to be built up over the long term. And the best time to build trust is between pandemics. But the pandemic requires us to find new ways to build trust even during a crisis period. And this, I think, would be a major opportunity for us to see if we can address the situation before that. And maybe the final point I'll make is that it also reflects in some extent how cohesive or polarized societies are prior to the pandemic. Because the pandemic is exacerbating and making much more prominent the different aspects of society that have existed before. Thanks, Professor Tan. I'd like to come back to you in a moment if I can to discuss the experience you've had in a practical level in Singapore, because there is a real diversity in experiences in terms of public health crisis, depending on which part of the world you're in. But first, I'd like to introduce Ben Page, who's the chief executive of Ipsos Mori. Welcome, Ben. Good morning. Good morning. You're kind of going to be able to serve our hypothesis today that we've got a problem with trust when it comes to the vaccine, correct? Well, we do. Although, actually, I have some positive news. And I think that is, as we start to see millions of people vaccinated, what we're seeing in the data is that during 2020, as scores of teams all over the world rushed to produce vaccines, we saw a decline in vaccine confidence in our global trend survey. But what we've now seen actually, since December, as we've actually started vaccination programs, is many more people now saying they will take the vaccine. Because, of course, if you know that in my country, 6 million people have now had it, and there haven't been new stories of massive side effects, we're actually now starting to see considerable rises in the proportion who say they're willing to take it. We're certainly not clear of trouble. And there is a trust problem, although I don't think it's new. It's perennial. It's been here for decades. But I think there are some positive signs. So that to me is really encouraging. There's still, of course, massive regional and national differences in the proportion who say they'll take it with countries like France and Russia very, very low. And of course, both have all sorts of challenges. But interestingly, places like Britain, Brazil, China are much more enthusiasm. But everywhere, since December, we've seen a rise in the proportion who say that they'll take it. So I think as long as there aren't stories about side effects breaking out across the world's media, I think we may, assuming we can get the distribution to work, we may be starting to turn the corner on this. But I absolutely agree with previous speakers that the trust challenge is there. There is a big gap between those who say they trust their government and those who don't, in terms of willingness to take it. And that, of course, is also related to your likelihood to engage in conspiracy theories and all sorts of other stuff. So trust in government absolutely matters. But we mustn't overdo the trust problem because it's been around for decades. And as Heidi has just said, if we can successfully deliver this, this may actually help build trust. Thank you there. I would suggest that we can also be in danger of being overly confident, right? Because the situation is so fluid that trust will ebb and flow as we go along. And also to say that we talk about the problem being there for decades, but also we have recent experience this century with SARS and other outbreaks that may inform what we need to do. I mean, Professor Larson, you had firsthand experience when it came to those problems. Yes. This is, I like the looking at it in a fluidity ebb and flow point of view. And we have learned learned a lot from previous experiences. I mean, when you think back to H1N1, the biggest challenge for people accepting vaccines was that they were too new. And that, that was a virus that we knew a lot. I mean, we were familiar with it was around since 1918. I mean, the character, these things evolved. But I mean, that particular strain was not a brand new strain. The flu vaccine was a very common preparation. It's just we needed to add that strain because it came into circulation later. But still it was the newness. And one of the phenomenas with the new vaccines is they're, they're brand, we've got a brand new virus, we're still running to catch up with and figure out. We've got whole new ways of making vaccines. Part of the reason they were so fast, that was the other anxiety is that they're able to be faster. And we haven't talked enough about the new technologies that have made this possible. So some of these things are historic. Even the rumors about COVID being caused by 5G. In H1N1, it was 4G. In SARS, it was 3G. I mean, these things are rumors like I write about in Stuck, my book. They kind of, they're there, they occur when the fertile ground allows them, and then they sleep, they hibernate, but then they're back when the moment is there. And this is a ripe, fertile moment for these kind of things. But I agree with Ben. There is an overall, I would say slight, Ben. I would caution that with slight. But the problem is that there's pockets of like health workers, we're very concerned about health workers, and marginalized groups that are still lagging behind. But I'll keep with the positive momentum and hope that keeps going. It's a complex issue because if Professor Tan, the experience of Singapore, it's at times been a model for how you handle public health crisis. There's some suggestion now that the risk towards getting more people vaccinated is that people are overconfident, that they feel there's no urgency because of how well the government's handled it. So there's trust. You don't want too much trust, so to speak. Well, I will say in Singapore, we have a healthy paranoia about not being complacent about the COVID pandemic. And we are, despite the quite quiet situation, taking many steps to prevent your outbreaks. Having said that, I think it's true that the well-controlled situation here can contribute to vaccine hesitancy. So in Singapore, the COVID situation has been quiet. For some months now, we've had 15 local cases in the past seven days. And if you travel around Singapore, things feel pretty normal, except everyone is wearing a mask and you still observe safety distancing practices. There are people in Singapore who worry about the safety of new vaccines, as Heidi mentioned. And of course, Singapore is as exposed to fake vaccine news and misinformation as everyone else. But it hasn't, fortunately, it hasn't turned out to be a significant problem so far for our vaccination rollout. And if I may, Mustafa, I just mentioned three things that we have been doing. As part of this first, as Heidi says, a very expensive public engagement program with multi-channels being used to experts, to committee leaders, to peers. In fact, it will also include door-to-door elements for older people to explain the vaccine to them. In parallel, we run very expensive webinars and meetings with physicians and healthcare workers to make sure that they up-to-date about how we are approaching vaccinations and so on. And when we see fake news, we try to call it out and correct it. Second, because there is very little local transmission, we can roll out vaccination to priority groups and overlapping them. So we started healthcare workers and frontline responders in early January. We have started essential workers in late January, and we will be starting there only from end January. So this allows those who are ready in each priority group to come forward to take up the vaccine while allowing us to keep up a good overall case of vaccination. And as Ben says, over time, we expect that as more and more people get safely vaccinated, there will be rising confidence among society, and we expect that the take-up rates will then start to increase quite sharply. And finally, we took a number of weeks, a couple of weeks, to ensure that the processes and systems for vaccination were working well because we want vaccination to be as convenient and as hassle-free as possible. And this means that everyone comes by invitation. We have a range of options, big high-to-put vaccine centers, many GPs and politics, and also mobile teams. We provide information before vaccines and we remind people to turn up for their second shots. So I think complacency is a real danger, I agree. And we're taking the measures that we can in Singapore to try to prevent that from getting the way of fast and efficient vaccine rollout while allowing people to choose if they want to have the vaccine or not. It's good to link the point of convenience with confidence that they are interlinked and also trust as well. They all go hand in hand. But also to make the point to the audience out there that we're not saying that if somebody is hesitant about the vaccine that somehow they are a crank or a conspiracy theorist or an anti-vaccine hesitancy is real and normal, and I think we're just trying to have a discussion, a frank discussion about it. And you mentioned fake news. I'm in the news business and there's enough real news that can create that anxiety and that hesitancy. For example, these new variants of the virus, whether the South African variant or the UK variant, I mean, how does that change the discussion? Ben Page, if I can come back to you to kind of say, you have to keep plugging in more factors to your model when you're trying to work out what people are thinking. Yes, well, I think the new variant of course has raised concern all over the world. I think to be honest, what we've seen is that the public's generally their attitudes from being very alarmed as the disease rolled out hasn't really shifted in a sense that levels of concern have stayed high throughout. So what we're seeing globally is that people recognize a clear and present danger when they see it, talking about populations as a whole, and the new variants in one sense just sharpen that. And therefore, there is willingness to do what it takes. And I think in an age of social media, it's the risk is that we pay so much attention to the loudest voices, often on social media amplified by the way the algorithms work, that we sometimes forget about the silent majority who are not ranting on social media. And social media does have a key role in all of this, because if you are concerned about the vaccine or indeed even susceptible to a conspiracy theory, we're finding that's much higher among people who use platforms like YouTube or Facebook for their news. There's a very strong correlation in believing that there are problems or even conspiracy theories with heavy use of social media. So there's a real responsibility on those platforms to manage themselves effectively. And we won't go into the rights and wrongs of social media regulation. But I would say that our polling globally shows an average in across the world of 78% wanting it more regulated. But I think overall, what our work shows looking at individual governments is that those that are consistent, that communicate regularly do far better than people who are inconsistent and who continually change the goalposts. So there's some messages there for people listening who are in the role of government communications as well as a big difference by countries according to how consistent in terms of their messaging the government has been. So Professor Larson, you're the head of the vaccine confidence project. So how do you tackle the medium of social media? Well, I actually work pretty closely with or collaborate pretty closely with Facebook and some of the other platforms. It's not so straightforward. It's not like the world is divided into into fake and real news. There's a lot of hugely ambiguous information and the extreme, the people who whose motive getting back to the trust definition, the people whose motive is to disrupt and is not about anxiety about vaccines are getting quite clever in the sense of they see they know about the regulations. It's all out there. So they they're turning their statements into questions. They're seeding doubt. They're seeding a whole more uncertainty. They're endorsing people's concerns. And that kind of thing is very hard to delete. It's not, you know, overt fact. If you have something that says drink a court of chloroquine to cure COVID that if I as Facebook, I can say that's overtly harmful. Take it down. But there's a lot of ambiguous, which makes it challenging. I'm not apologizing for the fact that, you know, more can be done. But it's not so straightforward. And I think in addition to the silent majority who are, I would call them in political sense, you've got your base, you've got your swing vote, and you've got your the opposition, which some of which is highly organized and disruptive. But that swing vote is much bigger these days than it has been historically. And part of the reason I'm sorry to say is that we haven't, we have taken for granted. We have been focusing as a public health community too comfortably on the base and not taking the questioners seriously enough. And too many of them are slipping to the opposition because the opposition is listening, they're listening, they're endorsing their concerns, they say we care, they have if there are 100 of them, they'll have 10 different groups for everybody's different concerns. The base is monotone, same message all the time, take that vaccine, take that vaccine. And we haven't done enough in the middle. And that's where we need to move. Professor Tan, do you have any thoughts on that? So I agree with what Heidi says and I think we need many different channels to reach out to different people. So in Singapore, for example, for the elderly, we need people who speak the native dialects with whom people can relate to go and talk to them. So we can do that in Singapore because it's a small place, it's a compact city, but it's necessary because we can't expect people who are older, maybe not as well-versed in English to just read materials that are sent out to the internet. So we need multiple channels to reach out to different groups to understand what are their real concerns and to address them as they are. And for the elderly, they could include things like, how do I get to the vaccine center? Will it be safe? Will there be people who look after me? So it has got to be something holistic, I think, that once enough people have experienced it, the vaccination, and found it to be smooth, easy for themselves, and they start to relate it to their peers in the community. I think that's where you can get most good action. Ben, do you want to come in there? Well, I think it's another example of something that we have seen in all sorts of societies over the last decade, indeed, since the crash, which is the need to understand the role of emotion in communications. And we've seen it in so many ways in numerous elections and political events around the world that the people in charge, the scientists, the economists, the rational people, the empirical people just assume that you tell people the evidence, the scientific truth. And after all, the evidence is that globally, scientists are the most trusted profession by far. You tell people the facts in a rational way, and they will believe you. And I think what the evidence has been over the last two decades or more is that increasingly, we need to use both emotion and fact to communicate. And that becomes really quite tricky, particularly when you're dealing with something like motivated ignorance. There are lots of reasons for rational ignorance. There's too much stuff in the world to actually, for any individual, to actually understand. So you can't understand everything. But there's also motivated reasoning and just wanting to believe that if you look at some of the conspiracy theorists in the US, it's almost a closed world that you can retreat into. And when there is huge risk and uncertainty in the world, and for many populations, that is the reality of life in the 21st century, it can be quite appealing to have a theory that seems to explain everything because an evil conspiracy, there's these people, somebody somewhere does actually know how it all works. And you can retreat and actually into this. But once you're in that loop, telling people facts isn't going to get them out of it. So I think the more governments can understand that one needs both fact and emotion in communications, the more likely we are to be successful because that's also what we're up against. I mean, we've got five minutes left. There's so much more we could touch upon. I mean, at the moment, there's a lot of discussion over actually producing and distributing the vaccines, whether we'll have delays, what kind of supply shortages that could come up that obviously will impact confidence. We also have different ethnic groups in different countries have different attitudes, so we can't communicate with a one-size-fits-all approach. And then, Ben, you talked there about science and providing the facts. But we currently have a lot of tension between the scientists and the policymakers. And each is saying something quite different. For example, what gap there needs to be between the first vaccine jab and the second, there seems to be a lack of agreement. Since we've got a few minutes left, I'll ask each of you to kind of just give us your final thoughts. If I could start with you, Professor Tan. Yeah, I think it's an important point. And I think scientists and also policymakers have to try and push the gap to look at uncertainty of science. There's a lot of uncertainties. But to translate them into practical approaches, practical solutions, and a consistent way to communicate them. And if we can do that in a very consistent manner, and also in an open and transparent manner, communicating through a variety of channels, understanding what different groups are most concerned about, I think that helps to engender the open dialogue as well as the trust. And that helps carry us through situations, sometimes where we may not have got it completely right. But it has provided the basis for us to continue to deal with unpredictabilities of this pandemic, which I think has still quite a number of twists and turns to come. Professor Larsen. Well, I think uncertainty is the, I mean, we often talk about risk and uncertainty and risk and trust coming back to our trust framing. And the more we can build trust, the more publics can, your threshold for accepting risk is quite different. And risk is about uncertainty. Risk is about, you know, pretty much everything's uncertain in life. But some of it has different implications than others. And vaccines are certainly high on the list in some people's perceptions. And they're constantly weighing, I mean, we often talk in public health about the difference between benefit and risk. But the publics don't look at it that way. They're much more sensible. They're comparing risk and risk, risk of the disease, risk of the vaccine. And so I think the external environment with uncertainty, I think we do need to learn to navigate it. And I think how people are guided through it during these times is going to be complicated. But I think it can also have a bringing people together. I see what it's done for bringing local communities together. I'm in a city with long commuters, and they're not doing that now. And I think a lot of people are getting to know their neighbors like they didn't know them before. Ben Page, if I can give you the last 30 seconds or so. Sure. I'll just say use stories and facts. Meet people where they are. Understand that they're worried about risk. Human beings, however clever they are, tend to have weak abilities at juggling different sorts of probabilities of risk to be quite honest. So tell people stories, tell people the facts, but use and use trusted figures to do that. And we will get through this together. It's been amazing to have the vaccines ready so quickly. So that we know what to do, but there are no shortcuts. But inshallah, we'll get there. Thank you all for joining us this morning. Thank you to our experts. Goodbye.