When Susan had a baby daughter, she was not planning on having her vaccinated. It didn’t seem abnormal to her – most of her mothers’ group didn’t vaccinate either. “I had friends who believed in natural healing, healthy food, being vegan, eating raw food. I just didn’t think that vaccines were necessary.” She was hardly alone. While teams around the world race to create a vaccine for Covid-19, the anti-vaxxers are racing to convince people that it will be dangerous. Australia has an excellent record on immunisation. The national coverage rates in children are above 90%, on average, with some concerning pockets of lower coverage. But the adult rate is lower – fewer than one in five got the swine flu vaccination in 2009 – and adults are more susceptible to this novel coronavirus. So there is a genuine concern that if and when the vaccine “ticket out” is found, efforts to get people to take it will flounder. While the pandemic that has infected millions and killed hundreds of thousands of people continues to rage, the anti-vaccination movement has capitalised on the fear and confusion created to spread viral propaganda. Some of the widely discredited conspiracy theories to reach the mainstream include that Microsoft founder Bill Gates is part of a global cabal, including the World Health Organisation and big pharma, that started the coronavirus as a method of social control, and that 5G is responsible for Covid-19 – claims that have been comprehensively debunked. A film called Plandemic featuring discredited scientist Judy Mikovits wove together several anti-vaccination and far right conspiracy theories to claim that a group of elites was using Covid-19 and its potential vaccine to make a profit and control people. It spread around the world with alarming speed, reaching 8 million people on YouTube, Facebook, Twitter and Instagram in just over a week. But the vaccine could be the world’s ticket out. The ticket to rebooting the economy, to travel, and to hugs. What happens if not enough people get vaccinated, and that ticket becomes invalid? Prof Stephan Lewandowsky is an Australian psychologist. Now at the University of Bristol, he recently released The Conspiracy Theory Handbook to help battle the “unhelpful surge of conspiracy theories circulating regarding Covid-19”. He said it’s no surprise that the current pandemic has spawned conspiracy theories that will put some people off a vaccine if and when it appears. “Whenever people are scared and they have a sense of losing control, that’s when these things emerge because for some people belief in a conspiracy is giving them comfort. It’s psychologically easier.” More than 100 potential vaccines are in development. At least 60% of people would need to take one up to reach a low level of “herd immunity” – a critical threshold needed to keep the virus at a controllable number. And there are barriers to even getting levels that high. Dr Rod Pearce is the chair of the Immunisation Coalition, a not-for-profit that is setting up a roundtable to work out how to make sure Australians are comfortable with a vaccine. “Will people trust it? There are so many fake stories around about what’s going to be involved,” he said. “There’s so much controversy, so much complexity.” What if you need three shots of the vaccine for it to work? What if the immunity doesn’t last and you need it twice a year? What if it is not perfectly effective? Who would be the first to get it? Will they be happy to give it to their children? Will rich countries get it first, or front line workers? Are there even enough needles to deliver it? “So far we’ve got all the questions and very few of the answers,” Pearce said. But he can see a way forward. “We think it’s a 12 to 18-month strategy … let’s pretend Australia will have a vaccine then,” he said. “What do we need to do to put it in place? We need transparency and the willingness to engage, we need to encourage people to ask questions.” Prof Julie Leask is one of Australia’s top experts on vaccination uptake. The University of New South Wales’ social scientist is part of the national and global conversations about vaccine acceptance and rejection. And she says while misinformation online is a problem, there is a much more complex reality. Leask talks about vaccine acceptance as a five-layer pyramid. At the base, the fattest part, are the people who will vaccinate. Then there are increasingly smaller, but increasingly resistant layers. There are the “cautious acceptors”. Then there are the “hesitant acceptors”, followed by the “selective vaccinators” who might accept certain vaccines but will reject others. At the sharp peak of the pyramid are the decliners, those who won’t vaccinate. Part of that small group are the anti-vaccination activists. That subgroup includes people like former My Kitchen Rules star Pete Evans, who has been sharply condemned for his non-scientific opposition to jabs. There are other “influencers”, including celebrities, sports stars including NRL players, and social media activists, who use their fame to seed suspicion about vaccinations. “They’re the keyboard warriors, who are out there day and night,” Leask said, but added that they’re only a small part of the problem. She is more worried about the barriers to access. Families who struggle to get vaccinations because they’re in a country town without a GP. Or a single parent struggling to wrangle children into a surgery. People who are socially excluded, or for whom poverty is a much more pressing issue. Leask is worried that a focus on the hardcore anti-vaxxer movement is a distraction from the banal reasons families fail to prioritise the jab. And she’s also concerned that people sitting on the metaphorical vaccination fence might just be pushed over the wrong side by zealots who force the issue, or by punitive measures such as “no jab, no play” legislation. “You don’t want to make it easy to opt out,” she said. “But you do want to make sure you have an outlet valve for those hardcore refusers who will never change or are being disengaged further from the healthcare system.” In the current pandemic, vaccine misinformation has become entangled with conspiracy theories about everything from the rollout of the 5G telecommunications network to the convoluted Qanon conspiracy. But Leask says active resistance (as opposed to access barriers) is more likely to be personal than Qanon-related. She was surprised, while researching attitudes towards vaccination, by how many parents had been frightened by a bad health care experience. An uncaring doctor or a cold, unforgiving health system. Lewandowsky, meanwhile, has a theory that the answer to vaccination hesitancy is … inoculation. A vaccine against anti-vaccination, if you will. “You need to inoculate people against misinformation by telling them ahead of time what they’re going to be exposed to,” he said. “Being informed. That will reduce their susceptibility to misinformation.” Susan, the Melbourne anti-vaxxer mother, told her maternal child health nurse that she wasn’t planning to vaccinate her daughter. That nurse referred her to a doctor. That doctor talked her through the risks, then unusually, talked her through some alternatives. He said she could have the vaccines that are often grouped together given to her daughter separately. He empathised and emphasised that some shots were more important than others. He took time to talk through her concerns while showing her the evidence and the statistics about vaccinations. Susan began to rethink her opposition. Meanwhile, one of her friends, who had also just had a baby, told her they needed to have a difficult conversation. “She wasn’t judgemental. She said until my child was caught up on vaccines, she wouldn’t be able to be around my child,” Susan said. “She wasn’t trying to manipulate me.” Susan changed her mind. Susan’s daughter, now in primary school, is fully vaccinated. And as soon as Susan heard about trials for a new vaccine, a protection against Covid-19, she rang one of the companies involved and volunteered to be a test case. “I volunteered to help, not to protect myself,” she said. “I felt an absolute obligation to other members of society.”