COVID-19 vaccination: Why some seniors are holding back, and how a little nudge can help
Some are grappling with pre-existing medical conditions, while others prefer to ‘wait and see’. Experts suggest ways to get more seniors to be vaccinated without the hard sell.
SINGAPORE: A few weeks ago, government officials knocked on Mr Ong Ser Hoe’s door and encouraged him to get vaccinated against COVID-19.
But chronic health conditions, such as diabetes, heart disease and a low platelet count, made the 69-year-old hawker feel ill-suited for the vaccine. He had also survived liver cancer about five years ago.
“I felt that (being jabbed) wouldn’t make much of a difference, since I go home after closing the stall after 3pm, and I don’t go out after that. I’d just be more careful around customers,” said Mr Ong, who has run a bee hoon stall in Mei Chin Road for nearly 20 years with his wife, who has been vaccinated.
“Since I have so many health conditions, we thought I’d just take things one day at a time.”
But his liver doctor did not raise any red flags about vaccination during a recent appointment. And now that he can walk into any vaccination centre without an advance booking — as announced last Monday — Mr Ong has changed his mind.
While the decision was “no big deal” for him, he said it will benefit his three grandchildren when they visit.
Some 280,000 senior citizens aged 60 and above, or just over a quarter of this age group, had not been vaccinated or booked a slot, Prime Minister Lee Hsien Loong disclosed in his May 31 address on the pandemic.
In a “special pitch” to get more of them vaccinated, he said even those who are not mobile can get vaccinated, by contacting the Silver Generation Office for a home visit.
Senior citizens approached by CNA Insider cited various reasons for not being vaccinated yet. Some said they were taking medicine for pre-existing conditions, while others preferred to “wait and see”. A few were fatalistic, and one was not yet convinced of the longer-term safety of the vaccines.
Mdm Tay H H, 77, is afraid that the vaccine might affect her blood circulation. The survivor of lymph nodes cancer, who has been in remission for 17 years, said she feels some numbness in her arms. On some mornings, she also feels “blur”.
As she goes out only twice a week to the market, she has decided not to get vaccinated for now. Her four children, two of whom have been vaccinated, are leaving the decision to her, she said.
A taxi driver who wanted to be known only as Mr Wong, 62, said he is on medication for insomnia and may seek vaccination advice from his psychiatrist on his next visit.
While he has heard stories of adverse reactions and is aware of conspiracy theories, the fact that “many friends” of his are doing well after vaccination gives him confidence, he said. “Everyone’s reasons are different, and they must decide for themselves.”
For seniors whose family members oversee their healthcare decisions, there may be more uncertainties involved. A psychotherapist who wanted to be known as Ms Goh, 40, said her husband’s grandmother, who has mild dementia, could not remember how serious her allergy to penicillin was.
During a routine appointment in February for diabetes and renal issues, the 89-year-old’s doctor advised the family to wait a bit before vaccinating her. After observing the data for a few months and with the recent increase in community cases, they feel it is time to sign her up for vaccination at home.
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Not everyone feels as reassured on the statistics, however.
An unvaccinated 69-year-old consultant in the building industry feels that the production of COVID-19 vaccines has been “very rushed” and that they have not been “100 per cent tested”.
“For us old folks, we’re kiasi (risk-averse). We just want to wait a while more and see whether there’s a vaccine that’s foolproof,” he said.
Health authorities note that although vaccines are the best defence against infectious diseases, no vaccine is 100 per cent effective.
For individuals who want longer-term data, Associate Professor Lim Poh Lian, the director of the National Centre for Infectious Diseases’ High Level Isolation Unit, has this to say: The journey of a thousand miles begins with a first step.
“You have to start somewhere. If you’re in a house on fire, and there’s a trampoline below with firemen shouting, ‘Jump!’, you can either debate the long-term safety and efficacy data of the trampoline, or you can trust those who spend their lives dealing with fires and jump,” she said.
“You only have to look at the COVID-19 situation in our neighbouring countries and India to realise that the analogy of fire isn’t far-fetched. Like fire, COVID-19 can spread rapidly and cause devastation.”
Assoc Prof Lim, a member of the Expert Committee on COVID-19 Vaccination, said the vaccines are backed by even more data than other vaccines because of the strong public interest and media scrutiny.
“Developing these vaccines could happen so fast because of funding from countries around the world, many bureaucratic obstacles were removed by regulatory authorities and because the pandemic was causing so many infections,” she cited.
“Most things in life aren’t 100-per-cent-tested, but we have enough certainty to move forward. There are urgent situations where doing nothing is a bad option.”
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Older people who catch COVID-19 have a higher chance of the virus affecting their lungs and ending up on breathing apparatus in intensive care for weeks, she added. Besides themselves, this affects their families and the healthcare system.
She noted that over 290 million doses of the mRNA vaccines have been administered in the United States alone, and the data does not connect vaccination with strokes or heart attacks.
In Singapore, over four million doses have been given. “Has there been a huge wave of strokes or heart attacks?” she asked. “On the other hand, we’ve seen COVID-19 patients — even young, healthy migrant workers — get heart attacks, strokes and blood clots.”
READ: 'No evidence' inactivated virus vaccines more efficacious against COVID-19 variants than mRNA ones: Singapore expert committee
GIVING THEM FACTS, SPACE TO DECIDE
Doctors do not believe, however, in trying the hard sell on the public. They prefer setting out the facts as clearly as possible and leaving people to make their own decision.
“Nobody likes to be told what to do or not do. Timely, consistent, measured and sustained clear messaging from trustworthy sources is critical,” said Dr Ng Wai Chong, the founder and chief executive of NWC Longevity Practice, which provides aged-care consultancy, training and research, as well as direct clinical services.
He feels that the Government and medical professionals enjoy fairly high levels of trust among seniors, and that people like ministers and specialist physicians should keep up the public education campaign. “Audio and video messages are more impactful,” he said.
The authorities should also continue to investigate claims and correct misinformation in a timely manner, he added. Besides communicating evidence, it is useful to show leaders or influencers getting vaccinated, he believes.
When he receives false information in chat groups with seniors, he respectfully tells them not to share it.
Research has shown that correcting misperceptions is no easy task, but it is more feasible for health than political issues, noted Assistant Professor Kim Hye Kyung of the Wee Kim Wee School of Communication and Information at Nanyang Technological University.
Studies have shown that rebuttals by health agencies and news media result in more accurate beliefs than rebuttals by one’s peers, she said. But it is still important to build up media literacy and resilience to fake news, she added.
Communication strategies aimed at seniors could present vaccination as a social norm instead of merely responsible behaviour, suggested Asst Prof Kim, who has done research on information-seeking amid the pandemic.
Seniors should also be encouraged to consult healthcare providers, for instance at vaccination centres, rather than be left to judge their own eligibility, she added.
Ultimately, Singapore’s seniors are a heterogenous group, said Dr Ng. They range from those who are connected, motivated and empowered to those who are isolated, demoralised and disabled.
“Beyond public education and awareness, it’s important to identify and engage those who are vulnerable, as well as their caregivers who could also be equally disconnected and vulnerable,” he said.