By: Julio Emilio Marco-Franco, Pedro Pita-Barros, David Vivas-Orts, Silvia González-de-Julián, and David Vivas-Consuelo
January 18, 2021
International Journal of Environmental Research and Public Health
We analysed issues concerning the establishment of compulsory vaccination against COVID-19, as well as the role of misinformation as a disincentive—especially when published by health professionals—and citizen acceptance of measures in this regard. Data from different surveys revealed a high degree of hesitation rather than outright opposition to vaccines.
The most frequent complaint related to the COVID-19 vaccination was the fear of side effects. Within the Spanish and European legislative framework, both compulsory vaccination and government regulation of FN (Fake News) appear to be feasible options, counting on sufficient legal support, which could be reinforced by additional amendment. However, following current trends of good governance, policymakers must have public legitimation. Rather than compulsory COVID-19 vaccination, an approach based on education and truthful information, persuading the population of the benefits of a vaccine on a voluntary basis, is recommended. Disagreements between health professionals are positive, but they should be resolved following good practice and the procedures of the code of ethics. Furthermore, citizens do not support the involvement of government authorities in the direct control of news. Collaboration with the media and other organizations should be used instead.
With the appearance of vaccines against COVID-19, it is worth asking whether their administration should be maintained as voluntary, which in turn raises the question of to what extent individual freedom can and should prevail over the common social good. On the one hand, this is a question that is rooted in community values (for example, in the USA, the value of the sovereignty and total autonomy of the individual is strongly rooted) and on the other, the concept of public health and the measures and institutions that are needed to take care of it, necessitating an analysis of how to make the corresponding regulations compatible with the individual values described.
The situation that arose after the outbreak of COVID-19, with lockdown measures and extra time for the generation, circulation, and reading of all kind of news, has been the perfect breeding ground for the development of denialist positions, conspiracy theories, and fake news (FN), which have sown turmoil in a part of the population that is facing a change of the social paradigm set after the Second World War and that seemed immutable.
The issue is particularly critical when misinformation or opinions that go against the flow of evidence-based information are publicized by expert professionals, as opinions of scientists, doctors, other health experts are generally considered very trustworthy.
However, political action must be based on good global governance, and good governance requires public legitimacy, something that is complicated when negative attitudes without a scientific basis become widespread and are even promoted by some health professionals.
This paper overviews the issue of compulsory vaccination when faced with misinformation concerning COVID-19, FN, and myths related to vaccination, with particular emphasis on those publicized by healthcare professionals or experts, analysing the legal bases for eventual regulatory control and its acceptance by citizens.
2. Materials and Methods
Following the legal reasoning (comprehensive Juristischen Methodenlehre) we analyse the autonomy of the individual and the freedom of information as essential elements of the freedom of expression, the fundamental, human, and conventional rights versus the compulsory introduction of the COVID-19 vaccine, and the possible regulation of published news. Public opinion input, as promoted by the Organisation for Economic Co-operation and Development (OECD/OCDE) and the EU, has been obtained as part of the current request for evidence in the good governance approach for policymakers.
Citizens’ opinions, from different surveys and countries related to FN in general and to COVID-19 in particular, have been obtained and processed (grouping and proportional computing, after being collected through Statista® (Statista GmbH, Hamburg, Germany). Specific information for the EU, including the Flash Eurobarometer 464, has also been used to gather information. Earlier references include the report for the European Commission (State of vaccine confidence in the EU) and the IPSOS survey for the World Economic Forum on vaccination to prevent COVID-19. The latest data on voluntary vaccination intentions in Spain come from the Centre for Sociological Research of Spain (CIS), and from the Invymark Institute, as presented in the two newscasts on the television channel La Sexta on 28 November 2020.
Recent documents and regulations from the EU and Spain have also been analysed, including information provided at the webinar (University of Salamanca, 26 November 2020) El Procedimiento de actuación contra la desinformación en la defensa del Estado de Derecho (Procedure for action against disinformation in defence of the rule of law) by the Director of the Department of National Security of the Presidency of the Government.
The legal analysis will be commented on in the discussion section. Public opinions related to FN are summarized in Figure 1. Surveys suggest that citizens do not much trust in information from the media but feel reasonably confident in their capacity to distinguish fake news from real.
The most frequent complaint, related to vaccination against COVID-19, is fear of side effects, which raises the question of how safe and effective the vaccine should be, and the procedures to counteract this fear, mostly developed after the confusion of ideas resulting from the constant circulation of FN.
FN is considered a major problem in 68% (65 or older) to 80% (18 to 29 years old) of USA citizens, and somewhat of a threat or a serious threat to democracy in 88% (Knight Foundation Gallup). The perceived level of FN on social media in the USA, as of May 2018, is quite consistent over all age groups (about 63%). Social media sites are considered partly or mostly responsible for the spread of FN in 89% of the cases, with 69% considering that these social media sites are not doing enough to stop the spread of FN on their sites (Monmouth University).
As for Europe and according to data from the Flash Eurobarometer as of February 2018 (n = 26,576), about 80% of the respondents encountered FN several times a month or more, with 37% of responses in the everyday/almost everyday group.
About 81% of Spaniards (2019) perceived FN “often” or “several times”, with only 7% indicating almost never, meaning the great majority of the population is perceiving a significant amount of FN.
In Italy, the share of online FN related to coronavirus between January and May 2020 was about 5% per week, with Facebook recognized by almost 80% of those surveyed, regardless of age, as the primary social media in this regard.
In the UK (September 2020), 20–30% of respondents had encountered information/news about coronavirus that they thought was false or misleading in the previous week, with a similar number saying they did not know, leaving less than 50% declaring they were unaware of false information. The pattern is consistent when analysed by age groups; 81% declared that received FN a few times a week or more, with 7% of them reporting ten or more times a day.
The issue of misinformation has become so critical that the World Health Organization (WHO) has dedicated a site specifically to reporting misinformation online. The European Commission also recommends following the advice of public health authorities, and websites of relevant organizations. The European Centre for Disease Prevention and Control (ECDC) and the WHO work in close cooperation with online platforms. There are also several funded projects for fighting against disinformation and a permanent analysis by the Social Observatory for Disinformation and Social Media Analysis (SOMA).
A 2018 EU survey on FN and disinformation online —where up to three answers could be chosen from seven possible options—requested the opinion of respondents on who should act to stop the spread of FN. After mathematical processing of the resulting 224 points as relative percentages, they were included in four main groups: (1) mass media professionals plus administrators or media organizations, (2) governmental authorities either at a national or EU level, (3) citizens, and (4) non-governmental organizations + other, with the predominant option to stop FN being for the professionals to act themselves (Figure 2).
In a 2018 a survey about vaccines with 28,782 respondents across the 28 EU member states, the perception towards vaccines was positive, with agreement (strongly or tend to agree) at 90%, safety at 82.8%, effectiveness at 87.8%, and compatible with religious beliefs at 78.5%. The importance of vaccination was found to be related to the disease.
According to the IPSOS survey for the World Economic Forum (24 July to 7 August 2020), 74% of respondents agree (37%) or somewhat agree (37%) on the question as to whether they will get the vaccine when available. Forty percent thought they would not have the ability to get the vaccine by the end of 2020. Among the reasons for not getting vaccinated, 56% were worried about side effects, 29% think that it will not be effective, 19% that they are not enough at risk from COVID-19, and 17% are against vaccines in general.
The perceptions and intentions of the Spanish population regarding the COVID-19 vaccine have been analysed by the Centre of Sociological Investigation of Spain (CIS) on a regular basis. The number of respondents willing to be vaccinated fell from 44.4% in September to 32.5% in November, when 55.2% of overall respondents chose the option of waiting to see the side effects, but among those within the 18–24 age range, 72.3% of the cases preferred to wait. Another survey from the Invymark Institute, during the week of 23 November, was broadcast by the television channel La Sexta (28 November 2020). Up to 61.6% among the groups surveyed do not believe that there will be effective vaccines in the coming months. Almost half of the respondents are not willing to be vaccinated when the vaccine is available (a similar percentage as in the CIS survey), with the reasons being, firstly, that they prefer to wait a while (50.1%), secondly, concern about side effects (44.4%), and, thirdly, that they do not believe vaccines are efficient (4.6%). Although there are some variations of the percentages in relation to the IPSOS survey data related to Spain, a substantial amount of the respondents expressed a high degree of hesitance rather than outright opposition to vaccines.
The lack of confidence in prevention is also evident in the response to the question (Invymark Institute) on when the respondent believes that a certain normality will return. The majority response (48.6%) is two or more years, for 42.0% in one year, and 8.8% believe that normality will not return for many years.