Society-Oriented Immunity of the Vaccines: Perception, Hesitancy, and (Non) Acceptance

Jakkrit Sangkhamanee and Abhirat Supthanasup

Read this article in Thai

The phenomenon pertaining to the coronavirus pandemic and the efforts to curb its spread entails several social dimensions. The outbreak of the virus is fundamentally linked to the biological dimension of the virus, its environment, and the health of living organisms such as human beings. However, besides the biological dimension, the outbreak concerns the physical dimension related to close relationships, spatial relations, and physical contacts. It also involves technical elements, particularly the development, storage, and distribution of the vaccine as well as the evaluation of humans’ bodily reactions to the virus and the vaccines. Most importantly, it has social and political implications as the spread of the virus and the efforts to curtail it are strongly entwined with the credibility of the production of the vaccines, the transparency of the information on the vaccines, the fair procurement and distribution of the vaccines, and the public attitudes towards the management of the outbreak in society.


Therefore, to understand the pandemic and the efforts to contain the spread of the coronavirus, we need to consider the ecology or the multi-layered and inextricable relationship of the vaccines’ biological, physical, technical, social, and political perimeters.  

Therefore, to understand the pandemic and the efforts to contain the spread of the coronavirus, we need to consider the ecology or the multi-layered and inextricable relationship of the vaccines’ biological, physical, technical, social, and political perimeters.  

The vaccines’ mechanism, successes, and limitations in providing immunity to society is, hence, not only about their effectiveness in providing virulence-oriented immunity for humans but more so about whether they have society-oriented immunity when being developed, acknowledged, accepted, and endowed to be expansively accessible in society.


In this paper, we are citing Australia’s and Thailand’s management of the pandemic as a case study to demonstrate, on one hand, the ecology and the manufacturing process, the procurement, the provision of information and the campaigns, and the distribution of the vaccines to the population, and on the other hand, people’s perception, attitudes, and concerns, which eventually lead to accepting or rejecting vaccination. We propose that different types of vaccines exist in, are accepted by, and have become a part of society to varying degrees. The difference in how each vaccine has been widely accepted and functioned in society stems not only from vaccines' different potential efficacy, but also from vaccines' different "society-oriented immunity."

The Ecology of the Vaccines

Vaccination has been a vital mechanism to prevent and curtail the spread of a disease. It is a safe and cost-effective public health intervention that can efficiently reach out to the world population with its diversity in races, faiths, age ranges, sexuality, financial status, and political systems.[1] Vaccines have been employed to manage different diseases in both humans and other living beings. The success of vaccination has made smallpox become relegated to history and will soon eradicate framboesia, poliomyelitis, and malaria.  


In this regard, vaccination has provided immunity to protect health and save lives and is an essential tool for the survival of humanity.


Vaccines, despite being technical products of biological and medical sciences, have never existed independently of social and political valuations. The technical process in laboratories is a key factor in acquiring an efficacious, safe, and transportable vaccine; nonetheless, it is only part of a success in providing immunity to eradicate and prevent the disease. In actuality, another element of success in disease prevention is an appropriate administration of the vaccines as well as the fact that said vaccines have public trust and the use of vaccination has to be widespread.[2]

Even though vaccines are technical products of biological and medical sciences, they have never existed in independence of social and political valuations.  

During the coronavirus pandemic, basic measures in social distancing, mask wearing, hand washing, quarantine regulations, and contact tracing have been widely and universally employed. These measures are nothing novel as they were used to contain quite effectively the spread of previous viruses such as SARS and MERS. However, said measures are not sufficient in containing this outbreak since the coronavirus can be transmissible during the asymptomatic phase. Swift and all-inclusive vaccination is, thus, believed to be a long-term solution in dealing with this disease.  


A vaccine development process comprises several stages and usually starts in a laboratory somewhere in the world. Sinovac (or CoronaVac) was jointly developed by Sinovac Biotech and Wuhan Institute of Biological Products, AstraZeneca by a team of Oxford University researchers, and Pfizer by the U.S. pharmaceutical company Pfizer Inc. in collaboration with the German BioNTech. These scientific institutions and pharmaceutical industry research organisations have played a crucial role in laying foundations for the paths and frameworks of different vaccines’ mechanisms, offering more options to the public. Still, it should be noted that the development of a vaccine starts with collecting specimens of the virus that has been spreading in society to study its genetics, biophysical characteristics, survival mechanisms, and transmissibility in the real world. Also, the development of a vaccine stems from social concerns as the disease is destroying human lives and economic and political stability, and it is being implemented while the whole hopeful world is watching.

The development of a vaccine starts with collecting specimens of the virus that has been spreading in society.

The specimens collected from the environment are then tested and developed in a laboratory. Despite being conducted in closed space, this process is usually closely monitored by the public. The public scrutinises and critiques all procedures: development paths for inactivated vaccine, recombinant protein vaccine and mRNA vaccine; in vitro phases; in vivo phases; progress and efficacy presentations; and recognition from national public health institutes as well as international organisations such as World Health Organization. [3]


Amid the pandemic, more widespread are human curiosity, debates, and valuation of different vaccines in different corners of the world.


Vaccines always arise from the midst of the social dynamics and hope.

Vaccines’ Perception and Reality

On “Good Vaccines” and “Better Vaccines”

In Australia, the Australian Technical Advisory Group on Immunisation (ATAGI) plays a crucial role in advising the Minister of Health on the medical administration of vaccines as well as advising research organisations and others.[4] In response to AstraZeneca safety concerns, ATAGI issued a statement on 8 April 2021 recommending Pfizer as the preferred vaccine for those under 50 years. This recommendation was based on a potentially increased risk of thrombosis with thrombocytopenia syndrome (TTS) following AstraZeneca vaccine in those under 50 years.[5] On 17 June 2021, ATAGI issued a statement recommending Pfizer as the preferred vaccine for those aged 16 to under 60 years. The recommendation was revised because of a higher risk of TTS related to the use of AstraZeneca observed in Australia in people aged between 50-59 years.


From early April to 16 June 2021, 60 confirmed or probable TTS cases were reported in Australia. This included an additional seven cases reported in the previous week in people between 50-59 years, increasing the rate in this age group from 1.9 to 2.7 per 100,000 AstraZeneca vaccine doses. TTS was a serious condition with the overall case fatality rate in Australia at 3% (2 deaths among 60 cases).[6] AstraZeneca had been selected as the main injection vaccinating the country; however, ATAGI’s recommendation affected public confidence in the vaccine, which in turn impacted the country’s vaccine rollout plan since Australia had secured 53.8 million doses of AstraZeneca vaccine with 50 million doses manufactured in Australia, while only a limited number of Pfizer vaccine doses were procured.[7] 


ATAGI’s recommendation caused a problem; there was a public perception that there were two vaccines: the “good” one and the “less good” one. So, people were asking, “Why can't I have the good one?”[8] The risk of getting AstraZeneca was compared to other risks, such as the chance of dying from a lightning strike or in a car crash, but people still compared the AstraZeneca risk to that of Pfizer. This fear resulted in cancellations of AstraZeneca bookings and concerns about receiving the second dose of AstraZeneca.

ATAGI’s recommendation caused a problem; there was a public perception that there were two vaccines: the “good” one and the less “good” one. So, people were asking, “Why can't I have the good one?”   

The Household Impacts of COVID-19 Survey conducted by the Australian Bureau of Statistics in June 2021 showed that 15% of all unvaccinated Australians said they had not received it because they wanted a different vaccine to what was available to them.[9] The number of unvaccinated people waiting for a different vaccine rose to 35% among those aged 50-69.[10]  52% of those who did not want the vaccine raised side effects as an issue, while 15% were concerned about the vaccine’s efficacy.  


Contradictory information confounded the public. The National Cabinet Statement 2021, issued on 28 June 2021, noted that general practitioners could continue administering AstraZeneca to Australians under 60 years of age.[11] Prime Minister Scott Morrison also urged any adult regardless of their age, including those under the age of 40, who wanted the vaccine to get it after consulting a general practitioner [12] despite the fact that ATAGI had revised the age recommendation for AstraZeneca from over 50 years of age to over 60 after it was found that those aged in their 50s had a potential risk of TTS. The prime minister’s statement caused confusion among the public as well as concerns among general practitioners who continued to endorse ATAGI’s advice that Pfizer was the preferred vaccine for under-60s.[13]


Even though Pfizer was regarded as a better vaccine than AstraZeneca, online misinformation instilled concerns in some communities about the new mRNA technology used to produce Pfizer. For example, posts on Chinese social media platform WeChat were spreading the false claim that mRNA vaccines could affect a person's DNA and gene expression. It was reported that said misinformation was shared in at least five active WeChat groups, where over 2,000 Chinese Australians discussed and shared this information. Such misinformation caused misunderstandings to people who had no medical background.[14] False claims as well as misinformation were shared on social media by those who did not speak English as their first language. Conflicts over COVID-19 and the safety of vaccines arose in families where members did not speak English and received information from international sources.[15]


On “Best Vaccine”: mRNA Better Than Viral Vector Better Than Inactivated Vaccine

In Thailand, there were disputes about the efficacy of each type of the three vaccines, namely mRNA vaccines (Pfizer and Moderna), viral vector vaccines (AstraZeneca), and inactivated vaccines (Sinovac and Sinopharm). Most people did not accept Sinovac for its inefficacy against the Delta variant, as indicated in the Ministry of Public Health’s study on Sinovac’s efficacy in Thailand. The study showed that Sinovac was 90% effective against the Alpha variant and 75% effective against the Delta. This reported result triggered many online discussions and criticisms over the credibility of said study.[16] Concerns over Sinovac’s efficacy drove people’s demands for mRNA, as seen in a great number of advance Moderna vaccination bookings.  On 5 July 2021, Ramathibodi Hospital’s website crashed due to the high traffic for Moderna bookings.[17] The websites of all private hospitals in Nakhon Ratchasima Province also crashed when the locals tried to make bookings for the second batch of Moderna.[18]

Most people did not accept Sinovac for its inefficacy against the Delta variant.

Apart from their concerns about different types of vaccines, people also felt apprehensive about the mix-and-match approach. On 12 July 2021, Thailand’s National Communicable Disease Committee approved the administration of mix-and-match vaccines. The Committee noted that those who got Sinovac for their first shot could have AstraZeneca for their second dose with a 3-4 week waiting period to increase the vaccine’s efficacy against the mutated Delta coronavirus. This recommendation caused trepidations among the public since the World Health Organization had issued a warning against the mix-and-match approach, citing that only a few studies supported the practice. People got confused, worried, uncertain, and unhappy that they would become guinea pigs while Prof. Dr. Yong Poovorawan affirmed that he had studied and evaluated the efficacy and side effects of the mix-and-match formula.[19]


The concerns over the efficacy and side effects of the vaccines as well as lack of public trust in the recommendations from the government and the experts representing the government resulted in a delay in the rollout of Sinovac, the primary vaccine for Thailand at that time. Also, people had to carry the financial and time burden of booking alternative vaccines with private hospitals. Due to the resulting distrust and discontent, the Public Health Minister’s and experts’ slogan “The best vaccine is the one you can get the soonest” became a joke in Thai society and got ridiculed widely on social media platforms.

The concerns over the efficacy and safety of the vaccines as well as lack of public trust in the recommendations from the government and the experts representing the government resulted in a delay in the rollout of Sinovac.

Weak Vaccines

Weak vaccines, aside from their efficacy, are those that are not trusted by society, as they are not accepted due to unclear information, lack of transparency in procurement, and untrustworthy campaigns. Prospective vaccine recipients’ worries reduce a vaccine’s social-oriented immunity. Amid the perception, hesitancy and (non) acceptance of a vaccine, what could be effective immunisation for a vaccine when it is to be administered in a community is to mitigate the public’s anxiety as well as ensuring legitimacy and acceptance of the vaccine.[20]  


In the next paper, we will discuss another important procedure to give the vaccine society-oriented immunity, namely relevant agencies’ campaigns for societal acceptance of the vaccine. 


This article is part of the Comparative Assessment of the Pandemic Responses in Australia and Thailand, supported by the Australia-ASEAN Council under Australia-ASEAN Council COVID-19 Special Grants Round, the Australian Department of Foreign Affairs and Trade.


[1] Casiday, Rachel E. 2005. “Risk and trust in vaccine decision making” Durham Anthropology Journal., 13 (1).

[2] Fuentes, Agustín. 2020. A (Bio)anthropological View of the COVID-19 Era Midstream: Beyond the Infection, Anthropology Now, 12:1, 24-32,

[3] Terence S. Dermody, Daniel DiMaio, Lynn W. Enquist. 2021. “Vaccine Safety, Efficacy, and Trust Take Time” Annual Review of Virology 8:1, iii-iv.

[4] Australian Technical Advisory Group on Immunisation (ATAGI). Australian Government; Department of Health.

[5] Australian Technical Advisory Group on Immunisation. ATAGI statement on AstraZeneca vaccine in response to new vaccine safety concerns. Canberra: Australian Government, Department of Health; 2021.

[6] Australian Technical Advisory Group on Immunization. ATAGI statement on revised recommendations on the use of COVID-19 Vaccine AstraZeneca, 17 June 2021. Canberra: Australian Government, Department of Health; 2021.

[7] Australia’s vaccine agreements. Australian Government, Department of Health; 2021.

[8] Frances Mao. Covid vaccine: Why are Australians cancelling AstraZeneca jabs?; 22 June 2021.

[9] Australian Bureau of Statistics. Household Impacts of COVID-19 Survey; 14 July 2021.

[10] Christopher Knaus. One in four unvaccinated Australians over 70 waiting for ‘different vaccine’; 14 July 2021.

[11] National Cabinet Statement; 28 June 2021.

[12] Bevan Shields. AstraZeneca creator says Australia’s mixed messages on vaccine may cost lives; 30 July 2021.

[13] Christopher Knaus. Some GPs refuse to give AstraZeneca jab to young Australians eager to get Covid vaccine; 29 June 2021.

[14] Bang Xiao, Tahlea Aualiitia, Natasya Salim and Samuel Yang. Misinformation about COVID vaccines is putting Australia's diverse communities at risk, experts say; 4 Mar 2021.

[15] Erwin Renaldi. Families divided over COVID-19 misinformation from conflicting news sources; 6 Apr 2021.

[16] PPTV Online. ชาวเน็ตถล่มเดือด ผลศึกษา สธ. พบ “ซิโนแวค” ป้องกันโควิดอัลฟา 90% เดลตา 75%. 21 กรกฎาคม 2564.

[17] PPTV Online. ยอดจอง “โมเดอร์นา” เต็มแล้ว ปชช.แห่จองวันแรกจนเว็บรพ.รามาฯล่ม. 5 กรกฎาคม 2564.

[18] Matichon Online. ชาวโคราชแห่จอง ‘โมเดอร์นา’ เอกชนจนเว็บล่ม – รพ.มหาราชจ่อเปิดจอง ‘ซิโนฟาร์ม’ 3 ส.ค. 30 กรกฎาคม 2564.

[19] BBC Thai.  นายกฯ ให้เดินหน้าฉีดวัคซีนโควิดสูตรผสม แต่ รพ. บางแห่งประกาศงดฉีด กันความสับสน. 14 กรกฎาคม 2564.

[20] Larson, Heidi J. 2018. “Politics and public trust shape vaccine risk perceptions” Nature Human Behavior 2:316.