Understanding vaccine hesitancy with Dr. Scott Wong

April 28, 2021

Dr. Scott Wong is a man of many titles. From national discus thrower-turned-weightlifter to medical doctor in the front line of the COVID-19 pandemic, and most recently, to medical officer and senior data analyst at the Ministry of Health (MOH) Office for Healthcare Transformation. With so many accolades and experiences under his belt, it can be tough to keep up with Dr. Wong, so we sat down for a chat with him last week to find out more about his time as a doctor in the front lines and what he’s currently working towards.

Right off the bat, Dr. Wong shared that despite his background in medicine, he’s very interested in technological products, and is actually formally trained in bio-design and design thinking. But what are these concepts and how do they apply to Dr. Wong’s career as a medical professional?

According to Interaction Design Foundation, design thinking is a non-linear, iterative process that is best used to tackle problems that are ill-defined or unknown. It involves empathising, defining, ideating, prototyping and testing, and allows individuals to better understand their users or target audience, challenge preconceived assumptions, redefine problems and create innovative solutions to them. In other words, it involves tackling problems from the ground up. Bio-design, on the other hand, adds a clinical twist to this process, which fits in very well with the role that doctors play, be it on the front lines or in everyday medical procedures.

“Deploying [products] to patients is often not as simple as deploying it to a simple consumer because of things like safety. As a doctor, things that we say have to be backed up by evidence,” explains Dr. Wong. This is especially true in uncertain times like these, where there is a lot of stress on doctors and medical staff to provide the most efficient service to patients in relation to COVID-19 and its vaccine.

Speaking about his time as a doctor in the front line in the heat of the COVID-19 pandemic, Dr. Wong recalls how the virus affected the local migrant worker community disproportionately. He saw first-hand how difficult it was for them to communicate effectively with doctors due to the language barriers present, which then inspired him to design the Covid Buddy application mid-last year. His application serves to help foreign workers better understand and communicate their symptoms to doctors through the use of pictures, audio and text in their mother tongues.

Fast forward to today, the problem Dr. Wong is attempting to tackle now is vaccine hesitancy among locals.

A vial of the Moderna COVID-19 vaccine lying atop a checklist of things to note before and after getting vaccinated.
“When you’re on the ground, you’ll find that people are less likely to question the Pfizer and Moderna vaccines, but they are more afraid of the Sinovac one. How do we tackle that?” — Dr. Scott Wong

As its name suggests, vaccine hesitancy is an unwillingness to take a vaccine due to personal reasons like fear or a lack of knowledge about the vaccine. Naturally, everyone would have different opinions and feelings towards any given vaccine, and in order to get a patient to accept said vaccine, we have to tackle very specific fears and reasons that they might have for hesitating.

“On the ground, what I found was that a lot of information (about the COVID-19 vaccine) was given in a shotgun approach,” said Dr. Wong. A shotgun approach is a strategy where breadth and quantity is prioritised over depth and quality. In other words, it’s a blanket strategy used to appeal to a wide audience by being very broad and generic, instead of appealing to a specific audience by being detailed and targeted. “You have these very long articles, often in English or just Mandarin and they would have the top 20 reasons why a person doesn’t want to take the vaccine, or why you should take the vaccine. But maybe the person is really just worried about side effects, or if the vaccine will cause allergies. So we really needed a tool that could accurately tell us maybe for the people above 65…specific myths that they have, or maybe specific beliefs that I can tackle better as a doctor.”

This is why earlier this year, Dr. Wong worked with OPPi to conduct a crowdsourcing campaign among 50 participants to find out what locals of different demographics think about getting the COVID-19 vaccine.

Based on the results of the poll, a greater number of respondents (58%) stated that they would be more willing to get vaccinated if they have friends or family that have taken it with no adverse reactions as opposed to seeing government officials or celebrities do the same (46%). Interestingly, a higher proportion of younger respondents (aged 18–44) feel more confident about getting vaccinated when they see friends and family doing so, while a higher proportion of older respondents (aged 45 and above) feel the same seeing government officials and celebrities getting vaccinated.

In a similar vein, a greater number of respondents (78%) are more willing to trust information about COVID-19 and its vaccine from doctors, scientists and public hospitals than they are about information released by the government (64%). One respondent went on to elaborate that they believe that the government has different but important priorities (e.g. public confidence, security) to take care of, but actively encouraging vaccination without sufficient long-term tests may not appear to be in our best interest.

This lack of long-term testing is another common concern shared by many respondents. Some were worried about the fast rate at which the vaccine was developed, while others were more afraid of the possibility of unknown allergic reactions and long-term side effects of the vaccine arising. In the words of one respondent, “The immediate or short term side effects of the vaccine have already been well documented. However, the question lies in the unknown long term data.”

This might not be something that doctors or scientists would have definitive answers to at the moment, but just as the COVID-19 situation continues to evolve, so do the fears and worries among locals.

“When the OPPi poll was first launched in February, there were many, many concerns that we needed to act fast to address, but by March, a different set of concerns arose, and people were more afraid of allergies. Now, in April, many people are more concerned about their own personal health. It’s like, ‘If I have diabetes, if I have high blood pressure, am I suitable (to get the vaccine)?’,” shares Dr. Wong.

Identifying these concerns is easy enough to do, but actually tackling and addressing them might not be as straightforward. This is where the behavioural change wheel comes in.

A screenshot of the behavioural change wheel, which expands on the three main points of capability, motivation, and opportunity.
The behavioural change wheel as based on the Capability, Opportunity, Motivation, Behaviour (COM-B) Model.

There are three main components to the wheel—capability, motivation and opportunity—and these components are what is believed to be able to change behaviours.

“For example, maybe in some rural areas in Indonesia, people really aren’t able to afford the bus ticket to travel four hours to get the vaccine, so we can classify it as a lack of capability. So maybe we can get a bus to pick them up to allow them to have the physical capabilities to get vaccinated,” explains Dr. Wong. “In the case of motivation, it could be like ‘I’m more motivated if I have a travel bubble and I can only travel if I’m vaccinated’.”

Essentially, this is what a behaviour change wheel is all about—classifying interventions into things that increase capability, opportunity and motivation. Or, in Dr. Wong’s simpler terms, “are you willing, are you able, and got chance or not?” And with OPPi’s flexibility and analytics, Dr. Wong shares that he is able to combine his knowledge in the fields of medicine and technology to tackle vaccine hesitancy.

At the end of the day, vaccine hesitancy is very much a contextual problem that is evolving day by day, and there can never be a blanket or shotgun solution to something as complex as this. Perhaps the most effective way to tackle this problem is for doctors like Dr. Wong to continue to listen to people on the ground and understand their worries and concerns in order to be able to change behaviours for the better and provide the best medical care.

“That’s kind of my philosophy in approaching medicine and technology,” says Dr. Wong. “Really understanding the true use of these digital means and methods and having the medical insight to be able to use them to help people and improve people’s health.”

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