The World Health Organisation (WHO) defines health literacy as “the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health”1. This definition includes two crucial elements that are integral to effective medical education and health communication campaigns, the access to and understanding of health information, and its impact on individual health-related decision making.
The health literacy of adults in the UK varies drastically and depends on several factors. A recent observational study suggested that 61% of adults struggled to understand health information that includes both text and numbers2. This deficit in understanding is estimated to cost between 3-5% of the annual UK health budget1.
The barriers to engagement are complicated and encompass a variety of linguistic, cultural, socio-economic, age and disability-related factors3. There is clear evidence to suggest that those with lower health literacy are statistically more likely to experience social deprivation, have a debilitating health condition or disability and have little to no educational qualifications3.
Public understanding of health information and the ability to make informed, rational decisions about one’s health is a vital component of the effective operation of the public sphere in a democracy. While this is always important, has been quite literally a matter of life and death during a pandemic. During the COVID-19 crisis the ability to assess complex health information has had personal and wide-reaching impacts, and the landscape has been increasingly polarised.
When the COVID-19 crisis first struck, social media was awash with conspiracy theories, from 5G to Bill Gates and Chinese lab leaks in Wuhan, misinformation was spreading like wildfire online. This created a powerful sense in some people’s minds that the virus was a myth and that an elaborate hoax was duping the public. While such outlandish theories are corrosive to the public discourse, the social distancing restrictions introduced by the Government partly mitigated their effects.
The repeated cycle of lockdowns, social distancing requirements and working from home rules restricted individual choice for the greater public good. While these were designed to reduce the spread of the virus and the subsequent proliferation of hospitalisations and deaths, they also imposed practical limits on the behavioural impact of the conspiracy theories.
It should not be concluded that conspiracy theories are harmless, as they may well impact public confidence in restriction measures and subsequent adherence. Polling figures from October 2020 at the height of the crisis show that 73% said they were following the rules completely – or nearly all of the time and 22% said they were following the rules most of the time – or about half the time4. It is unknown to what extent this resistance was driven by libertarian resistance to state interference, anti-COVID-19 conspiracy theories or a more general sense of fatigue and disillusionment with the situation. The next stage of the pandemic saw the emergence of the vaccine rollout, which changed the dynamic between health literacy, misinformation and behaviour change.
The vaccine rollout has been a gamechanger for tackling the COVID-19 pandemic; reducing the number of deaths, hospitalisations and removing the previous mandatory restrictions. However, the vaccine programme also changed the relationship between public health and individual choice. The COVID-19 vaccine is not a state-mandated activity at the time of writing. While it has been incentivised via some limited vaccine passport requirements for international travel and some public events and venues, it is not compulsory.
One of the key public health challenges to the vaccine rollout is the rise of the anti-vax movement. It is estimated that the biggest English-language anti-vaxxer social media accounts have a global following of 59.2 million people5. The Centre for Countering Digital Hate research suggests that annual revenues from the ‘anti-vax industry’, largely linked to advertising, are an estimated £750m6.
Opinion polling in the UK shows that most of the public (71.3%) are fully vaccinated7, but this still leaves a significant minority who haven’t and don’t intend to get vaccinated despite a year of public health campaigns from the Government.
With viral memes on social media protest marches, school gate pickets and fake news placards cluttering TV screens over the past year, the anti-vax movement has garnered a significant on and offline presence. We have already seen the international media storm surrounding Novak Djokovic’s controversial deportation from Australia over his failure to meet their vaccine requirements. Media events like this mean that anti-vaxxer messages reach a mass public audience as never before, with potentially dangerous consequences.
The statistics starkly illustrate the real-world health consequences of not having a vaccine. It is estimated that 61% of patients admitted to critical care in the UK were unvaccinated8. 74% of people admitted to hospital in the week of December 29th 2021, had not had three doses of vaccine—including 25% unvaccinated, 6% who had received one dose, and 43% who had received two doses8. The public health consequences of not being fully vaccinated are therefore clear.
Beating the coronavirus crisis requires a collective national effort, where we all do our bit to reduce the spread of the virus and protect the NHS. Viral misinformation and fake news about COVID-19 has serious public health risks. It undermines people’s confidence in the official Government guidance, with fatal consequences in some cases. We must also remember that the impact of poor health literacy and the pandemic isn’t limited to COVID-19.
Health officials at the UK Health Security Agency and the NHS have publicly called for an increased uptake of the measles, mumps and rubella (MMR) vaccine following a dramatic drop during the pandemic. It is unclear whether the reduction is due to practical restrictions during the pandemic and the tendency to stay away from clinical settings or the more pernicious influence of the anti-vax movement.
Whatever the cause, more than one in ten school entry-age children in England are at risk of measles due to not having their jabs9. The MMR vaccine is no stranger to controversy, with media reports erroneously linking the jab to autism in children, a myth that independent studies have subsequently disproved10.
Receiving two doses of the MMR jab is crucial to protecting five-year-olds from contracting measles, mumps and rubella9. These conditions can be fatal and leave children with serious long term health problems such as pneumonia, deafness, visual impairment and meningitis11.
The vaccine coverage for children in this age category is 85.5%, significantly below the recommended target of 95% to stop a resurgence in measles9. Measles is a highly contagious illness, and it is estimated that nine in ten people can catch it if they leave themselves exposed by being un-jabbed9.
We all know that having high vaccination levels in the population makes it harder for disease to spread between different people. It is also clear that vaccines radically reduce the risk. Two doses of the MMR vaccine give 99% protection against measles and rubella and about 88% protection against mumps9. Officials at the UK Health Security Agency fear that measles could make a major comeback now that the official COVID-19 restrictions are largely lifted.
Our national vaccine drive shouldn’t be limited to COVID-19 and include a national public health campaign to increase the uptake of all vital health jabs like the MMR vaccine. Increasing public understanding of measles, mumps, and rubella is crucial to prevent a future health crisis in this area. It’s time we all got more health literate as a nation; the future of our public health depends on it.
As healthcare communicators, it is our job to ensure that accurate information is easy to understand, trustworthy and engaging. Vaccines currently dominate the conversation regarding health literacy. However, the ability to correctly discern reliable sources of health information has consequences across diagnostic, preventative and therapeutic healthcare decision making, and the long-term health of the population.