Surprising as it may seem, there are some key lessons for the infrastructure sector arising from public attitudes to vaccinations in a pandemic, say Martin McCrink and Bruce Hugman.

Vaccination may seem distant from infrastructure, but both face common issues and challenges. Hostility to vaccination has parallels with opposition to infrastructure projects. The complex underlying causes of such hostility have many similar elements - risk management and damage limitation require much the same insight and skills in both fields.

Like infrastructure development, immunising a population takes time; the benefits and impacts are debated over long periods, even generations. To suppress or eradicate an infectious disease, a majority of the population must be vaccinated – anything up to 95%. In getting to this figure, the reputation of a vaccine and those responsible for deployment become the subjects of public debate creating an opportunity for damaging myths, fake news and hostile campaigns to take hold. 

Both vaccines and infrastructure aim for improved societal outcomes. Notably, the government’s ‘green book’ has now been updated to include social policy objectives to guide government when making investment decisions; social outcomes are now a determining factor.

The common challenge: nimble campaigns

• Risk: Campaigners and project promoters are often at odds because they assess benefits, risks and losses differently; public responses may be based on emotional or political positions, not data or technicalities.
• Beliefs: There is a small, but vocal group of anti-vaccination campaigners globally, promoting   a variety of strong beliefs and convictions.
• Undecided majority: Many people maintain a degree of agnosticism (or ‘vaccine hesitancy’); public health and infrastructure often fail to engage this quiet majority.
• Early capture: Compelling narratives are needed to counter hostile messaging and to reach and persuade undecided populations first.
• Trust: Infrastructure promoters and vaccination programmes need time to build trust by starting long in advance, continuing throughout and after; managing opposition requires our teams to be as active, creative and vivid in communications as opponents are. 

Five points infrastructure can learn from vaccine programmes:

1. Communications before major projects or programmes, and throughout, require sensitive and intense on-the-ground, face-to-face research about the multiple variables of public attitudes, loyalties, values and beliefs (standard consultations and surveys will not suffice to achieve long term change) 
2. Rarely has a single person or department in health or infrastructure the ability both to meet all the technical demands and deliver good communications
3. The profound influence of memory, contemporary culture and social media on public opinion must be recognised and managed, principally by engagement that is timely, empathetic, respectful and finely calibrated
4. Public assessments of benefit, risk and loss must be factored into the arguments for any proposition; they will be widely divergent and will diverge from professional views
5. We must seek to be trusted, through transparency, empathy, consistency, honesty, accuracy, genuineness and speed, even if in the end we are unable to reconcile all parties 

This five point agenda may result in:

1. Reduction of hostility and lessening of obstacles
2. Facilitation of engagement and negotiation
3. Persuasion and conversion of some opponents and alignment of the undecided
4. A reduction in lasting antagonism, bitterness and resentment
5. The enhancement of reputation

Infrastructure project teams and public health programmes set out to improve society. Neither wants to be remembered as heavy-handed, distant, neglectful, arrogant. Such an assessment would deeply damage our future prospects and public health as a whole.

Martin McCrink is managing partner at Copper Consultancy and Bruce Hugman is communications consultant at Uppsala Monitoring Centre, the WHO Collaborating Centre for International Drug Monitoring. 

Martin McCrink will be interviewing Bruce Hugman at a webinar on 9 December 2020 at 12.30pm. Click here to register for the webinar.