Vaccine Hesitancy: Understanding the Power of "No"

This article was written by Patricia A. O’Gorman, Ph.D., co-chair of the Medical and Addictions working group of the COVID-19 Psychology Task Force (est. by 14 divisions of the American Psychological Association), which sponsors this blog.

The subject of vaccine hesitancy is personal for me. I currently live in a rural section of New York state that has the highest positive rate for COVID-19 in the state. I, like many of you, am concerned. But there are many reasons why certain individuals are not getting vaccinated. Here, we will explore some of the underlying psychological reasons that explain why so many appear to actively refuse to be vaccinated and risk becoming ill and dying of COVID-19.

Source: Ryanniel Masucol/Pexels

In the media, discussions of vaccine hesitancy are usually couched in political terms: liberal vs. conservative, Democrat vs. Republican, vaxxers vs. anti-vaxxers, and so on. But we face a danger when we try to collapse all of these reasons into neat explanations, and this is how we miss ways we can motivate behavioral change.

We should consider, instead, the more subtle possible drivers of this seemingly self-defeating behavior, what may be meant by saying "no" during a pandemic, and why so many are asserting their power in this way.

For some, vaccine hesitancy is likely a result of their deciding not to use their emotional energy to worry about a more distant risk. Some unvaccinated people feel empowered because they haven’t become ill yet—or if they have, they didn’t die from their COVID-19 exposure, despite doing things that are supposed to be dangerous. With their families and friends, they may eat in restaurants, not wear masks, not socially distance, and attend large events. They’re OK, and very importantly, they’re living their lives as they want to. They may feel a sense of freedom despite the barrage of daily dystopian (as they see them) messages they receive.

"No" Is a Complete Sentence

Another key psychological motivation, however, may just be that vaccine resisters are feeling pushed by life and are pushing back—hard—despite the evident consequences. They are not as much resisting the vaccine as they are taking a stand on one of the few issues they feel they have control over: deciding not to be vaccinated.

It's often said that saying "no" is a complete statement—and a strong one at that. It does not leave room for a discussion. Just watch a two-year-old proclaiming "no" in the supermarket or a teenager acting out with a loud "no" as they are told the latest school directive. We all need to understand why so many are taking this extraordinary stance.

6 Reasons People May Say "No" to the COVID Vaccine

• Need to resist all the changes in their lives. Living through a pandemic is terrifying, challenging “life as we know it” for all of us. For many, their work-life has changed, and they may not be leaving their home. How they socialize has changed. Their role as a parent has changed; they may now be their kids' teacher. Their kids going to school has changed; they’re also now home all day. How they celebrate holidays has changed: they don’t, or at least not in a way that has the same meaning for them.
• Conflicting messages create anxiety. With our 24/7 news cycle, information is pushed through everyone’s waking hours, and for some who have the TV on during sleep, they’re hearing messages here as well. To keep news interesting and to have devoted fans, news outlets tweak their coverage to engage their base. This results in messaging shifts, however slight, and is confusing. Since the issue we are all confronting is a matter of life and death, the anxiety around shifting messages is very high.
• Individuals are forced to rely more on themselves. Trying to determine how to save your life and the lives of your loved ones is overwhelming. Feeling the need to sift through different messages from different sources, each with a different point of view, is high stakes. Our country has become more secular, but many individuals still look for spiritual guidance. In this search, they may have latched onto spiritual “exemptions” that offer them some cover or protection from taking a stance of their own.
• Fear of making the wrong choice, resulting in no choice. Many are frozen. They are afraid to make the wrong choice, so they make no choice. They’re afraid of side effects. This is what "no" means for them. They may be trying to wait out this decision until the decision to vaccinate or not vaccinate is no longer necessary—that the pandemic is over. Essentially, they’re pulling their blankets over their heads and checking out of the conversation.
• Feeling powerless. Many individuals around the world feel that directives designed to save their lives are taking away their power. They are frightened of losing what little power they have left, or they feel defeated and powerless. Thus, they fight back by saying "no," trying to regain some efficacy in their lives.
• Feeling isolated and confused about access. At least 10 percent of those unvaccinated are not sure how to navigate getting vaccinated. They may have no insurance and be unaware that the vaccine is free. Or they may have no consistent health care provider, or be an immigrant, or not have transportation. But they are willing.

They may be asserting their power through the one action that is open to them—saying "no!" In this age of terror, having some power—even if it is negative power—feels good.

Where We Go From Here

We need to tailor our messaging to specific parts of our population, encouraging the development of communications that empower, not frighten, discrete portions of our population to act in their own self-interest.

Yes, this is a tall order. But if we want to convince vaccine resisters to make the changes we need to return to "normal," we need to change the way we approach health messaging.