What Makes People Vaccine-Hesitant?

The politization of the COVID-19 vaccine has made many of people resistant to getting it.

Source: HakanGERMAN/Pixabay

COVID-19 vaccination has become a political land mine. We’re so polarized about a basic public-health initiative that we may have perpetuated the COVID-19 pandemic well beyond a reasonable endpoint.

The debate around COVID-19 sparked a multinational effort of scientists to look into what makes us vaccine-hesitant. Health and social science researchers on the study team were from countries including the United States, Brazil, South Africa, Germany, and South Korea, among many others. In total, the team surveyed nearly 7,000 participants across 20 countries.

The resulting article, Intentions to be Vaccinated Against COVID-19: The Role of Prosociality and Conspiracy Beliefs across 20 Countries, was recently published in the journal Health Communication. The title highlights only two of the key factors researchers identified as being related to vaccine intentions; religiosity, gender, and one’s belief about the risk of getting COVID-19 were also important. For instance, indicating that one is religious was connected with lower intention to get a COVID-19 vaccine.

A few things are important to note about this study to properly make sense of its findings. First, it took place during the early phase of the pandemic—prior to the vaccines actually being available. Second, the study design is cross-sectional. In other words, it’s a snapshot in time that prevents the authors from claiming causal relationships.

With these caveats acknowledged, the insight generated from this 20-nation collaborative work is valuable. Here are three important takeaways:

1. We cannot underestimate the significance of conspiracy theories.

The science is fairly clear on a number of factors that may make us prone to love or believe conspiracy theories. These include personal qualities and experiences such as low trust in government agencies, prejudiced beliefs about minoritized groups, lower self-esteem, and perceptions of existential threat.

The authors of the Health Communications article took conspiracy theory science a step further. They used a validated general measure of someone’s willingness to believe big-picture conspiracies. Their results showed that a tendency to endorse conspiracy-style thinking was associated with greater vaccine hesitancy.

The study’s authors argued that a pathway to increasing vaccination is to address conspiracy theories at their roots. Rather than trying to correct misinformation, the authors promote the goal of social media efforts to cease conspiracy theory content before it spreads.

2. Our sense of risk matters.

As a colleague often reminds me, everyone has a differing risk tolerance. The study’s authors factored that into the survey by asking how susceptible a person believed they were to contracting COVID-19. Unsurprisingly, the greater the perceived personal risk, the more willing a person reported being to get a vaccine. I say this is an expected observation because prior health behavior research supports the idea that depending on the degree to which we judge our own risk for something, the more or less likely we are to take precautionary actions.

Although this finding seems intuitive, it’s quite important. The role of perceived risks speaks to the importance of engaging anyone who is vaccine-hesitant in a conversation to fully understand the reasoning underlying their perceived risk. Health care providers, community leaders, trusted friends, and mentors can all play an important role in engaging vaccine-hesitant persons. Health care researchers have argued that teaching important messengers motivational interviewing skills can be a particularly useful tool when engaging someone about their perceived risk.

The study’s authors also highlight the role of engaging key community settings and leaders based on findings concerning religiosity. Religiosity may play a role in perceived risk or vaccine intention. Therefore, the authors suggest there is an opportunity for health care providers to partner with religious community leaders who are seen as “trusted messengers.”

Prosocial intent, or willingness to help and sacrifice for others, may be important for how we tackle vaccine hesitancy.

Source: Sasint/Pixabay

3. We need to understand and capitalize on prosocial beliefs and acts

Prosocial behavior is far more than just helping others. The authors captured several pieces of prosocial behavior by asking survey respondents several queries relating to their willingness to help or make sacrifices for others. These questions were framed specifically in the context of the pandemic. The researchers also assessed whether a respondent was willing to support major initiatives like mandatory vaccination for the collective good.

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A general pattern was clear: More prosocial intentions and beliefs equated to greater intention to get the vaccine. This trend suggests that public health messaging and other strategies promoting vaccination may use prosocial messaging and reasoning on an international scale. Other social media research supports the idea that prosocial messaging about close loved ones (“protect your loved ones”) is effective in promoting COVID-19 preventive behaviors.

In all, this 20-country collaborative identified a number of important characteristics linked to vaccine intentions. Researchers and health care practitioners alike can continue such vital science in order to maximize the impact to increase prevention through vaccination.