Approximately 10% of UK adults say they will never get vaccinated against COVID-19 or will avoid doing so for as long as possible. Scientists call this group the “vaccine hesitant”, though hesitancy may not seem the right term to describe views often held with clear conviction. People who are vaccine hesitant have often thought long and hard about whether to take a COVID-19 vaccine.
How can such views be shifted? Ideally, one would sit down with people, listen and discuss. In reality, public health campaigners have only mass messaging at their disposal: information disseminated through billboards, TV slots and social media. These are crude tools for tackling sometimes deeply ingrained personal beliefs. What messages delivered through them might really make a difference?
Over the past year, the Oxford Coronavirus Explanations, Attitudes and Narratives Surveys (OCEANS) team has tried to answer this question. We’ve worked to form a psychological explanation for vaccine hesitancy by canvassing the views of people for, against and undecided about vaccines.
We’ve found that hesitancy emerges from a nexus of beliefs, the most important being scepticism about the collective benefits of vaccination. The hesitant don’t accept that taking a vaccine means we’re all better off. They also tend to believe that COVID-19 isn’t a big danger to their health. And they worry that vaccines may be ineffective or downright harmful. The rapid development of COVID-19 vaccines reinforces these concerns.
Behind these specific ideas often lies mistrust. People who are hesitant tend to be suspicious of authority. But while it’s wise to make judgements based on evidence rather than blithely accepting what we’re told, in many cases we’ve found that the vaccine hesitant are susceptible to misinformation.
Fuelling this may be a sense of marginalisation. Vaccine-hesitant people are a little more likely to believe that they’re of lower social status. Feeling that society doesn’t care about them, they are unwilling to trust what they’re told by politicians and scientists.
Equipped with these insights, we decided to see whether we could craft messages that might shift negative attitudes. If people don’t appreciate the collective benefits of vaccination, let’s persuasively set out the case. Let’s explain that vaccines make it less likely we’ll pass on the virus, helping to protect others, particularly those especially vulnerable to the virus. And let’s make it clear that by reducing the risk of getting severely ill, we can help the country bounce back as quickly as possible. That should help shift attitudes, right?
To find out, in early February we surveyed nearly 19,000 UK adults, carefully selected to be representative for age, gender, ethnicity, income and region. Participants were then randomly asked to read one of ten texts about COVID-19 vaccines.
Some texts focused the collective benefits of vaccination, some on the personal benefits, some on safety and some a combination of messages. One text contained only basic information about the vaccine and didn’t provide any detail on benefits, and was used as a control. After reading their allocated text, participants completed a questionnaire on their willingness to be vaccinated for COVID-19.
The results were surprising. Previous surveys had suggested beliefs about the collective benefits of vaccination were pivotal to driving uptake. The extent to which people bought into this narrative seemed to determine their willingness to take a vaccine.
But the text that was most likely to change the minds of the vaccine hesitant (when compared to the control) emphasised not the collective but the personal benefits of vaccination. It pointed out that you can’t be sure that you won’t get seriously ill or struggle with long-term COVID-related problems, and that vaccination will minimise your chances of falling ill.
Months of media coverage in the UK has instead focused on collective responsibility – that we owe it to our fellow citizens to get vaccinated. But for the sceptical 10%, this hasn’t cut through, which is perhaps to be expected. If you think vaccines are unsafe, then you’ll be worried about what getting the jab will do to you. Your decision making then becomes dominated by personal risk.
The best way to counter these concerns, therefore, is to highlight the opposite: personal benefits – and our new research suggests this could well work. It’s also probable that for a group that’s more likely to feel socially excluded, messages that focus on the personal rather than collective ramifications of COVID-19 will be more compelling.
What about the view that the vaccines have been developed too quickly? It’s an understandable fear: these vaccines have been produced with unparalleled speed. In response to this, one text in our study explained that the speed of development reflects the exceptional commitment, investment and cooperation of scientists, governments, public health organisations and pharmaceutical companies – as well as of the tens of thousands of members of the public who volunteered to test the vaccines.
This text noted too that side-effects that affect a significant proportion of people don’t suddenly appear months and years after vaccination. Because of the way vaccines work – quickly training the body’s immune system to fight off a virus – any issues arise within a month and usually much sooner. Happily, this information did seem to reassure people and helped reduce hesitancy.
COVID-19 is unlikely to disappear in the foreseeable future, which means vaccination messaging will remain of critical importance. When it comes to persuading the vaccine hesitant, our research shows that we need to listen, understand concerns and address them seriously. No message will be truly effective if the messenger has not earned trust, nor if it doesn’t account for the desires and worries of those receiving it.
Daniel Freeman receives funding from the National Institute for Health Research and the Medical Research Council. The current research was funded by the NIHR Oxford Biomedical Research Centre (BRC) and the NIHR Oxford Health BRC.