Despite more than 450,000 deaths from COVID-19 so far in the U.S., nearly a third of Americans say they definitely or probably will not get the vaccine, according to a recent Associated Press-NORC Center for Public Affairs survey. If those numbers hold, it will be well short of the number needed to prevent the spread of the disease,  according to the National Institute of Allergy and Infectious Diseases.

Much of the reluctance is the byproduct of rampant misinformation. In a recent study on misinformation and vaccine hesitancy published in Nature, researchers show that “exposure to misinformation lowers individuals’ intent to vaccinate to protect themselves and lowers their altruistic intent to vaccinate to protect others, which could complicate messaging campaigns focusing on altruistic behaviors.” They also found that misinformation purporting to be based in science or medicine appears to be particularly damaging to vaccination intentions.

Of course, vaccine hesitancy did not begin with the COVID-19  virus. An age-old problem beginning with the invention of the first smallpox vaccine, vaccine fears have been more widespread in recent years due to the amplification of social media, where anti-vaccine movement leaders have been found to have a cumulative following of 7 million followers on Facebook alone  The World Health Organization declared vaccine hesitancy to be a top 10 threat to global health in early 2019, well before the COVID-19 outbreak, and digital misinformation has been a major contributor to the development of vaccine hesitant attitudes and beliefs and ultimately individuals delaying or declining vaccination.

Vaccine Hesitancy and Misinformation

UF College of Journalism and Communications doctoral candidate Amanda Sams Bradshaw has been studying vaccine hesitancy and misinformation, particularly vaccination of young children. She specifically hopes to address the childhood vaccine information gap, which occurs during the prenatal period. One of her first research studies at UF, which was published in Health Communication, was singled out by the Centers for Disease Control and Prevention’s Health Communication Science Digest in January of 2020 as one of the key papers focusing on social media and health topics at that time.

The study involved joining the largest anti-vaccine closed Facebook group to understand the dialogue and how those discussions might persuade new mothers who might be on the fence about vaccinations. She found that in some cases, within the course of just a few hours or days, those mothers decided to not vaccinate their children based on resources they were given, such as documentary links and links to other social media pages.

Bradshaw and a team of researchers also studied “Vaccines Revealed,” a 2017 documentary series that was shared on this closed anti-vaccination Facebook group and touted as the top resource that parents should view to become fully informed about the risks of vaccination. This nine-part documentary series, which promotes reasons that parents should avoid vaccinating their children, had more than 29,000 shares on Facebook alone. These films were promoted as being superior to the knowledge of doctors and were often referenced in Facebook comment threads as the trigger which convinced “ex-vaxxers” to discontinue vaccinating their children or to never begin in the first place.

The team studied the content, sources, and messaging portrayed in the series to understand the messages affecting vaccine-hesitant parents, which could serve to help combat misinformation about the harms of vaccines. Five overarching themes were found throughout the series:

(Perceived) Solidified Science: To solidify the perception of science, the series presents information as rational, educational, and logic-based.

Collusion and Conspiracy: “Big Pharma,” governmental agencies and the media are portrayed as interested only in financial gain in regards to what information is being presented to the public. Pediatricians are portrayed as uneducated and blindly misled.

Canary in the Coal Mine: The series presents a message for parents to watch out for signs so they can be poised to discover a problem before it becomes widespread. Specifically, 200+ adverse side effects ranging from minor skin infections at injection sites to autism are presented as the canary showing parents that there is still time to detox children and prevent harm by avoiding vaccines before it is too late.

Fear Appeals: Dramatic music, parent testimonials, and clips of children and adults suffering from alleged vaccine injury run throughout the series, creating a sense of fear.

Individual Choice: The series emphasizes the freedom of parents to choose whether or not to have their children vaccinated as a basic human right. Morality and the necessity of individual choice is a major theme, with not being able to opt-out of vaccines presented as un-American.

How can communicators counteract these anti-vaccination messages? “The crux of the matter is that people who oppose vaccination definitely dislike messages that are presented as black and white,” Bradshaw concluded. “Any medical intervention in the world has risks involved. Messages that dismiss those or messages that are dismissive of Internet research or things people might have seen on Facebook don’t tend to work as well. In fact, there’s a backfire effect that sometimes can antagonize people that are opposed to vaccines.”

Additionally, public health experts and strategic communication practitioners must understand that vaccine decision making is an ongoing choice, and acceptance does not equate to lack of hesitancy. Therefore, messages must be carefully tailored and targeted not just to fence sitters of vaccine rejectors but to vaccine acceptors as well, not taking for granted individuals’ continued acceptance of necessary vaccines for their children simply because they consented to vaccines in the past.

Unintended Consequences of AI-Based Recommendations

Telecommunication Assistant Professor and  Consortium on Trust in Media and Technology Trust Scholar Jieun Shin has been studying how technology companies like Amazon and Facebook use algorithms to determine what content should be presented to users based on their previous behavior and preferences.

In one study, she and a colleague looked at how Amazon recommendations were highlighting anti-vaccination books. For seven days, they pulled the first 10 pages of Amazon’s “vaccine” search results and then coded the results into three categories: vaccine-supportive, vaccine-hesitant, and unclear.

Of the books analyzed, 62% were vaccine-hesitant. The three top-ranked books across the week and the three most-frequently recommended books were all vaccine-hesitant ones. As a result, the majority of information delivered to a user who is anti-vaccination will likely reinforce their beliefs. In addition, a user without an opinion on vaccines may conclude that this information is the most valid since it is the most prevalent.

While Amazon and other platform companies claim to stay neutral in their algorithms, the research suggests that pre-programmed algorithms may unintentionally channel users’ exposure into opinions that are not supported by the science and medical community. This may create the illusion for users that a misinformed minority view is accepted widely in the public.

A Roadmap to Building Confidence in Covid-19 Vaccines

The United Nations, which recently launched the Verified initiative to combat misinformation about COVID-19,  engaged the Center for Public Interest Communications to work with organizations around the world to apply social, behavioral and cognitive science and identify research-based messages that might overcome vaccine hesitancy.

The center’s research team, led by Center Research Director Annie Neimand and Post-doctoral Research Associate Jack Barry, identified 16 of the foremost scholars in building vaccine trust, and convened them for a Living Literature Review, a research process the Center developed assembling scholars from a range of disciplines in the same (Zoom) room for a productive intellectual exchange where ideas are championed, challenged, and sometimes cast aside.

Based on those conversations, the Center in November published A Practitioner’s Guide to The Principles of COVID-19 Vaccine Communications and identified eight principles that could help increase  trust, acceptance and demand for vaccination.

1. Work within worldviews, identities and moral values. Understand what others see as right and wrong and connect with what’s most important to them. Find the common ground between what you hope to achieve and what matters to them.
2. Use timing to the best advantage. It’s far easier to build trust when you’re the first to articulate a message. It’s equally important that they hear that same message multiple times from an array of sources.
3. Use the right messengers for the audience. Ideally, the messenger is someone with deep expertise: a doctor, a scientist or a public health practitioner. But trusted messengers are also those in our “in-groups,” people we see as being like us and who share our values.
4. Make the content concrete, supply a narrative and provide value. If messages aren’t concrete and don’t include stories, our powerful sense-making brains will fill the abstraction with stories and ideas that make sense to us.
5. Recognize that communities have different relationships with vaccination. Different societies also have different relationships with authority. In societies where people trust authority, they’re more likely to accept direction even if they don’t support it.
6. Reinforce positive behaviors. To change behavior, you have to shift people’s perceptions of what normal behavior looks like.
7. Evoke the right emotions. It’s tempting to activate emotions like fear or shame to get people to take a vaccine, but it’s unlikely to work. Look to more constructive emotions like awe, hope and parental love to get people to act.
8. Be explicit and transparent about motivations. We’re less likely to trust a vaccine if we question the motives of the people advocating for us to take it.

The guide includes insights from a survey fielded in the U.S., U.K., Germany and France that tested messages and strategies for building vaccine confidence.

Center Director Ann Christiano and Barry, in a piece written for The Conversation, explained that the  factors that lead people to make choices to take vaccines are nuanced. “People’s choices are affected by how they see the world, their perceptions of the choices people like them will make, whom they trust, their perceptions of risk, consistency of message and convenience of actually getting the vaccine.”

The Center is now building on this framework through a partnership with Project ECHO’s National Nursing Home COVID-19 Action Network, which is supported by the federal Agency for Healthcare Research and Quality in collaboration with the Institute for Healthcare Improvement. This effort relies on an interdisciplinary research approach to identify messages and strategies to build vaccine trust and confidence among nursing home workers, particularly certified nursing assistants.

Posted: February 14, 2021
Category: College News, Health Communication News
Tagged as: vaccine hesitancy