Why people reject vaccinations - and how to change their minds

Created: 01/21/2022, 15:30

From: Foreign Policy

January 15, 2022, Boston, Massachusetts, USA: Anti-COVID-19 vaccine mandate protesters march in downtown Boston against the Boston Mandate.

Boston Mayor Michelle Wu announced that proof of vaccination against COVID-19 will be required to enter certain indoor areas in Boston as the city's vaccination regulations take effect on January 15, 2022.

© Keiko Hiromi / Imago

The beliefs of those opposed to vaccination are strongly dependent on the cultural and social context.

Two studies conducted in the US found the following.

• Anyone who regards the Corona * vaccination fatigue in the wealthier countries as a new phenomenon neglects the rise of anti-vaccination sentiment worldwide in recent decades.

• Because we have to understand vaccination skepticism as an emotional, social and cultural problem.

• Social scientists from around the world need to work together to identify the causes of vaccine reluctance.

• This article is available in German for the first time – it was first published in

  Foreign Policy

  magazine on December 18, 2021

  .

As of early December, about 8.5 billion doses of the COVID-19 vaccine had been administered worldwide. This makes the COVID-19 vaccination by far the largest public health effort in history - and yet with mixed success. The world's most vulnerable countries are being deprived of their fair share of vaccine doses, while in the more affluent countries the main problem is not access but hesitancy, often centered on certain regions with anti-vaccination sentiment. The eastern German state of Saxony, for example, has a vaccination rate of only around 56 percent and an infection rate more than twice that of Germany as a whole.

Much of the discussion about COVID-19 vaccine reluctance has focused on how much the COVID-19 vaccine is different from other vaccines — for example, no other vaccine was developed as quickly.

However, viewing COVID-19 vaccine fatigue as a recent phenomenon neglects the meteoric rise of broader anti-vaccination sentiment around the world in recent decades. 

Why people reject vaccinations - and how to change their minds

There is arguably no better example of this than the measles vaccine. Because measles is an exceptionally contagious disease, about 95 percent immunization coverage is required to achieve herd immunity—a point at which the disease can no longer circulate freely among the population. In 1978, a year before the first dose of measles vaccine was introduced in Romania, 540 people out of 100,000 contracted measles. By the turn of the millennium, 96 percent of children had been vaccinated and the incidence in Romania* had fallen to 0.16 per 100,000 people - an enormous success that is something to be proud of.

But then vaccination rates against measles began to fall. In 2017, the first dose was 86 percent and the second dose 75 percent of the population, and Romania, like much of Europe, found itself in a years-long epidemic. In 2018 there were 83,540 cases of measles across Europe, compared with 5,273 just two years earlier.

In cases like Romania, where vaccination rates are high and then fall, the problem is not access to vaccines but reluctance to vaccinate.

In Italy*, for example, there were also measles outbreaks in 2017-2019, which can be attributed to a similar vaccination gap.

The demographic patterns of cases in such outbreaks underscore the role of refusal to vaccinate: 78 percent of the cases in a 2013 measles outbreak in New York involved children who were unvaccinated because their parents refused or intentionally delayed vaccination. 

Corona vaccinations: a look at history - vaccination skepticism and psychological and cultural reasons

Vaccination reluctance might seem like a niche behavior — some research suggests that only eight percent of Americans reliably identify themselves as “anti-vaxxers” — but it is, and will remain, a well-established public health issue. Almost a year before the emergence of COVID-19*, the World Health Organization identified vaccine hesitancy as one of the top ten threats to global health. Disease eradication will not be possible until we understand the complex psychological and cultural reasons underlying anti-vaccination attitudes. 

Let's start with the psychological aspects. Vaccination is psychologically counterintuitive. Human behavior is strongly motivated by rewards—specifically, immediate and tangible rewards that elicit strong emotional responses. When the quick indulgence of junk food is pitted against the subtle, long-term benefits of a nutrient-dense diet, healthy eating rarely wins out. This calculation does the vaccine no favors. A successful vaccination is characterized by the fact that one does not get sick - a non-event that is difficult to perceive, let alone count as a reward. 

In addition, the reputation of vaccination suffers from the psychological phenomenon of omission bias.

People see the harm caused by taking action (e.g. the side effects of a vaccination) as more serious and meaningful than the harm caused by inaction (e.g. becoming ill after not being vaccinated). ). 

What do vaccinations mean for humanity?

Motivation very culture specific

Perhaps worst of all, vaccines can become victims of their own success.

When vaccination rates increase, disease rates decrease.

Generations who have grown up without exposure to diseases like measles have little reason to fear its consequences.

When misinformation about the risks of vaccines meets ignorance about the risks of diseases, vaccination rates fall.

That is, until the next outbreak.

In 2018, measles vaccination coverage in Romania rose again to 81 percent for the full two doses – an example of an increase in vaccination coverage that often occurs when the consequences of not being vaccinated become visible.

For those who are most strongly opposed to vaccination, debunking myths about vaccination only increases their skepticism.

Jenna Clark

But vaccine rejection isn't just about what's going on in our heads;

it is also in constant contact with our social and cultural environment.

The motivation for vaccination is very culture specific.

Many anti-scientific beliefs are best understood as the product of certain origins of attitudes or psychological motivations that keep people from changing their minds, even in the face of evidence to the contrary.

For those who are most strongly opposed to vaccination, debunking myths about vaccination only increases their skepticism.

To overcome vaccination reluctance, we need to dig up those roots and figure out what vaccination means to people—something that doesn't always translate to all cultural contexts.

Vaccination Conspiracy Ideologies: Donald Trump and US Republicans

In the United States, for example, opponents of vaccination are often convinced of conspiratorial ideas or supporters of the Republicans*. Conspiracy theories appeal to devotees for many reasons – one, they can help make people feel intelligent because they see through society's lies. The reasons why Republican political affiliation has been linked to anti-vaccination stance are more complex, but statements by influential figures such as former US President Donald Trump*, who advocated the COVID-19 vaccine during his tenure , but expressed doubts about vaccinations both before and after his presidency have helped vaccine hesitancy become a common belief among American conservatives.

Our research team at Duke University's Center for Advanced Hindsight explores novel solutions to increase vaccine acceptance. In the case of the measles vaccine, we decided to focus on the self-protection aspect of conspiracy theories. If believing in privy to a secret helps covert thinkers validate their sense of self as intelligent people, what happens when we meet that need in other ways?

In 2019, we asked 1,087 pregnant mothers in the United States* to tell us about a time when they felt intelligent, a time when they felt like good parents, and a time when they felt like bad parents felt, or completing an unrelated task.

Then we had them read a persuasive text advocating measles vaccination.

Finally, we asked them about their intentions to have their future child vaccinated.

Our main interest was intelligence testing because we wanted to see if we could offer our participants a way to validate their self-esteem in a healthier way.

The responses we received to our intelligence query were mostly small moments expressed in a sentence or two.

Women told us how they quickly adapted to new jobs, successfully passed math classes or tests, solved problems for loved ones, won arguments with colleagues, innovated at work, or impressed a manager. 

Corona vaccinations: Impact of different pro-vaccination messages on COVID-19 vaccination intentions

Despite the brevity of the responses, those who wrote that they felt smart were significantly more likely to agree that they would have their child vaccinated. And why? They found the pro-vaccine text more persuasive than those who had written about something else. Once their psychological need to feel intelligent was satisfied through another source, they could accept the science and consider vaccination as an option. Their reluctance to be vaccinated had nothing to do with ignorance, but with what refusal to vaccinate means to someone in the United States of America.

Recently, our team has turned their attention to the COVID-19 vaccination. This spring, we examined the impact of various pro-vaccination messages on COVID-19 vaccination intentions by interviewing a representative sample of 1,748 people from the Southeastern United States. We showed our participants one of six different informational strategies, ranging from presenting the vaccine as a way back to normal life to explaining the US Food and Drug Administration's testing process, and then asked them about their attitudes towards the COVID-19 19 vaccine.

Only two of our approaches have helped increase immunization readiness.

The first successful message focused on tackling the omission effect by highlighting the risks of not vaccinating as far greater than the risks of vaccinating.

The second successful message was a little more unusual.

We presented the COVID-19 vaccination as an act of patriotism - a way for people to help the United States meet the challenge of COVID-19. 

The idea for this intervention arose directly from consideration of what motivates a negative attitude towards the COVID-19 vaccination in US culture. Trump's historic anti-vaccination statements and post-presidency remarks helped create an environment in which pro-vaccine is synonymous with anti-Republican — and in the United States, political party affiliation is more of an identity-determining factor than even race or religion. By linking vaccinations to patriotism, another value held dear, readers were able to sidestep the uncomfortable tension between Republican identity and vaccination behavior. In fact, our message on patriotism was particularly successful with Republican participants, almost eliminating the divide between political parties.

Corona: Social scientists from around the world need to work together to identify the causes of vaccination reluctance

But what has worked in the United States may not necessarily work elsewhere.

The omission effect may be universal, but other motivating factors behind anti-vaccination attitudes are not the same across countries. 

For example, in 2003 several predominantly Muslim states in northern Nigeria boycotted the polio vaccine because they feared it could spread HIV and cause infertility. These concerns were the result of many complex factors, including fears of a US anti-Islamic crusade prompted by the US response to 9/11 and the memory of Pfizer's deadly 1996 drug tests for meningitis in Nigeria Kano, the last Nigerian state to maintain the boycott, only lifted it after ten months when it received vaccines made in Indonesia - a predominantly Muslim country. There can hardly be a clearer example of a culture-sensitive solution.

The same applies to the COVID-19 vaccination. Social scientists from around the world need to work together to identify the causes of vaccination reluctance and to understand how these factors vary across communities at the national and local levels. We are then able to go beyond information and education and target hotspots of hesitation, either by addressing the psychological needs being met by the anti-vaccination community or by presenting vaccination as part of important cultural values. Whichever path we choose, one thing is clear: we will not be able to protect ourselves and our loved ones from COVID-19 unless we view vaccine skepticism as an emotional,Understand social and cultural problem and apply tailor-made solutions accordingly.

by Jenna Clark

Jenna Clark

 is senior behavioral scientist at Duke University's Center for Advanced Hindsight, where she specializes in applied behavioral science work to promote preventive health behaviors.

This article was first published in English in the magazine "ForeignPolicy.com" on December 18, 2021 - as part of a cooperation, it is now also available in translation to the readers of the IPPEN.MEDIA portals.

*Merkur.de is an offer from IPPEN.MEDIA.

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