There should be no doubt about it: COVID-19 vaccines are saving lives. However, vaccine hesitancy is not a new phenomenon and has been documented for other types of vaccinations. Research universities, such as London Metropolitan University, are among those that have conducted research on vaccine hesitancy.
Researchers studying vaccine scepticism say that it may not be a lack of information or knowledge that drives resistance, but certain psychological beliefs. In Singapore, Associate Professor Thoon said, “Vaccine hesitancy may arise due to concerns surrounding potential side effects from the vaccines, concerns about their efficacy, or even misinformation.”
Sociologist Tan Ern Ser from the NUS said that those who have no access to, are unable to comprehend or do not trust official information may also be less accepting of vaccination. There may be a small group of people who perceive vaccination as an “instrument of oppression” as well, but they are unlikely to catch the virus or rationalise that the vaccine is ineffective, Tan added.
Based on In-Cube’s March survey findings in Singapore, Associate Professor Edson of NTU said that:
- People from higher-income households expressed stronger levels of willingness to get vaccinated.
- A strong predictor of willingness to get vaccinated is trust in information about Covid-19 that comes from the Government and health professionals.
- Those who think Covid-19 still poses a serious threat and those who think they remain at risk of getting the disease are more willing to get vaccinated.
Interestingly, he added that some people who remain hesitant about getting vaccinated are well-read about the topic. However, it is difficult to ascertain the real intention behind those who create questionable claims about COVID-19 vaccines.
Fortunately, scientists began studying vaccine hesitancy long before Sars-Cov-2 was first identified in Wuhan in December 2019, and they have explored various models which attempt to capture the differences in people’s health behaviour. One of the most promising is known as the 5Cs model, which considers the following psychological factors:
- Confidence: the person’s trust in the vaccines’ efficacy and safety, the health services offered them, and the policymakers deciding on their rollout
- Complacency: whether or not the person considers the disease itself to be a serious risk to their health
- Calculation: the individual’s engagement in extensive information searching to weigh up the costs and benefits
- Constraints (or convenience): how easy it is for the person in question to access the vaccine
- Collective responsibility: the willingness to protect others from infection, through one’s own vaccination
When considering these different factors and the ways they may be influencing people’s behaviour, it is also useful to examine the various cognitive biases that are known to sway our perceptions. Consider the first 2 Cs—the confidence in the vaccine and the complacency about the dangers of the disease itself. Jessica Saleska at the University of California, Los Angeles points out that humans have two seemingly contradictory tendencies—a “negativity bias” and an “optimism bias”—that can skew people’s appraisals of the risks and benefits of new technologies.
The negativity bias concerns the way you appraise events beyond your control. “When you’re presented with negative information, that tends to stick in your mind,” says Saleska. The optimism bias, in contrast, concerns your beliefs about yourself—whether you think you are fitter and healthier than the average person. These biases may work independently, meaning that you may focus on the dangerous side effects of the vaccines while simultaneously believing that you are less likely to suffer from the disease, a combination that would reduce confidence and increase complacency.
Then there’s the famous confirmation bias, which can also twist people’s perceptions of the risks of the virus through the ready availability of misinformation from dubious sources that exaggerate the risks of the vaccines. This reliance on misleading resources means that people who score highly on the “calculation” measure of the 5Cs scale—the people who actively look for data—are often more vaccine-hesitant than people who score lower. “If you already think the vaccination could be risky, then you type in ‘is this vaccination dangerous?’, then all you are going to find is information that confirms your prior view,” says Betsch.
Remember that these psychological tendencies are extremely common. Even if you have accepted the vaccine, it has probably influenced your own decision-making in many areas of life. To ignore them, and to assume that the vaccine-hesitant are somehow willfully ignorant, is itself a foolish stance.
Nor should we forget the many social factors that might influence people’s uptake – the “constraints/convenience” factor in the 5Cs. Quite simply, the perception that a vaccine is difficult to access will only discourage people who are already on the fence. When we spoke, Betsch suggested that this might have slowed the uptake in Germany, which has a very complicated system to identify who is eligible to receive the vaccine at any given time. She says people would respond much more quickly if they received automatic notifications.
Razai agrees that we need to consider the question of convenience, particularly for those in poorer communities who may struggle with the time and expense of the journey to a vaccination center. “Travelling to and from that may be a huge issue for most people who are on minimum wage or unemployment benefits,” he says. That’s why it’s often best for the vaccines to be administered in local community centers. “I think there has been anecdotal evidence of it being more successful in places of worship, mosques, gurdwaras, and churches.”
Finally, we need to be aware of the context of people’s decisions, he says, such as the structural racism that might have led certain ethnic groups to have lower overall trust in medical authorities. It is easy to dismiss someone else’s decisions if you don’t understand the challenges they face in their day-to-day lives.
Ways To Increase Vaccine Confidence
Rather than shaming, guilting, or embarrassing those who are vaccine-hesitant, research shows that taking advantage of messaging that uses positive emotions may be more effective in fostering vaccine confidence.
For example, a paper published last October in Health Communication, a peer-reviewed academic journal covering communication in the healthcare industry, suggested that as part of a vaccine education strategy, people should:
- Acknowledge the fear and anxiety of those still not keen to take vaccines
- Appeal to altruism and hope as part of vaccine education
- Emphasise the safety and efficacy standards of the Covid-19 vaccine development process
Interested to learn more about people’s behaviour within a society? Aventis School of Management offers working professionals a Graduate Diploma in Social Psychology and Counselling, as well as a Master of Science in Psychology, offered by London Metropolitan University. Both Psychology programme is specially designed for non-psychology graduates.
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