Dealing with ‘Vaccine-Hesitancy’ in the Midst of a Pandemic Better Communication May be the Answer, Northwestern Researchers

Dealing with ‘Vaccine-Hesitancy’ in the Midst of a Pandemic

Better Communication May be the Answer, Northwestern Researchers

By Howard Wolinsky

As many as 40% of American adults are still “hesitant” to undergo vaccination against COVID-19, but steps can be taken to try to persuade at least some of them to change their minds to help protect the community at large, according to Northwestern University communication researchers.

Nathan Walter, Assistant Professor in the Department of Communication Studies and a faculty member in the Center for Communication and Health at Northwestern University, says, “Defining vaccine-hesitancy is the one billion dollar question. The main problem is we don’t have a good handle of what hesitancy means.”

Barbara O’Keefe, Professor of Communication Studies and former Dean of the School of Communication at Northwestern, agrees that there is no clear definition of vaccine-hesitancy. She says the term is used to label anyone who has not yet been vaccinated or declared a committed intention to get vaccinated.

“Vaccine-hesitancy is common and has been so across the decades of public health efforts aimed at preventing dangerous infectious diseases,” says O’Keefe, who like Walter, is a member of Northwestern COVID-19 Vaccine Communication and Evaluation Network (CoVAXCEN), a coalition of academic, industry and government experts.

“At present, a bit over 60% of the U.S. population are committed to get vaccinated against COVID-19,” O’Keefe says. “The remaining 40% fall on a spectrum from the uncertain to the firmly resistant. The percentages of people falling at each defined point on the spectrum are somewhat different in demographic characteristics. At this point, relatively few people are fully committed to rejecting vaccination; many who say they will not voluntarily accept vaccines also say that they will be vaccinated if it is required of them.”

(For information on attitudes on COVID-19 vaccines, go to Kaiser Foundation Covid19 Vaccine Monitor.)

Walter says the numbers of those who are hesitant have been shrinking as the vaccine has become more widely available. But he says about 10% are hard-core refusers. He says many people are just delaying vaccination until they get satisfactory answers to their concerns about vaccines.     

Who are the vaccine-hesitant?

Walter says his research suggests that vaccine-hesitancy is “the last bastion of bipartisanship that we have. If you look at the celebrities that are anti-vaxxers, it’s really both sides of the aisle. It’s a weird combination of the less educated, the more conspiratorial-minded individuals and also the more affluent people.”  O’Keefe adds that the vaccine-hesitant population includes people with a libertarian ideology, members of ethnic and racial minorities, and, somewhat surprisingly, health care workers.

How should public health advocates and health communicators approach the issue of vaccine-hesitancy in the midst of the COVID-19 pandemic?

Walter says efficacious COVID-19 vaccines were produced in record time, months not years, but communication about it has lagged. “Public health departments realize that in many cases, we’re dealing with the problem of communication and not a problem of science. The problem is that people are not complying.  And that’s a problem of communication."

He recommends focusing vaccination efforts on those willing to be vaccinated and then on those with legitimate concerns, such as the significance of rare blood clots in young women from the Johnson & Johnson COVID-19 vaccine that led to an official “pause” on the vaccine in April and concerns about whether vaccines are effective against new variants.

O’Keefe agrees that priority should be given to programs to get the willing vaccinated until the point where there is a surplus of vaccine doses. However, she says concentrated populations of hesitant individuals must be addressed immediately because they pose a risk of incubating new variants of COVID-19.  

She believes that based on well-established social scientific findings about the process of social influence, strategies can be identified that are “most likely to succeed in leading people past the obstacles they face and toward vaccination. However, we recognize that in dealing with many resistant people, persuasion is at best a very lengthy process and may not work at all.”

Walter says that in communicating with those who are hesitant, we need to take everyone’s concerns seriously.  “This is all legitimate. We need to be very effective in crafting a message that says there is uncertainty but still to protect yourself and your loved ones, you should get vaccinated. That’s a tough one because people don’t like uncertainty,” he says.

He says small incentives may help, such as the national doughnut maker that is offering a free doughnut per day for the rest of the year if the customer can prove he or she has been vaccinated. “From a psychological view, if you start to associate the vaccine with something nice and happy like a doughnut, as opposed to pain and sickness, that’s not a bad approach,” he says.

But Walter rejects another plan to pay people $200 or more to be vaccinated. “It’s a terrible idea. It’s like parents who give money to their kids for good grades,” he says. “In the long term that would be the end of vaccination as we know it. But small incentives are fine."

Walter says hesitancy and skepticism are considered good values in America. “But in a pandemic, it can’t be perpetual. Let’s just make sure we vaccinate as many people as we can like Dr. O’Keefe says, and then we’ll see where we’re at because it might be just the case that people will join the party.”

The Northwestern COVID-19 Vaccine Communication and Evaluation Network (CoVAXCEN) brings together a panel of experts in immunology, infectious disease, epidemiology, regulatory science, and health communication.

Headquartered in the Institute for Global Health's Center for Global Communicable and Emerging Infectious Diseases, with the cooperation of the Center for Communication and Health, seeks to achieve consensus on a variety of issues related to the safety and efficacy of COVID-19 vaccines and then produce and disseminate written materials for scientists, healthcare professionals, and the general public describing its conclusions.