As numerous studies have shown that just more than half of Americans report intending to get the COVID-19 vaccine, this week’s review focuses on vaccine hesitancy and how effective communication strategies can increase vaccine uptake.

Reasons for Anti-Vaccination Perspectives

There are multiple reasons why people choose not to be vaccinated against COVID-19, but misinformation is one of the main reasons. Particularly among Black and Latino populations, this study found heightened rates of vaccine hesitancy because of misinformation. The authors recommend addressing information and distrust with academic-community partnerships and focused community-engaged interventions that address specific reasons for vaccine hesitancy within particular communities. It is not just the general public who are hesitant. In this study of skilled nursing facility workers, the researchers found that misinformation was widespread among the staff, which led to more reluctance in being vaccinated. They found that sharing positive stories was more effective than data at increasing vaccine uptake.

Additionally, this study found that people who reported lower levels of trust in the CDC, lower social norms of COVID-19 preventive behaviors, higher skepticism of COVID-19, not receiving the flu vaccine the previous year, or identified as politically conservative, female, or Black did not intend to get the COVID-19 vaccine. The researchers argue for cross-partisan messaging in tailored campaigns using social network diffusion strategies for improving vaccine promotion.

Effects of Vaccine Hesitancy

As noted, many people are not getting the COVID-19 vaccine because of beliefs in misinformation. This study found that anti-vaccine narratives, even those with small persuasiveness, affected a large part of the population. This exposure has led to more people adopting anti-vaccine views and ultimately slowing down the rate at which people are being vaccinated.

Strategies for Encouraging Vaccination

Persuading enough people to be vaccinated against COVID-19 to reach herd immunity has shown to be a slow process. However, scholars and public health officials argue it is necessary. To improve the likelihood of someone getting vaccinated, this commentary argues that eight evidence-based practices have shown to be effective in other contexts and should be evaluated to assess the likelihood of success with increasing COVID-19 vaccination uptake. The strategies create the acronym PANDEMIC, and stand for the following tactics:

• Presumptive language
• Asking for advice
• Norms on an anonymous level
• Description of favorable attributes
• Emphasizing clinicians’ own experiences
• Mandated choice
• Images
• Communication of risk

This study found that the best way to disseminate COVID-19 information to increase people’s knowledge, which leads to increased adherence to preventive behaviors such as the vaccine, is to use multiple sources, particularly television media, health care providers, and public health officials. They also found that it is vital to use clear and concise messaging to increase knowledge and counter misinformation. Another study also recommended using the medical community to disseminate vaccine information as they are uniquely positioned to be a trusted source of information given most were the first to be vaccinated. Therefore, it is important to provide communication training to these credible and trustworthy allies. Other studies also suggest including health care providers in vaccine promotion efforts. This study determined predictors for willingness to get the vaccine and recommended information campaigns highlight the safety of the vaccine, promote that the vaccine will protect the health of the people who take it, and use health professionals to discuss the effectiveness of the vaccine.

Additionally, this study found that normalizing uncertainty is an effective strategy for mitigating ambiguity aversion and helps to reduce ambiguity-averse cognitive and emotional responses. More research is needed, however, to test uncertainty-normalizing communication strategies’ effectiveness on behavioral responses.

Another strategy suggested by researchers is to counter the most common cognitive biases people have that are influencing their decision-making around vaccine uptake: confirmation, negativity, and optimism biases. The authors of this commentary recommend the following tactics for countering biases and promoting acceptance of COVID-19 vaccines:

• Avoid unprompted attempts to “debunk” the myth that vaccines cause disease
• Emphasize the reason for vaccine side effects: reactogenicity
• Stress the prosocial reasons for getting the vaccine
• Build vaccination opportunities into health care such that people “opt out” rather than “opt in”

Finally, in a webinar intervention with cancer patients, researchers were able to decrease vaccine hesitancy and increase vaccine enthusiasm by using positive framing. The researchers recommend patient education programs co-hosted by multiple stakeholders and delivered by health care providers to increase patient enthusiasm for the COVID-19 vaccine. Another study also found that practical public messaging via social media reinforced positive attitudes towards COVID-19 vaccination among younger individuals.