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3 Ways to Change the Mind of Your Vaccine-Hesitant Loved One

New study shows how to change the minds of the vaccine-hesitant in your life.

Key points

  • A new large-scale U.S. study of the vaccine hesitant shows that reluctance may stem from political influence and concern about side effects.
  • To convince a loved one to get a COVID vaccine, strategically appealing to their politics and listening empathically to their concerns may help.
  • Understanding the psychology of the vaccine-reluctant can provide important public health benefits.

For people waiting eagerly to receive the COVID vaccine, the news of its availability couldn’t have come soon enough. Not only could they be protected from contracting the disease, but they could also play a role in advancing everyone toward herd immunity. Once the pandemic subsides, furthermore, there are the very practical benefits that all can enjoy, including the possibility of freedom from wearing a mask and the potential to return to a variety of pre-pandemic activities—from travel to attending public events—without the need to socially distance. When the vaccine became available in early 2021, then, it seemed to many to be a true win-win.

Even while vaccination schedules were being ramped up by federal and local officials, at least in the U.S., reports began to emerge about the so-called “vaccine-hesitant.” To you, this might seem like a euphemism, with “hesitant” sounding like a gentle way to say “adamantly opposed.” After all, hesitancy implies a wait-and-see attitude. As more and more (i.e. millions) of people line up to get their own “shot in the arm,” it would seem like time might not be the major deterrent for those who continue to refuse inoculation. The proper classification of this psychological state might be closer to “vaccine-reluctant” than “hesitant.”

Perhaps you have close family members or a romantic partner who fall into this category. At the beginning of the vaccination rollout, perhaps they told you that they’d like to be sure that the vaccine is safe and effective. As the data continue to reinforce both of these qualities of the vaccines in use (even Johnson & Johnson, which was briefly paused), you wonder what more ammunition you need to convince them to get over their reluctance. You tell them that you’ll feel safer having them around the children, feel comfortable having them over to your house, and will even pay for a night out at your favorite restaurant. However, no amount of bribing, sharing vaccination data with them, or just plain begging will get them to change their minds.

Fortunately, there is a new study that may be of help. Conducted by a pair of internationally known Stanford University public health researchers, Robert Kaplan and Arnold Milstein (2021), and published in a prestigious peer-reviewed journal, this research could just be the source you need to convert the reluctant into the acceptant.

As the Stanford researchers point out, and as you undoubtedly know, vaccine reluctance isn’t unique to COVID. Among children under the age of 18, over one-third didn’t get a flu shot in 2018-19, and among adults, the rate rises to over half. Indeed, a survey conducted by the authors on willingness to receive the COVID vaccine showed comparable rates, with one-third reporting they would not do so. Adding complexities to the COVID vaccine issue in the U.S., politics became part of the reasoning people used to say they would refuse the vaccine.

To be fair, as Kaplan and Milstein point out, there are reasons to be skeptical about certain vaccinations, given that even the time-tested flu shot is effective in only half of cases. On the other hand, the COVID vaccine has a far higher efficacy rate of 95 percent, so that concerns about whether or not it works would seem less relevant than in the case of influenza vaccines.

To disentangle the potentially complex interactions among reasons for vaccine reluctance, Kaplan and Milstein adopted an approach from market research called “conjoint analysis” in which survey participants choose from a set of options with various features such as high-risk, low-benefit vs. low-risk, high-benefit. This approach fits the reality that consumers face when making health-related decisions in balancing off competing advantages and disadvantages represented by the same set of features.

Drawing from a nationally representative study population (YouGov survey panel), the Stanford researchers interviewed 1,000 individuals in August 2020, and conducted a replication study on another sample of 1,000 matched individuals in December 2020.

Participants indicated their likelihood of taking the vaccine in each of 27 cases representing different combinations of risk and benefit with each participant rating 3 different scenarios. For example, in one scenario minor side effects were described as sore arm, low-grade fever, and headache, and major side effects as inflammation of the brain and other neurological results. The benefits were listed as a 95 percent reduction in the chances of getting COVID. The scenario described the probability of minor side effects as 50 percent and that of major side effects as 1 per 100,000.

What is the likelihood you would take the vaccine under these conditions? With this in mind, it will probably not surprise you to learn that respondents indicated a greater likelihood of taking the vaccine as the benefit increased from 50 to 70 percent and above. The likelihood of taking the vaccine was not influenced by the risk of minor side effects but did decrease across participants as the risk of major side effects dipped to 1 in 1 million or lower in comparison to 1 in 100,000.

All of this seems very logical, and could help explain the pattern of findings showing greater acceptance of a COVID vaccine when it's described as having high efficacy and low risk of major side effects or only minor side effects. However, given the flurry of attention to the politics of COVID in mid-2020, particularly with the Presidential election, the authors decided to add these non-vaccine-related factors to their equation in predicting vaccination likelihood.

The Illogical Logic of Predicting Vaccine Reluctance

Turning now to the factors outside of “logic” that predicted the likelihood of taking the COVID vaccine the first was, as indicated earlier, politics. The potential endorsement of President Trump for taking the vaccine produced an overall increase of 18 percent in the likelihood of taking the vaccine, but the endorsement by Anthony Fauci more than doubled this increase to 38 percent. So far, politics seems to have only a moderate effect on vaccine acceptance. However, when the authors asked participants who stated they were very likely to take the vaccine, only 27 percent favored Donald Trump compared to the 64 percent who said they would vote for Joe Biden.

By the time of the December 2020 replication, favorability toward the vaccine among the study sample increased slightly compared to the August data, but there was no difference in the relative role of politics compared to statistics in predicting likelihood. However, with Biden now serving as President-Elect, his role in endorsement could be added to the prediction equation. As the authors reported, even with a vaccine having 90 percent effectiveness, more Biden (38 percent) than Trump (27 percent) voters stated they would be very likely to line up for their own shot in the arm.

The findings suggested to the Stanford researchers that when faced with differing combinations of risks and benefits, the Americans in this study were able to evaluate each factor separately, weighting effectiveness most heavily followed by the potential for serious (vs. minor) side effects.

All of this is well and good, and reassuring in that it appears that people can look at data and form their own, science-based, conclusions. However, these conclusions had a small impact on vaccine likelihood compared to the impact of political ideology and candidate preference. Unfortunately, the result is that people will discount evidence from a political viewpoint counter to their own and magnify the evidence from the party and person they support. As the authors conclude, “In order to improve acceptance of a vaccine, future studies should more systematically evaluate the psycho-political-social factors in concert with the traditional factors of risk and benefits” (p. 4).

What Do You Tell the Vaccine Reluctant in Your Life?

You can see from the Stanford U. findings that data and statistics pale in comparison to the emotional reaction that people have to the political affiliation of the conveyor of vaccine information. However, this doesn’t mean that there’s no way for you to change the course of the pandemic within your own sphere of influence. These 3 tips can help you frame your approach as you seek to transform their reluctance to acceptance:

  1. Use politics to your advantage. You might have to lean into, rather than against, their worldview and the belief system they’ve developed around the virus. Although major figures such as presidential candidates obviously stand as the leaders of their party, there will still be many local, if not national, examples you can draw from to show that, as they say, the “virus doesn’t care” about your political affiliation.
  2. Turn to data, data, data. The YouGov-based study suggests that people can use data reasonably well when they make health-related decisions. For example, even when considering the risks of having the vaccine, the authors noted that “These results suggest that many people may not be deterred by side effects that are possible, but highly improbable.” In other words, if the people you care about worry about themselves experiencing side effects, noting the rare nature of these effects could be helpful. Construct your own scenario from the 90 percent effective-low side effect combination and share this with the individual. For reference, you can consult this recent Boston Globe article with facts about vaccine side effects.
  3. Appeal to the heart if not the head. Apart from politics and data interpretation, recognize that there is an emotional component to almost everything involved with the pandemic. You are reminded on a daily basis about the deadliness of this virus and as new surges hit different parts of the world, many people cannot look at the situation from an objective point of view. Understanding those “psych-“ related factors, as Kaplan and Milstein suggest, can be important in communicating the public health messages you share with the people close to you. Talk to them non-judgmentally and try to discern what underlying emotional issues are involved in their personal reactions to getting the vaccine. By showing that you are interested in hearing their perspective, you may find that they'll be more open to hearing your reasons for wanting them to get vaccinated.

To sum up, even with an effective vaccine, the Stanford U. team points out that “those vaccinated remain at great peril if exposed to others who decline vaccination” (p. 4). By adapting these tips to your own situation, it is possible for you to play your own, however seemingly small, role in making the world safer for everyone.

References

Kaplan, R. M., & Milstein, A. (2021). Influence of a COVID-19 vaccine’s effectiveness and safety profile on vaccination acceptance. PNAS Proceedings of the National Academy of Sciences of the United States of America, 118(10). pnas.2021726118

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