The Surprising Reasons Behind Vaccine Hesitancy

pharmacist filling out a vaccine card As COVID-19 continues making its presence known worldwide, politicians and public health officials are perplexed by the increased resistance to vaccine safety and efficacy. In searching for a reason to explain this resistance, psychology and, more specifically, cognitive biases research have a lot to offer.

Education can reduce the dissemination of misinformation about vaccine safety and lack of understanding of basic science; however, educational interventions alone are ineffective in changing the minds of those holding anti-vaccine beliefs. Unfortunately, the much deeper seeded cognitive hindrances are considerably harder to eliminate.

Through evidence-based research, psychologists have discovered that people who are refusing to get vaccinated may fall victim to various cognitive biases or errors in thinking. Errors in thinking often occur when we need to make a complex decision but lack information to do so or have strong emotions related to our choice. The exact means of how vaccines work can be difficult for most people to understand, thus, leading to several cognitive biases when deciding whether or not to vaccinate.

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It arises when an individual has incompatible thoughts or behaviors. To reduce the discomfort produced by these inconsistencies, we either need to change our behavior or our beliefs. For example, when we read about the efficacy of vaccines but also worry about the side effects, we may conclude that vaccines don't work to remove the dissonance. While these conclusions are factually inaccurate, choosing to believe them makes us feel better about our decision not to vaccinate.

Confirmation bias is our propensity to focus on information that supports our already existing beliefs. From time to time, we all fall victim to confirmation bias. But when it comes to vaccines, individuals choosing not to vaccinate regularly disregard abundant research and evidence demonstrating the necessity and effectiveness of vaccines. Instead, they focus on any possible sign supporting what they already believe about vaccines to validate their decision not to vaccinate.

It occurs when we believe that the act of vaccinating, which may have a slight chance of side effects, is worse than not taking any action at all. Even when the likely results of this non-action pose a significantly higher risk, that is to say, while the risks involved with choosing not to get vaccinated are greater, not getting vaccinated can feel safer.

Here, a person makes judgments about the probability of an event based on how easily an example or an instance comes to mind. Regrettably, this cognitive bias leads to us remembering rare or infrequent instances in which vaccines have failed instead of considering and recalling all the cases in which vaccines have effectively prevented disease. For example, while watching the evening news, we are very likely to be reminded of these rare occurrences, and therefore that will be the first information that comes to mind.

We know that educating people about the relative risks of vaccines instead of the diseases they prevent is insufficient in changing beliefs and attitudes toward vaccination. In theory, communicating pro-vaccination community norms may have some positive effects that can lead to superior education efforts and restore confidence in vaccines' safety. Collectively, we should:

  • Focus resources on the importance of vaccination for both the health of the individual as well as for the health of the general public;
  • Stress how every one of us plays a vital role in the health of our communities;
  • Highlight that it is in everyone's best interest to get vaccinated regardless of their own health status or personal beliefs; and
  • Improve our understanding of how people may react to negative events and the heuristics they employ.

Several months into the distribution and administration of COVID-19 vaccines and we have learned one of the best ways to encourage individuals to be vaccinated is to understand family and friends' personal experiences with vaccination to reduce doubt. This personal connection can be a more effective source of reducing doubt rather than continued encouragement from public officials and even healthcare professionals.

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To view the latest educational resources, visit CareFirst BlueCross BlueShield's Coronavirus Resource Center.