Look Who’s Talking: Encouraging Positive Conversations About Vaccination

Article | Dr Tonia Thomas, Vaccine Knowledge Project Manager at Oxford Vaccine Group

One of the challenges of the coronavirus (COVID-19) pandemic is the coinciding ‘infodemic’, defined by the World Health Organization as an abundance of information, both online and offline. While technology allows us to share important public health messages quickly and effectively, it also allows misinformation to spread on an uncontrollable scale. At its most dangerous, misinformation about medical interventions has cost lives, with global reports of incidents involving alcohol and bleach intoxication and people refusing treatment for COVID-19.

An area that is often a key focus for misinformation campaigns is the anti-vaccine narrative. While vaccine opposition has existed for as long as vaccination itself, modern communication tools, such as social media, have propelled the sentiment into the hands of many more people. This increase in antivaccination content circulating online has led to concerns about vaccine acceptance within the wider population. Considerable media reports have speculated about the issue and its potential to jeopardise vaccination campaigns. However, it is often difficult to translate reports into our local communities and areas, and we must consider the challenges for individual contexts.

When discussing vaccine acceptance, it is important to remember that vaccine hesitancy forms a continuum. The number of people who refuse all vaccines is very low (approximately 1–2% in the UK), but there is a larger proportion of people who fall into the ‘vaccine-hesitant’ group.

The reasons for refusing or hesitating about some vaccines are extremely varied, and while some stem from misinformation circulating online, many arise from broader influences.

There are also specific concerns from particular groups, such as vaccines containing animal products that are banned in some religions. Without a clear understanding of what underlies an individual’s hesitancy, it is impossible to have a constructive conversation on the topic. But these complexities should not deter our efforts.

Many of the concerns about vaccination centre around autonomy, as vaccines are one of the few medical interventions given to healthy adults and children to protect the population as well as the individual. Taking an interest in one’s own medical treatment is expected, and it’s important to encourage people to ask questions, with the role of health professionals being to support informed decisions.

This can sometimes be lost in media coverage, which often focuses on scientific and medical information about vaccines and categorises those who have questions and concerns as ‘anti-vaxxers’. This polarisation is unhelpful and forms a barrier to positive conversations.

Health and social care professionals continue to be the most trusted source of advice about vaccinations, with 93% of parents surveyed by Public Health England agreeing with this statement. Evidence shows that effective interactions with parents can positively influence vaccine decisions.

A study found the main reason that parents changed their mind about getting a vaccination was “information or assurances from a health provider”. This, alongside their experience and familiarity with local communities, places health and social care professionals in a strong position to have encouraging conversations about vaccines.

Reasons for being hesitant about vaccination can vary greatly depending on the vaccine. Common concerns include:

• vaccine safety

• side effects

• need for vaccination with low disease incidence

• vaccine effectiveness

• vaccine ingredients

• preference for natural prevention strategies

• long-term effects such as myths about autism or infertility

• speed of development (for the COVID-19 vaccines).

With the recent rise in access to information online, and the switch in trust to ‘new power’ sources such as influencers and peers, it would be imprudent to assume these concerns are founded in a lack of research.

Many individuals will have read extensively about these areas online, but they may be unfamiliar with how to ensure their sources are accurate and reliable.

Misinformation often targets common areas of insecurity, such as fertility and disability, to trigger an emotional response, which is more difficult to overcome than a knowledge gap. This is why it is essential to empathise with an individual’s concerns and to uncover the true reason for their hesitance.

Given the inherent complexities of this area, studies have examined the most effective communication strategies to support informed decisions about vaccination. Motivational interviewing techniques have been used to identify helpful strategies (Table 1).

Table 1. Helpful and unhelpful strategies; motivational interviewing recommends a ‘guiding style’.

Directing style – “this is what you should do”

Righting reflex – using information and persuasion to achieve change

Missing cues

Using jargon

Discrediting information source

Overstating vaccine safety

Confrontation

Guiding style – “may I help you?”

Care with body language

Eliciting concerns

Asking permission to discuss

Acknowledging/listening/ empathising

Determining readiness to change

Informing about benefits and risks

Giving or signposting to appropriate resources

In a clinical study, Leask et al. provides a framework for health and social care professionals that focuses on establishing rapport, encouraging questions and concerns, avoiding excessive persuasion and using good information sources, such as the University of Oxford’s Vaccine Knowledge Project. This framework is summarised in Table 2.

Table 2. Communicating about vaccines: a framework for health and social care professionals.

Ask questions to gain greater insight into the main concerns and listen to them.

Avoid giving a fact-filled lecture, simply giving more information is not effective.

Focus on the concerns raised and provide a limited number of main points in response, expressed simply.

Focus on the risk of the diseases. The public have little experience of diseases, and even with COVID-19, many people won’t have personal experience of the disease.

Evidence suggests that restating a myth serves to reinforce it. Instead identify a myth as being false and focus on the facts.

Acknowledge that we all want the best for our patients.

Do not belittle patients’ concerns.

If asked whether you have been vaccinated, it is important to confirm if you have.

This framework provides a useful reminder that focusing on the patient is key. Putting aside any preconceptions about why people may be hesitant about vaccines and retaining empathy for the individual concerns expressed are essential for effective interactions. Although a single interaction may not be enough to overcome a person’s concerns about vaccination, keeping the door open for them or booking a follow-up call can lead to vaccine acceptance later down the line.

The strategies outlined above align with those suggested by psychologists for conversations with people who believe in conspiracy theories. There is extensive research in this area, as the number of people looking for alternative explanations about the pandemic and other global challenges is increasing. People often believe misinformation and conspiracy theories because they are anxious about the reality of their circumstances or world events, such as politics and health. Misinformation uses simple and emotional narratives, which are easier to digest than complex (and often uncertain) scientific information.

Conversations with a friend or relative who believes misinformation theories should be approached with empathy rather than ridicule, regardless of how bizarre the theories appear. As with the vaccine conversations above, the first step is to listen to the individual concerns in a respectful manner, without being dismissive. It can be helpful to educate people on how to question and challenge the information they read online. The sceptical approach that is being applied to mainstream beliefs can be applied to all material, which encourages conversations around the plausibility of the theories.

Another method is to challenge the source of information and the tactics being used to convince people:

• Could the source have an ulterior motive, such as a financial or reputational incentive?

• Is the information presented in an unusual way, perhaps with lots of capital letters or exclamation marks?

• Is the person posing as an expert linked to a university or health organisation?

Many of these questions can be answered by searching reputable websites, such as those of universities and health institutions, where reliable information can be found.

There are also fact-checking websites, such as Full Fact and Snopes, which debunk common misinformation circulating online. These conversations are likely to be challenging and sometimes awkward but encouraging friends and family to be savvy when browsing online can have an impact, even if it takes many conversations.

When considering these challenges with vaccination and misinformation, it’s important to remember that vaccine uptake is generally high in the UK. Although acceptance is lower in some areas and communities, evidence suggests that most people do support vaccination. The largest UK survey of beliefs about vaccines during the COVID-19 pandemic showed that 80% of people would take a COVID-19 vaccine, with the most supportive being those over 70, the age group at highest risk of severe disease. An additional 14% were unsure, with only 6% saying they would not take a vaccine. A global survey on vaccine confidence also reported increased confidence between 2015 and 2019 in some European countries, including the UK.

One reason often cited for low vaccine uptake is complacency, due to low disease prevalence. This belief has fluctuated historically, with confidence rising following disease outbreaks and higher vaccine confidence in countries with high disease rates. On this basis, we would expect to see increased vaccine confidence following the current pandemic. Evidence of reduced virus transmission in Israel following a successful start to their vaccination programme has been widely reported, with the hope of boosting confidence in this effective public health tool.

There are many reasons to be hopeful, and with these communication strategies we are cautiously confident that vaccine acceptance will not be the limiting factor in controlling the pandemic

Our Look Who’s Talking feature is the perfect platform to have your say about the topics that matter most in health and social care. If you would like to get involved and chat to us, please get in touch at bsatoday@bluestreamacademy.com

Dr Tonia Thomas is a science communication expert with a background in pharmacology and physiology.

Since 2019, Tonia has specialised in vaccine communication as Vaccine Knowledge and Public Engagement Manager for Oxford Vaccine Group.

This role involves undertaking qualitative and quantitative research to understand attitudes to vaccination and clinical trials, and leading academic communication for the Oxford COVID-19 vaccine trials.