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Understanding the psychology of vaccine hesitancy could help to change minds

“I do not understand why people would not get vaccinated?”. “It is not socially responsible to stay unvaccinated when one is eligible to do so”. “Why don’t they see what the scientific data shows?”

Differentiated treatment for unvaccinated individuals may not convince them to consider getting vaccinated, says the author.

Differentiated treatment for unvaccinated individuals may not convince them to consider getting vaccinated, says the author.

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“I do not understand why people would not get vaccinated?”. “It is not socially responsible to stay unvaccinated when one is eligible to do so”. “Why don’t they see what the scientific data shows?”

Admittedly, I have made such remarks when I think about the unwillingness of some Singaporeans to get vaccinated against the highly transmissible coronavirus.

However, my training as a psychologist puts a halt on my tendency to berate those who see coronavirus vaccination differently from me.

Embracing a diversity of perspectives in a non-judgmental manner is a key skill that has proven beneficial in my personal and professional life. Hence, I quickly remind myself that there is more to it than what meets the eye.

In Singapore, about 6 per cent of those eligible for the vaccination have not received their jabs.

Vaccine hesitancy may have its roots in many factors. These include misinformation, the influence of family decision-makers, adverse vaccine history, access to anti-vaccination campaigns, concerns about potential side-effects, fear of the unknown and conspiracy theories about the mRNA vaccines.

But there are other less obvious psychological underpinnings that explain the phenomena.

First, people value autonomy and prefer to do things of their own volition and choice rather than due to an imposition of any sort.

Strong directives to get vaccinated, notwithstanding the importance of doing so, may ironically harden their resolve for autonomy and be perceived as an attempt to curtail their freedom to choose.

So differentiated treatment for unvaccinated individuals may achieve little in convincing people to consider getting vaccinated.

Secondly, another line of research from social psychology shows a human tendency to stay committed to our beliefs despite contrary evidence.

People find it easy to dismiss evidence that requires them to rethink their entrenched views on a topic or come out of their comfort zone, a tendency popularly known as confirmation bias in psychological literature.

For example, there is clear evidence to show that cigarette smoking is injurious to health. Yet despite warnings about how it may cause lung cancer, people continue to smoke. They divert their attention away from facts that challenge their beliefs.

Similarly, it is not surprising that even in the presence of scientific evidence that shows how vaccines mitigate the danger of the coronavirus, many people who have preconceived anti-vaccine notions and attitudes, continue to hold on to their ideas.

Further, evidence from persuasion literature shows that people respond better to "soft" influence tactics rather than "hard" influence tactics.

This seems quite intuitive as the use of pressure and power tends to leave us feeling defensive and uncared for.

For example, consider the statements: “If you continue to remain unvaccinated, I’m not sure if I can continue to meet you that frequently” versus “I’ve always seen you caring so much about your family, would you consider learning more about the vaccine to see if it can benefit them?”

The former message is clearly more aggressive than the latter.

Another point to consider is that studies in psychology have shown that people actually have an inclination to want to appear consistent in their behaviour.

It is possible that vaccine hesitators feel this cognitive dissonance when they embrace medical science in other spheres such as seeking treatment for a life-threatening disease but dismiss it when it comes to vaccination.

The same goes for them showing support for other precautionary measures such as wearing masks, adhering to social distancing or undertaking frequent testing to check for infection, but still rejecting vaccination.

There is a natural human inclination to address the psychological discomfort and appear consistent either by changing the attitude or the behaviour in question.

As a psychologist, I can vouch for the human capacity for mindset and behavioural change.

Here, I would like to propose four strategies that can help us break through deep psychological bases of vaccine hesitancy.

The first step is to recognise and accept the existence of socio-cultural and psychological barriers to vaccination instead of passing judgement on those who choose to be unvaccinated.

This notion of expanding one’s knowledge on a particular issue as a precursor to doing something about it, is beautifully captured in Maya Angelou’s famous quote: “Do the best you can until you know better. Then when you know better, do better.”

Next (once we know better), we can do better by determining how communication about vaccine acceptance can be tailor-made for greater effectiveness.

Instilling autonomy and a sense of agency might reduce reactance and increase personal relevance.  For example, posing questions (“How would you feel if your loved ones got infected?”) rather than directives (“Get vaccinated as it’s the morally right thing to do”) might encourage people to rethink their existing views.

Thirdly, soft tactics that employ a consultative approach as opposed to use of pressure and power may help to increase effectiveness of vaccination appeals.

Inviting the person to share his or her reservations and opinions and active listening (“I’m really keen to understand your opinion about Covid-19 vaccines”) may unlock some of the resistance that accompanies forceful attempts (“Get vaccinated or be prepared to face the differentiated treatment”) to get someone out of their predisposition.

Last but not least, creating awareness of the mismatch between professed attitudes and their behaviour and showing practical ways to get rid of this psychological dissonance that comes with it, can compel individuals to "walk the talk".

For example, gentle reminders (“vaccination is an important part of our fight against Covid”, “You have trusted medical science before…”) can help to kindle a move towards the desired behaviour.

Dr Jennifer F. Kelly, American Psychological Association President, has enthusiastically proclaimed the need for the psychological community in any country to come forward and help break down the barriers to vaccine uptake.

I reckon that her belief is grounded in the people skills psychologists deem to possess, such as empathy, patience and compassion backed by a strong scientific background.

However, these qualities are not privy only to psychologists. The trusted next-door neighbour, family doctor, aunty at the hawker centre, friends and relatives may be equally adept at spreading the message of vaccine uptake in a socially sensitive and non-discriminatory manner.

Therefore, here is my call to action. Fighting vaccine hesitancy and communicating credible information is not the sole responsibility of the Government.

As citizens, we can play our role to support government efforts in making Singapore a safe place to live, work and enjoy.

The above-mentioned strategies are well suited to different types of interpersonal contexts between friends, colleagues, family members and relatives.

Know anyone who has chosen to remain unvaccinated? Want to try changing their mind?

My advice would be to take the path of gentle prodding, sans judgement and with nudges backed by scientific evidence to show how the number of deaths and the hospitalisation rate are markedly low for fully vaccinated individuals.

I dare say it will not be easy, but if there is anything that this pandemic has taught us, it is the ability to face challenges and difficulties head-on.



Dr Tania Nagpaul is a senior lecturer at the S R Nathan School of Human Development, Singapore University of Social Sciences. Her research interests include self-determination theory, occupational well-being, social issues surrounding food insecurity, youth-at-risk, migrant workers and mixed methods research.

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Covid-19 coronavirus vaccine vaccination conspiracy unvaccinated psychology

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