The Psychology of Vaccine Hesitancy

One of the most negative components of how the pandemic has been managed has to do with psychological factors. From the impact of the initial lockdown to pandemic fatigue, the role of behaviors and beliefs in following mitigating measures (e.g., wearing a face mask, social distancing, hand washing), and now getting vaccinated, all have a major impact on ending the pandemic and saving lives.

A few months ago, my wife and I joined a WhatsApp group created by our former high-school classmates as we are approaching our 50th graduation anniversary. We enjoyed seeing pictures of their children and grandchildren, their gardens and homes, and stories of old. However, we were not prepared to see the intense reaction of many regarding the pandemic and now the vaccines: “COVID is a hoax”; “This is a maneuver from those in power to control the people”; “The vaccines are dangerous”; “If you get vaccinated you are a guinea pig”; “Trust the natural remedies instead”; “Where do you place your trust? Aren’t you supposed to trust God?” 

These are all graduates of an Adventist school, and all the quotations above are from currently active members of the Adventist Church. Among the skeptics are a couple of physicians and a handful of nurses, including one who had oversight of vaccination programs in a large city. A brief and excellent video explanation of the COVID vaccines by a committed Adventist professor and expert from Loma Linda University (LLU) was summarily dismissed. My wife, a professor in the School of Medicine at LLU, is remembered by our classmates as an excellent student. She kindly provided some additional information but was told that she was “misinformed.”

I do not know how prevalent this sentiment is among members of the church and the surrounding community where you live. Still, most of us would agree that getting vaccinated is critical to turning the tide of the pandemic, as well as protecting lives. We just lost our sister-in-law to COVID before she was able to get vaccinated. “Vaccine hesitancy” is how researchers are describing this phenomenon. The situation and arguments surrounding COVID are mostly unique to this virus. Still, the behavior and beliefs about vaccination are not radically different from those used in the past on other medical conditions.

How are we to understand vaccine hesitancy? Might the church play a constructive role with its members and the surrounding communities in decreasing the suspicion and even countering the misinformation?

Beliefs, Behaviors, and Vaccine Hesitancy

There is nothing new about people being hesitant about medical treatments and vaccines. The pandemic, however, has made it imperative that most of us get vaccinated to achieve herd immunity. 

Vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite the availability of vaccination services. Research suggests five main individual-level determinants of vaccine hesitancy: confidence, complacency, convenience (or constraints), risk calculation, and collective responsibility. 

Confidence denotes trust in the effectiveness and safety of vaccines. Complacency is said to occur when perceived risks of vaccine-preventable diseases are low, and vaccination is not considered necessary (e.g., “COVID only affects a very small percentage of the population”). Constraints denote barriers to accessing vaccination. Risk calculation indicates a deliberate comparison of the risks of infection and vaccination, from which to derive a decision (“Nobody knows if the vaccine provides true protection over time”). Collective responsibility refers to the willingness to protect others by one’s own vaccination, and unwillingness means avoiding that responsibility (“I’ll let others get vaccinated to achieve herd immunity”).¹

You can see the salience of beliefs and behaviors for each one of these drivers of vaccine hesitancy. Let me highlight the role of confidence or trust. A recent study in the United Kingdom highlights the role of confidence in the information for those accepting the vaccine and those who are hesitant about it: “Those resistant to a COVID-19 vaccine were less likely to obtain information about the pandemic from traditional and authoritative sources and had similar levels of mistrust in these sources compared to vaccine accepting respondents.”²

Paying attention to the role of emotions is essential. Psychologist and public health scientist Perry Halkitis put it this way: “Emotions and psychosocial conditions too often usurp logic and reason, which fuel in turn disease.… Experts tend to overlook medical mistrust, fear/avoidance, and stigma.”³ In fact, we are talking about very distinct areas of the brain that process rational information and emotion-based reactions. Emotions, then, more than logic, drive misinformation, disinformation, and conspiracy theories about the vaccine.

Misinformation, Disinformation, and Conspiracy Theories

Disinformation, which is strategically and deliberately spread false information; misinformation, which is false information, not necessarily shared with intent to mislead; and mistrust, which denotes more than the lack of trust but suspicion of ill intent, commonly referred to as “conspiracy theories” — these fuel fear, promote avoidance, and become the “rationale” to be hesitant about the vaccination process. Conspiracy beliefs are “attempts to explain the ultimate cause of an event … as a secret plot by a covert alliance of powerful individuals or organizations, rather than as an overt activity or natural occurrence. It can be difficult to persuasively present evidence to refute these types of ideas, especially because experts are often seen as part of the conspiracy, and new pieces of contrary evidence can be rationalized into an existing narrative.”⁴

Our former classmates engaged in misinformation (e.g., “Nobody knows how the vaccine affects your genes”) and echoing conspiracy theories (e.g., “Pharmaceutical companies are out to just make money instead of promoting natural remedies”). You can see why our Loma Linda colleague’s explanation and even my wife’s points were dismissed. Both aimed at the part of the brain that deals with reason, while our classmates were processing their understanding with the part of the brain that deals with emotions.

Could the Church Help?

Could the church help in addressing vaccination hesitancy, misinformation, and even addressing conspiracy beliefs? In fact, the organized church and members are already helping by providing written statements and information pieces, disseminating accurate information, and providing vaccination sites. Could the church help by more directly addressing the fears/avoidance of vaccine hesitation? I believe we could.

Let me share a few ways this could be done based on some of my work with a non-Adventist faith community, understanding that not all the issues can be discussed here.

1. Frame the message, keeping in mind that your message will not be effective unless you deal with emotions. What might generate trust? Engage trusted messengers. My wife was able to persuade a few because they know who she is. Trusted messengers are not only scientists. Often scientists use too much jargon and, at worst, are perceived as co-conspirators. People in your community who survived COVID may bear witness to the real threat posed by the virus, or those who lost a loved one to COVID may appeal in very personal ways.

2. Lead by example: Post pictures on social media of church leaders from all ethnic groups in your community taking the vaccine. Open your church to be a vaccination site, especially if located in a poor part of your community. Videotape an interview with members who have been vaccinated. Do an interview with a medical professional if one is available. A dialogue makes it more accessible; in it, speak candidly about the concerns you know exist in your community.

3. Lead by the word: Use the pulpit to speak about the importance of getting vaccinated, framing it as an expression of caring for others as part of our Christian duty to protect the community. Frame the message in the context of the church’s theology of health. As Adventists, we have a distinct advantage: we are pro-faith, pro-natural remedies, and pro-medical care, especially when it is preventive. We believe in one and the other. Anchor it in our understanding of human beings as bio-psycho-social-spiritual beings; thus, all of the above applies to wholeness (including vaccines). Although you may personally believe that conspiracy theories are outrageous, avoid terms such as “conspiracy beliefs.” Also, speak and address the fears. Here are some of the fears/beliefs present in the faith community I consulted with: “Getting the vaccine shows a lack of faith in God’s protection and power.” “I trust in natural and spiritual remedies.” “I am young and healthy.” “I don’t trust science, I only trust the Word of God.” “I don’t trust the government.” The preaching may affirm the role of faith, God’s power, and God’s consistent choice to empower human beings to be His hands in the ministry of healing.

4. Be courageous and realistic: Talking about these issues can result in intense reactions. Remember that emotions usurp logic and reason. Be courageous, and keep in mind that you will not be able to “win them all.” Just aim at moving the needle in the right direction.

Ten years ago, it was my privilege to organize a conference dealing with the church and mental health. A psychiatrist and public health leader from the World Health Organization came to Loma Linda University to participate. We became friends, andhe told me what impressed him the most. First, he met Adventists from every continent. Second, he learned that we take health seriously and make it part of our spiritual beliefs. Third, he saw the network of local churches, schools, and medical facilities in communities around the world. A man of vision and expertise in community health, he wondered about the powerful reach of a church that could activate the synergy of her churches, schools, and hospitals, moved by religious convictions to improve the health of those in need.

Imagine if we could do that to help put an end to the pandemic. Imagine if church members could activate this health-saving message in the community! We would be making Ellen G. White’s vision a reality. We would be living out the healing ministry of Jesus.

Carlos Fayard is an associate professor of psychiatry at Loma Linda University in Loma Linda, California, United States, director of the WHO Collaborating Centre for Training and Community Mental Health, and the author of Christian Principles for the Practice of Counseling and Psychotherapy (WestBow Press, 2017).

__________________________

1. C. S. Wiysonge et al., “Vaccine Hesitancy in the Era of COVID-19: Could Lessons from the Past Help in Divining the Future?” Human Vaccines & Immunotherapeutics (2021), 1. DOI: 10.1080/21645515.2021.1893062

2.  J. Murphy et al., “Psychological Characteristics Associated with COVID-19 Vaccine Hesitancy and Resistance in Ireland and the United Kingdom,” Nature Communications 12 (2021), 1292. DOI: 10.1038/s41467-020-20226-9

3. P. Halkitis, “A New Public Health Psychology to Mend the Chasm Between Public Health and Clinical Care,” American Psychologist 75, no. 9, 1289-1296. DOI: 10.1037/amp0000743

4. J. Jaiswal, C. LoSchiavo, and D. C. Perlman, “Disinformation, Misinformation and Inequality-Driven Mistrust in the Time of COVID-19: Lessons Unlearned from AIDS Denialism,” AIDS Behavior 24, no. 10 (2020): 2776-2780. DOI: 10.1007/s10461-020-02925-y