How can curiosity help address vaccine apathy and hesitancy?
In July this year, the Health and Social Care Committee published its report on vaccination as a response to decreasing vaccination rates across the country. It reflects on the need for the UK to maintain its position as a leader in vaccine innovation and delivery. NHS England now intends to set out an integrated vaccination strategy. The Committee advised that the strategy must:
1.Tackle practical challenges
2.Make the best use of all HCPs who can administer vaccination
3.Empower local leaders to address uptake in their own areas
4.Provide best practice on how trusted voices can communicate messaging
This last point cannot be about broadcasting messages. instead, we need a genuine dialogue led by empathy and informed by science.
Since the Covid-19 pandemic, there has been a concerning drop in immunisations for all age groups but is particularly worrisome among children.1 The reasons behind this drop in uptake are varied and complex. Misinformation surrounding vaccination has created confusion and concern among many about the safety and efficacy of vaccines; others have felt overwhelmed by both the sheer volume of information, causing them to take themselves out of the conversation. Vaccine hesitancy and apathy continue to be a challenge for governments, healthcare providers and vaccine manufacturers and an effective healthcare communications strategy needs to address both. Here, we will dig into vaccine hesitancy and apathy and what should be considered when developing a vaccination uptake strategy that speaks to the needs of these groups.
Vaccine hesitancy and vaccine apathy continue to play a significant role in individuals’ and families’ decisions surrounding vaccination and shape their intent to vaccinate. While vaccine hesitancy and vaccine apathy sound similar, they are separate beasts that require unique approaches. Vaccine hesitancy is characterised by a mindful, emotional and cognitive response to assessing the risks and benefits of vaccination.2 Vaccine apathy, on the other hand, is defined by disinterest and weak attitudes towards vaccination, with little time spent considering vaccination’s benefits or risks.2 Compared to their vaccine hesitant counterparts, those that are apathetic have not yet engaged enough with the topic to even be considered vaccine hesitant.2
We mustn’t confuse vaccine hesitancy and apathy with anti-vaxx attitudes. Anti-vaxx attitudes sit outside of these, primarily characterised by negative attitudes and opposition towards vaccines and vaccine mandates.
How did we get here?
While the recent COVID-19 pandemic fuelled the fire, vaccine hesitancy and apathy aren’t new. As far back as the 18th century with the first vaccination against smallpox, misinformation and hesitancy were common.3 Many were concerned over the pain associated with receiving the first iteration of vaccines, where a lancet was used to make small cuts in an individual’s arm and vaccine matter (in this case, pus from a cowpox pustule) spread on the wounds.3 This process led to opposition from some religious groups, who viewed the cutting of the skin and intentional introduction of foreign bodies as a violation of the body made in God’s image. 3 Others feared how the introduction of the cowpox virus could alter their appearance, a worry leveraged by others to discredit the effectiveness of vaccination and fear-monger individuals with images of an ‘Ox-Faced Boy’ and ‘Mange Girl’ featured in pamphlets against vaccination.3
Vaccine hesitancy and apathy have continued on long since the advent of the smallpox vaccination and the enactment of the 1853 Compulsory Vaccination Act. 3 The 1970s saw a rise in hesitancy and apathy regarding the MMR vaccination in Canada, where many parallels can be drawn with today’s current environment: changes in parenting styles and attitudes, popularisation of alternative medicine, and shifts in political mindset all fuelled changes in peoples’ perceptions of vaccination.4
Parenting styles that focused on parental rights and parental instinct started to grow in popularity in the 1960s, with many parents beginning to value their own instincts and belief over the advice of healthcare practitioners. 4 Many parents also started to regard measles as a right of passage for children, seeing it as a ‘benign childhood disease,’ fuelling parents’ questions as to what children would gain from vaccination. 4 Alongside this, there was a growing popularisation of alternative and natural medicine – even among health professionals. 4 Approaches to health shifted away from medicines and focused on diet and what one was consuming, with Dr Paul-Emile Chevrefils stating that “good health is based on eating organic food and rejecting pharmaceuticals.” 4 Measles outbreaks in the 1970s corresponded with a shift in mindset among the public of seeing personal health and health promotion as an individual responsibility as opposed to a collective one, with many rejecting public health initiatives and government recommendations or perceived interference.4
Vaccine hesitancy and apathy have continued to play a role in shaping decisions surrounding vaccination, with the Andrew Wakefield paper having led to a drop in MMR vaccine uptake.5 Wakefield’s discredited paper was published in The Lancet in 1998, using a press conference to reveal the paper’s findings and gaining significant coverage. Despite ten out of twelve of the authors of the paper discrediting Wakefield’s claims, it was too late, changing the media landscape for vaccines forever, requiring one anti-vaxxer for every pro-vaxxer interviewed or featured in a piece.6
Misinformation and information overwhelm have only been further compounded by the advent of social media, with recent research demonstrating social media’s role in shaping vaccine perceptions and intentions regarding COVID-19 vaccinations.7 As the way people consume information continues to evolve and shapes health decisions, adopting a communications strategy that is sensitive to these and addresses the mindsets and emotions of vaccine hesitant and vaccine apathetic groups will be integral to the success of future vaccination promotion campaigns.
What to consider when developing a vaccination promotion strategy
So, where does this leave us? A strategic health communications programme can play a significant role in addressing vaccine hesitancy and apathy – but it has to be done right. Because vaccine hesitancy and apathy are different matters, they require different approaches. Taking the time to understand your audience, adopting empathy as a driving force, and delivering the right messages in the right place are vital to a successful vaccination promotion campaign.
Get curious and lead with empathy
Engage empathy to learn more about your audience. What is their current mindset, what are their biggest concerns? What motivates them and improves their intention to vaccinate? Why might they feel the way they do? What and/or who is shaping their view? A healthy sense of curiosity from the start can help with understanding your audience and provide a robust backdrop from which you can develop a campaign.
From the very beginning, treat empathy and compassion for your audience as motivating factors of the campaign. While as healthcare communicators and healthcare professionals we might not agree with their stance, we must start by acknowledging that these perceptions are rooted in legitimate concerns, experiences, and emotions.
The perceptions of those experiencing vaccine hesitancy might be shaped by misinformation, wider attitudes and beliefs, or previous experiences, or they may be based on the feelings and emotions that arise when discussing vaccination or as a response to vaccination messages themselves.8 For those experiencing vaccine apathy, their disinterest and lack of concern may be a result of information overwhelm, news burnout, or simply not seeing vaccination as a priority when compared to the other responsibilities and pressures in their life.
Decision-making around vaccines is not only done through a rational, analytical process, but is also rooted in one’s emotional response to the information – which, while it might not seem rational or consistent with the content of the message, should still be treated as valid.8
Meet them where they are – literally and figuratively
When trying to reach vaccine apathetic populations, the key is to minimise friction in how they access messages. Find ways to meet them where they are by executing a campaign in places that they visit regularly, whether out in the world or online. We should not assume that digital channels are always the answer; particularly given the profiles or those people who are more likely to miss opportunities for vaccination. For those experiencing vaccine apathy, engaging with the message need to require low-involvement and low-effort, getting the point across in a way that’s quick to digest while still delivering the information it needs to.
For those experiencing vaccine hesitancy, meet them where they are mentally and emotionally. While it’s important that the messages are displayed where they can see them without needing to search for them, it’s important to understand that those who are vaccine hesitant may desire more information to ease their concerns and anxiety. Vaccination campaigns should consider how they can provide detailed information on vaccine safety, efficacy, and side effects.
When it comes to evidence, it’s not one size fits all. What people consider counting as evidence and who they view as trustworthy sources will vary. 8 Those who are vaccine hesitant may value the message being delivered by a health care professional, especially one they feel a connection to, or valuing information from someone who shares similar life experiences as them, such as information about vaccination being delivered by a parent to another parent. On the other hand, vaccine apathetic audiences may prefer vaccination promotion messages to be delivered by a familiar face, such as a healthcare professional with a public profile, a celebrity or an influencer they follow, caring less about medical expertise.2,8
Sending the right message
We’ve all heard it before: it’s not just what you say, but how you say it. When devising your vaccination promotion strategy, it is important to be sensitive to the complex ways that people process information and what they value in the communication. While quick, punchy messages may be enough to motivate those with vaccine apathy, those who are vaccine hesitant may want to engage on a deeper level, valuing a more conversational style of communication.
When it comes to vaccination uptake strategies, it’s not one-size-fits all. Taking the time to understand your audience upfront and developing multi-faceted programmes to engage vaccine hesitant and apathetic groups will be key for the success of any vaccination campaign.
The team at Curious Health has worked on vaccination programmes since the days of the Andrew Wakefield paper. We have over two decades worth of experience of patient activation, HCP education, launch programmes and issues management.
If you’d like to chat to us about how Curious Health can help you to create a vaccination communications programme that hits the mark, email us at email@example.com
 Statistics published for all routine childhood vaccinations in England in 2021-22: statistical press release – NDRS, 2022. NDRS. Available at: https://digital.nhs.uk/news/2022/childhood-vaccinations-2021-22. Last Accessed: June 2023.
 Wood, S., Schulman, K., 2021. When Vaccine Apathy, Not Hesitancy, Drives Vaccine Disinterest. JAMA 325, 2435. Available at: doi.10.1001/jama.2021.7707. Last accessed: June 2023.
 Complacency, Convenience, Confidence: The History of Vaccine Hesitancy – Science Museum Blog, 2021. Science Museum Blog. Available at: https://blog.sciencemuseum.org.uk/complacency-convenience-confidence-the-history-of-vaccine-hesitanc. Last Accessed: June 2023.
 MacDougall, H., Monnais, L., 2018. Vaccinating in the age of apathy: measles vaccination in Canada, 1963–1998. Canadian Medical Association Journal 190, E399–E401. Available at: https://doi.org/10.1503/cmaj.171238. Last Accessed: June 2023.
 Dowden, A., 2019. Tackling the declining uptake of childhood vaccinations. Prescriber 30, 34–37. Available at: https://doi.org/10.1002/psb.1763. Last Accessed: June 2023.
 Science Media Centre, 2002. MMR: Learning Lessons, Science Media Centre. Science Media Centre, London, United Kingdom. Available at: https://www.sciencemediacentre.org/wp-content/uploads/2012/09/Science-Media-Centre-MMR-report.pdf. Last Accessed: June 2023.
 Zhang, Q., Zhang, R., Wu, W., Liu, Y., Zhou, Y., 2023. Impact of social media news on COVID-19 vaccine hesitancy and vaccination behavior. Telematics and Informatics 80, 101983.
 Parrish-Sprowl, J., 2018. Vaccine hesitancy communication: What counts as evidence. Vaccine 36, 6529–6530.