COVID-19 Vaccination and Mitigation Behavior Promotion through Peer Modeling of Refutation of Reasons for Hesitancy, Reluctance, and Refusal

Effective public communication for promoting behaviors such as vaccination, mask-wearing, social distancing, and other behaviors to mitigate the COVID-19 pandemic in the U.S. requires more than recommendations, which have modest effects but far from the impact required to stem the spread of this disease (Goldberg, et al., 2020 ).

Behaviors such as vaccination, wearing protective masks, and social distancing have become entangled in political and cultural disputes (Flaskerud, 2020). While being male, of younger age, and less educated have traditionally been factors that delay adoption of innovations in public health behavior, political partisanship, distrust of government, and associated misinformation have greatly heightened the challenge of promoting behaviors that protect communities against this new viral infection. “Conspiracy theories” and information from YouTube videos by bogus experts, as well as stories in “alternative” news media, are notable impediments to the promotion of healthy public responses to the pandemic (Romer & Jamieson, 2020), and their emergence and spread in the population has been tied to both powerful public figures and diverse sources of “fake news” that disseminate disinformation broadly via social media such as Facebook, Twitter and YouTube (van Mulukun, et al., 2020; Sanders, et al., 2020).

According to data presented by Romer & Jamieson (2020) 15-20% of the adult population in the U.S. ascribe with certainty to beliefs such as COVID-19 being a secret Chinese weapon that was either purposely or accidentally released, that news media deliberately exaggerate virus threat to harm the current U.S. President, that Bill Gates is creating a tracking device that will be included in vaccinations, that sinister forces are promulgating the virus in a deliberate effort to selectively decrease unwanted population groups, and/or that the government is seeking to control public behaviors and limit individual freedom in small ways in order to prepare the public for more direct and coercive government control in the future. New conspiracy theories are continuing to emerge (Lynas, 2020) and severely hampering public health authorities’ efforts to promote behaviors to slow or halt the pandemic.

Misinformation concerning covert and powerful malign forces can be reassuring for many people in that it can reduce distress by providing the illusion that the COVID-19 pandemic is controlled by malign individuals and groups and not the out-of-control spread of a deadly but mindless virus that infects populations as easily as it is allowed to. Sophisticated social and behavioral science concepts are urgently in need of an application in public communication aimed at controlling the pandemic (VanBavel, et al., 2020).

Rather than ignoring misinformation, public health communicators are being urged to consider a technique from the social sciences known as “psychological inoculation,” which refers to the direct presentation of misinformation and refutation of it (Van deLinden, 2020). This can prepare audiences to resist misinformation when they encounter it and persuade some who hold erroneous beliefs to revise them. Another potentially useful way of promoting reconsideration of firmly held misinformation is a technique known as “behavioral journalism” (McAlister, 2017), in which communicators find real people who have changed their minds and behaviors and present their stories in a way that can help others to make similar changes.

Based on this analysis, Foundry512 proposes that public health communicators develop a science-based strategy for COVID-19 communication campaign with these three central features: 

1. Destigmatizing belief in fake news and conspiracy theories and explicitly recognizing that to cling to these beliefs is natural and comforting but illusive. 
2. Directly communicating about many diverse forms of fake news and conspiracy theorization while providing evidence and counter-arguments to refute them explicitly. 
3. Telling stories about real people who fit the profiles of audiences most resistant to COVID-19 mitigation behaviors, but who have had learning experiences, insights, countering influences, or for other reasons have come to reject previously held misinformation and are presently behaving in ways that can mitigate the pandemic.

The core content should be many “peer model” videos edited into a length suitable for television spots or digital ads (video, social, rich media, etc.), with longer versions of 2-3 minutes containing the model’s entire “story” about how they initially felt about vaccination, what led them to change their mind, the things they said to themselves during that process, and finally clearly stating their intentions to get vaccinated or that they have already gotten their vaccinations. The peer models should speak to the camera in medium close up, giving their responses to prompts such as, “When you first thought about getting the shots, what were you thinking?” or “Explain why you felt reluctant or wanted to refuse or avoid getting the shots?” Then they would respond to prompts such as “What made you change your mind?” or “How did you decide to go ahead and get the vaccination anyway” Tell us what your thought processes were.” The videos will end with the peer model responding to prompts like, “So when and where will (or did) you get your vaccination?” and “How did you feel after you got the shots?”

The types of peer models should include health care workers, older adults fitting priority populations for vaccination, essential or frontline workers, teachers, and other groups selected in consultation with our partnering public health agencies. They should, of course, include men and women, African-Americans, Latinos, Caucasians, and Asian-Americans, each group refuting misinformation causing reluctance among their group. They should include liberals, moderates, conservatives, and radical conservatives representing high, moderate, and low levels of education and income.

The types of misinformation and others identified in concert with public health partners that should be addressed include:

1. Fear of harm from vaccination (causing infection, allergic reactions, side effects, flu-like symptoms, etc.).
2. Concerns about governmental control (“Big Brother”) and loss of independence in decision-making.
3. The belief that the virus is a hoax or that its dangers are greatly exaggerated in an effort to make certain political or cultural groups appear bad or make people fearful and easy to control.
4. Specific “conspiracy theory” beliefs such as that Bill Gates or others want to implant microchip tracking devices, or that the vaccination will serve other malign purposes of covert forces.

Depending on resources available each peer model can be distributed in many ways, including email to specific audience groups at health care organizations, Facebook or other social media advertisements, broadcast television and radio spots, and other channels of distribution identified after discussions with our public health partners.

Sources

• Flaskerud, J. Masks, politics, culture & health, Issues in Mental Health Nursing, 41(9), 846-849, 2020
• Goldberg, M., et al. Mask wearing increased after a governmental recommendation, Frontiers in Communication, 2020.
• Lynas, M. COVID top 10 current conspiracy theories, Cornell Alliance for Science, 2020
• McAlister, A. Behavioral journalism in health and risk messaging, Oxford Research Encyclopedia on Communication, 2017.
• Van Bavel JJ, et al., Using social and behavioural science to support COVID-19 pandemic response, Nature Human Behavior, 2020.
• Van deLinden S, et al., Psychological inoculation against fake news about COVID-19, Frontiers in Psychology, October 2020.
• Van Mulukum, V et al., Antecedents and consequences of COVID-19 conspiracy theories. Psyarxiv 2020
• Romer D & Jamieson K, Conspiracy theories as barriers to controlling the spread of COVID-19 in the U.S., Social Science & Medicine, 2020.
• Sanders, A, et al., Unmasking the conversation on masks, medRxiv, 2020

For more resources, download our official Covid-19 White Paper on Resistance Refusal Conversion Communications, “Achieving Herd Immunity with the Covid-19 Vaccine in the Era of Distrust.“ To implement a Covid-19 Vaccine communications campaign, start a conversation with a subject matter expert.

This article was co-authored by Dr. Alfred McAlister, Ph.D. Behavioral Sciences.

Foundry512 is a full-service advertising agency located in Austin, TX. Since 2008, F512 has worked with public health organizations and healthcare brands on communications, digital, and experiential campaigns that have been published and featured in journals like BMJ. Foundry512 builds and scales deep relationships that help brands and organizations motivate behavioral change.