- researchers craft messages of guilt, shame to foster vaccine compliance

There’s an entire field of research dedicated to developing messaging designed to persuade “vaccine-hesitant” individuals to get the COVID-19 vaccine — and none of it has anything to do with facts.

By Ann Tomoko Rosen

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There’s an entire field of research dedicated to developing messaging designed to persuade “vaccine-hesitant” individuals to get the COVID-19 vaccine.

None of the messaging examined by researchers involves conveying factual evidence that supports the claims — widely disseminated by Big Pharma, Big Media and public health agencies — that the vaccines are “safe” and “effective.”

Researchers last month published the results of a clinical trial involving two survey experiments on how to manufacture consent for COVID vaccines.

The Yale-sponsored study, “Persuasive messaging to increase COVID-19 vaccine uptake intentions,” examined how different persuasive messages affected 1) intentions to receive a COVID-19 vaccine, 2) willingness to persuade friends and relatives to get the vaccine, 3) fear of those who have not been vaccinated, and 4) social judgment of people who choose not to vaccinate.

According to the study’s authors:

“Given the considerable amount of skepticism about the safety and efficacy of a COVID-19 vaccine, it has become increasingly important to understand how public health communication can play a role in increasing COVID-19 vaccine uptake.”

The paper did not address the underlying reasons someone might have concerns about the safety or efficacy of COVID vaccines but focused instead exclusively on how to persuade them to get the vaccine.

 

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From the paper:

“We conducted two pre-registered experiments to study how different persuasive messages affect intentions to receive a COVID-19 vaccine, willingness to persuade friends and relatives to receive one, and negative judgments of people who choose not to vaccinate.

“In the first experiment, we tested the efficacy of a large number of messages against an untreated control condition … In Experiment 2, we retested the most effective messages from Experiment 1 on a nationally representative sample of American adults.”

The messages tested by the researchers have been woven into mainstream media narratives and public health campaigns throughout the world. But the study completion date for part 1 was July 8, 2020, which means all of these messages were created prior to the release of any science to support them.

The baseline information control message states:

“To end the COVID-19 outbreak, it is important for people to get vaccinated against COVID-19 whenever a vaccine becomes available. Getting the COVID-19 vaccine means you are much less likely to get COVID-19 or spread it to others. Vaccines are safe and widely used to prevent diseases and vaccines are estimated to save millions of lives every year.”

In order to establish which messaging strategies elicited an inclination to get vaccinated, 10 additional messages were added to bring context to the baseline message.

These messages incorporated themes of self-interest, community interest, guilt, embarrassment, anger, bravery, trust in science, personal freedom, economic freedom and community economic benefit.

“We find that persuasive messaging that invokes prosocial vaccination and social image concerns is effective at increasing intended uptake and also the willingness to persuade others and judgments of non-vaccinators,” the researchers wrote.

To study the impacts of guilt, embarrassment and anger, researchers prompted people to think about how they would feel if they did not get vaccinated and then spread the virus to others.

“Emotions are thought to play a role in cooperation, either by motivating an individual to take an action because of a feeling that they experience or restraining them from taking an action because of the emotional response it would provoke in others.”

The “not brave” and “trust in sciences” messages were designed to evoke concerns about reputation and social image. The “not brave” message “reframed the idea that being unafraid of the virus is not a brave action, but instead selfish, and that the way to demonstrate bravery is by getting vaccinated because it shows strength and concern for others.”

The “trust in science” message suggested, “those who do not get vaccinated do not understand science and signal this ignorance to others.”

Personal freedom, economic freedom and community economic benefit messages drew on concerns linked to COVID restrictions.

Overall, it was a message that appealed to community interest, reciprocity and a sense of embarrassment that proved most persuasive, resulting in a 30% increase in intention to vaccinate, a 24% increase in willingness to advise a friend to get vaccinated and a 38% increase in negative opinions of people who decline the vaccines relative to the placebo message.

Community interest messages that incorporate embarrassment were determined to be most effective in getting people to encourage others to get the vaccine, while “not brave” messaging showed the most promise in creating negative judgments of non-vaccinators.

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The Yale study findings are consistent with another recent paper, “Vaccination as a Social Contract,” which demonstrated people view vaccination as a social contract and are less willing to cooperate with those who refuse vaccination.

The study stated:

“The experiments consistently showed that especially compliant (i.e., vaccinated) individuals showed less generosity toward nonvaccinated individuals … It is concluded that vaccination is a social contract in which cooperation is the morally right choice.

“Individuals act upon the social contract, and more so the stronger they perceive it as a moral obligation. Emphasizing the social contract could be a promising intervention to increase vaccine uptake, prevent free riding, and, eventually, support the elimination of infectious diseases.”

Forget the facts, appeal to ‘values’

Saad Omer, one of the authors of the Yale study, has an extensive interest in public health messaging.

His efforts to combat vaccine hesitancy earned him a spot on the World Health Organization’s (WHO) Strategic Advisory Group of Experts working Group on COVID-19 Vaccines, the Sabine Vaccine Institute’s Board of Trustees and the WHO’s Global Advisory Committee on Vaccine Safety.

In 2020, Omer initiated a “Building Vaccine Confidence Through Tailored Messaging Campaigns” project involving randomized trials in five countries using social media messaging to increase COVID and childhood vaccine coverage.

In his keynote address at the first WHO Global Infodemiology Conference in June 2020, Omer referenced “moral foundation theory” and suggested appealing to values could change decision-making behaviors.

Omer provided details about a messaging study for the HPV vaccine and discussed how similar strategies could be applied to create compliance for COVID measures:

“We wanted to test out, can we have a purity-based message? So we showed them pictures of genital warts and described a vignette, a narrative, a story, talking about how someone got genital warts and how disgusting they were and how pure vaccines are that sort of restore the sanctity of the body.

“So we just analyzed these data. This was a randomized control trial with apriori outcomes. We found approximately 20 percentage point effect on people’s likelihood of getting an HPV vaccine in the next 6 months …

“We are trying out liberty-based messages or liberty-mediated messaging around this behavior related to COVID-19 outbreak. That wearing a mask or taking precautions eventually make you free, regain your autonomy. Because if the disease rates are low, your activities can resume.”

The ‘science’ of infodemiology, infoveillance and infodemic

Omer is one of many prominent voices in what is known as the field of “infodemiology,” a term coined in 2002 by Dr. Gunter Eysenbach.

As the first infodemiologist and founder of the Journal of Medical Internet Research, Eysenbach defines infodemiology as ”the science of distribution and determinants of information in an electronic medium, specifically the Internet, or in a population, with the ultimate aim to inform public health and public policy.”

Eysenbach also coined the terms “infoveillance,” defined as “a type of syndromic surveillance that specifically utilizes information found online,” and “infodemic,” which refers to “an overabundance of information” that generally includes deliberate attempts to disseminate wrong information to undermine the public health response and advance alternative agendas of groups or individuals.”

Using just three words, Eysenbach created a scientific niche, identified a problem and proposed at least part of a so-called solution.

The WHO readily embraced this language during the pandemic. An editorial in the August 2020 issue of The Lancet began with a quote from WHO Director-General Tedros Adhanom Ghebreyesus: “We’re not just fighting a pandemic; we’re fighting an infodemic.”

The WHO hosted several infodemiology conferences throughout the pandemic. Asserting that “misinformation costs lives,” the WHO, the United Nations and other groups created the perfect justification for social media surveillance and the suppression of dissent.

In 2020, the WHO created a resolution asking member states to take measures to leverage digital technologies to counter “misinformation” and “disinformation” and worked with more than 50 digital companies and social media platforms, including TikTok and even Tinder, to support these efforts.

The efforts to eliminate “misinformation” resulted in unprecedented censorship of virtually anything that steps outside of state-sanctioned consensus and the creation of a captive audience primed to accept a singular narrative.

A National Defense Authorization Act amendment in 2012 that legalized the use of propaganda on the American public makes it easier for governments to create self-serving narratives.

And thanks to a multi-billion dollar budget from the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC), we are under the influence of the best messages money can buy — whether or not those messages are true.

This is likely why the CDC, public health departments and mainstream media can make broad assertions like this: “COVID-19 vaccines were developed quickly while maintaining the highest safety standard possible,” and this: “Hydroxychloroquine shouldn’t be used to treat COVID-19,” and claim they are “fact.”

Articles and posts that challenge those assertions are regularly removed if they’re even permitted to be published in the first place.

 

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Public health compliance: A cottage industry

Yale is not the only university researching the science of compliance. Academic institutions and government agencies throughout the world are immersed in this emerging behavioral science.

In February 2021, the University of Pennsylvania newsletter, Penn Today, published, “When the Message Matters, Use Science to Craft It,” covering behavioral scientist Jessica Fishman’s Message Effects Lab (MEL) initiative and research related to “what sways decision-making,” particularly with regard to COVID vaccination and testing.

MEL currently has partnerships and ongoing projects with the World Bank, the National Institutes of Health, the CDC, Penn Medicine, The Children’s Hospital of Philadelphia, Independence Blue Cross/Blue Shield and the Government of Canada to address health-related behaviors.

The Agency for Healthcare Research and Quality, a branch of HHS, also sponsored research to explore influences on COVID vaccine decision-making. The study, “Attitudes Toward a Potential SARS-CoV-2 Vaccine: A Survey of U.S. Adults,” concluded:

“We found that a substantial proportion (42.2%) of participants in a national survey conducted during the coronavirus pandemic would be hesitant to accept vaccination against COVID-19. Black race was one of the strongest independent predictors of not accepting vaccination; this is especially alarming, given the outsized impact of COVID-19 among African-Americans.

“Our findings suggest that many of the individuals who responded ‘not sure’ may accept vaccination if given credible information that the vaccine is safe and effective. As vaccine development proceeds at an unprecedented pace, parallel efforts to proactively develop messages to foster vaccine acceptance are needed to achieve control of the COVID-19 pandemic.”

Behavioral scientist Dr. Rupali Limaye took the messaging a step further. She teaches a free online training course, offered by Johns Hopkins University, that “prepares parents of school-age children, PTAs, community members and school staff to be Vaccine Ambassadors and promote vaccine acceptance in their communities.”

Limaye will be a panelist for an interactive webinar “Making COVID-19 vaccines APPEALing: Pilot message testing in India,” later this month.

Changing messages, same goals

While government agencies and the scientific community cling to unsupported beliefs about vaccine safety and efficacy, they appear to recognize the importance of constantly revisiting their understanding of the impacts of messaging.

UPenn’s updated research found intentions around vaccination have changed. The university’s Annenberg School for Communication reported:

“The researchers found that trust in scientific institutions and health authorities was central to individuals’ intentions to be vaccinated, especially in the early part of the pandemic. However, as the pandemic continued, other factors related to trust emerged …

“The evidence, the researchers wrote, ‘documents the need for the public health community to redouble its efforts to preemptively and persistently communicate not only about how vaccines in general work but also about their benefits, safety, and effectiveness.’”

Research from Civics Analytics, a technology company that creates data-driven audience campaigns, seconds the notion that effective messaging must evolve.

With funding from the Bill & Melinda Gates Foundation, the company explored COVID concerns among different demographics and determined that a “one-size-fits-all” message would not work. The company said:

“In the spring of 2021, before the Delta variant emerged in the U.S. and when vaccine mandates had not yet been implemented, we found that messages highlighting experiences that are off-limits to unvaccinated individuals (such as concerts or international travel) or emphasizing personal choice were most persuasive…

“As you’ll see in this research, the most persuasive messages have changed.”

According to Civics Analytics, FOMO (fear of missing out) and “personal decision” messages were the most impactful. But more current data indicates the “protecting children” message has become more effective at persuading people to get vaccinated.

From the study:

“For general messaging targeting all unvaccinated people, focus on protecting children from COVID-19 and on the financial ramifications of contracting the virus.”

The company found “vaccine safety,” “scary COVID statistics” and “personal story” messages were inclined to backfire and could decrease the likelihood of vaccinating.

Perhaps some good scientists will advance the learning curve and study what happens when the public discovers that “proven messages” lack supporting scientific data.

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of Children's Health Defense.

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