Analysis: How to talk (and not talk) about Covid-19 vaccination to people with doubts

By Dr Jess Berentson-Shaw*

Analysis - It will be a good day for New Zealand and for the world when we have left the worst of the Covid-19 pandemic behind us.

We will be able to see those people we have been long separated from. Our nurses and doctors will turn up to their shifts at the hospital knowing it will be just a normal day. Our older people will be at much less risk. Our businesses will be able to plan again with more certainty. A world with the Covid-19 pandemic behind us will not be perfect but there will be an opportunity to refocus our considerable collective energy on solving the long-term problems we are facing.

Vaccination is key to putting Covid-19 behind us. It is why most people in New Zealand are either enthused about or supportive of getting it. However, surveys do show about a quarter of people have some hesitations, while a small proportion say they will refuse to be vaccinated.

As with any health intervention, we need to be persuaded that vaccination matters, that it is better to get it than not, especially if we are not experiencing an illness at the time. We need to be heard and have our questions answered.

In relation to Covid-19, New Zealand is in a relatively good position, very few people have become ill or died, which can make it hard for some to see the necessity of vaccination, hard to see the benefits. We live in a world full of information of varying quality, communicated by many different people, where trust is contextual and truth has been spun as relative. Having a small group of people who are not sure about the vaccine is to be expected. Expected, but also something we can engage helpfully with.

Given the importance of people across all communities receiving the vaccine, persuading people who are unclear about the proven benefits and the opportunities it will give us as a country and as a world, is crucial work.

Doing it effectively matters. If people go about it in the wrong way the risk is we push people who are hesitant into refusing the vaccine. We could also worsen the differences in health between different communities as only some people would have access to information that they can understand and connect with. Fortunately, we have good data and insights on both communication approaches to avoid and those we should put our efforts into when talking to hesitant people. Those people who adamantly refuse vaccines are a different story...

[h ]A principle of connecting instead of correcting

The overarching principle of communicating with people who are hesitant about getting vaccinated is to connect with them and their communities, as opposed to spending time correcting false information. While our default persuasion approaches tend to be fact-led with a focus on correcting false information, it makes more sense and is more effective to leave the correcting aside. With that in mind, we should avoid doing the following four things:

1. Avoid engaging with or amplifying false information (even to debunk it)

As advocates for vaccination, we often feel compelled to take all the false information we have heard, repeat it (often in bold font) and detail why it is incorrect. Using mythbusting or debunking as our primary communication strategy is, unfortunately, unhelpful. The reason why lies in how our brains work to process information and how our information environment, especially social media, has been designed.

By engaging with and repeating false information about vaccination, we end up amplifying it and exposing hesitant people (and everyone else) to it. This matters because the more we see and hear and talk about false information, the more familiar with it we become. It starts to flow smoothly and easily through our thinking. Cognitive scientists call this effect fluency. And the last thing we want to do is make false information more fluent. In addition, because people often don't recall where they heard information, we can inadvertently become the trusted and reliable source of false information when we repeat it (even when trying to debunk it).

We also need to consider social media algorithms. These are set up to take advantage of the attention we pay to alarming and controversial information. Mythbusting and debunking often attracts very vehmant responses from all sides, more alarm, attention, comments and disagreement leads to more sharing, and more money for the companies. Debunking can simply spread false information further and deeper into people's media feeds and awareness.

When we care deeply about the people whose false information is hurting, and because it undermines our good work, we naturally want to tell people how wrong this information is. But, as the cognitive linguist George Lakoff says, if you ask people not to think of an elephant, they will inevitably think of an elephant.

More generally, it is just deeply unhelpful and makes little sense to spend our finite energy and resources trying to shift the small minority of people who are firmly opposed to vaccination - while ignoring the information needs of those who are more likely to be persuaded and need an effective communication strategy that they can connect with.

2. Avoid leading with facts and science

Persuading people about the validity of science is quite different from leading your communications with facts and science. It's a common and understandable error we all make. We do it because of something called the Information Deficit Model. We assume that people need filling up with good information to motivate them to act. If they don't do so then we make the next cognitive leap and assume they lack critical thinking skills. Both are inaccurate assumptions.

We have highly sophisticated systems of thinking to make the work of processing information easier. Logic features late in the process. Automatic, subconscious and fast thinking is our default. It's evolutionarily advantageous. If we had to logic our way through every piece of sensory information we encountered, we wouldn't get past getting the Weetbix out of the packet at breakfast.

This default fast thinking system (thanks Daniel Kahneman) means we use feelings, perceptions of trust, pre-existing and deeply embedded schemas to subconsciously and rapidly assess the relevance of information we hear. Put another way, people's feelings don't care about your facts.

Added to this, we have an information environment that is both overwhelming in scale and size, and full of manipulated and false information. Even the very processes of how facts are researched, agreed upon and shared has been undermined by groups of people wanting to grab or maintain power.

It means that facts and science are rarely a compelling invitation for people to consider new information, especially if they have already been exposed to false information.

To capture people's attention and slow their thinking down to consider more complex information, such as vaccination, it's better to use strategies that create an invitation for them to more willingly consider the good information you want to share.

3. Avoid engaging with people's most self-interested motivations

It is difficult to persuade people to engage in an action that will support the long term wellbeing of the collective by tapping into their most self-interested aspect, whether it be money, economic catastrophe, or personal safety. If you use personal health or safety as an argument, for example, there are plenty of people who are at low risk of the virus who may choose not to get the vaccine, considering it unlikely that they will catch Covid-19 or experience significant harm if they do.

Likewise, if people are encouraged to think about financial loss or gain as a reason to consider getting vaccinated (for the economic benefits, for example), we are much more inclined to focus on the short-term personal benefits and less inclined to think about long-term benefits to others. Vaccination, especially the Covid-19 vaccination, is a community good. It needs to be communicated as such.

4. Avoid assuming your trusted expert is everyone's trusted expert

For many people, especially those who have access to media channels, a doctor or a well-known scientist may represent a trusted expert. A mainstream media outlet also. For others, such people and organisations are deeply untrustworthy, exactly because of who they are and who they represent. Trust and expertise is about perception. People's negative experiences with such people and the organisations they represent can deeply undermine people's trust and willingness to listen.

What then should people who want to communicate the benefits of vaccination to hesitant people do, once they know what not to do?

1. Focus on the positive story of vaccination. Rinse and repeat (it's what hesitant people need)

Approach vaccination communication with a clear idea of the positive outcomes that you want people to think about and understand. It is important that people see how vaccination will improve the situation we have now and the way it will positively impact our communities and our day-to-day lives. This is the cake that vaccination gives us, and all of us take a slow pass by a tasty looking cake.

2. Give people a way to look at vaccination through what matters to all of us

Vaccination is, at its heart, a community endeavour. We should talk about it as such. We have seen plenty of community-minded action in the last 12 months. Our love and care for others in our family, community, our older and younger generations, even our responsibility to those generations to come, can be a powerful motivator to vaccinate.

3. Use facts to help you explain how vaccination benefits us all

Think of facts as the character in a story you need to be telling to help people understand the different positive aspects of the Covid-19 vaccination. Instead of providing a number of deaths from Covid-19 prior to community wide vaccination and the number of deaths after vaccination, assuming that the story is self-explanatory, explain how vaccination works, how it stops Covid-19 spreading and how mass vaccination helps us leave Covid-19 behind.

4. Inoculate people against false information

Instead of focusing on false information, spend resources alerting people to the sorts of strategies that people use when spreading false information, and their motivations. For example, try explaining the use of fake experts, or how astroturfing works. This technique, known as inoculation is a way to improve people's critical thinking skills in a very fast moving information environment. It probably works, researchers think, because people value the freedom to receive good information and feel upset if they are prevented from getting it.

If you wish to debunk false information, then do so very carefully, using a scientifically tested formula which you can read about in the Debunking Handbook.

5. Work with trusted people from across our communities

Trust and hence a willingness to listen to good information about vaccination requires a perception that the person speaking shares values with the listener. Research in the US has found people will move their views on vaccination from hesitant to supportive (and vice versa) when the expert who they see themselves as sharing values and worldviews with also shifts their views. Therefore, working with a wide variety of people from across our different communities to deliver good information about Covid in a form that is most effective, is going to give it a much better chance of being heard.

People are capable of holding many different views and ideas at any one time. While some of us may be fixed about some things some of the time, most of us are capable of being shifted towards the best information when people connect with us in helpful and thoughtful ways. People who are hesitant about Covid-19 vaccinations are no different.

*Dr Jess Berentson-Shaw is the author of A Matter of Fact. Talking Truth in a Post-Truth World and Co-Director of The Workshop.