A trio of researchers from the Psychological Science Department at Eastern Connecticut State University recently published a conceptual paper analyzing the behavior of “anti-vaxxers.” Published in the journal “Behavior and Social Issues” by the Association for Behavior Analysis International (ABAI), the research offers strategies to encourage vaccination among vaccine-hesitant and vaccine-averse populations.

“A Behavior-Analytic Approach to Antivaccination Practices” stemmed from an undergraduate paper by recent graduate Sumah Confer ’20 before the onset of the COVID-19 pandemic. Her paper, which looked at antivaccination behavior among parents of young children, attracted the attention of Psychology Professors James Diller and Jeffrey Danforth, who helped develop the paper in the following semesters.

“Vaccines are amazing, so I never understood why some people don't get them and why it's so hard to motivate some hesitant people to get vaccines,” said Confer of the initial question that spurred her undergraduate paper.

As described in the researchers’ published article, “Vaccination involves the controlled delivery of infectious agents to promote the response of the immune system without direct exposure to a disease. The vaccination of large groups of people reduces the risk of infection of any particular member of that group, in a phenomenon known as herd immunity.”

The paper explains that the modern-day antivaccination movement began in 1998 when former physician Andrew Wakefield fabricated a link between vaccinations and autism in a paper published in “The Lancet,” a prominent medical journal. The paper was subsequently retracted and Wakefield’s medical license was revoked, yet the autism link continues to be a popular argument worldwide against vaccines.

“As Wakefield’s findings quickly garnered international media attention, the percentage of children who received a measles diagnosis also rose,” wrote the Eastern researchers, suggesting Wakefield’s influence over people’s vaccination choices. They noted that the United States went from having 86 confirmed measles cases in 2000 to 668 in 2014.

Measles was nearly eradicated after the development of the MMR vaccine in 1963, yet cases are near a 25-year high, according to the researchers, despite the availability of a preventable vaccine. “The measles reemergence did not occur by chance, but rather is the result of a shift in human behavior.”

Reasons for antivaccination

In 2019, the World Health Organization (WHO) identified vaccine hesitancy as a top threat to global health.

“We found that there are a lot of reasons why people are antivaccination or vaccine hesitant,” said Confer, “ranging from a distrust in science, to the social media they consume, to religious beliefs or a lack of access.”

The Eastern researchers identify other “motivating operations” for antivaccination, including resistance to governmental interference or a loss of personal liberty; the disproven “link” to autism or other diseases; social or familial ridicule; and distrust in government. “Unintentional” reasons for not getting vaccinated include financial barriers, lack of medical coverage or lack of awareness. 

Regarding religious beliefs, they noted a popular misconception that major religions, such as Islam, forbid vaccination. Through their research, they found that in the United States only the Dutch Reformed Church and Church of Christ, Scientist have theological objections to vaccination.

In certain religious communities, the researchers note, “The consequences, real or imagined, such as resentment, shame or concerns about eternal damnation, may be sufficiently strong to prevent vaccination.”

Another reason for antivaccination is doubt in the seriousness of a disease. “Today, parents rarely see children with the diseases that vaccines prevent,” the article reads. “As such, the reinforcing value of vaccines to prevent these diseases is reduced, and the probability of behavior that leads to vaccinations (such as taking one’s child to the doctor for vaccination) is weakened among some individuals.”

The researchers likened this phenomenon to speeding and receiving a ticket. Because people seldom are ticketed relative to how often they speed, the rule against speeding is weak. Conversely, “If a person directly contacted the contingency specified by the rule (i.e., received many speeding tickets), they may be much less likely to speed in the future.”

The antivaccination behavior of people who doubt the seriousness of a disease, therefore, may only change if they personally are affected by the disease.

The researchers referenced the case of Tara Hills, a parent of seven children in rural Ottawa, Canada, who ceased vaccinating her children following media reports and conflicting information. Later, all seven of her children developed pertussis (whooping cough), a life-threatening infectious disease. “Hills subsequently vaccinated all of her children and is now a prominent supporter of vaccination.”

Strategies to encourage vaccination

The researchers presented several strategies to encourage vaccination among antivaccination groups.

One approach could be to increase the difficulty of receiving exemptions. In the state of Washington, for example, people applying for exemption must attend a meeting with a physician to discuss vaccination information, according to the researches.

In religious communities, they recommend leaders renounce the antivaccination falsehoods within their religion. “Because most religious communities in the United States are not against vaccinations, having more well-publicized statements in support of vaccinations from religious leaders could bolster vaccinations in their congregations.”

Incentives may be another effective strategy in increasing vaccination. According to the researchers, in Australia, people get lower insurance rates and tax rebates in exchange for vaccination. Relatedly, they pointed to the popular “I Voted” sticker in the campaign to increase voter turnout.  “Using an ‘I Vaccinated’ sticker as a reinforcer may attract positive social attention and act as a visual prompt.”

The trio recommends broad campaigns to renounce the false claims about vaccines, coupled with good information related to the diseases they prevent and the current medical science.

Speaking to the distrust in science surrounding COVID-19, Confer said: “The general population is seeing, potentially for the first time, the scientific process unfold. A really important lesson right now is for people to understand that the scientific process involves making mistakes, revising and trying again. If some information about COVID was incorrect or later changed, that does not mean the scientists and researchers are wrong, or that they shouldn't be trusted. It's simply the process of researching.”

Finally, the researchers recommend compassion as a strategy, noting the sensitivity of politics and personal values. They cited a study that found that when drivers were asked to buckle up by a person holding a sign that read “please buckle up, I care,” they were more likely to do so than when they saw a “click it or ticket” sign.

“People who make the choice to vaccinate, or not, have reasons for doing so, based on their learning history and contemporary environment,” concludes the article.

“Modifying this behavior will require change on governmental, social and provider levels. At the basic level, vaccines should be affordable and accessible, and exemptions lacking medical necessity should be made difficult to receive.”

Read the full article at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186869/ .