Fake news, politics, and behavioral biases: A perfect storm for vaccine hesitancy

Data and research continue to offer indisputable evidence that vaccines are effective and safe. A recent study in South Africa of more than 1 million people found that the unvaccinated are five times more likely to get infected with COVID-19 and 20 times more likely to die from infection complications. In fact, the reductions in risk from the vaccines are so sharp that it reduces the risk of mortality from the virus to less than that of influenza. In terms of safety, the same study recorded zero vaccine-related deaths and extremely low chances of side effects – almost all of which resolved quickly without treatment. More importantly, it was found that the risk of developing these same side effects was up to 112% more likely from a COVID-19 infection.

The data is also clear that COVID-19 remains a real threat, with emerging strains such as the omicron variant. The concern is not only for those that contract and survive the virus, but one in three people who have previously been infected are experiencing “long COVID.” With continuing symptoms and damage to the lung, heart and brains, long COVID-19 is considered by many to be the next public health crisis in the making.

Vaccines represent the most reliable route to return to normalcy. Yet, vaccine hesitancy remains a common thread globally with the Centers for Disease Control and Prevention estimating that hesitancy rates range across states from 3% to 27%.

Many ascribe this reluctance to the antivax movement or to politics. While these are certainly strong driving forces, in our recent worker study, we asked people who stated that they are not going to get the vaccine why – only 10% cite that they are against vaccines in general and only 8% cite political reasons. When asked for specifics around hesitancy, the responses included mistrust of government (43%) and the companies and scientists that developed the vaccine (25%), and the most cited reason (52%) was concern over side effects.

Despite such overwhelming evidence about the need for the vaccine and its safety and efficacy, people still rank concern over the minute chance of side effects above the much higher risk of serious, prolonged infection. Irrational decision-making like this can usually be explained by powerful cognitive biases, and the myriad of false news and misinformation surrounding the vaccine is creating a perfect storm for them.

To help overcome vaccine hesitancy and to guide people, companies, and countries to the other side of the pandemic, we examined the various behavioral biases at play and offer strategies to address.

Confirmation bias

In the new digital age, the world’s information is at our fingertips. Thirty years ago, when the internet was blossoming, most assumed that access to more information would mean people would be more informed. Fast-forward to today and we see that most suffer from a severe side effect of access to humanity’s collective knowledge: information overload. We’re not swimming in a sea of information, we’re drowning in it, allowing self-proclaimed authorities and fear mongers, across social media especially, to have a larger voice.

This sets the stage for confirmation bias – the tendency to look for, interpret, and remember information in a way that supports one’s prior beliefs or favored conclusions, ignoring contrary information, and interpreting ambiguous evidence to support their existing beliefs. The effect is especially strong for emotionally charged issues and deeply entrenched beliefs, often underpinned by overconfidence in one’s own beliefs.

For those who are mistrustful or disillusioned with establishments like government and pharmaceutical companies, especially those of certain political leanings, the conspiracy that the vaccine is ineffective and unsafe may be an attractive, emotionally charged idea. Such individuals will likely receive misinformation supporting this hypothesis through social media and then search for and filter all other information to confirm their belief.

Optimism bias

It’s been nearly two years since the pandemic swept the world, upending our ways of work and socializing. Many today have an illusion of control and may think that the actions that they take day-to-day like wearing masks and sanitizing can prevent infection or that they can generally manage the risks. When faced with the choice to get vaccinated, some people feel they don’t need it because they’re generally healthy. In fact, 18% of our vaccine hesitant respondents said exactly that. Others feel that it won’t happen to them – they won’t be the ones in the ICU on a ventilator.

Loss aversion

First proposed by Kahneman and Tversky in 1979, and backed by multiple controlled studies since, loss aversion describes how people react to potential losses and gains. These psychologists found that people don’t behave rationally and react differently depending on whether there was the potential for losses or the potential for gains. They termed this difference in reaction ‘loss aversion’ because people tend to prefer avoiding losses to acquiring equivalent gains. This generally exhibits itself in a situation where any deviation from a given reference point could result in potential losses or gains.

How does this relate to vaccine hesitancy? Our research suggests that people are already settling into a new normal, with self-assessed mental health and wellbeing returning to pre-pandemic levels and most people being happy with their current work situation. In all of this, many may have factored the risk of COVID-19 infection (and, at worst, death) into the steady state of their lives. So, any decision from this reference point, like getting the vaccine, would be evaluated for its perceived gains and losses.

For the vaccine-hesitant, confirmation bias has led to doubt that vaccines are effective and safe, or worse–a belief that they are ineffective and unsafe. On top of this, optimism bias and illusions of control may lead such a person to not assess their COVID-19 risk correctly. Finally, the vaccine presents a situation where the perceived loss (e.g., side effects) is immediate and tangible, but the gain is intangible. This puts a thumb on the scale that makes the vaccine’s perceived gains look smaller and the perceived losses appear larger. So, when the time comes to choose to get vaccinated, loss aversion leads such a person to avoid the perceived losses, rather than acquiring the gain.

We see evidence of loss aversion in the effectiveness of workplace vaccine mandates to flip the vaccine hesitant. Consistently when implemented, vaccination rates climb above 90%. This is because mandates put another thumb on the scale of loss aversion – adding significant, tangible consequences (such as job loss) to the equation which people would rather avoid.

Behavioral science: a key to unwind vaccine hesitancy

As behavioral biases can help us understand why people refuse to vaccinate, they also can be used to encourage people to get the vaccine. That’s why we’re sharing our data and recommendations based on more than 20 years of harnessing behavioral science to create initiatives and incentives that drive behavior change. This was the impetus behind the behavior change framework we used to educate, engage, and reward members to get vaccinated. These interventions relied on the same human behavioral biases that cause vaccine hesitancy to attempt to unwind it:

1. Educate. Confirmation bias and information filtering has created a situation where many are not aware of the scientific evidence that vaccines are safe and effective. Many are also not aware of the impact that vaccinating and other positive behaviors have on those around them. Getting information in the hands of our members was the first step to unwinding the effects of misinformation and confirmation bias. This includes motivational and educational communications, blog posts, webinars – from trusted experts – and a toolkit of resources for employers, insurance clients and the broader community.
2. Engage. Create practical, personal goals for members to achieve. This included gamified activities that test COVID-19 knowledge and motivate members to do their part in preventing the spread and impact of the virus, and of course, getting vaccinated.
3. Reward. Incentivize people to participate, ranging from points and gift cards for achieving goals and getting vaccinated to allowing employers to link vaccination status to healthcare contributions. Incentives add another thumb to the scale of loss aversion.

Together these interventions maximized the likelihood of behavior change, and the results were stark. Before the campaign, we surveyed over 90,000 of our members and 30% responded that they were either vaccine-hesitant or undecided. From the participating vaccine-hesitant pool, 69% increased their willingness to or got vaccinated and 74% of those who were originally undecided received the vaccine. In vulnerable groups, we also saw strong results, with 67% of those with elevated clinical and/or lifestyle risks increasing their willingness to get the vaccine. This demonstrates that behavioral science can be leveraged to cure behavioral biases and are pivotal tools to unwind vaccine hesitancy.

Employers play an important role in thwarting the dangerous cloud of vaccine misinformation. As organizations navigate returning to physical workplaces, grappling with vaccine hesitancy will form a vital part of any return-to-work strategy. Understanding the human psychology driving hesitancy and leveraging techniques to counter it hold the key to resuming physical operations effectively and safely.

Matthew Daniel is an actuary and director of technical marketing at Vitality.