Online Social Endorsement and Vaccine Hesitancy
Our new study explores how people’s attitudes and their consumption of Covid-19 news and information links to their intention to use social media and personal messaging apps to encourage or discourage vaccination.
By Andrew Chadwick, Johannes Kaiser, Cristian Vaccari, Daniel Freeman, Sinéad Lambe, Bao S. Loe, Samantha Vanderslott, Stephan Lewandowsky, Meghan Conroy, Andrew R. N. Ross, Stefania Innocenti, Andrew J. Pollard, Felicity Waite, Michael Larkin, Laina Rosebrock, Lucy Jenner, Helen McShane, Alberto Giubilini, Ariane Petit & Ly-Mee Yu
Vaccine hesitancy is a longstanding challenge for public health, but it has now assumed great urgency. By early 2021, the UK had the world’s highest Covid-19 mortality per million of the population. And yet, between a fifth and a quarter of UK adults is either very unsure or strongly hesitant about getting vaccinated.
All vaccination programmes depend on where and how information about the vaccines’ safety and efficacy is communicated. They also require public engagement. This is all the more important because, due to the general uncertainty caused by the pandemic, attitudes to the Covid-19 vaccines are currently in the balance and are likely to remain so for some time.
Some basic principles of public health communication have not changed. Health authorities need to present clear, transparent, honest, and fact-based information. But over the last decade, our media system has been transformed. Traditional, top-down communication such as press conferences and advertisements are unlikely to be sufficient on their own. People will rightly expect to see their family, friends, and acquaintances are keen to get vaccinated. People also need to feel confident about encouraging others to get protected.
There are some important dilemmas here. Research has shown that online endorsement can make a significant difference to people’s attitudes and decisions, yet we also know that anti-vaxxer disinformation circulates widely online. People’s media and information diets provide material they share with others, but those diets can vary considerably and can play a role in the circulation of misinformation. Equally, those who avoid news can be very difficult to reach using media campaigns of any kind.
Yet if public messaging campaigns target specific media and information settings with good quality information, not only would this give vaccine endorsers material to share online, it could also counteract disinformation from anti-vaxxers.
These ideas led to our new study, which is published in the journal Social Media & Society. Based on a survey of 5,114 UK adults in October 2020, we explored how people’s attitudes and their consumption of Covid-19 news and information link to their intention to use social media and personal messaging apps to encourage or discourage vaccination.
The research is part of the ongoing Oxford Coronavirus Explanations, Attitudes, and Narratives II (OCEANSII) project — a collaboration involving Oxford, Loughborough, Cambridge, Aston, and Bristol universities, led by Professor Daniel Freeman at Oxford. Our team includes scholars in clinical and social psychology, communication, moral philosophy, immunology, vaccinology, medical sociology, medical statistics, and economics and financial behaviour. We joined forces to learn more about Covid vaccine hesitancy and how to reduce it.
Our survey revealed that about a third of the UK adult population say they intend to use social media and personal messaging apps to encourage people to get vaccinated against Covid-19.
A significant minority — a tenth of the UK adult population — say they intend to use social media and personal messaging to discourage others from getting vaccinated.
Most of the public — around 57% — are undecided if or how they will endorse the vaccines online.
We identified six main media diets among the UK population for getting news and information about Covid. News avoiders use all media sources well below average. Mainstream/official news samplers use mainstream sources (newspapers in print and online, television, radio) and official sources (government and NHS websites) slightly more than average, while their use of social media is below average. Covid news super seekers use all sources far more than the average. The omnivores use all sources, but each source is used only moderately above average. The fifth group are the social media dependent, who use all social media much more frequently than average and all mainstream and official sources less frequently than average. Finally, the TV dependent get news and information about Covid-19 mainly from television and use other sources well below the average.
We then analyzed the connections between these media diets, people’s levels of vaccine hesitancy, and two key attitudes. The first is conspiracy mentality, which is the hostile distrust of public authorities. It stems from the false belief that secret organizations influence political decisions. The second attitude is “the news finds me,” which means giving low priority to active monitoring of news and relying more on one’s online networks of friends for information.
The survey data show a clear link between vaccine hesitancy and the intention to use social media and personal messaging apps to discourage others from getting vaccinated.
But beyond that, specific media diets and attitudes are also associated with online encouragement and discouragement of vaccination:
- The combination of avoiding news and having a news-finds-me attitude is also likely to be associated with the online discouragement of vaccination
- Overall, super-seeker and omnivorous media diets are most likely to be associated with online encouragement of vaccination
- The combination of a social media dependent media diet and high levels of conspiracy mentality is most likely to be associated with online discouragement of vaccination
The statistical links between avoiding news, having a news-finds-me attitude and discouraging others from getting vaccinated are perhaps the most troubling among our findings. Those who generally avoid news about Covid are less likely to be exposed to authoritative sources and will have fewer opportunities to learn about the vaccines. They do not prioritize information-seeking, yet they are also more prepared to discourage vaccination, even though they are less likely to have gathered the facts.
The connections between conspiracy mentality, social media use, and negative online social endorsement will also undermine the UK vaccination programme to some extent.
On a more optimistic note, only a small minority of the UK public say they will go online to overtly discourage others from taking a vaccine. And, when people gain a broad perspective from a range of different media sources, as the super seekers and the omnivores do, they gather evidence and are more likely to positively encourage vaccination among their online networks. This is good news for collective public health.
These findings provide some ideas for how public health communication that takes account of online social endorsement might improve vaccine take-up. We outline some simple, practical recommendations, some of which are already being implemented, but could be further enhanced. These include:
- Direct contact, through the post, workplace, or local community structures, and through phone counselling via local health services, could reach the news avoiders.
- TV public information advertisements should point people away from TV and encourage visits to authoritative information sources, such as NHS and other public health websites, which should then feature clear and simple ways for people to share material among their online social networks.
- Informative social media campaigns could provide Covid news super seekers with good resources to share, but should also encourage social media users to browse away from social media platforms and visit reliable online sources.
- Social media companies should intensify their removal of vaccine disinformation and anti-vax accounts.
Social media companies have recently become more assertive in their removal of vaccine disinformation. Facebook announced an important new initiative a day before we submitted our research for peer review. Difficult though it is, due to freedom of speech issues, as the vaccination programme proceeds there is a need to expand these efforts while also ensuring they are monitored by well-resourced, independent organizations.
The next stage of our project involves in-depth, experimental testing of the key themes and messages that could be used in the settings we have identified.
Professor Andrew Chadwick, Online Civic Culture Centre, Department of Communication and Media, Loughborough University, Loughborough, UK.
Dr Johannes Kaiser, Online Civic Culture Centre, Department of Communication and Media, Loughborough University, Loughborough, UK.
Professor Cristian Vaccari, Online Civic Culture Centre, Department of Communication and Media, Loughborough University, Loughborough, UK.
Professor Daniel Freeman, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, UK.
Dr Sinéad Lambe, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, UK.
Dr Bao Sheng Loe, The Psychometrics Centre, University of Cambridge, Cambridge, UK.
Dr Samantha Vanderslott, Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
Professor Stephan Lewandowsky, School of Psychological Science, University of Bristol, Bristol, UK.
Meghan Conroy, Online Civic Culture Centre, Department of Communication and Media, Loughborough University, Loughborough, UK.
Andrew R. N. Ross Online Civic Culture Centre, Department of Communication and Media, Loughborough University, Loughborough, UK.
Stefania Innocenti, Smith School of Enterprise and the Environment, University of Oxford, UK.
Professor Andrew J. Pollard, Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
Dr Felicity Waite, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, UK.
Dr Michael Larkin, Department of Psychology, Life and Health Sciences, Aston University, Birmingham, UK
Dr Laina Rosebrock, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, UK.
Lucy Jenner, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, UK.
Professor Helen McShane, Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.
Dr Alberto Giubilini, Oxford Uehiro Centre for Practical Ethics, University of Oxford, UK.
Ariane Petit, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, UK.
Dr Ly-Mee Yu, Nuffield Department of Primary Care, University of Oxford, Oxford, UK.