The psychology of vaccine hesitancy and refusal

The World Mental Health Day campaign has chosen “Mental Health in an Unequal World” as the theme for 2021. This is partly to raise awareness of the disparities between countries and individuals that has been highlighted by the Covid-19 pandemic over the past two years.  

Access to health-care resources is impinging the ability of countries around the world to address the effects of the pandemic, and stark inequality regarding pivotal elements such as access to vaccines have become visible. Obtaining, storing and distributing vaccines has proven to add another burden to countries that are already financially and resource-impeded. 

Yet, once South Africa secured adequate amounts of vaccines, we were faced with a baffling dilemma. How to get people to actually take it? In trying to understand the psychology behind vaccine hesitancy, it is interesting to note that even before the outbreak of the Covid-19 virus the World Health Organisation listed vaccine hesitancy (delaying or refusing vaccination) as one of the top 10 threats to global health.

Why people refuse or resist vaccination

To understand why people — who are otherwise reasonable, conscientious and informed individuals — would refuse or resist vaccination, it is helpful to look at the 5C model. The first aspect is confidence — the extent to which the person trusts that the vaccine is safe and will in fact do what it is said to do. Confidence is also affected by the level of trust that the individual has in the system that dispatches the vaccine — consequently, individuals who are hesitant to vaccinate are likely to be suspicious of authority figures and structures. 

Another factor is the number of constraints individuals face in getting access to the vaccine. If there are many barriers (for example, unable to afford transport to the vaccination site) in terms of the calculation of costs versus benefits, it is easier to delay or refuse vaccination. Interestingly, perceived scarcity makes items more desirable. Perhaps it is the very fact that the vaccine is free and available that makes people not interested in receiving it. 

Having a sense of collective responsibility and altruism are important characteristics in those who submit to vaccination. People who refuse vaccination tend to be more individualistically orientated and less motivated by the greater good of all, than by their own personal preferences. 

And this brings us to the final C, which is complacency. People who perceive the risk of Covid-19 as low tend to feel less urgency to vaccinate. These are the patients who admit to Covid ward frontline workers that they now regret not getting vaccinated when they had the chance; instead, they frequently come to this realisation once their prognosis is terminal and they are facing the harrowing reality of dying, separated from their loved ones. 

And then we all know someone who believes in an “alternative” explanation for the Covid-19 virus and its vaccine. There are many hypotheses as to why people prefer conspiracy theories over scientific truth — some of which include the fact that the science behind understanding viruses and their prevention is quite abstract and too complicated for lay people to understand. 

Unless they witness the devastating effect of the virus first-hand, it may be difficult to comprehend that an invisible entity can do so much damage. 

Another explanation is that the truth of a natural disaster such as a pandemic, which can occur at any time, randomly, and without warning, catching humanity off guard, is too frightening to accept. So, it makes us feel safer to believe that humans are in control and created Covid-19 for some larger sinister goal. Otherwise, we are left to contemplate how vulnerable we all really are. Instead, we deny reality and substitute it with something that makes us feel a bit better. 

Encourage people to get vaccinated

How do we encourage people to get vaccinated for our society to regain some pre-pandemic normality? Force, anger, and frustration (which are undoubtedly justified, particularly by those who work on the front line, and by those who have lost loved ones) are not going to get us there. Instead, we need religious and other leaders to set the example and publicly advocate for vaccination. 

We need to tailor the information for the vast majority of South Africans who are not science-literate, making it understandable in their home language. Unfortunately, there is a significant percentage who will not be swayed by these actions, and for these fellow South Africans I have the following message:

It does not matter anymore whether or not Covid-19 is the product of a global conspiracy and whether or not the companies that create vaccines do so only for financial gain. It does not matter that this all happened very fast and that we all realised how terribly weak and vulnerable the human body is. 

What does matter is that this virus is here. In our homes, our schools, cities, and country. And the only way to get rid of it, or at least to continue our lives alongside it, is for all of us to be vaccinated. 

We have science — facts, not opinions or feelings or theories or beliefs — to tell us that vaccines are safe and effective. In 10 years from now, this will be the plague of 2020. I hope that you will be able to say that you were brave, even though you were scared, even though you were unsure, even though you might have been fine without the vaccine, but that you were strong enough and kind enough and human enough to do this small thing for the greater good of humanity. 

Our children will thank you for restoring connection and hugs, concerts, and playtime at school without distancing and sanitiser and masks. You will have done something important for your community and your country and the world. This is your chance to be part of a great victory of humanity over a seemingly insurmountable tide of death and suffering. Our hope lies in you. Take this great responsibility, wear it with pride and importance, and meet us at the other side of Covid-19.

Keep the powerful accountable

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Angie Vorster
Angie Vorster is a clinical psychologist at the University of the Free State’s School of Clinical Medicine

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