COVID-19 Vaccination Policy Resistance

Version	Summary	Created by	Modification	Content Size	Created at	Operation
1		Aleksandar S Mojašević	--	2009	2022-09-08 15:57:25	\|
2	format	Jason Zhu	+ 121 word(s)	2130	2022-09-09 05:18:41	\| \|
3	format	Jason Zhu	Meta information modification	2130	2022-09-15 08:44:57	\|

This entry is adapted from the peer-reviewed paper 10.3390/su141710728

The pandemic of the infectious disease COVID-19 caused by the SARS-CoV-2 virus drastically changed the world and led to the so-called “new normality”. It was reflected in reduced social and physical contacts, considerable changes in business operations, loss of employment, mental health impairment, endangerment of material existence, etc. While the situation seemed hopeless at the outset of the pandemic, generating great fear and anxiety, people became mentally accustomed to the new situation over time. The situation was significantly improved upon with the discovery of vaccines, but the emergence of vaccines was accompanied by new dilemmas, social divisions and conflicts. The point of contention between experts and citizens was the vaccine’s safety. Contradictory information started spreading through social networks, creating huge animosity among citizens.

COVID-19 vaccination policy resistance

1. Introduction

The pandemic of the infectious disease COVID-19 caused by the SARS-CoV-2 virus drastically changed the world and led to the so-called “new normality”. It was reflected in reduced social and physical contacts, considerable changes in business operations, loss of employment, mental health impairment, endangerment of material existence, etc. ^[1]. While the situation seemed hopeless at the outset of the pandemic, generating great fear and anxiety, people became mentally accustomed to the new situation over time. The situation was significantly improved upon with the discovery of vaccines, but the emergence of vaccines was accompanied by new dilemmas, social divisions and conflicts. The point of contention between experts and citizens was the vaccine’s safety. Contradictory information started spreading through social networks, creating huge animosity among citizens. It resulted in a division into “vaxers” and “anti-vaxers”. These pejorative terms have further strengthened the ubiquitous polarization.

In the circumstances of polarized opinions and strong emotional charge, the space for rational reasoning and action was suddenly narrowed. Thus, the automatic and fast System 1 of cognitive apparatus prevailed over the slow and rational System 2 ^[2]. It was in such a heated atmosphere that an adequate vaccination policy had to be conceived and implemented. Judging by the percentage of the vaccinated population, some countries have succeeded in their efforts (e.g., Portugal), and some have not (e.g., Serbia). Generally, both Serbia and Portugal applied a universal vaccination policy (vaccines were available to all). According to recent data ^[3], Portugal records 93% of fully vaccinated citizens (updated data from 10 March 2022) while Serbia has 47.6% (updated data from 22 March 2022). Absolute numbers are even more convincing: Portugal records 9.66 million vaccinated people (population: 10.4 million) while Serbia has 3.35 million vaccinated (population: 6.9 million); the number is almost three times higher in Portugal. It may be interesting to look at the ratio of “booster” doses in these two countries, according to the initial protocol of doses per 100 inhabitants: Portugal 61:164 (total: 225), Serbia 27:96 (total: 124). When looking at the number of deaths, the data are as follows: Portugal records 21,545 deaths (on 28 March 2022), with the number doubling in the last 427 days (more precisely, in relation to 10,721 deaths since 25 January 2021); Serbia records 15,768 deaths (on 28 March 2022), with the number doubled in the last 188 days (more precisely, in relation to 7846 deaths from 21 September 2021). Both countries may be compared with the trend at the European level: 371 days in which the number of deaths has doubled; thus, Portugal is 156 days above this level while Serbia is 283 days below this level. These numbers clearly show that, in the last six months, Serbia has recorded a drastic increase in the number of deaths from COVID-19, in a situation when the vaccine was widely available!

2. COVID-19 Vaccination

A study was conducted in Japan with the aim of examining the causes of negative attitudes towards vaccination, resulting in a refusal to get vaccinated ^[4]. The target group included people of different age groups. The research showed that young people were more vaccine-hesitant than older people, as well as that young women were more hesitant than young men. The roots of such a repulsed attitude are health concerns, i.e., uncertainty regarding the side effects of the vaccine. Considering the different age groups of the respondents, the researchers concluded that an effective fight against vaccination indecision should include a change in communication strategy to avoid applying a single strategy to all age categories (one size fits all approach). Another research project on resistance to vaccination was conducted on a sample of young people in America ^[5]. The most common reasons among respondents (about 24%) who had a negative attitude toward vaccination were: (1) the desire to wait to make sure the vaccine is safe (about 56%); (2) concern about possible side effects of the vaccine (about 53%); (3) other people are in more need of a vaccine (44%); (4) disbelief that a vaccine is needed (about 23%). The researchers concluded that, in the group of young people who were hesitant to get vaccinated, health authorities should address the reasons for hesitancy, their concerns about the vaccine’s safety and side effects, and promote the importance of vaccination for this population group.

Some studies specifically deal with the relationship between fear and anxiety and people’s hesitancy to get vaccinated. For instance, one study ^[6] investigated the impacts of the COVID-19 vaccination on fear and economic anxiety (measured by Google search trends regarding different topics, including recession, stock market crash, survivalism, and conspiracy theories) by using a worldwide sample of 194 countries observed from 1 December 2020 to 4 March 2021. The main finding is that fear and economic anxiety were highly influenced by the emergence of COVID-19 vaccines, given that fear and anxiety increased once the vaccines started being applied. The researchers recommended that the number of older adults willing to get vaccinated would increase if the competent authorities explained the benefits of vaccination and refuted false information about the vaccine and its severe side effects. Another research project in Germany ^[7] investigated the effects that personality traits, risk-taking conduct and anxiety have on affective reactions (e.g., worries and concerns) and anticipated behaviors (e.g., denial of medical operations) among the general population during the COVID-19 pandemic. As opposed to risk-taking and personality traits, anxiety had a direct effect on people’s concerns about safety and hygiene in hospitals. The study recommended that health workers should carefully address the issue of people’s anxiety in the context of hospitalization.

Vaccine hesitancy has been a research subject in other countries. For example, a study in Bangladesh ^[8], conducted on a sample of 1134 respondents of the general population, found that 32.5% were hesitant. The researchers recommended that the evidence-based educational and policy-level initiatives should be applied mainly to the poor, elderly and chronically ill individuals. A recent study in the same country ^[9] identified 27.4% of vaccine-hesitant people after one year of vaccine introduction; the researchers recommended that educational campaigns should specifically target semi-urban, low-income and low-educated Bangladeshis. Further, COVID-19 Vaccine Hesitancy (VH) was the subject matter of a systematic research and meta-analysis in Pakistan ^[10], including a total of 323 studies from January 2020 to October 2021. The main finding was that there was a significant heterogeneity in the reported VH in the population, which could not be explained by any co-variables from these studies. The researchers recommended that an in-depth analysis of COVID-19 VH on a representative sample should be undertaken to measure the magnitude of VH and to explore and identify the VH factors. A qualitative study conducted on the Nepali population in the UK ^[11], which included in-depth interviews with 20 people, found that attitudes towards COVID-19 are mainly positive. The researchers identified three main factors of vaccine hesitancy on which vaccination policy for ethnic minorities in the UK should be based: (1) external (rumors and misinformation, religious restrictions; preference of home remedies and yoga; etc.); (2) specific (doubt in vaccine effectiveness after changing the second dose timeline); and (3) personal (lack of confidence in the vaccine, past negative experience with flu vaccines, and concern about side-effects).

Some studies focus on conspiracy theories during the COVID-19 pandemic and their harmful impact on people’s conduct. Recent research ^[12], including two studies conducted in the USA (n = 220; n = 288) and one in the UK (n = 298), has shown that different forms of conspiracy beliefs have different effects on people’s behavior during the pandemic. Thus, the belief that the pandemic is a hoax leads to people not taking sufficient protective measures (personal hygiene, physical distancing), while the belief that the virus was “made in a laboratory” increases egocentric prepping behavior (alternative remedies, hoarding). The researchers connect these beliefs with the existence of the so-called conspiracy mentality. Another cross-cultural study ^[13], conducted by using an online survey in the UK (n = 1088) and Turkey (n = 3936), examined the levels of COVID-19 vaccine hesitancy and its association with beliefs about the origin of the new Coronavirus. The results have shown a worrying level of vaccine hesitancy, especially in Turkey (31%) as opposed to 14% in the UK, and a 3% rejection vaccination level in both countries. The researchers emphasized that a wider communication of the scientific consensus on the origin of the virus with the public is needed.

Another study ^[14] recommends adjusting interventions depending on individual barriers to vaccination: complacency, convenience, a lack of confidence in vaccines and utility calculation (the so-called Four C Model). For instance, since people with a lack of confidence in vaccines hold strong negative attitudes toward vaccination (as opposed to the complacency and convenience types), debunking vaccination myths would be an appropriate intervention. Another paper, focusing on the extensive use of behavioral and social science findings ^[15], provides a critical overview of previous research on topics relevant to pandemics, such as: threat management, social and cultural impact on behavior, communication science, moral decision making, leadership and stress management. Relying on this, the researchers recommend numerous behavioral measures that are appropriate for COVID-19, such as: (1) playing the card of “common identity” and acting for the common good; (2) identifying credible authorities in the community who would share public health messages; (3) promoting cooperative behavior; (4) combining norms of pro-social behavior with the expectation of social approval from the authorities; (5) highlighting “bipartisan” support for anti-COVID measures to reduce polarization and biased reasoning; (6) targeting public health information towards marginalized communities; (7) sending messages that: (i) emphasize the benefits to the recipient, (ii) focus on protecting others, (iii) align with the moral values of the recipient, (iv) call for social consensus or scientific norms, and/or (v) emphasize the possibility of group approval; (8) developing people’s awareness of the benefits of access to other preventive measures; (9) preparing people for disinformation and providing accurate information and counter-arguments against false information before encountering conspiracy theories, false news or other forms of misinformation; (10) the use of the term “physical distancing” rather than “social distancing” because social connection is possible even when people are physically separated. There are also studies that point to the importance of nudge policies in encouraging people to get vaccinated ^[16]. In this regard, recent meta-research on the effectiveness of behavioral interventions confirms a statistically significant relationship between these interventions, especially defaults, and changes in human behavior in different domains ^[17].

In addition, there are opinions ^[18] from the behavioral science perspective on what researchers have learned during the COVID-19 pandemic for future use in the same or similar pandemics: (1) trust in the state (government) is one of the strongest predictors of adherence to prescribed measures and vaccination; (2) adherence to measures is not only a consequence of human motivation but also of possibilities and abilities, which especially refers to socially and economically vulnerable groups, such as ethnic minorities; (3) clarity and consistency of vaccination policy and messages are very important because people must understand the rules of conduct, which means that they should be clearly formulated and “communicated”; (4) pandemic preparedness should focus on protection, not restrictions, which especially refers to financial and other measures aimed at supporting work from home. Finally, it is worth mentioning a special edition of a book dedicated to COVID-19 from the behavioral science perspective ^[19]. It contains 34 research on the use of behavioral insights in health care, divided into six subtopics: (1) risk communication and public health messaging; (2) public education and health literacy; (3) community engagement; (4) psychological impact of COVID-19; (5) coping strategies and the COVID-19 pandemic; (6) adherence to public health preventive recommendations. Last but not least, in October 2020, the World Health Organization (WHO) published a report ^[20] which identifies the shortcomings in the existing vaccination policy and emphasizes the need to apply measures from the corpus of behavioral science in order to popularize the vaccine against Coronavirus: (1) creating a favorable environment for vaccination by facilitating the vaccination process, making vaccines available to all without excessive administrative burden; (2) encouraging social influence by engaging trusted people in the community to promote vaccination as an example of good practice; (3) increasing the motivation of citizens for vaccination through open and transparent dialogue and communication about the risks that the vaccine may involve.

A review of the Serbian Citation Index ^[21] indicates abundant scientific research on the topic of COVID-19, mostly from the perspectives of medical science and various social sciences but not from the perspective of behavioral science. The research conducted in Serbia seeks to fill this gap and to popularize behavioral science in the field of health care.

References

Health. Clevelandclinic. Available online: https://health.clevelandclinic.org/heres-how-the-coronavirus-pandemic-has-changed-our-lives/ (accessed on 6 June 2022).
Kahneman, D. Thinking, Fast and Slow, 1st ed.; Farrar, Straus and Giroux: New York, NY, USA, 2013.
Our World in Data. Available online: https://ourworldindata.org/covid-vaccinations (accessed on 29 March 2022).
Khan, M.S.; Watanapongvanich, S.; Kadoya, Y. COVID-19 Vaccine Hesitancy among the Younger Generation in Japan. Int. J. Environ. Res. Public Health 2021, 18, 11702.
Adams, S.H.; Schaub, J.P.; Nagata, J.M.; Park, M.J.; Brindis, C.D.; Irwin, C.E., Jr. Young Adult Perspectives on COVID-19 Vaccinations. J. Adolesc. Health 2021, 69, 511–514.
Awijen, H.; Ben Zaied, Y.; Nguyen, D.K. COVID-19 Vaccination, Fear and Anxiety: Evidence from Google Search Trends. Soc. Sci. Med. 2022, 297, 114820.
Ostermann, T.; Gampe, J.; Röer, J.P.; Radtke, T. Antecedents of Individuals’ Concerns Regarding Hospital Hygiene and Surgery Postponement During the COVID-19 Pandemic: Cross-Sectional, Web-Based Survey Study. J. Med. Internet Res. 2021, 23, e24804.
Ali, M.; Hossain, A. What Is the Extent of COVID-19 Vaccine Hesitancy in Bangladesh? A Cross-Sectional Rapid National Survey. BMJ Open 2021, 11, e050303.
Ali, M. What Is Driving Unwillingness to Receive the COVID-19 Vaccine in Adult Bangladeshi after One Year of Vaccine Rollout? Analysis of Observational Data. IJID Reg. 2022, 3, 177–182.
Khalid, S.; Usmani, B.A.; Siddiqi, S. COVID-19 Vaccine Hesitancy in Pakistan: A Mini Review of the Published Discourse. Front. Public Health 2022, 10, 841842.
Simkhada, P.; Tamang, P.; Timilsina, L.; Simkhada, B.; Bissell, P.; van Teijlingen, E.; Sah, S.K.; Wasti, S.P. Factors Influencing COVID-19 Vaccine Uptake among Nepali People in the UK: A Qualitative Study. Vaccines 2022, 10, 780.
Imhoff, R.; Lamberty, P. A Bioweapon or a Hoax? The Link between Distinct Conspiracy Beliefs about the Coronavirus Disease (COVID-19) Outbreak and Pandemic Behavior. Soc. Psychol. Personal. Sci. 2020, 11, 1110–1118.
Salali, G.D.; Uysal, M.S. COVID-19 Vaccine Hesitancy Is Associated with Beliefs on the Origin of the Novel Coronavirus in the UK and Turkey. Psychol. Med. 2020, 1–3.
Betsch, C.; Böhm, R.; Chapman, G.B. Using Behavioral Insights to Increase Vaccination Policy Effectiveness. Policy Insights Brain Sci. 2015, 2, 61–73.
Bavel, J.J.V.; Baicker, K.; Boggio, P.S.; Capraro, V.; Cichocka, A.; Cikara, M.; Crockett, M.J.; Crum, A.J.; Douglas, K.M.; Druckman, J.N.; et al. Using Social and Behavioural Science to Support COVID-19 Pandemic Response. Nat. Hum. Behav. 2020, 4, 460–471.
Reñosa, M.D.C.; Landicho, J.; Wachinger, J.; Dalglish, S.L.; Bärnighausen, K.; Bärnighausen, T.; McMahon, S.A. Nudging toward Vaccination: A Systematic Review. BMJ Glob. Health 2021, 6, e006237.
Mertens, S.; Herberz, M.; Hahnel, U.; Brosch, T. The Effectiveness of Nudging: A Meta-Analysis of Choice Architecture Interventions across Behavioral Domains. Proc. Natl. Acad. Sci. USA 2022, 119, e2107346118.
Williams, S.; Drury, J.; Michie, S.; Stokoe, E. COVID-19: What We Have Learnt from Behavioural Science during the Pandemic so Far That Can Help Prepare Us for the Future. BMJ 2021, 375, n3028.
Jackson, T.; Steed, L.; Pedruzzi, R.; Beyene, K.; Chan, A.H.Y. Editorial: COVID-19 and Behavioral Sciences. Front. Public Health 2022, 9, 830797.
Technical Advisory Group on Behavioural Insights and Sciences for Health. Behavioural Considerations for Acceptance and Uptake of COVID-19 Vaccines; World Health Organization: Geneva, Switzerland, 2020; p. 18.
Serbian Citation Index. Available online: https://scindeks.ceon.rs/default.aspx?lang=en (accessed on 8 June 2022).

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Aleksandar S Mojašević

Aleksandar Mojašević

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1. Introduction

2. COVID-19 Vaccination

References