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
resea
uthorchers 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
resea
uthorchers 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
resea
uthorchers 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 re
viewsearch 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
resea
uthorchers 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
resea
uthorchers 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
authoresearchers 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
authoresearchers 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
review, the
authoresearchers 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
wresearche
rs 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
resear
ticlesch 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
we conducted in Serbia seeks to fill this gap and to popularize behavioral science in the field of health care.