A woman wearing a mask speaks and gestures to a friend

The Antidote to Vaccine Hesitancy

Prebunking, inoculation, and other best practices in health communication

Interview by Melissa Hartman

For pandemic-weary Americans who got their COVID-19 shot at the first opportunity, vaccine hesitancy has become increasingly difficult to understand. But for social and behavioral scientist Rupali Limaye, the reasons are clear, and they boil down to one word: Trust.

Director of behavioral and implementation science at the International Vaccine Access Center and an associate scientist in International Health, Limaye, PhD ’12, MPH, MA, is an expert on vaccine behavior and decision-making. In this Q&A, she discusses the roots of vaccine hesitancy, how she responds to it, and how we can prevent it from flourishing.

What do you see as the biggest drivers of vaccine hesitancy? 

There’s lots of concerns with regard to the vaccine development process—that the development of the vaccine was very quick, or that the vaccine has been out for a very short period of time, so long-term effects have not been adequately studied. 

Autonomy and liberty are another piece. Think about all the nonpharmaceutical interventions we promoted where people said, “You can’t tell me to wear a mask” or “You can’t tell me to stay at home.” Vaccines are another intervention where people say, “You can’t tell me what to do, I have autonomy over my body.”

The third piece is misinformation and disinformation. In early August when mask guidelines changed again, we in public health saw that as part of the scientific process: gathering data, analyzing that data, and then using that data to change recommendations if need be. That is not at all how the public sees it. They see this change as public health scientists not knowing what they’re doing, and that has been fueled by a lot of misinformation, which has been rampant on social media. 

This looks less like individual skepticism than a group problem in those pockets of resistance. How do you solve that?

Social norms are important in any type of behavior that could be seen as sensitive. 

If I go on social media and say, “Hey, who’s gotten the vaccine? Can you guys tell me what you think?” I’m going to be communicating and connecting with people who already think the way I do. Unfortunately, polarization has led to disparate clusters of people who think the same way and share the same political views. In these clusters, people would not even entertain the idea of doing an opposing behavior. It’s been a real challenge to break through these echo chambers.

How can you do that?

You can apply a public health response. We can use AI and other tools to see where this messaging comes from, for example, and develop responses. We can have community and public health leaders acknowledge the misinformation they’re seeing and debunk it. We can also use something called prebunking and inoculation, which is exposing people to small “doses” of opposing information or showing them what misinformation looks like. Then they won’t be as susceptible when they encounter misinformation and won’t be as resistant to opposing ideas.

It’s really important for all of us to keep empathy front and center and to not be dismissive. A lot of people just need to talk it out and have a longer conversation.

We’re starting to see reports of people who opposed vaccines now getting COVID and encouraging others to get vaccinated. Can they change people’s minds?

When you have Republican leaders saying, “I got the vaccine,” that can nudge people in groups who share their norms to get the vaccine. 

There was a dad in Florida, I think, who was on a ventilator and saying, “I should have gotten the vaccine.” It concerns me that it may take essentially a near-death experience to convince individuals who are that firmly rooted in their resistance to accept the vaccine. 

There have been reports of people who’ve lost family members to COVID and still refuse the vaccine. How can they be persuaded?

We’re living in a very uncertain time, and people are going to do anything they can to reduce that uncertainty. That might mean glomming onto a conspiracy theory or listening to someone they trust but who might not have scientific evidence backing their claims. It’s really important for all of us to keep empathy front and center and to not be dismissive. A lot of people just need to talk it out and have a longer conversation.

How would you respond to questions about microchips in vaccines, for example?

The important thing is not to immediately try to correct the misperception. Instead of building trust, this can lead to the boomerang effect, where your message generates the opposite attitude or behavior of what was intended. 

If I am confronted with a myth or a misperception, I say something like, “I know there’s a lot of information out there and it can be hard to discern what is true.” I talk through how the vaccine was developed, including the ingredients, the approval process it goes through. Then I explain that from an evidence-based perspective, it’s impossible to inject a microchip in any vaccine. 

To me, all of these questions are valid. People have heard that the vaccines could do this or that—there’s just so much misinformation.

Looking back on how all this has unfolded, what could we have done better from the outset? 

We need to get better at risk communication at all different levels, not just public health entities talking to the public. It’s also when we work with journalists. We need to provide context for any data point that comes out and not focus on sensational headlines. 

At the very beginning of the pandemic I worked on the communication response of the Baltimore COVID-19 public-private partnership. For the mayor’s and governor’s press briefings, I said, “There are three things you have to talk about every time: Here’s what I know, here’s what I don’t know, and here’s what I’m asking you to do.” 

One thing we learned is that even if we don’t know the answer, having open, transparent communication will increase trust in the public health response.