How to increase the adoption of public health recommendations during the COVID-19 Pandemic (Past Academic Essay)

This essay was written whilst I was a student attending Northumbria University between 2021 - 2023 and it was designed to assess my ability to apply social psychology to real world problems using a critical evaluation of the usefulness of social psychology in understanding and intervening in issues of behavioural compliance. The purpose of this assessment was not on the scope of the problem selected, but on how effectively social psychology could be applied to the problem.

The context of this essay was focused on the COVID-19 pandemic, where government bodies increasingly looked to social psychologists and other behavioural scientists for advice on how to encourage people to adopt public health recommendations (such recommendations included hand-washing, mask-wearing, and physical distancing). The assessment required me to write a brief report explaining how to increase adoption of one or more of the public health recommendations. In the report, we were asked to explain how social psychology can provide the resources to understand why people do and do not follow official advice. We were also asked to describe a concrete strategy that could be put in place to increase the adoption of public health recommendations. As additional information, we were told to focus attention on the problem more broadly (e.g. how to get people across the nation to wash their hands more regularly) or more narrowly (e.g. how to discourage churches from singing or how to encourage secondary school children to wear masks).

Throughout history, humans have successfully developed vaccines for many diseases which may have been life-threatening, including meningitis, mumps, and rubella. Despite their proven efficiency and protection, some individuals are still unwilling to be vaccinated. One specific group of individuals will refuse to get the coronavirus vaccine, and that group is known as the “anti-vaxxers". An anti-vaxxer is 'a person who opposes the use of vaccines or regulations mandating vaccination'. (Anti-vaxxer definition and meaning, 2001) There are many excuses that individuals may use to explain their reasons for not getting vaccinated. Some include lack of safety concern, side effects of the vaccine, effectiveness of the vaccine, and conspiracy theories (e.g. That the vaccine may be microchipped or that it includes genetic mutation qualities). 

This essay will explore these concerns from a psychological perspective and then will continue to give recommendations on increasing adherence to getting the vaccine for this group of individuals. The public health recommendation addressed in this essay is the recommendation to get vaccinated for the coronavirus. It will also specifically address anti-vaxxers with an explanation of critical social psychological principles or theories that explain why people would not follow the recommendation and an explanation of social psychological principles or theories that explain how to increase adherence to the recommendation. This will include a description of a concrete intervention that can be applied to increase adherence to the recommendation. Throughout, it will consider a critical evaluation of the usefulness of social psychology in understanding and intervening in issues of behavioural compliance.

Germs exist in the environment and human bodies, but when an individual becomes susceptible to germs, they may encounter a harmful organism that could lead to illness and death. A pathogen is a type of bacteria, virus, or fungus that may cause illness within the body. The human body may defend itself from pathogens using skin, mucus, and cilia as physical barriers to prevent these pathogens from entering the body, but when these barriers fail, the body's immune system is triggered, which causes the pathogen to be attacked and destroyed. These subparts of the pathogen may be made up of multiple smaller parts called antigens that form in the body, and the antibodies in the human body will attack. Antibodies must create specific antibodies to attack the correct antigens and stop the disease. Once the antibodies have been produced, the body will maintain antibody-producing memory cells, which will remain alive after the pathogen has gone, just in case it decides to return; meaning that if the pathogen returns, the body will fight the disease much faster and more effectively than the first time. Vaccines contain 'weakened or inactive parts of a particular organism (antigen) that trigger an immune response within the body’. (How do vaccines work?, 2020) This weakened antigen will not cause the disease itself in the person receiving the vaccine, but it will help the person's body respond to the disease quickly and effectively if they do catch the disease. Some vaccines require multiple doses to 'allow for the production of long-lived antibodies and development of memory cells’; (ibid., How do vaccines work?, 2020) in other words, they help the body train for specific ailments. Vaccines protect individuals from specific diseases, but it is acknowledged that not everybody can be vaccinated. For example, if they have underlying health conditions, their immune system is compromised, such as an autoimmune disorder or cancer. Some may also have an allergy to vaccines. When most people within a community are vaccinated, the disease has a hard time spreading because most of the people whom the disease encounters are immune.

Some argue that it would be cheaper and more effective to partake in herd immunity. Herd immunity is when everyone collectively gets the illness and develops antibodies. No single vaccine can give 100% protection, but it provides more protection than herd immunity because herd immunity does not protect those who cannot safely be vaccinated, nor does it protect those who have pre-existing ailments such as weakened immune systems, as they may die if they catch the disease. Vaccinating protects communities, as well as individuals. 

Vaccines are made by firstly reaching a pre-approval stage, following clinical trials. This pre-approval stage means they must be assessed for quality, safety and efficacy criteria prior to administering. During pandemics such as the coronavirus, the WHO Emergency Use Listing Procedure (EUL) allows the administration of emergency vaccines. Emergency vaccines allow ‘a fast-tracked but rigorous process, designed to bring impactful products to all those in need, as quickly as possible, on a time-limited basis and based on a risk-versus-benefit evaluation’. (Manufacturing, safety and quality control of vaccines, 2020) These vaccines are still safe and have been tested, however, they tend to be considered safe based on an emergency basis which means they are considered to do more good than harm. 

In terms of the coronavirus, multiple vaccines have been made to protect the community from the disease. Hundreds of vaccinations were made for the coronavirus, but only ‘7 out of every 100 will be considered good enough to move into clinical trials in humans'. (The different types of COVID-19 vaccines, 2020) Once they have been trialled, three will typically be administered. One will use the whole virus or bacterium, another will use the parts of the virus that trigger the immune system, and the third will use the virus's genetic material. Each of these is then tested to see which one will be most effective. The vaccines that prove most effective will then be mass-produced and administered across a community. Firstly, they will be administered to the most vulnerable who will not survive the disease if they were to catch it on their own. Then the vaccine will be allocated gradually among everyone who can take it. The vaccine has been proven to work against the coronavirus, but it has also been proven to provide some protection against the new virus variants.

The group of individuals known as anti-vaxxers refuse to get vaccines based on theories they have generated that goes against the use of vaccines. One way in which these theories have been generated and spread is via social mechanisms. Most individuals would be more likely to believe facts about COVID from a health professional than they would on social media; however, anti-vaxxers are well-known for spreading misinformation about the pandemic and the vaccines via social media. In March 2021, a study was published that conducted a behavioural analysis on the anti-vaccination infodemic on social media. The results of this study showed that Twitter seemed to be the main culprit of the anti-vaccination profiles, with 536 actions per month compared to only 144 actions for the pro-vaccination group. (Germani, F., & Biller-Andorno, N., 2021) These results highlight the amount of misinformation being spread compared to the correct information on social media.

So how can social psychology increase the adherence to the COVID vaccination? Information has already been made available on the World Health Organisation website for individuals to research whether the vaccine is safe and efficient. However, some individuals still go further to research the vaccine elsewhere. Each of the reasons for not getting vaccinated must be addressed and sorted. The reasons for anti-vaccinators tend to fit within five categories. 

Firstly, they are uncertain whether the vaccines are efficient or safe. (Robson, D., 2021) In 1999, Hogg and Grieve conducted a study where they showed PowerPoint slides to a group of individuals that tested high uncertainty to conditions and unambiguous slides. (Grieve, P., & Hogg, M., 1999) The individuals were categorised into a group that would later meet to discuss their interpretations and a group that would not. The researchers then asked the individuals to write about the pictures and rate how specific their interpretation was. The results showed that those who met as a group later were less sure of their interpretation of the slides, whereas those who did not were more sure of their interpretation. The uncertainty amongst anti-vaxxers is most likely due to the spread of misinformation being discussed within the group rather than the individual's true beliefs, thus the community have convinced themselves of this misinformation due to their social ties. One way this could be resolved would be to contact people on an individual basis that gives them the correct information. This method would be beneficial because it would allow the individual to feel heard and respected; however, it would also be time-consuming, and there are not enough doctors to realistically do this. 

Secondly, anti-vaccinators do not consider the disease itself a severe risk to their health. (ibid., Robson, D., 2021) Although it has been proven multiple times that COVID can seriously impact an individual's life, most still believe it will not impact theirs. To explain this issue, it may be wise to consider the social comparison. Social comparison creates a social identity by comparing others to those worse off than that individual. For example, one individual may be relatively healthy and not be suffering from health concerns; however, their neighbour may be suffering from a compromised immune system that would mean that they may require hospitalisation if they were to contract the COVID disease. As the individual would not require hospitalisation, they can compare themselves with that scenario and may feel they do not need the vaccine because they are not as compromised as those around them. Therefore, they acknowledge the disease may make them unwell, but they also acknowledge that it will not kill them as it may do to others. This narcissistic response lacks empathy for those who would not survive if they contracted the illness, so how can it be resolved? This issue may be resolved by spreading further awareness about those who would not survive due to catching the illness. This may include social media posts relating to the individual's personal lives, such as the elderly individuals in their lives or friends and family members who may be compromised. Influencing the anti- vaccinator's empathy may be possible to get a positive response to the vaccine. In addition to this approach, it has been shown that individuals tend to categorise themselves on a social level. This may include their ties to other anti-vaxxers and the misinformation they share. Using social media to portray anti-vaxxers negatively would create a social competition that may make them feel guilty about their decisions not to get vaccinated. (Islam G., 2014)

Although this approach may be considered beneficial, there are some pitfalls. Most anti-vaxxers have already colonised themselves within communities of another anti-vaxxer; therefore, attempting to remove them from these groups may feel like a betrayal to them. This guilt may be more impactful than the decision not to get vaccinated. In addition, many individuals will see social media posts about guilt-inducing issues currently happening in the world and will still believe it does not apply to them. 

Thirdly, the individual may have read extensive information that weighs up the costs and benefits, thus deciding more cons than pros. (ibid., Robson, D., 2021) This could be resolved by using terror management theory, first established by Greenburg, Solomon, and Pyszczynski in 1997. This theory argued that individuals have existential anxiety about death, which causes them to invest in activities, values, and cultures that provide them with symbolic immortality. When individuals accept their values within a community, they feel a sense of self-esteem that overcomes their fear of death. This theory can spread terror amongst social media by reminding individuals that there is a high mortality rate for this disease if they do not get vaccinated. 

This method may be beneficial as it reminds people why the vaccine is essential, especially as anti-vaxxers are already using fear to prevent people from receiving the vaccine via conspiracy theories and propaganda. However, it can also have many adverse outcomes. For example, many people already have high anxiety about the coronavirus, so adding more to the fear of this disease could cause a mental health pandemic on top of the already occurring COVID pandemic. In addition to this, some individuals do not care whether they live or die, so it would not impact them. 

Fourthly, they may have decided that there are constraints on the information provided by the vaccine. (ibid., Robson, D., 2021) The lack of information provided is significant as to adhering to the vaccine. An individual is more likely to believe facts given by a doctor than someone who does not know a subject. This means all health professionals must be trained adequately enough to provide knowledge about the COVID vaccine without getting facts incorrect. A study conducted in 1991 showed that people are more likely to reject information if facts seem errored. (Christianson, S.-Å., & Loftus, E. F., 1991) This theory was supported by neuroimaging data that showed increased brain activity during encoding was linked with lower susceptibility to misinformation. If even one doctor spreads misinformation, even something that is just phrased in a way that may come across as false, the person will be less likely to trust what they have to say. As doctors are members of the authority, trust is vital to the individual. This approach would be beneficial because most doctors would agree that vaccines are essential to the protection of individuals. However, those who are opposed to vaccinations after conducting their own research still may not listen to an authoritative figure due to being set in their ways. 

Finally, they do not believe that they have the collective responsibility to protect others from infection through vaccination. (ibid., Robson, D., 2021) Some individuals believe that the coronavirus should be based on survival of the fittest, and those who are not fit enough to survive should be taken out by the disease. This lack of empathy for other people causes individuals to put themselves first and ignore the community members who may require further help. This can, however, be threatened still. Altruism is when an individual acts in a way that will decrease its survival chances but improve the survival chances of others. The leading theory used here is within kin selection which was established by Burnstein et al. in 1994. (Burnstein, E., Crandall, C., & Kitayama, S., 1994) Kin selection is the theory that individuals are more likely to help their kin than someone not a part of their immediate family (e.g. if a building were burning down, a mother would be more likely to rescue her child from the burning building than her neighbour). If the government were to spread information that targets the vulnerability of children from this disease, then it might influence anti-vaxxers who have children to get vaccinated. This may also work by showing the mortality rate statistics on elderly individuals and showing studies on how this loss may affect young children. 

Again this approach is beneficial as it plays on losing a close family member; however, creating an entire research document is time-consuming, and most anti-vaxxers probably would not read it. In addition to this, the statistics have always been available online, but people cannot trust them. This is because it has been proven that non-COVID related cases are being filed as COVID deaths. Alternatively, those who have died of COVID have possible other conditions that affect their recoveries, such as cancer or autoimmune disorders.  

Another pitfall in this approach is that COVID may be compared with other illnesses that are now vaccinated but were not in the past. An example of this could be chickenpox. There are now vaccines available for children before they encounter chickenpox. However, this vaccine is not part of the routine childhood vaccination schedule because there is no high mortality rate for chickenpox. Some may assume that because a vaccine is available but not mandatory and survived chickenpox easily, why should individuals be forced to get the COVID vaccine when they could risk getting COVID and surviving it in the same way. 

In conclusion, social psychology could take many approaches to enforce vaccinations amongst those who oppose them. Some of these included giving information from reliable sources, the human desire to protect families and children, and terror tactics. Each method has its benefits as well as its pitfalls. Social psychology can be highly beneficial in helping to understand issues of behavioural compliance, however, it is less useful in the intervention. 

Referenced

• Anti-vaxxer definition and meaning. (2001). Retrieved 8 March 2022, from https://www.merriam-webster.com/dictionary/anti-vaxxer

• Burnstein, E., Crandall, C., & Kitayama, S. (1994). Some neo-Darwinian decision rules for altruism: Weighing cues for inclusive fitness as a function of the biological importance of the decision. Journal of Personality and Social Psychology, 67(5), 773–789. https://doi.org/10.1037/0022-3514.67.5.773

• Christianson, S.-Å., & Loftus, E. F. (1991). Remembering emotional events: The fate of detailed information. Cognition and Emotion, 5(2), 81–108. https://doi.org/10.1080/02699939108411027

• Germani, F., & Biller-Andorno, N. (2021). The anti-vaccination infodemic on social media: A behavioral analysis. PLOS ONE, 16(3), e0247642. doi: 10.1371/journal.pone.0247642 

• Grieve, P., & Hogg, M. (1999). Subjective Uncertainty and Intergroup Discrimination in the Minimal Group Situation. Personality And Social Psychology Bulletin, 25(8), 926-940. doi: 10.1177/01461672992511002 

• How do vaccines work?. (2020). Retrieved 8 March 2022, from https://www.who.int/news-room/feature-stories/detail/how-do-vaccines-work

• Islam G. (2014) Social Identity Theory. In: Teo T. (eds) Encyclopedia of Critical Psychology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5583-7_289

• Manufacturing, safety and quality control of vaccines. (2020). Retrieved 8 March 2022, from https://www.who.int/news-room/feature-stories/detail/manufacturing-safety-and-quality-control

• Robson, D. (2021). Why some people don't want a Covid-19 vaccine. Retrieved 8 March 2022, from https://www.bbc.com/future/article/20210720-the-complexities-of-vaccine-hesitancy

• The different types of COVID-19 vaccines. (2020). Retrieved 8 March 2022, from https://www.who.int/news-room/feature-stories/detail/the-race-for-a-covid-19-vaccine-explained

Citing this essay:

Article Title:
Author:	Mx. R.J. Gittins
Publisher:	SheThinkDifferent (The Unseen Spectrum)
Date Written:	Spring 2022
Date Published:	August 2024