What influences people’s attitudes towards vaccination? Laura Kudrna and Kelly Ann Schmidtke report on an experiment seeking to determine whether messages aligned with people’s politics influenced their intentions to take up the influenza vaccine. They find that the messages had no substantial effect

Kudrna, Laura

Schmidtke, Kelly Ann

English

LSE Research Online

Speaking	to	hearts	before	minds?	Public	healthmessages	aligned	with	people’s	political	intuitionsmay	not	increase	vaccination	uptakeWhat	influences	people’s	attitudes	towards	vaccination?	LauraKudrna	and	Kelly	Ann	Schmidtke	report	on	an	experiment	seekingto	determine	whether	messages	aligned	with	people’s	politics	influenced	theirintentions	to	take	up	the	influenza	vaccine.	They	find	that	the	messages	had	nosubstantial	effect.In	2019,	the	Health	Secretary,	Matt	Hancock	said	that	he	is	‘open’	to	makingvaccines	compulsory,	and	Labour	MP	Paul	Sweeney	argued	that	failure	to	vaccinate	children	should	be	a	‘criminaloffence’.	But	mandates	are	difficult	to	enforce,	and	punishments	diminish	public	trust.	In	addition,	people	still	opt	outof	mandatory	policies,	and	effectiveness	increases	when	people	freely	comply.	Instead	of	mandates,	we	advocatebehavioural	approaches	that	preserve	individual	freedom,	and	agree	with	Professor	Heidi	Larson	that	additionalemphasis	should	be	placed	on	public	perspectives	when	planning	vaccine	policies	and	programs.Public	health	messaging	about	vaccines	is	particularly	important	in	light	of	COVID-19.	In	April	2020,	the	UnitedKingdom’s	Vaccine	Taskforce	convened;	in	May,	the	United	States’	‘Operation	Warp	Speed’	took	off.	This	speedelicited	optimism	among	some	but	handed	a	megaphone	to	the	anti-vaccination	movement.	Del	Bigtree,	founder	ofthe	Information	Consent	Action	Network,	cautioned	that	‘You	shouldn’t	rush	to	create	a	product	you	can	inject	intoperfectly	healthy	people	without	doing	proper	safety	studies’.	Here,	identical	factual	information	–	a	vaccine	is	beingdeveloped	quickly	–	elicited	reasoned	responses	that	were	both	optimistic	and	pessimistic.	However,	intuitionscome	first	and	strategic	reasoning	comes	second.	Where	public	health	messages	do	not	align	with	people’sautomatic	intuitions,	factual	and	reasoned	information	may	go	unheeded.On	21	September,	we	conducted	an	online	experiment	to	determine	if	public	health	messages	aligned	with	people’spolitical	intuitions	influenced	their	intentions	to	take	up	the	influenza	vaccine.	Influenza	vaccinations	have	long	beenimportant,	but	are	particularly	important	now	in	the	context	of	COVID-19	because	co-infection	increases	mortalityrates.	We	recruited	192	participants	living	in	England,	aged	50+,	and	who	had	not	already	vaccinated	this	season.Half	identified	as	being	affiliated	with	the	Labour	Party	and	half	with	the	Conservative	Party.	Participants	viewed	amessage	either	aligned	or	unaligned	with	their	automatic	political	intuitions	(see	Figures	1	and	2).	Then	they	statedhow	much	they	agreed	with	a	statement	about	their	intentions	to	take	up	the	influenza	vaccine	this	season	on	a	7-point	scale,	where	higher	numbers	indicated	more	positive	intentions.British Politics and Policy at LSE: Speaking to hearts before minds? Public health messages aligned with people’s political intuitions may not increasevaccination uptakePage 1 of 4		Date originally posted: 2020-10-15Permalink: https://blogs.lse.ac.uk/politicsandpolicy/public-health-messages-political-intuition/Blog homepage: https://blogs.lse.ac.uk/politicsandpolicy/Professor	Johnathan	Haidt	describes	the	automatic	intuitions	we	set	out	to	influence	as	moral	foundations.Typically,	people	who	identify	as	being	more	left-wing	are	most	strongly	influenced	by	their	care	and	fairnessintuitions	(a	desire	to	prevent	harm	to	others	and	to	ensure	equality).	In	contrast,	people	who	identify	as	being	moreright-wing	are	more	strongly	influenced	by	the	remaining	foundations:	purity	(a	desire	to	avoid	contaminants),authority	(to	preserve	traditions),	loyalty	(to	strengthen	group	bonds),	and	liberty	(to	preserve	individual	freedom).British Politics and Policy at LSE: Speaking to hearts before minds? Public health messages aligned with people’s political intuitions may not increasevaccination uptakePage 2 of 4		Date originally posted: 2020-10-15Permalink: https://blogs.lse.ac.uk/politicsandpolicy/public-health-messages-political-intuition/Blog homepage: https://blogs.lse.ac.uk/politicsandpolicy/Research	conducted	in	the	United	States	and	Australia	has	already	identified	some	of	the	foundations	associatedwith	parental	vaccine	hesitancy,	and	suggests	that	public	health	messages	can	be	framed	to	increase	parents’intentions.	For	example,	a	message	designed	to	promote	purity	might	say:	‘Boost	your	child’s	natural	defensesagainst	diseases!	–	Vaccinate!’.	These	proposals	are	a	good	start,	but	without	evidence	that	they	are	likely	to	beeffective,	public	health	practitioners	have	little	reason	to	prefer	them	to	the	messages	developed	in-house.	Themessages	used	in	the	present	study	were	informed	by	messages	used	in	a	previous	one	that	significantly	alteredpeople’s	intentions	to	recycle.Our	main	prediction	was	that	our	left-wing	message	would	increase	labour	participants’	intentions,	and	our	right-wing	message	would	increase	conservative	participants’	intentions.	We	did	not	find	this.	As	shown	in	Figure	3,	themessages	had	no	substantial	effect.	One	explanation	is	that	the	moral	foundations	used	in	our	advertisements	werenot	relevant	in	a	UK	context,	which	we	plan	to	address	in	future	work.	We	aim	to	conduct	a	general	UK	surveydescribing	moral	foundations	in	the	population	and	use	the	survey	results	to	inform	a	collaborative	online	workshopwith	public	contributors	and	health	specialists,	which	is	in	keeping	with	Professor	Heidi	Larson’s	calls	to	involvepublic	perspectives.	This	pilot	study	lays	the	groundwork	for	such	future	research.British Politics and Policy at LSE: Speaking to hearts before minds? Public health messages aligned with people’s political intuitions may not increasevaccination uptakePage 3 of 4		Date originally posted: 2020-10-15Permalink: https://blogs.lse.ac.uk/politicsandpolicy/public-health-messages-political-intuition/Blog homepage: https://blogs.lse.ac.uk/politicsandpolicy/We	asked	people	some	follow	up	questions	too.	In	a	free-text	box,	participants	were	asked	to	explain	theirintentions	to	vaccinate.	Their	explanations	largely	fell	within	five	categories,	which	in	addition	to	their	foundationsmay	have	been	influenced	by	the	messages	they	read:	Protect	Self;	Protect	Others;	Protect	the	NHS;	BeingEligible/Invited;	and	Habits.	We	also	asked	questions	about	people’s	intentions	of	taking	up	a	COVID-19vaccination	and	wearing	a	face	mask.	Similar	to	recent	research,	people	were	more	likely	to	express	intentions	totake	up	a	future	COVID-19	vaccination	(72%)	than	the	current	influenza	vaccination	(65%).	We	suspect	that	theseexpressed	intentions	may	be	a	bit	optimistic.	Indeed,	most	participants	(89%)	also	expressed	that	they	would	weara	face	mask	in	a	store	that	did	not	require	them	to	do	so,	which	is	higher	than	our	casual	observations	at	thegrocery	store	around	the	time	of	the	experiment	(before	additional	penalties	were	introduced).	Acquiescence	biasmay	have	led	our	participants	to	be	agreeable	in	this	survey,	particularly	as	they	just	saw	messages	promotinghealth-related	behaviour.	But	this	need	not	preclude	identifying	meaningful	differences	between	randomizedconditions.	Our	research	team	looks	forward	to	better	understanding	the	intuitive	influences	on	vaccinationbehaviour._____________________About	the	AuthorsKelly	Ann	Schmidtke	is	Assistant	Professor	at	the	Warwick	Medical	School,	University	ofWarwick.		Laura	Kudrna	is	Research	Fellow	at	the	University	of	Birmingham.				British Politics and Policy at LSE: Speaking to hearts before minds? Public health messages aligned with people’s political intuitions may not increasevaccination uptakePage 4 of 4		Date originally posted: 2020-10-15Permalink: https://blogs.lse.ac.uk/politicsandpolicy/public-health-messages-political-intuition/Blog homepage: https://blogs.lse.ac.uk/politicsandpolicy/

Speaking to hearts before minds? public health messages aligned with people’s political intuitions may not increase vaccination uptake

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Speaking to hearts before minds? public health messages aligned with people’s political intuitions may not increase vaccination uptake

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