What behavioural science can teach governments about vaccine hesitancy

By Melissa Coade

Tuesday August 3, 2021

The Vaccine Hesitancy Determinants Matrix might help Australia meet its vaccination targets. (Prostock-studio/Adobe)

Public confidence is key to progressing to phase B (vaccine transition phase) of the Australian government’s four-stage plan in response to the COVID-19 pandemic, and behavioural science can help us get there.

With the federal government announcing what vaccination targets will need to be met to progress Australia’s recovery through the COVID-19 pandemic (70% of the eligible population fully vaccinated to move to phase B, and 80% before snap lockdowns can end), how to lift public confidence in getting the jab is the challenge for public health teams across the nation.

Professor Ben Newell and Dr Kate Faasse from UNSW Sydney’s school of psychology, have highlighted research that can improve health campaigns promoting vaccination among the general public.

They suggest following one of the most influential behavioural science models — known as the Vaccine Hesitancy Determinants Matrix — developed by a working group appointed by the World Health Organization’s strategic advisory group of experts (SAGE).

“[The WHO] talks about the ‘three Cs’: convenience, confidence and complacency, but a subsequent study has added a fourth C: calculation,” Newell explained.

“The idea is that the four Cs are different avenues that you can pursue in order to get people over the perceived barriers of taking the vaccine. They are different categories which could affect people’s willingness to get vaccinated.”

By focusing on convenience, confidence, complacency and calculation issues when addressing why it is people are not stepping forward to get vaccinated, the psychologists believe government messaging to urge more Australians to get the jab can be enhanced.

Making convenience a priority

Newell explained that for convenience, vaccine policy and messaging needed to consider how easy it was for people to make bookings, seek advice, and access a local clinic.

“The easier you make the choice for people, and the simpler it is to find the information you need to make the booking, then the more likely you are to get people over that initial barrier.”

Only last week, NSW chief health officer Dr Kerry Chant was appealing to residents to support elderly residents and friends organise their vaccines against COVID. On Friday Chant said that with more sites to access the AstraZeneca vaccine – like pharmacies – now available in the community, it was a ‘no-brainer’ that uptake among older people should improve.

The CHO said she remained concerned about the stubborn number of people in the community over-70 who were not vaccinated. New federal government data released on Thursday showed that only 39% of people over the age of 70 in NSW had received two doses of the COVID-19 vaccines. A total of 77% of NSW residents in this age group have received one dose. 

Countering complacency with urgency

Complacency, another issue beleaguered by confused government messaging in Australia which has switched from ‘it’s not a race’ to an urgent call to get jabs in arms, is another issue public health communications and political leaders need to directly address, Newell added. 

The cognitive psychology professor said when people do not consider vaccination as necessary and important, it naturally shifts down their list of priorities. 

“In Australia’s case, this is because the virus hasn’t been in the community so there hasn’t been a sense of urgency to get the vaccine.

“So to overcome this, you need to emphasise that it’s just not for you, it’s for the social good, because lots of people in the community are susceptible to it.”

Newell and Faasee have played a role in advising the government on vaccine hesitancy, in particular how to overcome the confused public sentiment towards the readily available vaccine against COVID-19 in Australia: AstraZeneca. 

They also believe that supply issues are one of the reasons vaccine uptake has been slow in Australia but also argue that there is ‘no doubt’ confusion about the AstraZeneca vaccine has fuelled general vaccine hesitancy, and towards all available COVID-19 vaccines in Australia.

“It’s clear the supply issue (of Pfizer vaccine doses) is going to supersede a lot of these categories.

“But it’s also problematic that – in the complacency case – that I really might want it, but if I get online to book and have several failed attempts, then that’s likely to shift it down my list of priorities and I won’t bother to book,” Newell said.

Driving confidence about vaccine efficacy

Fear about the potential side-effects of the COVID-19 vaccines is one of the biggest issues undermining public confidence about it. Indeed, the positive trend of improved vaccination uptake in Australia has gone in hand with growing fear about catching the virus (see complacency above) as leaks of the Delta variant have broken out in major capital cities during 2021

“We need to debunk the myths around vaccination, but also develop trust and any information about that is going to help with the confidence factor,” Newell said. 

He explained that confidence was about two things: whether people were confident in the efficacy of the vaccine itself, and also whether they trusted the authority advising people to get vaccinated. 

“During COVID, there’s been a lot of discussion about how the vaccine was developed so rapidly, what is mRNA, and the issue of AstraZeneca has also been tricky.

“So we need to build confidence around that, getting [the community] to understand that it has been a rapid development because it has been unprecedented effort by governments and corporations to develop them,” Newell said. 

Appealing to the ‘pros and cons’ group

Another group of people in the community put store in making calculated decisions, and public health information can help inform them about their best options to avoid complacency. Newell said this group liked to participate in an evaluation where they had the opportunity to weigh pros and cons about getting a vaccine for themselves.

“What’s going to be the impact on me if I do, versus if I don’t have it?” Newell explained. 

Another thing that governments can do for people in this category group is to provide structured incentives that show getting the jab can improve their lifestyle.

“This could include fewer restrictions, less likelihood of lockdowns, the ability to travel interstate and overseas and not have to quarantine on return,” Newell said. 

Finally, Professor Newell said that by deploying the ‘four Cs’, governments and health authorities could lift vaccination uptake from 50% to 70%. This is essentially the difference between Australia remaining in the ‘suppression phase’ of the national four-stage plan in response to the COVID-19 pandemic

“There’s a gap between the numbers of people that can get the vaccine and are eligible to get it, and then [those who] actually get it.

“Say you get to 50% of the population vaccinated, but you want to get to 70% – the 20% you need probably aren’t antivaxxers, they probably haven’t got around to it. 

“It’s thinking about how we are going to get those ‘I just haven’t got to it’ people over the line. Thinking about these ‘four C’ issues might be a way to appeal to them,” he said. 


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