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Rotman Insights Hub | University of Toronto - Rotman School of Management

To overcome vaccine hesitancy, governments need to show citizens what’s in it for them

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Anita M. McGahan, Peter Zhang

As the rate of COVID-19 vaccinations begins to falter in the United States, governments at all levels are bolstering their efforts to fight vaccine hesitancy. The international community is watching this closely. Around the globe, leaders hope to develop effective strategies to overcome vaccine hesitancy in order to take a critical step towards controlling disease and reopening the economy. 

Vaccines are different from other medicines in the skepticism that they evoke. People are compelled to take most medicines as a remedy to a personal health issue. Medications like antibiotics or cold medicine can provide immediate and noticeable relief to physical discomfort. However, vaccines are targeted at people without a physical ailment and who are not experiencing any distress.

When governments ask citizens to get vaccinated, the framing of the ask is perceived by some as a fulfillment of societal needs rather than an effort to protect individual health. Resistance arises among citizens who do not trust the government, do not respond to society’s problems, and view social needs as illegitimate. Fear of disease itself may blur into fear into the technical features of a vaccination and concerns about real and imagined side effects may arise. For these reasons, a wait and see approach becomes easy to justify.

This problem is not new. Prior to COVID-19, the vaccine against measles, mumps and rubella was the dominant exemplar of vaccine hesitancy. An explosive study by Dr. Andrew Wakefield wrongfully associated the vaccine with the development of autism. As a result, vaccination rates fell globally, giving way to outbreaks of measles across the world. The paper was later retracted for flaws in scientific methodology, but it was too late. Vaccine hesitancy towards the measles vaccine continued.

This is a long-standing phenomenon that extends well beyond the United States. And it is becoming increasingly prevalent. Studies have shown that, in other preventable infectious diseases such as polio, vaccine hesitancy escalated in countries where distrust in government and its institutions are common.

In India, for example, a history of family planning initiatives targeted at the Muslim minority, and the lack of investment in healthcare infrastructure in marginalized communities led many to distrust government-led vaccination efforts. The logic ran like this: if the government did not care about the community’s health before rolling out the vaccine, then why would this initiative be any different? If the government tried to reduce the population of minority communities through birth control, on what basis should members of that minority trust the government to prevent illness?

Although many governments attempt to address these criticisms by explaining that vaccines are a health product, incongruencies between government messaging and government actions can render the effort futile. In fact, it was not until a strategy was developed that could address deficiencies in fundamental health services, that India would make progress in the elimination of polio.

Similarly, the mistrust of government in the United States contributes to hesitancy over COVID-19 vaccines. The problem has been amplified by the politicization of healthcare and science in general. For this reason, the promotion of vaccines as a national priority rather than as a personal health priority can push hesitant groups further away.

In the United States, experimentation with alternative messaging is under way. Certain states are promoting a strategy that incentives individual benefit. Namely, states such as New York, Maryland, and Ohio are implementing financial incentives through vaccine lotteries for those who choose to get vaccinated. Other states, like West Virginia, are giving $100 bonds to people who get the COVID-19 vaccine.

Although such strategies may incentivize those seeking to gain a financial boost, it is unlikely to address the mistrust that underlines hesitancy. Furthermore, it perpetuates the idea that getting vaccinated results from a government need, as it signals a willingness to pay people to be injected.

Instead, governments need to demonstrate a genuine commitment to improving personal health beyond the pandemic, particularly in marginalized communities. Otherwise, those who are vaccine hesitant will see that authorities will only care about health needs when it suits their interests. 

Anita M. McGahan, is university professor and the George E. Connell chair in Organizations & Society at the University’s Rotman School and Munk School of Global Affairs and Public Policy.  

Peter Zhang, PharmD, is an MBA candidate at the University of Toronto’s Rotman School of Management.

They are two of the authors along with Alejandra Bellatin, Azana Hyder, and Sampreeth Rao of Overcoming vaccine deployment challenges among the hardest to reach: lessons from polio elimination in India which appeared in BMJ Global Health.