Vaccination Resilience: Building and Sustaining Confidence in and Demand for Vaccination

"In our noisy social media and peer advice overwhelming environment filled with conflicting vaccine narratives, building vaccination resilience is key to minimizing the development of hesitancy and ensuring that immunization programs are not derailed by incidental misinformation and vaccine scares..."

In this commentary, Eve Dubé and Noni E. MacDonald argue that the emphasis on vaccine hesitancy - a term used to refer to those who occupy the middle of a continuum between those who refuse all vaccines with conviction and those who actively demand vaccination - must not eclipse the importance of encouraging and supporting those who accept vaccination. They focus on the concept of vaccination resilience, drawing on what psychology defines as the individual's capacity to positively cope with significant adversity but broadening it to encompass social networks, organisations, formal institutions, and broader health and political systems. Currently, they observe, accepting vaccination is by far the most common vaccination decision, and this pro-vaccine social norm must not be taken for granted. As proposed in this commentary, to strengthen vaccination resilience, immunisation programmes will need to implement innovative and evidence-based pro-vaccine interventions that are well coordinated and tailored to the context.

An example of the kind of adversity that vaccination resilience could guard against is "social contagion" of vaccine concerns, which happens when well-functioning immunisation programmes are derailed after safety concerns arise and are hyped by anti-vaccine rhetoric that is widely shared in the media. When parents make decisions about vaccines for their infants, children, or adolescents, they often consult with their peers, their social networks. While the majority of parents choose to vaccinate their children against diseases, most of them do not speak publicly about their decisions - i.e., less social contagion for this positive behaviour. In contrast, "anti-vaccines" stances are often presented online as being endorsed by a significant number when in reality only a tiny - but vocal - minority hold these views. Dubé and MacDonald contend that it is vital for public health organisations to understand social media platforms and how parents use them. This might facilitate the development of online public health strategies to promote trust in vaccines and increase vaccination resilience - for instance by sharing positive stories about vaccination. However, they stress that such strategies need rigorous and thoughtful evaluation to ensure they are working as intended and are not leading to increased hesitancy.

Dubé and MacDonald next suggest four key areas to help build vaccination resilience.

1. First, noting that education and information alone are not sufficient to counter hesitancy-related beliefs and fears, they call for whole community communication approaches that bring together academics, private and civic organisations, and informal social networks along with government and public health authorities to promote vaccine acceptance as the social norm. Pro-vaccine stories coming from different voices (e.g. an immunisation expert, a scientist, a mother, a teenager, etc.) could strengthen vaccination resilience. If social contagion has a negative impact on vaccine acceptance, this collaborative community approach can be used to positively shift the negative vaccination discourses.
2. There is a need, they say, to change risk perception through communication, which means that messages need to be tailored and targeted to account for the realities of community-driven knowledge systems and the unique information needs and preferences of particular communities. This suggests the fact that successful communication is a two-way process that entails listening as well as telling. Understanding the perspectives of the people for whom immunisation services are intended, and their engagement with the issue, is critical.
3. To help build long-term trust in vaccination, Dubé and MacDonald indicate that people need benefit and risk information that is accessible, understandable, trustworthy, and empowering to enable informed health decisions. When healthcare providers communicate effectively with parents about vaccines' benefits and risks, the value and need for vaccinations, and vaccine safety, parents are more confident in their decisions.
4. They suggest reinforcing that vaccine acceptance is the social norm and that those who choose vaccination are not only protecting themselves, but also their community. The idea is to appeal to individuals' social identity by pointing out that most of their peers behave a certain way; the impact on resilience of such an approach should be evaluated.

Dubé and MacDonald conclude by calling for more collaboration between and within countries, as well as a more interdisciplinary approach bringing new expertise (e.g., social and behavioural scientists, ethicists, communication experts, etc.) to address vaccine acceptance challenges.