Latest Roadblock to Immunity: Vaccine Apathy

June 10, 2021

Public health campaigns to convince the nearly 40 percent of the population that is still unvaccinated rely on facts and medical data to relieve anxiety and inspire confidence. But that approach entirely ignores an important group: the millions of people who seem to be shrugging their shoulders at the question of whether to get vaccinated.

They’re not vaccine hesitant but rather vaccine apathetic.

Vaccine hesitancy is a “mindful emotional/cognitive response” to understanding the risk and benefits of vaccination, sometimes leading to anxiety or fear, whereas vaccine apathy refers to disinterest, researchers say. The vaccine apathetic are characterized by a low level of involvement or interest in whether or not to get vaccinated. It could be they’re overwhelmed by family obligations, work long hours, or have greater immediate concerns such as food insecurity. Or perhaps they perceive things as having already returned to normal and don’t see an urgency.

A Pew survey in February revealed that some people seemed to be shrugging off the vaccine while not taking a strong stand against it. Of the 30% who reported they probably or definitely won’t be vaccinated, 42% listed, “I don’t think I need it” as a major reason for not getting it.

In a recent Viewpoint in the Journal of the American Medical Association, Kevin Schulman, MD, MBA, of the Stanford Clinical Research Center, and Stacy Wood, PhD, of the Poole College of Management at North Carolina State University argue that vaccine apathy exists across socioeconomic groups and that marketing to these individuals requires a unique approach.

“The less involved a person is with a choice, the less persuaded they are by strong arguments based on logical or fact-filled appeals.

Drawing on their expertise in behavioral economics and consumer marketing, Schulman and Wood point to the Elaboration Likelihood Model (ELM) for a formal description of subpopulations based on their level of involvement and engagement in the decision-making process. ELM contends that what persuades people differs by their involvement level in the decision. “The less involved a person is with a choice, the less persuaded they are by strong arguments based on logical or fact-filled appeals,” they write.

These individuals are more readily persuaded by messages that are “quick and easy” to process, perhaps delivered by likeable celebrities or with catchy slogans, and preferably delivered to them in forms they will easily see.

The new article follows Schulman and Wood’s earlier paper in the New England Journal of Medicine that explored how principles of consumer marketing could help health care professionals and policymaker frame their messages to encourage vaccination. Such campaigns could include public recognition or even prizes.

“In the next wave of vaccine promotion,” write Schulman and Wood, “attention to low-involvement populations (the ‘vaccine-apathetic’) and the development of specific vaccine-promotion messaging to help overcome vaccine apathy may be a critical element for achieving national vaccination goals.”

- Laurie Flynn