The Science of Vaccine Hesitancy

Our faculty engage in cutting-edge research and produce innovative creative works every day as they bring new ideas to our students and our communities locally and globally. We’re pleased to continue this monthly spotlight series featuring our faculty’s work through a question-and-answer style article published on the first Friday of every month during the academic year.

Featured research article: Science-based communication to decrease disparities in adult pneumococcal vaccination rates, Journal of the American Pharmacists Association (November 1, 2020), and co-authors Brian Krueger, Associate Dean of the College of Arts and Sciences and Professor of Political Science, and Marc Hutchison, Chair of the Department of Political Science

Q: Could you please talk about your role in co-authoring this article?

DR. BRIAN KRUEGER: This was a grant funded project that had many people involved and several components from three national surveys to field experiments undertaken right inside Rhode Island Pharmacies that primarily serve underrepresented populations. Our overall project, including the publication, is a joint effort of Pharmacy and Political Science researchers. For my part, I was CO-PI and one of the key authors of the $600,000 grant (funded by Pfizer Independent Grants for Learning & Change), was the primary creator of the surveys and experiments, helped analyze the data, and wrote much of the first draft of the article.

DR. MARC HUTCHISON: I was a CO-PI on a grant from the Pfizer Independent Grants for Learning and Change that funded the surveys and fieldwork that formed the basis of this article. Dr. Kerry LaPlante, now the Department Chair of Pharmacy Practice, was the PI on this grant and it was a collaboration between our two departments. In this paper, I worked with Dr. Krueger on the overall survey designs, the survey experiments, the data analysis, the field experiment design and implementation, and drafting of this manuscript. 

Q: What inspired you to look into science-based communication in relation to attitudes towards pneumococcal vaccinations?

BK: Adult pneumococcal disease, basically pneumonia, is a major public health problem leading to about 150 thousand hospitalizations each year. It can be deadly, especially for older adults. While there is an adult vaccine, pneumococcal vaccination rates among BIPOC populations lag well behind white adult populations. Making this worse, the burden of pneumococcal disease in these minoritized populations is especially problematic because these lower vaccination rates are coupled with a higher prevalence of pneumococcal risk conditions, such as asthma, diabetes, and cardiovascular disease. Access and equity in care is one big issue, but is not the whole story. What other researchers have found is that correcting for racial disparities in access and quality of health care does not eliminate this racial vaccination gap. We needed to also consider how we message public health campaigns and talk to patients about vaccines when shaping efforts to close the gap in pneumococcal vaccination rates between whites and other racial and ethnic groups. The problem was that most vaccine promotion materials had utilized standard messaging in a “one size fits all” approach, with little attention paid to the racial and ethnic groups that had the lowest rates of vaccination. Different racial and ethnics groups have different histories with heinous medical trials, the health care system, and the government, which creates differences in trust, openness to vaccination and different reasons for hesitancy. Too often the share of Black and Latinx participants is too low to draw any conclusions about these groups in medical and public health trials. As such, to reduce vaccination disparities across racial and ethnic groups, we needed to move away from general population studies composed primarily of white participants, to conduct a more focused study so that we could determine the types of messages that would best resonate with the groups least likely to be vaccinated.

MH: This study came together years before the current COVID-19 pandemic where many of these issues have come to the forefront of public consciousness. But even then, vaccine hesitancy, particularly among adults, was a persistent public health concern. More concerning, was the major disparities in vaccine rates across racial and ethnic groups across the United States; major disparities that persisted even after controlling for socioeconomic and health access factors. This strongly suggested that there was an attitudinal component that required further research and understanding so medical professionals and health institutions could craft more effective messaging to reduce this vaccine hesitancy.

The story of how this particular project came together speaks to some of the strengths of URI as an academic institution. For a little background, I had been friends with Dr. LaPlante for many years prior to this grant and had worked with Dr. Krueger since my start at URI. Dr. LaPlante and I had always wanted to work together but bringing together the knowledge and skills from our two disciplines on a meaningful project took us a few years to figure out. Dr. Krueger and I would consistently discuss different areas of study in the area of political behavior and public opinion so we knew of each others’ interests in vaccine attitudes, or, more accurately, our fascination with anti-vaccine attitudes and behavior. I had worked quite a bit on projects studying ‘trust in government’ attitudes across the world, which is an attitude that has a strong connection with vaccine hesitancy. At a social gathering with Dr. LaPlante the topic of anti-vaxxers came up and I shared my ideas that this behavior is likely tied to political trust attitudes. It was then that we realized that not only did we have a mutual area of research interests but also potentially a worthwhile interdisciplinary project to pursue. Dr. LaPlante identified the Pfizer grant that we could apply for and I approached Dr. Krueger. He was already interested in vaccine attitudes and is probably the foremost expert on survey design and survey experiments at URI. We knew we needed him for the project to be successful. On her side, Dr. LaPlante brought together the relevant experts from Pharmacy Practice, including Dr. Orr and Dr. Caffrey. As Dr. LaPlante often says, this is a great example of a ‘trans-disciplinary’ project that transcends the traditional disciplinary silos that we often occupy.

Q: Was there anything that especially surprised you when doing research for the article?

BK: Although I knew this research existed, it was still disarming to closely read studies that show that presenting factual, scientifically backed information about the benefits and safety of vaccines to the most vaccine hesitant people typically leads to even deeper opposition towards vaccines. Vaccine hesitancy is not about a lack of scientific knowledge generally or scientific knowledge about vaccines specifically. This speaks to the broader need for more interdisciplinary teams of researchers working on pressing societal problems, such as this one, to find new creative solutions. Our team’s diverse nature is a big reason why the applied science pharmacists and liberal arts political scientists found success working together.

MH: While it should not have surprised me as someone who primarily studies and teaches politics for a living, I was surprised by how entrenched the vaccine hesitancy was among certain groups of people. Dr. Krueger and I marveled at how exposure to more accurate information to vaccine benefits and safety actually made vaccine hesitancy stronger among this subset of the population. I was also surprised by the different demographic pockets of vaccine hesitancy that we found in our data that did not correspond to the sort of ‘linear’ trends along various socioeconomic measures. Some of these pockets were predictable, like individuals with a strong conservative, libertarian political ideology. Others were more interesting. For example, we would find more hesitancy among highly educated white females than you would see from other highly educated individuals.

Q: Do you believe there is some correlation between the research done in this article and the current public hesitation on taking the COVID-19 vaccine?

BK: One of our Pharmacy co-authors and the PI on the grant, Kerry LaPlante, was named to Rhode Island’s COVID-19 Vaccine Subcommittee. As I understand it, she distributed our article to the subcommittee to help inform the state’s COVID-19 communication strategy. I think there are significant lessons to be learned. For example, both the pneumococcal vaccine that we studied and the COVID-19 vaccine are adult vaccines and we are one of the few studies that focuses on vaccine hesitancy for adult vaccines. Most vaccine research centers on adult attitudes towards childhood vaccinations, so there are likely real parallels with our work when thinking about how to best communicate about the COVID-19 vaccine. Also, COVID-19 and pneumococcal disease have disproportionate negative impacts on communities of color and our work is special in that it centers on designing public health communication that considers the vaccine attitudes and perspectives of the BIPOC population.

MH: There have been so many parallels between our research and COVID-19. Both involve adult vaccinations and the similar pockets of vaccine hesitancy emerged from almost the outset. If anything, the last 3-4 years has seen even more of the attitudinal trends and polarization regarding vaccines.

Q: What do you hope is the main takeaway from this research?

BK: When public health officials communicate about adult vaccines, if they primarily emphasize the evidence for the safety of the vaccine, then this message may actually widen racial gaps in vaccination rates. This “it’s proven safe” message resonates with white populations more so than with the BIPOC community. We need to be careful when choosing our public communication approach. Even well meaning, factual, public health campaigns may increase health disparities. We find that instead of solely stressing the evidence for the safety of a vaccine, we should be emphasizing how getting vaccinated can help keep one’s community and family from going to the hospital or dying. Emphasizing our collective duty to our community and those we love resonates powerfully across all racial and ethnic groups and may even have an outsized positive effect of reducing vaccine hesitancy in communities of color. A lot has been made of the somewhat high vaccine hesitancy rates in the Black community. Some of this, of course, is understandable given the historical abuses of their community by medical scientists in medical trials. But what I hope more people come to understand is that public health campaign communication can either help or or exacerbate the racial gaps in openness to vaccination. When we ask why certain groups are less open to vaccination, we should pause and first ask, have scientists, medical practitioners, and public health officials examined their own practices’ messages about vaccination to make sure their communications resonate with our most vulnerable populations?

MH: Properly calibrated messaging can make an impact on overcoming some of the vaccine hesitancy among the population. I was heartened to read an article about public health officials in Texas turning to more messaging emphasizing family and duty to get some vaccine hesitaters to get the vaccine. I forwarded that article to our project team and pointed out how similar this was to our findings from before COVID.

~Organized by Taylor Petrini, English Major, URI Class of 2021