By MARY-CATHERINE SEGOTA, Psy.D

Today 56.3 percent of adults in Florida have received the full COVID vaccine, and 66 percent have received one dose (OurWorldInData.org). Currently, more females than males are vaccinated. The age group of 65-74 represents the highest percentage of vaccinated. The average daily death rate is 376.4, and 51,889 individuals have died in Florida due to COVID. Given the spread rate of the disease, the mortality rate, and the length of time since the pandemic began, the vaccination rate is lower than is needed. Vaccine hesitancy (the delay or refusal of vaccines despite the availability, WHO 2015) is not new. Previous research helps identify the critical factors to understand, to better speak with your patients and assist them in their decision-making about vaccination.

There is a lot of misinformation spread through social media, websites, and anecdotal tales, which leads to confusion about the COVID vaccine. It is essential to know what the misinformation is to address it when you hear it from your patients. Some examples of highly spread misinformation include:

• Vaccine can cause cancer, infertility, or cause you to sprout a third arm
• Vaccination will cause a stronger response to the virus if you do contract it
• Vaccination causes the virus to mutate
• You can die from the vaccine
• Obtaining natural immunity is less dangerous than vaccinating
• Vaccines have tracking devices
• Vaccines have substances in them that will make you magnetic
• Belief that social distancing/isolation protocols is all that is required
• Belief in the strength of herd immunity
• Feeling the risks of contracting the virus or the risks of the virus itself are exaggerated
• Belief that they have already had the disease (not diagnosed) and can’t get it again
• Belief in permanent immunity after contracting the disease

The average person has difficulty discerning the credibility of information they see and read on the internet. The power of social media and repeated messaging from influencers, politicians, and other people in a perceived position of power significantly affects attitudes toward vaccination. Betsch C et al. (2010) found that exposure to as little as 5–10 minutes of negative and inaccurate information about vaccines increases the risk perception associated with vaccination. Other factors influencing people’s perception of vaccination include:

• General distrust in the government, scientists, or healthcare professionals
• Distrust in the safety of the vaccine and the process to create the vaccine
• A sense of individual vs. collective responsibility
• Belief that getting vaccinated is giving up a personal right and will lead to greater loss
• Associated political influences
• Confirmation bias

Confirmation Bias (Wason 1960), an important concept in understanding how people consume information, states that your existing opinion changes how you perceive information. It is an unconscious process that readily occurs when looking for and consuming information. Even if exposed to information that disagrees with your opinion, you might not take it in, misremember it, or find a reason to ignore it. You’ll keep searching until the information you see is what you want to see. Regarding COVID, if you have strong opinions about the virus or the vaccine, and then you go looking for evidence that supports them, you’ll think you see it – even if it means misinterpreting or distorting the information you are consuming. You will also have a more challenging time absorbing evidence that points in the opposite direction. Due to the mechanics of social media, individuals are bombarded with posts that continue to reinforce their belief system.

Historical research has identified several common psychological factors in individuals who experience vaccine hesitancy (Murphy et al., 2021). These individuals are more likely to have decreased cognitive reflections, the ability to suppress an incorrect, intuitive answer and come to a more deliberate, correct answer. These individuals also tend to experience reduced altruism, a decrease in the concern for the well-being of others. Additionally, they are more likely to have an internal locus of control, meaning the ability to take action, be effective, influence your own life, and assume responsibility for your behaviors, rather than seeing external variables influencing life. They also tend to endorse an increased amount of conspiracy thinking.

It is important to understand the difference between vaccine hesitancy and vaccine opposition to influence change. Realize that thinking based on strong emotions and morals are difficult to change. Those opposed to vaccination are firmly and emotionally grounded in their belief system are less likely to be open to possibilities. Those that are hesitant are apprehensive but have not yet permanently closed themselves off to the idea. You may be able to affect the most change with this population. Reasons that some people are hesitant to obtain the vaccine include:

• Feeling unsure about the risks and benefits and taking a “wait and see” approach
• Not feeling they have enough information to make a decision
• Feeling like vaccine will flare up or worsen underlying medical conditions
• Feeling like there are risks associated with the vaccine
• Fear of potential side effects
• Fear of the “unknown” long term effects of the vaccine
• Fear of needles or the lack of time to go get vaccinated
• Worry about the cost of the vaccine

Based on this new understanding of the psychological factors and beliefs that are at play, what approach should healthcare providers take to overcome vaccine hesitancy best? First, have a conversation, don’t lecture. Provide emotional support and a sense of understanding of their fears, anger, and other negative emotions. Be patient in listening to their concerns. Ask a lot of questions and find out what they would need to know to consider the vaccine. Don’t blame, and try to understand their mistrust. Try sharing your experience; sometimes, relatable events may sway their thinking. Take the emotion out of it - when you feel passionate about their decision, it could increase their defensiveness, particularly when they are leaning opposite your stance. Other techniques include:

• Combat misinformation by providing information from a reputable source
• Emphasize safety, but also talk about the known risks – muscle soreness, fatigue, fever, and rare allergic reactions
• Align your messaging with a trusted source within their community
• Make sure information is in their language of preference
• Talk about religion when it is a factor – “God created the knowledge for the scientists to develop the vaccine.” “The Pope has said it is Catholics moral obligation to be vaccinated.”
• Offer to help – it may be a logistical issue: How do I get it? How can I get there? How do I pay for it?
• Help them see vaccination as a right or privilege that they would not want to be taken away

Community versus individual factors do influence decision-making for many individuals. When discussing options, focus on individual personal agency and individual benefits, but alternatively frame vaccination as a step toward a meaningful goal for the society as a whole and create a sense of being part of a community in the battle against the virus. Attempt to increase a sense of altruism by eliciting someone specific in their life who would be kept safe by vaccination (a close elder or child). Focus on the future and “getting life back.” Realize that it may be a process – not one conversation, but a series of conversations that brings the patient closer to the decision of vaccination. Regardless of a patient’s individual decision regarding vaccination, it is important to continually reinforce the established precautions to prevent the spread of COVID.

With a doctorate in clinical psychology and over 20 years of experience in the field, Dr. Mary-Catherine Segota has conducted university-based behavioral medicine research, acted as a consultant to professionals and organizations, and worked with a diverse number of psychological and medical conditions. By identifying unique needs, the source of distress, and what’s perpetuating the problem, she will help develop the tools to overcome seemingly insurmountable circumstances. Visit www.CounselingResourceServices.com