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Behavioural Insights to Overcome Vaccine Hesitancy in COVID-19

Leads: Dr Kelly-Ann Schmidtke, Dr Laura Kudrna, Dr Angela Noufaily (Meths), Prof Aileen Clarke (Public Health)

Five public contributors, from a range of backgrounds, worked with the team to develop the project. One contributor was recruited as a co-applicant, and has worked closely with the team throughout to develop all aspects of the project including the protocol, ethics application and designing the workshops.

Dates: April 2021 - March 2022


Information can influence people’s vaccination intentions by altering their perceptions of Complacency, Convenience, Confidence, Calculations, and Communal responsibility, i.e. the “5Cs”. Information campaigns may fail to increase intentions where they focus only on rational thinking processes and neglect automatic-intuitive thinking processes. Moral Foundations Theory offers a cross-culturally validated framework to understand automatic-intuitions, and shape more sensitive messages about the 5Cs to increase vaccination rates. The Foundations include care (concerns about others’ wellbeing), fairness (concerns about proportionality), loyalty (about group relations), authority (about tradition), sanctity (about purity), and liberty (concerns about freedoms). Previous research identified links between several Foundations and parental vaccination intentions. In the USA, Amin et al. (2017) identified sanctity and liberty. In Australia, Rossen et al. (2019) identified sanctity and authority. Both suggest that messages aligned with identified Foundations may increase uptake, but do not evaluate such messages’ effectiveness. We will expand this research to COVID-19 vaccinations intentions in the UK and evaluate the messages’ effectiveness.

Policy and Practice Partners:

This research may influence messaging strategies used by the government to encourage vaccine uptake. The online workshop will enable us to engage with healthworkers and policymakers most likely to use these messages. Matt Keeling will help us recruit the right policy makers to attend this meeting, and has the capacity to do so as he is a current member of the Joint Committee on Vaccination and Immunisation.

Co-Funding Partners:

TBC – University Hospitals Birmingham NHS Foundation Trust.

Aims and Objectives:

This research program has three aims. Aim 1 is to describe the top four Foundations most strongly associated with people’s plans to receive a COVID-19 vaccination. Aim 2 is to develop pro-vaccination messages with public contributors, public health specialists, and policymakers aligned with the identified Foundations. Aim 3 is to demonstrate the effectiveness of the co-produced message on people’s plans to receive a COVID-19 vaccination.


For Aim 1, an online survey will be conducted a representative sample of people from the UK population’s age, gender, region and social class quotas. The results will be analysed using proportional-odds logistic regressions to identify the four Foundations most strongly associated with people’s willingness to receive the COVID-19 vaccination.

For Aim 2, an online workshop will be conducted wherein a team consensus approach is used to develop one pro-vaccination message for each Foundation identified from Aim 1. Four small teams will convene, each including two public contributors, one experienced immuniser (e.g. nurse/gp), one public health specialist and one policy maker; totalling 20 people outside our research team. After the workshop, one informative and accessible infographic will be created to accompany each of the four messages.

For Aim 3, an online survey will be conducted with a new sample (same stratification) of 5,400 participants. Participants will be randomly allocated among five groups in a 2:1:1:1:1 fashion, that see either no-message or one of the four co-produced messages respectively, then indicate their plans to receive a COVID-19 vaccination, and complete the same Foundations and demographic questions as in Aim 1. The percentage who indicate planning to receive the vaccine in each message group will be compared to the no-message group using a logistic regression model. Secondary analyses will assess the influence of each moral foundations endorsement.

Anticipated Main Results:

We will identify some foundations as being more strongly associated with people’s intentions to receive the COVID-19 vaccine. Our workshop contributors will develop four amazing messages that will be complimented with an image created by a professional graphic designer. And finally, some of our messages will prove more effective than a no-message control in our final online trial, and the effectiveness of those messages will depend on how strongly participants endorse the relevant moral foundation.

Anticipated Conclusions:

Recommendations will be made to increase vaccination rates in the United Kingdom. Where possible, these recommendations will be tailored to different messaging routes (e.g. social media, poster campaigns, or radio adverts) and across stratified population segments (e.g. UK regions or ethnic groups).

Implications for Implementation:

As the vaccination programme in the UK moves towards a younger cohort, we anticipate that vaccine hesitancy may increase. This work will be vital in helping us to further understand the issues involved in vaccine hesitancy and to ensure that advertising, etc. is as tailored as possible to the current constituencies receiving the vaccine.

If a more targeted set of behaviourally informed messages are used to encourage vaccination uptake, we anticipate that more people will take them up. This is important not only for the current vaccination campaign, but for future vaccination campaigns. For example, if people are invited to take up a COVID-19 vaccination in 2025 when the number of deaths and cases are no longer featured on the front of the BBC each day.