Psychologist Neetu Abad, PhD, has traveled the world in support of vaccination campaigns for polio, measles, cholera, and other preventable diseases. As a behavioral scientist in the Global Immunization Division at the U.S. Centers for Disease Control and Prevention (CDC) since 2016, she applies her expertise in social psychology to encourage vaccination and understand vaccine hesitancy.
When the COVID-19 pandemic began, Abad was tapped as a co-leader of the vaccine confidence and demand team for the CDC’s pandemic response in the United States. She and her colleagues gather data and draw on psychological theory to understand vaccine hesitancy, intentions, and disparities—and drive up vaccination rates. They come at the problem from a variety of angles: developing training materials for health care providers; planning social mobilization efforts with local governments, schools, and businesses; and sharing what they’ve learned about vaccine confidence with health departments, tribal partners, and the media. The Monitor talked to Abad about the drivers of vaccine hesitancy and how psychologists can help people overcome them.
How important is behavioral science in responding to the pandemic?
The pandemic has been all about behavioral mitigation—mask-wearing, social distancing, and eventually vaccines. Very quickly we saw the need to pull in strong behavioral science to tell us how to inform response strategies. Once vaccines came on the scene, we understood there were varying perspectives toward them. Some people were early and enthusiastic adopters; others had questions or concerns. We spent a lot of time trying to find ways to connect with communities about their concerns. We’re still finding ways to connect, but also looking at vaccine requirements and incentives to encourage vaccination.
What drives vaccine hesitancy?
Prior to the pandemic, I was part of a World Health Organization working group studying behavioral and social drivers of vaccination. Since 2018, we had been coming up with a behavioral model that we think captures this information (Data for Action: Achieving High Uptake of COVID-19 Vaccinesopens in new window, World Health Organization, 2021). There are a few different domains that relate to vaccine uptake and intent to vaccinate. One category is what people think and feel. This includes their perceptions of the vaccine and what they think about risk and vaccine safety. This is also subject to misinformation. At this point, most everyone has been exposed to some misinformation about the vaccines. Then there are social processes—what people around you are doing and what you think people want you to do. Public health researchers have traditionally done a pretty good job of understanding individual-level attitudes, but we need to do more to understand these social processes, especially globally.
Then there are practical issues. Do people know where to get vaccinated? Are clinics open at accessible hours? These practical issues related to access are important. Addressing them can help reduce health disparities.
How do you start getting through to people who aren’t yet vaccinated?
We’ve learned that what works over time are behavioral nudges—things that prompt behavior, either consciously or unconsciously. That might be making vaccines available at your work, or scheduling default appointments for vaccination that you would have to opt out of. Requirements can also be powerful. What works less consistently are what we might call “thinking and feeling interventions.” Changing people’s minds is difficult on a population level. Communicating accurate messages about vaccines is important, but those messages don’t consistently lead to behavior change. We’re still searching for effective interventions to increase vaccine confidence. The influence of social networks is important. Sharing vaccine selfies on social media can help build the social norm at the micro level. We need to reinforce the fact that the majority of U.S. adults have gotten vaccinated against COVID-19.
What’s unique about the hesitancy around COVID-19 vaccines?
Before COVID, my work generally focused on childhood vaccinations for diseases like measles and polio. Those vaccines have been around a long time and most people get them, so you’re dealing with smaller pockets of people who don’t want the vaccine or can’t access services. COVID has been a game changer. We’ve had less than 2 years with this disease. The vaccines are new, and two of them were created using new mRNA platforms.
We have to remind ourselves that it’s natural for people to have questions. We should expect people to want to know about new diseases and new technology used to defeat them. But now we’re at the point where we need to think about the people who have persistent concerns. We’re learning new ways to communicate effectively to help people understand why these vaccines are so beneficial. The COVID vaccines have shown themselves to be incredibly effective. We’re going to see more vaccines down the line, and we’re going to be able to address and prevent more diseases than ever before, but we have to keep sight of the fact that this is new for people.
What can psychologists do?
There are endless opportunities for impact. For clinicians, these conversations may come up in therapy. Psychologists can use motivational interviewing skills to find the motivations in a person’s life and draw on those common goals to discuss the intention to vaccinate. Everybody has something important to them—the people they love, things they want to protect, the disruption of the pandemic to stop. Maybe someone has a needle phobia or is worried about being the only one in their social circle choosing vaccination. Psychologists can help people work through some of that anxiety. Research has also demonstrated that recommendations from health care providers of all types can impact vaccination, so an endorsement from a psychologist can go a long way.
There’s so much room for research psychologists in this field. We need psychologists who understand behavioral theory, research methods, and analysis and can apply this to public health. Besides immunization, there are many areas of public health that can benefit from a behavioral science perspective. We are likely to see more public health emergencies in the future, and the need for behavioral scientists working in public health will continue to grow.