Does Seeing What Others Do Through Social Media Influence Vaccine Uptake and Help in the Herd Immunity Through Vaccination? A Cross-Sectional Analysis

"...exploring whether the willingness to vaccinate is higher or lower by seeing what others are doing in their social media is a salient differentiator to inform vaccine uptake."

Significant variations are observed in the willingness to take the COVID-19 vaccination by citizens across different countries. The multifaceted nature of this willingness (or lack thereof) can be traced to informational, psychological, socio-demographic, and cultural factors. For example, during the COVID-19 pandemic, information has been abundant. Often, perceptions of what others are doing guide individuals' vaccination behaviours for vaccination, particularly in light of the influence of the internet and social media. With a grounding in the Health Belief Model (HBM), this study aims to determine the factors that impact willingness to vaccinate for COVID-19.

Randomly sampled online survey data were collected between December 2020 and January 2021 from 372 citizens from multiple regions, including Asia, Europe, the Middle East, and North America. The survey included questions about willingness to vaccinate, knowledge of COVID-19, information-seeking behaviour, social media usage, government perceptions, and HBM constructs.

On average, 10% of the sample would definitely vaccinate, 46% would very probably vaccinate, 19% would probably vaccinate, 19% would probably not vaccinate, and 6% would definitely not vaccinate.

Ordered probit regression suggests that the HBM constructs hold. Perceived severity of COVID-19 and action cues of others taking the vaccine positively influence a subject's vaccine intent, as do perceived benefits and perceived efficacy of the vaccine. Perceived barriers negatively influence vaccine intent.

As for media usage, mainstream media (e.g., TV, newspaper) and social media both negatively influence a subject's vaccine intent. Social media platforms that are more entertainment and social-based, such as WhatsApp, Instagram, and YouTube, have a negative and significant influence on vaccine intent compared to other more information-based social media platforms (e.g., Twitter, LinkedIn). Knowledge of COVID-19 treatment positively influences vaccine intent.

The study also found that the public seem to have an overall negative perception of the effectiveness of their government's mitigation strategy and performance against COVID-19. This perception, in turn, has negatively impacted their willingness to vaccinate. This negative perception might be due to the uncertainty surrounding the COVID-19 virus; governmental efforts were often misaligned with media coverage and a mix of misinformation, leading to a lack of trust in governmental efforts. These findings highlight that perceived governmental efforts directly impact willingness to vaccinate.

Reflecting on the findings, the researchers note that:

• The action cue finding coheres with a "wait and see" attitude about COVID-19 vaccination that can be reinforced by messages from others in the community. People lean toward conformity bias, a desire to agree with others and trust others' judgment. This finding highlights the importance of mounting a well-planned vaccination campaign that involves and demonstrates that leaders, doctors, and celebrities support vaccination. In addition, doctors, scientists, and politicians should publicly speak in support of COVID-19 vaccine science.
• The finding that perceived severity influences willingness to vaccinate is crucial to herd immunity. With the massive amount of ciculating misinformation on the pandemic, perceptions of the disease's severity may be undermined, and some people may believe the vaccine is not needed. This finding indicates that correct, clear messages should be communicated on the severity of the COVID-19 virus.
• The benefits of the vaccination should also be well communicated. The study reveals that the higher the perceived benefits, the greater the influence on one's intent to vaccinate. Thus, health authorities and policymakers need to clarify any misinformation about the vaccine's benefits to the public. They should also work to address perceived barriers to vaccination, which this study found influences willingness.
• This study finds that media, both traditional and social media, negatively impact one's willingness to vaccinate - a finding that is consistent across the sample. The researchers suggest that social media companies need to police their networks and root out false information about the COVID-19 vaccine. Trusted scientists and politicians need to speak in support of COVID-19 vaccine science on all media platforms. Lawmakers should do more to regulate sources of misinformation, just as they have done for other threats to health, such as tobacco. The study's findings imply that even stricter measures should be taken on social media platforms that are used more for entertainment purposes. In addition, the information needs to be well communicated that such sources should not be trusted. Policymakers and governments should appropriately use social media and information channels by spreading clear information on vaccination and its benefits.
• The finding that negative perceptions of governmental efforts harm willingness to vaccinate is in line with the lack of trust in general and the pandemic's political ramifications. The public seems to have an overall negative perception of all sorts of media, whether from the government or other sources.

The study highlights the importance of action cues from others and leaders in the community. It also suggests the need to shape media information for vaccination through informative media and social media outlets to counteract misinformation.