Exposure to COVID-19 Vaccine Hesitancy Is as Impactful as Vaccine Misinformation in Inducing a Decline in Vaccination Intentions in New Zealand: Results from Pre-Post Between-Groups Randomized Block Experiment

"Exposure to vaccine hesitancy information is as potent as exposure to outright misinformation in reducing public intentions for a COVID-19 vaccine."

Concerns about COVID-19 vaccines are fueled by widely circulating false or misleading information on social media platforms. Conducted in a country (New Zealand) where adherence to COVID-19 protocols has reportedly been high but vaccine hesitancy might be an issue, this study looks at how exposure to information about vaccine hesitancy, as compared to misinformation, is associated with COVID-19 vaccination intentions. It also differentiates between intentions to vaccinate to protect oneself and intentions to vaccinate to protect vulnerable groups, family, and friends.

The study is based on data from a nationally representative survey experiment conducted online between February 15 and March 6 2021 (N = 1,083). The New Zealand government had planned to start vaccinating the general public in July 2021, so this study was conducted prior to actual vaccine rollout.

The researchers surveyed popular misinformation on COVID-19 vaccines in New Zealand, choosing the following based on the criteria of prominence and popularity: (i) a widely shared vaccine misinformation social media post, including by a New Zealand political party, falsely stating that the vaccine will interfere with genetic material (DNA); and (ii) a newspaper article in the national press detailing a mother's concern about vaccinating her son against COVID-19 who is otherwise vaccine compliant (see image above). For control, they used a Facebook post from "Unite Against COVID" featuring a governmental announcement about the safety and regulatory approval of the vaccine.

Respondents were primed to treat the exposure to this content as information shared on social media, with these instructions: "Please read the information presented in the image and answer the following questions. While answering these questions, imagine that the image were shared by your friends, followers, or people you follow on any social media platform that you use." They were then asked if they would accept the COVID-19 vaccine for (i) themselves and (ii) others ("When a coronavirus (COVID-19) vaccine becomes available - Would you accept the vaccine if it meant protecting friends, family, or at-risk groups?") Responses to both questions were measured on a four-point scale from "Yes, definitely" (1), "Unsure, but leaning towards Yes" (2), "Unsure, but leaning towards No" (3), and "No, definitely not" (4).

The composition of the three groups who participated in the study - those exposed to the misinformation, those exposed to information about vaccine hesitancy, and the control group - was similar on demographics and COVID-19 vaccination intentions before exposure. Key findings include:

• Both the misinformation and hesitancy exposure conditions increased vaccine hesitancy compared to the control group. That is, viewing this content reduced COVID-19 vaccination intention to protect self and to protect others.
• The image's believability was lower in the misinformation and hesitancy conditions than in the control condition. There was also a significant difference between the misinformation and hesitancy conditions, such that the respondents in the hesitancy conditions were more likely to believe in the information presented in the image.
• Respondents in misinformation and hesitancy conditions were less likely to say they intended to share the image with friends and followers compared to the control condition. However, respondents were more likely to share information in the hesitancy condition than the misinformation condition. The researchers suggest that one of the possible pathways through which hesitancy affects vaccine intentions is by being more believable compared to outright misinformation, thereby increasing the shareability of information among family and friends. Dissemination of information among social networks is likely to affect how individuals perceive what significant others are doing, thereby affecting their own behaviour - highlighting the role of social norms.

In short, this study demonstrated that it is not only exposure to outright vaccine misinformation but also exposure to information about vaccine hesitancy that can reduce COVID-19 vaccination intentions to protect self and protect others, compared to the control.

Based on the study's results, the researchers suggest that misinformation correction campaigns - not only in New Zealand but elsewhere - should not only focus on outright misinformation but also on vaccine hesitancy, such as by clarifying the extremely rare risks associated with vaccines. Public health officials should transparently inform people of the limitations of vaccinations, providing them with an authoritative resource rather than driving them to alternative sources that may misinform the public. Incorporating messages addressing individuals' concerns through messengers they trust could also be part of a strategy for helping overcome vaccine hesitancy and improving COVID-19 vaccination rates.