In the last two blog posts, we looked at the history of vaccine hesitancy, the contextual factors for vaccine hesitancy, and the individual and group factors for vaccine hesitancy.

This week we examine the vaccine-specific factors for vaccine hesitancy and the characteristics of successful vaccine efforts and campaigns.

Quick Recap of Definition and History

Vaccine hesitancy is the refusal of or delay in accepting vaccines. This hesitancy ranges from those who fully accept vaccination to those who delay vaccination to those who completely reject it.

Vaccine hesitancy has been an issue since vaccines were invented.

In the United States, approximately one in five children have a parent who is hesitant to have their child vaccinated for childhood diseases such as measles.

For seasonal influenza vaccination, in 2020, less than half (48.4%) of adults received the flu vaccine.

For the COVID-19 pandemic that began in 2020, a sizable proportion of the population in the US reported they either did not plan to, or were unsure about, getting vaccinated with vaccines approved by the US Food and Drug Administration.

Moreover, being employed in the health-care sector did not appear to significantly influence COVID-19 vaccine hesitancy.

Vaccine-Specific Factors for Vaccine Hesitancy

Vaccine-specific factors for vaccine hesitancy include perceived concerns and uncertainties about the following:

• trustworthiness of risk-management authorities

• the disease, the vaccines, and the vaccination recommendations

• accuracy and sufficiency of data from vaccine clinical trials

• need for vaccination and immunity

• susceptibility to the disease or diseases in general

• chances for infection or severe infection from the disease

• pain or discomfort of vaccination

• short-term and long-term side effects

• costs

• benefits

• pharmaceutical process for making the vaccine

• adverse effects on individuals with special health conditions, such as pregnancy, allergies, or underlying health problems

• value of health prevention and disease-protection efforts (for example, fatalism)

• difficulties involved in registering for a vaccination program

• approvals needed for vaccination

• experiences of others who have received the vaccine

• risks of a new vaccine, new vaccine formulation, vaccine with only experimental authorization, or a new recommendation for an existing vaccine

• mode of vaccine administration

• reliability and effectiveness of the vaccine

• supplies of the vaccine and follow-up shots

• vaccination schedule

• strength of support from leadership for vaccination

• knowledge or skills of the individual health-care professionals administering the vaccine

Characteristics of Successful Vaccine Efforts and Campaigns

Evaluation studies indicate that successful vaccine communication efforts and campaigns use the following:

• trusted sources of information, such as health-care providers

• knowledge from stakeholder engagement

• multiple communication channels

• plain language

• visuals

• messages tailored to specific vaccine concerns, historical experiences, values, religious or political affiliations, and socioeconomic status

• messages tailored to a person’s place on the vaccine-hesitancy continuum scale

• materials that clearly describe benefits, costs, risks, and uncertainties

• messages that present vaccination as a socially valued practice

• messages that challenge views that a large proportion of individuals are hesitant or refuse vaccination

• storytelling and emotive anecdotes

• appropriate content, word choice, style, technical information, organization, layout and design, and visual aids

• information from baseline studies of knowledge, beliefs, and behaviors (this information should be used to set and monitor communication objectives)

• messages acknowledging that uncertainties and complexities are the beginning of the communication effort

• insights from neuroscience and the behavioral sciences

Final Thoughts

Evaluation research indicates Americans’ perceptions about COVID-19 vaccines and their safety differ by political party, race, age, and geography.

Survey data indicate that communications around COVID-19 vaccine hesitancy are most effective when they do the following:

• explain the benefits of getting vaccinated (not just the consequences of not doing so)

• focus on the need to return to normal and reopen the economy

• avoid judgmental language

• explain the vaccine-development process

• focus on the effectiveness of approved vaccines

• explain that the chance of severe side effects is extremely small

• explain that mild side effects are a normal sign the body is building protection (and that most side effects last only a few days)

Pathway Prompt: Think about the messaging you’ve heard around the COVID-19 vaccines. How would you grade the effectiveness of the messaging?

Communicating Effectively When Feelings, Fears, and Facts Collide

More information about risk, high-concern, and crisis communication can be found in Dr. Covello’s video-based course Pathway to Risk, High-Concern, and Crisis Communication. This master class introduces communicators to the tools and techniques for communicating effectively—while providing greater insight into why audiences react the way they do during times of stress.

The course comprises nine video lectures and accompanying text modules, plus supplemental materials for putting valuable lessons into practice. More information about the course, including group rates and partnering opportunities, can be found by emailing

Dr. Vincent Covello

Dr. Vincent Covello, director of the Center for Risk Communication, is one of the world’s leading experts and practitioners on risk, high-concern, and crisis communication. He is the author of more than 150 articles in scientific journals and the author/editor of more than 20 books. Dr. Covello is a consultant, writer, and teacher. He is a frequent keynote speaker and has conducted communication skills training for thousands.


Santibanez, T.A., Nguyen, K.H., Greby, S.M. (2020). “Parental Vaccine Hesitancy and Childhood Influenza Vaccination.” Pediatrics, 146(6):1–10. Accessed at:

Centers for Disease Control and Prevention (2020). Flu Vaccination Coverage, United States, 2019–20 Influenza Season. Accessed at:

See., e.g., Dror, A.A., Eisenbach, N., Taiber, S. (2020). “Vaccine hesitancy: the next challenge in the fight against COVID-19.” European Journal of Epidemiology 35: 775–779 (2020). Accessed at:; Wen-Ying Sylvia Chou, W.S., Budenz, A. (2020). “Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence.” Health Communication, 35:14, 1718–1722.

Nowak, G., Karafillakis, E., Larson H. (2020. “Pandemic Influenza Vaccines: Communication of Benefits, Risk, and Uncertainties.” Pp. 162–178 In P. Bahri, ed., Communicating about Risks and Safe Use of Medicines. Singapore: Springer Nature. P. 166.

MacDonald, N.E. and the SAGE Working Group on Vaccine Hesitancy. (2015). “Vaccine hesitancy: Definition, scope and determinants.” Vaccine. 33 (34):4161–4164. See also Olson, O., Berry, C., Kumar, N. (2020). “Addressing Parental Vaccine Hesitancy towards Childhood Vaccines in the United States: A Systematic Literature Review of Communication Interventions and Strategies.” Vaccines 8(4): 590.

See Beaumont Foundation and the American Public Health Association (2020). Changing the COVID Conversation. Accessed at:;