Can Communication Strategies Combat COVID-19 Vaccine Hesitancy with Trade-Off between Public Service Messages and Public Skepticism? Experimental Evidence from Pakistan

"...new strategic insights for the global health authorities and vaccine promoters to proactively address the downward spiral of people's willingness to take the COVID-19 vaccine..."

Vaccine-related conspiracy theories around COVID-19 vaccines (e.g., falsehoods about infertility, surveillance, and microchips) have built new momentum for vaccine hesitancy and are of concern in light of the global effort to combat the pandemic. To this end, several nations worldwide, including Pakistan, are struggling to boost public trust and enthusiasm to get vaccinated. This study explores the potential effects of various communication strategies, including public service messages (safety benefits versus fear appraisals), media types (traditional versus digital), self-efficacy, and perceived benefits and threats (susceptibility and severity), on the willingness to get vaccinated for COVID-19. The research provides experimental evidence to address questions around: how individuals process COVID-19 related public service messages; how their cognitive, affective, and behavioural reactions to these messages are affected by message attributes; and how these responses are affected by the medium of the message.

The Health Belief Model (HBM) serves as the study's main theoretical underpinning. Its constructs include: perceived susceptibility (e.g., how vulnerable am I to contracting COVID-19?), perceived severity (e.g., how risky is COVID-19 to my health?), perceived benefits (e.g., what good will it do me to accept COVID-19 vaccination?), perceived barriers (e.g., what concerns (e.g., about side effects) prevent me from getting vaccinated?), and self-efficacy (e.g., am I able to make arrangements to get the COVID-19 vaccine?). The HBM also postulates that people's behaviour can be influenced by cues to action, both external and internal. External cues are social influences (e.g., peers, media, health experts) and some peripheral influences that can inform or promote awareness to provoke preventive behaviours. On the other hand, internal cues comprise psychosomatic prompts (e.g., discomfort) that prompt one to embrace new behaviours. In addition, the research draws on the affect theory of persuasion, which highlights the role of emotional factors in the vaccination decision. Thus, the study incorporates the HBM and affect theory to experiment with the efficacy of public service message frames, including fear appraisal (i.e., emotions) and safety benefits (i.e., cognitive).

Specifically, this research employed a cross-sectional experimental factorial 2 (type of media: traditional vs. digital media) X 2 (message frame: health and safety benefit of COVID-19 vaccine vs. fear appraisal) between-subject design to examine the effectiveness of promotional messages in promoting immunisation behaviour to accept the COVID-19 vaccine. Due to COVID-19 restrictions, the study was conducted online. Participants included 320 adult Pakistani nationals who were then assigned to four groups (n = 80): Group 1: health and safety benefit of COVID-19 vaccination, narrated in public service message published in a local newspaper; Group 2: health and safety benefit of COVID-19 vaccination, narrated in a promotional message circulating on social media; Group 3: fear appraisal related to not having the COVID-19 vaccine, narrated in public service message published in the local newspaper; and Group 4: fear appraisal related to not having the COVID-19 vaccine, narrated in a promotional message circulating on social media.

The study posed five hypotheses, findings about which are as follows:

• The findings of hypothesis one illustrate that the perceived threat of COVID-19 positively influences the willingness to take a COVID-19 vaccine more favourably for fear-appraisal-framed public service messages than safety-benefits-framed public service messages.
• Likewise, the results of the second and third hypotheses indicate that the perceived benefits of COVID-19 vaccines and self-efficacy were found to positively influence the willingness to take the COVID-19 vaccine more favourably for fear-appraisal-framed public service messages as compared to safety-benefits-framed public service messages.
• The findings of hypothesis five suggest that when individuals have a higher level of skepticism toward COVID-19 vaccines, they are less willing to take COVID-19 vaccines. The implication here is that the misinformation and conspiracy theories widely circulating on social media platforms make it more challenging for public health officials to inform and convince the public about vaccine benefits.

Moreover, public skepticism negatively moderated the effects of media types and public service message attributes on willingness to get vaccinated in relatively high (i.e., group two), moderate (i.e., groups one and four), and low intensities (i.e., group three).

Concerning the role of action cues, the researchers found that the traditional media's public service message of fear appraisals of not getting COVID-19 vaccine influence the willingness to take a COVID-19 vaccine more favourably than other action cues. Thus, policymakers in Pakistan (and elsewhere) are advised to disseminate public service messages about the COVID-19 vaccine - particularly those relying on fear appraisals - on traditional media more frequently. In addition, to build public trust in COVID-19 vaccines, the researchers suggest the proper editorial gatekeeping of science communication via publishing, broadcasting, and sharing factual and scientific information about the COVID-19 vaccines. That is to say, the content shared on social media platforms can be moderated to make it more vaccine-friendly and factual such that scientific evidence can be shared instead of non-factual information. Finally, previous research shows that civic dialogue with vaccine-hesitant people is a significant step to address their concerns about vaccine efficacy.