Using Rhetorical Situations to Examine and Improve Vaccination Communication

"[T]his essay indicates how trust is negotiated in a hybrid media ecology where traditional epistemic positions are challenged and points to the practical consequences of such negotiation...for public health authorities who wish to address vaccine hesitancy."

Opinion polls have documented considerable public skepticism towards COVID-19 vaccines in various contexts around the world. Scholars have argued that approaches to COVID-19 vaccination are rooted in past beliefs and attitudes towards vaccination and that communicators seeking to address vaccine hesitancy should keep in mind that audiences are not "blank slates". Grounded in the tradition and theory of rhetoric, this essay explores persuasive content strategies health communicators can use to increase vaccination rates.

First, the authors briefly summarise the vast literature on vaccine hesitancy. Their focus is on the situational character of the appropriate communication strategies. As research has shown, context is a complicating factor for persuasion attempts. The challenge for health authorities is not only to select the most relevant information but to convince those who are hesitant of the credibility of this information. Here, emotional factors, including trust, play major roles in the resistance to vaccination; and appeals to the cognitive faculty of health literacy might not provide the most effective solution.

In light of this discussion, they use the notion of "rhetorical situation" to generate insights for content strategies that build trust in health authorities, generally, and vaccination programmes, more specifically. A rhetorical situation consists of exigence, audience, and constraints. That is, the orator must:

• Define and grasp the exigence (problem to be solved) with words - The specific rhetorical problem here is the lack of confidence in vaccines and the advice of health authorities, more generally. When offering COVID-19 vaccines, public health authorities encounter lack of trust in the vaccines, which requires a rhetorical response to "why should the vaccine be trusted?" Taking risk bearers' levels of institutional and epistemic trust, as well as their cognitive and emotional orientation to the risk, into account is vital for efforts to strengthen trust through rhetoric. Of particular importance is the sociological assumption that trust is a social construct that has to be analysed in particular sociocultural and political contexts.
• Identify an audience that potentially can help solve the problem - In the context of this paper, the audience is the group of people who, according to the health authorities, should either get vaccinated themselves or should vaccinate their children, but are hesitant. One particularly promising sub-group within this audience to reach out to is healthcare workers who are unsure about the COVID-19 vaccine. Strengthening trust between them, the health authorities, and policymakers is particularly pressing. (In this case, the rhetorical situation is complicated because one has to address an intermediate audience - those who in turn communicate with patients - as a means of reaching one's ultimate aim.)
• Understand the constraints in the situation and what rhetorical strategies are required to overcome these - For instance, the level of trust in institutions in a specific country will form a constraint or a possibility for risk communication on vaccines. The changed fragmented media landscape presents a constraint (where anti-vaccination information spreads rapidly online) but also an opportunity: The use of credible spokespersons on social media can be a useful strategy for creating institutional trust, pointing to the importance of factors such as competence, expertise, knowledge, objectivity, fairness, consistency, sincerity, caring, empathy, compassion, and goodwill in rhetoric.

Five communication principles are deduced from this analysis of the rhetorical situations of vaccine communication and related to the literature on trust:

1. Vaccine hesitancy is not irrational per se.
2. Messages should be tailored to the various hesitancy drivers.
3. What is perceived as trustworthy is situational and constantly negotiated.
4. In areas of uncertainty where no exact knowledge exists, the character of the speaker becomes more important.
5. The trustworthiness of the speaker can be strengthened through finding some common ground - such as shared feelings or accepted premises - with the audience. (One recommendation would be to partner with opinion leaders that are trusted by a particular group.)

In conclusion: "This list of suggestions is certainly not exhaustive, but it does provide a starting point for empirical testing and further theorization. In particular, more research is needed to reflect how the mentioned changes in the media landscape call for a revised conceptualization of the rhetorical situation as well as modified strategies to achieve fitting responses in practice."