Better public health communication needed to address post-pandemic vaccine scepticism

Research led by Professor Elena Semino (Lancaster University) with UCL, the UK Health Security Agency and Georgetown University, analysed a 9-million-word body of tweets posted on X focusing on ones that compared and evaluated vaccines – like the MMR, flu and Covid-19 vaccines.  

The research team noticed reoccurring linguistic expressions that highlighted an emerging new kind of vaccine scepticism: 

• users typed “vaccine” within quotes to challenge the status of the term, 
• users differentiated between “shots” and “vaccines”, with the former indicating an inferior medical intervention, 
• users believed that some vaccines were more “real” or “proper” than others. 

Examples of posts analysed in the study included: 

“Vaccine: polio, MMR, smallpox. You don't have to get them again and you won't get the disease. Shot: tetanus, flu, Covid. You have to keep getting them because they aren't a cure because there is no cure, especially for a coronavirus. Stop calling it a vaccine. It's a shot.” 

“It’s not even a real vaccine. You can catch Covid and also spread it if you are vaccinated. You don’t catch polio or MMR after you are vaccinated.”

This “vaccine-is-not-a-vaccine" scepticism was rarely expressed on X (formerly known as Twitter) before 2020; the research indicates its emergence is tied to the Covid-19 pandemic, though this scepticism has come to spread to other vaccines, like those for the flu. 

The research focused on X as it has been a comprehensive source of data for studying vaccine attitudes and misinformation, but also an important channel for sharing vaccine-related public health messaging. 

In the UK, confidence in vaccines declined between 2019 and 2023, and vaccine hesitancy has been identified by the World Health Organization as a top 10 global health threat. As such, the researchers underscore the importance of addressing this new form of scepticism about vaccines, which are important in preventing serious illness. 

Looking at the body of tweets, the researchers noted that the Covid-19 vaccine attracted more negative evaluations in comparison to the MMR vaccine. 

An analysis of the language used to express this vaccine scepticism shows a mismatch in public expectations of vaccine efficacy, and public confusion around what the different types of vaccines do. 

The Covid-19 vaccine primarily reduces the severity of illness, different to MMR, which prevents measles, mumps and rubella. Covid-19 is also unique in that it is more easily tested for, in contrast to the flu. Lateral flow tests became widely available during the pandemic, making visible whether an individual had the virus. 

Disappointment and suspicion around the effectiveness of the vaccine could thus arise after receiving a positive test despite being immunised due to confusion around the purposes of the vaccine. 

Widely advertised data on the efficacy of vaccines in clinical trials during the pandemic may have furthered a mismatch between individuals’ expectations of what the vaccine should do – “prevent” Covid – and their lived experience. 

In the wake of the Covid-19 pandemic, this has thus led to the emerging idea that in comparison to a preventative vaccine like the MMR, the Covid-19 vaccine has a lower effectiveness against infection and is therefore not a “true” vaccine at all. 

Professor Semino says, “The finding that some people on Twitter/X question the status of the COVID-19 vaccines as vaccines was unexpected. It shows that it is important to explain how different vaccines work, depending on the nature of the disease.” 

The team notes that future public health messaging needs to address potential confusion among the public about what vaccines are. 

The researchers note that the use of “shot” to suggest an inferior intervention to “vaccine” is particularly concerning, especially in contexts where “shot” may be used as an alternative to “vaccine” in public health communications. 

Dr Demjén says, “For those involved in developing public health messaging, it is also worth bearing in mind the different associations attached to the words ‘shot’ and ‘vaccine’ that this study has revealed. 

“While ‘shot’ is more frequently used in the US, recently more localised campaigns in the UK, aiming to increase up-take of seasonal vaccines, adopted this more informal term. Our finding that ‘shot’ was seen as ‘not a vaccine’ suggests that this may be best avoided in large-scale campaigns” says Dr Demjén.

Related links

• Read the paper: ‘It's a shot, not a vaccine like MMR’: A new type of vaccine-specific scepticism on Twitter/X during the COVID-19 pandemic
• Read in The Conversation: Uncovering a new trend in vaccine scepticism
• Dr Zsófia Demjén’s UCL profile
• Centre for Applied Linguistics
• Department of Culture, Communication and Media

Image

Gregory Miller via Adobe Stock.