“I Would Never Push a Vaccine on You”: A Qualitative Study of Social Norms and Pressure in Vaccine Behavior in the U.S.

Abstract

Previous researchers have established the influence of social norms on vaccine behavior. However, little work has been performed contextualizing individuals’ experience with these social factors and how they operate to persuade individuals’ acceptance or refusal of a vaccine. We aimed to determine the mechanisms of familial and societal pressure or expectations that contribute to COVID-19 vaccine decision-making. We conducted four focus groups and eleven individual interviews (total n = 32) with participants from across the U.S. of different vaccination statuses. We identified three emergent themes: (1) Altruistic reasoning was particularly prevalent among initially hesitant late adopters—the desire to protect loved ones and others constituted a dominant motive, more powerful than protecting oneself. Vaccination was also reckoned as part of a joint effort to return to normal life; hence, it invoked a sense of responsibility or “obligation”; (2) expectation often became pressure; although most vaccinated participants stated that they respected others’ choices, late adopters or unvaccinated participants perceived differently and felt rushed or “forced” into choosing, and many resented being “targeted” or “bullied”; (3) vaccination status became a new label, frequently dividing families, thus producing familial mandates, exclusions, or social stratifications. This caused sadness and feelings of isolation, along with the formation of a camaraderie among the excluded unvaccinated. A vaccine decision builds from the complexities of individuals’ experiences and cultures. The vaccinated were not free of hesitancy nor were the unvaccinated all anti-vaxxers. Vigorous vaccine promotion successfully converted some undecided individuals but also fostered distrust of government; alarmingly, the push to receive the COVID-19 vaccine further triggered doubts about established vaccines. Communication strategies need to be developed and implemented carefully so as not to ostracize the unvaccinated community and strengthen their resistance.

Barriers and Facilitators to COVID-19 Vaccine Uptake among Polish Patients: A Qualitative Interview Study

“…Thus, information must be communicated in a more comprehensible manner and best practices must be followed [ 43 , 44 ]. Caution in the implementation of communication strategies to avoid escalating resistance among non-vaccinated communities is emphasised [ 14 ].…”

“…Undertaking this type of research is crucial due to the severe socioeconomic burden of the pandemic. It needs to be emphasized that only a few published qualitative studies have shown barriers and facilitators to vaccine uptake in populations from other countries, although they did not include individuals previously hospitalized due to COVID-19 [ 14 , 16 , 21 , 23 , 30 , 47 , 48 ]. The greatest value of our study lies in the fact that the respondents were recruited from several hospitals and thus had experiences of hospitalization in several different healthcare institutions.…”

“…Significantly, qualitative findings can help to explain people’s attitudes and behaviours when making vaccination decisions. A recent qualitative study conducted in the USA highlighted that vaccine decisions build from the complexities of individuals’ experiences and cultures [ 14 ]. It also indicated that the main factors associated with vaccine hesitancy were mistrust, fear, and lack of information [ 15 ].…”

Investigating Attitudes, Motivations and Key Influencers for COVID-19 Vaccination Uptake among Late Adopters in Urban Zimbabwe

“…These attitudes may be driven by social norms, as well as altruism. In western cohorts, altruistic reasoning has been shown to be an important factor in vaccine uptake decision-making [ 47 ]. In this study, we show that similar attitudes play an important role in vaccine uptake among African late adopters.…”

Preventable Disease, the Case of Colorado: School District Demographics and Childhood Immunizations

“…It would be interesting to know how other countries pair on these trends. Based on the narrative presented, future efforts should be directed to the characterization of environmental [ 41 , 45 ] cultural differences [ 34 ] of vaccination attitudes and by clearly identifying stakeholders [ 48 ], which can improve effective vaccination campaign efforts that do not alienate the unvaccinated or strengthen their resistance [ 49 ]. Dealing with low vaccination rates among privileged populations is a challenge, since their privilege allows them to decide against vaccination.…”