Background: Misinformation and disinformation around vaccines has grown in recent years, exacerbated during the Covid-19 pandemic. Effective strategies for countering vaccine misinformation and disinformation are crucial for tackling vaccine hesitancy. We conducted a systematic review to identify and describe communications-based strategies used to prevent and ameliorate the effect of mis- and dis-information on people's attitudes and behaviours surrounding vaccination (objective 1) and examined their effectiveness (objective 2). Methods: We searched CINAHL, Web of Science, Scopus, MEDLINE, Embase, PsycInfo and MedRxiv in March 2021. The search strategy was built around three themes(1) communications and media; (2) misinformation; and (3) vaccines. For trials addressing objective 2, risk of bias was assessed using the Cochrane risk of bias in randomized trials tool (RoB2). Results: Of 2000 identified records, 34 eligible studies addressed objective 1, 29 of which also addressed objective 2 (25 RCTs and 4 before-and-after studies). Nine ‘intervention approaches’ were identified; most focused on content of the intervention or message (debunking/correctional, informational, use of disease images or other ‘scare tactics’, use of humour, message intensity, inclusion of misinformation warnings, and communicating weight of evidence), while two focused on delivery of the intervention or message (timing and source). Some strategies, such as scare tactics, appear to be ineffective and may increase misinformation endorsement. Communicating with certainty, rather than acknowledging uncertainty around vaccine efficacy or risks, was also found to backfire. Promising approaches include communicating the weight-of-evidence and scientific consensus around vaccines and related myths, using humour and incorporating warnings about encountering misinformation. Trying to debunk misinformation, informational approaches, and communicating uncertainty had mixed results. Conclusion: This review identifies some promising communication strategies for addressing vaccine misinformation. Interventions should be further evaluated by measuring effects on vaccine uptake, rather than distal outcomes such as knowledge and attitudes, in quasi-experimental and real-life contexts.
Bibliographical noteFunding Information:
This study is funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation (NIHR200929), a partnership between UK Health Security Agency and the London School of Hygiene & Tropical Medicine, and by the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, in partnership with UK Health Security Agency (UKHSA). The views expressed are those of the author(s) and not necessarily those of the NIHR, UK Health Security Agency or the Department of Health and Social Care.
We are grateful for the support of Russell Burke, Information Specialist and Assistant Librarian at the London School of Hygiene and Tropical Medicine, in developing our search strategy. The NIHR Health Protection Research Unit in Vaccines and Immunisation is a partnership between the UK Health Security Agency (UKHSA) and the London School of Hygiene and Tropical Medicine, in collaboration with the University of Cambridge. Website at https://www.lshtm.ac.uk/research/centres-projects-groups/nihr-hpru-vaccines-immunisation#welcome. The Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at University of Bristol is part of the National Institute for Health and Care Research (NIHR) and a partnership between University of Bristol and UK Health Security Agency (UKHSA), in collaboration with the MRC Biostatistics Unit at University of Cambridge and University of the West of England. We are a multidisciplinary team undertaking applied research on the development and evaluation of interventions to protect the public's health. Our aim is to support UKHSA in delivering its objectives and functions. Follow us on Twitter: @HPRU_BSE
© 2022 The Authors
- Communication strategies
- Vaccine acceptance
- Vaccine hesitancy