Mistrust of the Medical Profession and Higher Disgust Sensitivity Predict Parental Vaccine Hesitancy

"...begin to paint a picture of who is vaccine hesitant, and provide further insight into the demographic and attitudinal predictors needed to create successful public health messaging."

Evidence shows that vaccine hesitancy and refusal has increased worldwide, yet the need for confidence in vaccines is even more crucial in light of the COVID-19 pandemic. Although vaccine hesitancy has been explained as being due to a lack of knowledge or a miscalculation of risk, the provision of scientific information about the benefits of vaccines has been found to be ineffective in counteracting anti-vaccination beliefs. Considering this, the researchers of the present study sought to support development of more effective strategies to combat anti-vaccination movements by investigating the demographic and attitudinal predictors of parental vaccine hesitancy.

Using Amazon MTurk, the researchers recruited 484 parents who are citizens of the United States (US), Canada, or the United Kingdom (UK), and queried their attitudes on childhood vaccination, level of education, age, religiosity, political affiliation, trust in medicine, and disgust sensitivity. The Parent Attitudes about Childhood Vaccines Scale (PACV) was used to define parental vaccine hesitancy in the cohort. Responses were scored from 0-100, with higher scores indicating greater vaccine hesitancy. A second attitude scale, the Three Domains of Disgust Scale (TDDS), was used to measure 3 factors of disgust sensitivity: pathogen, sexual, and moral disgust (with a 7-item subscale corresponding to each factor). Participants were asked to rate how disgusting they find the events described in each of the 21 items on a 7-point scale, with higher values indicating more disgust. Examples of items include: "seeing a cockroach run across the floor" (pathogen subscale), "hearing two strangers having sex" (sexual subscale), and "cutting to the front of a line to purchase the last few tickets to a show" (moral subscale). The global trust in medicine score was created by combining trust in physicians, surgeons, and hospital subscales.

The study found the following predictors for parental vaccine hesitancy:

• Younger age - Possible reason, based on previous research: Younger parents are more likely to obtain parenting advice from the internet, where they may be exposed to online misinformation about vaccines.
• Lower levels of education - Possible reason, based on previous research: Lower levels of education have been associated with reduced online heath literacy, which may provide an additional challenge in discerning what is true and untrue about online vaccine information.
• Greater religiosity - Possible reason, based on previous research: Religious beliefs are a legal avenue for personal vaccine exemptions, and some religious groups do not support the use of vaccines.
• Lower levels of trust in physicians - This finding suggests that pro-vaccine campaigns that rely on assumed trust in physicians may be ineffective for parents who are vaccine hesitant. An alternative approach would be to use a combination of scientific fact and storytelling - adopting the narrative strategies often used on anti-vaccination websites.
• Higher levels of disgust sensitivity, especially sexual disgust - The researchers suggest that it could be that sexual disgust is reflecting a more robust measure of general disgust sensitivity. They also cite previous work that has found that vaccine-hesitant parents emphasise the moral foundations of purity and liberty. Through this lens, vaccines violate purity, as they contain unnatural toxins, and they curtail liberty, as they are seen to impose government control.

In conclusion, these results may help guide targeted research and public health messaging. "Counteracting vaccine hesitancy and refusal will require a multifaceted effort, and a better understanding of key demographic and attitudinal predictors will be required for an effective approach."