Addressing vaccine hesitancy in writing:

How has COVID-19 changed hesitancy

communication, and what works?
Michelle Guillemard vaccine1 due to concern about blood clot risks. you? The answer requires a big-picture approach.
Health Writer Hub, Queensland, Australia In other states, experts encouraged under-60s to Why do people do things that are bad for them,
get whatever vaccine they could access. Months and why don’t they do things that are good for
later, Queensland’s message changed;2 under-60s them?
Correspondence to: could get AstraZeneca if they first spoke to their It’s not because of stupidity or ignorance,
Michelle Guillemard doctor. Critically, health experts did not writes emergency physician Edwin Leap, in
[email protected] specifically address their earlier comments and MedPage Today.4 “Human decisions are far more
why they changed their message, creating even complex, nuanced, and personal than most of us
more public confusion. realise.” He added, “We needn’t agree with a
Abstract Consistent public health messaging is the key choice to understand it,” before offering a few
To address vaccine hesitancy in writing, it is to alleviating fears. Reliable communications that logical reasons why people don’t do things that
important to put yourself in your reader’s address hesitancy will help to avoid mixed are good for them, including:
shoes, demonstrate an understanding of the messaging around safety. Messaging needs to be l science is hard to understand

hesitancy, and form an effective response strong enough to motivate behaviour change, too. l an understanding of science is not innate

using evidence-based writing techniques, One of our first consistent public health messages l people distrust pharma companies and the

clear communication, courtesy, and empathy. was to get vaccinated to do the right thing and government in general
This article examines practical ways to achieve protect your community,3 but it has since l poverty

these objectives. changed to focus more on “returning to normal”. But importantly, not all people who are
This perfect storm of hesitancy is, of course, hesitating feel and think the same. Vaccine hesi-
worsened by media fearmongering. Journalists tancy is a complex spectrum,5 from consideration

n
E
ighteen months before the COVID-19
pandemic began, I wrote about vaccine
hesitancy for the March 2018 issue of Medical
love to spread fear through speculation,
sensationalist headlines, and language use. But
fear doesn’t change behaviours – it creates
right through to outright denial. Different stages
require different messages, and each fear requires
a targeted, consistent response. If a hesitant
Writing. confusion, which makes hesitancy worse. And, to reader reads a different answer every time they
Back then, health communicators were con- recap my 2018 piece: knowledge, facts, and express their specific hesitation, they’ll likely feel
cerned about hesitancy and the MMR vaccine. evidence alone don’t help to address vaccine more confused and hesitant.
We were furious at Andrew Wakefield and hesitancy any more than fear does, unfortunately. Over the past months, I’ve read many
frustrated with mothers who spread misinforma- The first step towards addressing hesitancy is perspectives online to understand more about
tion online while choosing not to vaccinate their putting yourself in your audience’s shoes. the spectrum of COVID-19 vaccine hesitancy.
newborns. Demonstrate an understanding of the hesitation, Two of the main themes underlying hesitancy
How the world has changed. and then form an effective response. seem to be:
l Fear of the unknown – fears related to long-

COVID-19 and hesitancy Putting yourself in your reader’s term side effects, unfamiliar ingredients, and
As outbreaks and infection rates continue to soar, shoes pregnancy risks
vaccination – while not a silver bullet – is the only Targeted communication is more effective than l Loss of control over choice – fears related

weapon we have against COVID-19. But poor generic communication. Putting yourself in your to loss of ownership over one’s body, which
messaging has hindered rollouts and uptake in reader’s shoes and thinking about what they need also relates to losing control of freedom
countries like Australia. For example: our over- to know helps you to communicate clearly, giving Anger and frustration, two highly emotional
60s have had access to vaccines since March – but you a better chance of achieving your desired states, are closely related to these themes. So, it’s
rates remained low for months. Why? Access result. Asking questions that explore people’s not surprising that many of us end up in
issues aside, there are two likely reasons: mixed reasoning behind their decisions is a useful first arguments when discussing hesitancy. Putting
messaging and a lack of communication step. (See the Appendix for a related writing yourself in your reader’s shoes helps you avoid
specifically addressing hesitations – both of exercise.) arguments, communicate clearly, and engage in
which have created a perfect storm of hesitancy. I recently asked my Instagram followers why respectful debate.
In Queensland, where I live, health experts they got the vaccine, and one astute reader When I asked a friend about her reasons for
told under-60s not to get the AstraZeneca responded with a simple question: Why wouldn’t hesitation, she was more than happy to discuss

12 | December 2021 Medical Writing | Volume 30 Number 4

 Guillemard | Addressing vaccine hesitancy in writing

her feelings rationally. It was like I was the only of fear combined with messages of hope help to infectious disease social scientist also at the
person who had taken the time to have a civil inspire behaviour change. UNSW’s School of Population Health, said: “By
discussion about hesitation with her. And by This effect worked well in a 2017 skin cancer being activated, by being primed, the research
understanding and acknowledging prevention public health campaign. shows people are more likely to go in to see their
her perspective, I was able to learn An effective Therefore, a consistent fear-hope GP and their health provider with a more
more about hesitation. “Treat vaccination message might work well positive mind frame.”
[people who are hesitant] as
response – as long as it’s not too menacing.
potential allies rather than should be Comparably, research into smoking The final word
enemies,” concludes Dr Leap. “Try targeted, prevention7 has shown that “short If you’re communicating about vaccine hesitancy
to learn from them and apply that evidence- and sweet” messages focused on and you want to discuss the benefits of
information to future situations. immediate gains work better than vaccination, here are the key points to keep in
But do not, under any circum-
based, and highly threatening or fear-eliciting mind:
stance, treat them as simpletons or considerate. messages. l Put yourself in your reader’s shoes – under-

dismiss their concerns out of A separate study8 found that stand your reader’s reasons for hesitation
hand.” negative messages containing l Form an effective, evidence-based response
Understanding the reasons for hesitation deception and disgust pushed readers into – use health communication tactics, such as:
helps you form an effective, relevant response. defensive responses – making them best avoided. l Fear-hope messages (but avoid frighten-
Narratives and real-life success stories are ing messages)
Forming an effective response persuasive tools, too. Embedding facts in a story l Short and sweet messages focused on

An effective response should be targeted, is more persuasive9 than simply presenting facts immediate gains
evidence-based, and considerate. And we can alone. Incorporating stories about hesitant l Narratives and real-life success stories to

look to other public health campaigns to see individuals who have changed their minds may persuade
which communication tactics have successfully work well. l Keep your communication targeted - use
changed people’s behaviours. For example, health Engaging particular groups through targeted relevant messages in susceptible communities
communication research6 has shown that, while communication is important as well. Speaking to or age groups
fear alone doesn’t change behaviours, messages News GP,10 Associate Professor Holly Seale, an

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Addressing vaccine hesitancy in writing | Guillemard

6 tips to help you write

clearly about COVID-19

To alleviate pandemic-related anxiety, aim to

provide clear, factual communication that
supports health literacy.

n1 Clearly define unfamiliar COVID-19

medical terms
Think of the words and phrases that could be
unfamiliar to your target audience and define
them before using them in a sentence. To
determine which terms are unfamiliar, you’ll go with COVID-19, make sure your poor readability.
need to research your target audience and capitalisation is consistent. Here are some examples:
gather your requirements in detail. The clearest Using consistent key terms is important, as Global pandemic: Global is unnecessary, as a
way to define an unfamiliar medical term is to it alleviates confusion. For example, if you use pandemic is, by definition, global or affecting
define the term first, and then use it in a the terms physician, health professional, multiple countries
sentence. doctor, and GP interchangeably, your readers COVID-19 virus: As COVID-19 stands for
l CORRECT: The time after exposure and may think you’re referring to different people. coronavirus disease 2019, virus is unnecessary
before having symptoms is called the Tip: SEO best practices tell us to use a range A total of 30,000 people: A “total of ” is
incubation period. The average incubation of synonyms for Google’s algorithm, but there’s unnecessary.
period for COVID-19 is 4.9–7 days. a balance between substituting terms for Watch out for general redundant words and
Sometimes, you may not be able to define variety and confusing your readers. expressions, like:
the term before using it in a sentence. While l First and foremost

it’s best to define the term first, including a

definition in the second sentence is better
than not including a definition.
n
4
Define acronyms
Most abbreviations and acronyms need
defining, except the ones you can assume
l My own opinion

l Past experience

l Exactly the same

l EXAMPLE: The average incubation period everyone understands. For example, writing
for COVID-19 is 4.9–7 days. The
incubation period is the time after exposure
and before having symptoms.
“Cable News Network (CNN)” is unnecessary.
But your readers may not know what PPE or
AZD1222 vaccine mean.
n6 Convey factual information
If your writing feels too emotional or
threat-based, readers become anxious and may
The correct way to use an acronym is to not understand. A review of media dramati-

n
2
Differentiate between similar-
sounding terms
Many pandemic-related terms sound similar
spell it out in full at first reference, then include
the abbreviation in parentheses. You can then
use the abbreviated term throughout your
sation of the H1N1 pandemic suggested that
news content stressed threat-based informa-
tion over accurate and factual information,
and can confuse your readers when misused. content. creating artificial hype or hysteria around the
An essential aspect of writing clearly about l CORRECT: Personal protective equipment new virus.
COVID-19 is differentiating between common (PPE) To avoid confusion and alleviate pandemic-
terms to avoid confusion. Here are just some of l INCORRECT: PPE (personal protective related anxiety, focus on providing:
the many similar-sounding terms you may need equipment) l Accurate information about the signs,

to define or explain: l INCORRECT (no need to capitalise every symptoms, and risk factors
l Restrictions and measures word): Personal Protective Equipment l Information on how to effectively prevent

l Physical distancing and social distancing (PPE) or control the disease

l Quarantine and isolation Tip: You don’t have to place an abbreviated Practical, actionable information gives your
l Lockdown and self-isolate term in parentheses if you’re not going to refer readers a sense of control and reduces
l Medication and vaccination to it in your content. confusion.
An increasing number of people are reading

n3 Use key terms consistently

One of the fundamental rules of plain
English writing is to use consistent key terms.
n5 Be careful of redundancy
Redundancy is when your words and
phrases repeat information unnecessarily.
about how viruses spread, how to prevent
diseases, and how vaccinations work. By
providing good-quality information, we can
Decide whether you’re going to use the term These extra words can confuse your readers help our readers make informed choices and
COVID-19 or coronavirus, for example. If you and make sentences longer, contributing to create better health outcomes.

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 Guillemard | Addressing vaccine hesitancy in writing

4. Leap E. Vaccine hesitancy is complex.

MedPage Today. 2021 [cited 2021 Sep 1].
Available from:
https://www.medpagetoday.com/opinion/
rural/93783
5. Leask J, Danchin M, Chad NJ. Australians’
attitudes to vaccination are more complex
than a simple ‘pro’ or ‘anti’ label. The
Conversation. 2017 [cited 2021 Sep 1].
Available from:
https://theconversation.com/australians-
attitudes-to-vaccination-are-more-complex-
than-a-simple-pro-or-anti-label-74245
6. Nabi R, Myrick J. Uplifting fear appeals:
Considering the role of hope in fear-based
persuasive messages.
Health Commun. 2019;34(4):463–74.
doi:10.1080/10410236.2017.1422847
7. Mollen S, Engelen S, Kessels LT, van den
Putte B. Short and sweet: The persuasive
effects of message framing and temporal
context in antismoking warning labels.
Keep communication consistent, clear, and https://www.abc.net.au/news/2021-06- J Health Commun. 2017;22(1):20–28.
courteous. 30/qld-cho-rejects-morrisons-astrazeneca- doi:10.1080/10810730.2016.1247484
comments-covid-vaccine/100256022 8. Leshner G, Clayton RB, Bolls PD, Bhandari
Health writers should also continue to: 2. Layt S, Dennien M. Queensland CHO M. Deceived, disgusted, and defensive:
l Look at what has worked in previous modifies AstraZeneca advice as case Motivated processing of anti-tobacco
pandemics and public health campaigns numbers rise. Brisbane Times. 2021 [cited advertisements. Health Commun.
l Look at what is helping to increase rates of 2021 Sep 1]. Available from: 2018;33(10):1223–32.
vaccination now, in real time https://www.brisbanetimes.com.au/ doi:10.1080/10410236.2017.1350908
Good scientific writing is about promoting a national/queensland/queensland-cho- 9. Krause RJ, Rucker DD. Strategic
socially responsible message in line with the best modifies-astrazeneca-advice-as-case- storytelling: When narratives help versus
available scientific evidence. And in the COVID- numbers-rise-20210803-p58fdz.html hurt the persuasive power of facts.
19 pandemic, that message is to get vaccinated. 3. Why should I get vaccinated for COVID- Pers Soc Psychol Bull. 2020;46(2):216–27.
Our job is not to bring all views to the table, 19? Health.gov.au. 2021 [cited 2021 Sep 1]. doi:10.1177/0146167219853845
because not all views are backed up by evidence. Available from: 10. Attwooll J. Is there enough public data on
Our job, as health communicators, is to help https://www.health.gov.au/initiatives-and- COVID-19 vaccine hesitancy? NewsGP,
readers make the choice that leads to better programs/covid-19-vaccines/getting- RACGP. 2021 [cited 2021 Sep 1].
health outcomes and is in the best interest of vaccinated-for-covid-19/why-should-i-get- Available from:
public health. vaccinated-for-covid-19 https://www1.racgp.org.au/newsgp/
clinical/is-there-enough-public-data-on-
Disclaimers covid-19-vaccine-he
The opinions expressed in this article are the
author’s own and not necessarily shared by her
employer or EMWA.

Conflicts of interest
The author declares no conflicts of interest.
Author information
References Michelle Guillemard is the founder of Health Writer Hub, Past
1. Zillman S. Queensland’s Chief Health President of the Australasian Medical Writers Association, and a
Officer rejects Prime Minister’s comments freelance medical writer. Michelle teaches health writing courses
on AstraZeneca’s COVID-19 vaccine for to students worldwide and is passionate about creating better health
under-40s. ABC News. 2021 [cited 2021 outcomes through effective health communication.
Sep 1]. Available from:

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Addressing vaccine hesitancy in writing | Guillemard

Appendix. Vaccine hesitancy writing exercises

1. Addressing common fears 2. Common reasons why people get vaccinated
Consider these common hesitations, and write an empathetic, “short and Sharing reasons why others choose to get vaccinated may help to persuade
sweet” response that includes a fear-hope message: hesitant individuals. Consider these common reasons why people have been
vaccinated and write a response to a hesitant individual.

Hesitation Your response Justification Your response

The AZ vaccine isn’t as Keeping family safe

effective

The vaccine won’t stop me I don’t want to die of COVID-19

from getting the virus

Why get vaccinated if you can I care about the community and
give it to other people? public health

I’m scared of the blood clot I want to travel again and live
risk normally

I’m scared of the risk of I’ve seen the multitude of

immediate death after benefits of vaccines over so
receiving the vaccine many years, can’t see why this is
different

Nobody I know has had COVID Worried about spreading the virus

I want to wait and see what I want the peace of mind

happens

I’m worried the vaccine will I want to live without anxiety and
affect my fertility fear

It’s an experimental vaccine Protection against long COVID-19

that was rushed to market

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