There’s a lot of talk about a vaccine for COVID-19. However, vaccines only work if people take them, and for that we require people to think cogently and coherently about the coronavirus.

But if that were actually happening, there might not actually be a pandemic in the first place.

Take this gentleman from Missouri, quoted last week in The Guardian. On Friday the whole world stopped what it was doing when the American president was laid low by the corona, but this guy wasn’t having any of it. “It’s a hoax,” he maintained. “There’s no pandemic.”

He went on:

If he [Trump] is sick, then they planted it when they tested him. It’s what they did to me when I went to hospital for my heart beating too fast. Two weeks later I got a cold…It’s political. I don’t trust the US government at all. Who are they to mandate personal safety?

For a vaccine to be effective, we would need this guy — and lots more like him — to take it.

Good luck with that.

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Back in May, a CNN poll suggested that around one-third of Americans would decline a COVID-19 vaccine if it were available. A similar survey by RTÉ last week showed that 32% of Irish people would be “unlikely” to get vaccinated. These trends reflect what we’ve seen in many countries for several years. Vaccine hesitancy is real, and it could end up killing us all.

Psychological research paints a mixed picture as to the causes. We know that anti-vaccination attitudes are as old as vaccination itself. Ever since the first inoculation programmes were instituted, sceptics have condemned vaccines as ineffective, toxic, and part of a government-sponsored money-making scam.

Radical anti-vaccinationists have become adept at spinning over the past two hundred years. Their approach seems to centre around four rhetorical strategies: (a) misrepresenting the science behind vaccines; (b) proposing vague and changeable counter-theories; (c) ignoring contrary opinions; and (d) vehemently attacking critics.

The situation is further complicated by political overlap. In the 21st century, all manner of contrarian protest movements have sought to expand their audience by appropriating vaccine anxiety. Groups as diverse as pro-gun lobbyists, anti-abortion campaigners, and xenophobic Far Right fanatics have each expediently taken anti-vaccine positions, often linking them to loose arguments about “freedom”.

Ultimately, the psychological dimension is key. Emotion, not empiricism, drives the dynamic. Conspiracy theorists gain ground because they can tell a good story, unencumbered by peer-review, legal standards of evidence, or the rigours of scientific quality control.

But anti-vaccine anxiety is not all due to extremists. Indeed, attributing vaccine hesitancy to the efforts of anti-vaxxers is itself a conspiracy theory: it gives unwarranted credit to co-ordinated factions pursuing long-term ulterior motives.

In reality, the psychology of vaccine hesitancy is far more messy and mundane.

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Most often, low uptake of vaccination arises from a variety of psychological barriers. One example is the way people find it so difficult to use maths to calculate risk (a universal form of innumeracy that makes the gambling industry profitable). Another relates to optimism bias: humans hold unwarranted feelings of personal invincibility. The influence of community groupthink is also pivotal, as is a general lack of awareness of how human bodies — and viruses — work.

Research in individual psychology shows that most people make decisions on the hoof, by instinct, and without deep rational analysis. We are hampered by several quirks in our ability to “do logic”, such as our habit of fixating on easy-to-remember examples while ignoring abstract information that might well be more pertinent (a foible psychologists refer to as the availability heuristic).

At the social level, misinformation pathways are numerous. A key problem is our in-built gullibility. We humans are very poor at detecting dishonesty. In fact, one of our central failings is our gut-feeling that when other people say something, there must be “something to it.” We attach undue weight to anecdotal accounts.

We also tend to be very busy. Most serious people have little time to conduct their own research, and so tend to be swayed by what they hear other people saying.

But the people we listen to most are the ones we have chosen to include in our social orbits. What we hear is but a snippet of what is said throughout the world, and the selection is based on our personal tastes and interests. Over time this skews our perception of the social consensus; we mislead ourselves into believing that we know what most people think. This process, which psychologists refer to as “active information avoidance,” is endemic in our echo-chamber era, and is the driving force behind groupthink.

Research into vaccination programmes has been ongoing for many years but, in my humble opinion, much of it rests on some pretty naive assumptions about why vaccine hesitancy has been such a problem for so long.

Among the interventions that seem to improve vaccine uptake — at least for those people who are either favourable or, at worst, ambivalent about vaccination to begin with — are things like this:

• Reminders that facilitate immediate action, such as telephoning people to prompt uptake and allowing them to book their appointment in the same call.
• Reminders that present vaccination as the default option (“you are due for your vaccination this month“), which serves to demonstrate a supportive social norm.
• Anything that primes people to think vaccines are “normal”, including being surveyed about their attitudes toward vaccines.
• Anything that reduces choice anxiety, such as proposing a single date for a vaccination appointment instead of a choice of dates.

Quite a lot of psychologists seem to observe that the best way to improve vaccine uptake is to remove barriers such as cost and availability. That is fair enough, but it addresses only part of the problem. People who avoid vaccines because they are grossly misinformed will care little about pricing or logistics.

And misinformation is a difficult problem to address. Providing “good” information is rarely the solution. Indeed, research shows us that giving sceptics “corrective” advice about vaccine safety actually makes them less willing to vaccinate their children.

At the end of the day, people hear what they want to hear.

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Minds are rarely changed by going through the front door. The challenge is to unfreeze and then reshape people’s prior assumptions, helping to foster an openness to new knowledge. That knowledge must be offered in a transparent and non-threatening way. It should not be given in a manner that makes receivers feel that we think they are all just dumb.

There are few quick fixes to the problem of mass misinformation. But we do know that the solutions will not be confined to public health. Civic conscientiousness is a social challenge that pulls threads throughout our political system. When we see so many racists, homophobes, and anti-democracy gun-nuts protesting hard against vaccination, perhaps we should take the hint about what is actually going on here.

Miseducation is, at its core, a political failing.

The long game begins now. After all, we have plenty more pandemics to look forward to.