Vaccination hesitation means to delay or refusal to accept vaccines, although vaccination services are available. Vaccine hesitations are complex and specific to the situation and vary with time, place, and vaccines.
It is influenced by factors such as indifference, comfort, and confidence. Anti-vaccination is increasing day by day and affects the society very seriously. We will try to perceive this anti-vaccination opposition in behavioral aspects. Behavioral factors affect the decisions we make in the decision-making process. These behavioral factors are our values, personality, risk propensity, and the potential for the decision to mismatch. The most effective thing in our decision-making process is our ability to think rationally. Rational people know that the vaccine is the most important defense and protection method for the society, as they always try to maximize the benefit from the benefit and harm duo. Irrational people, on the other hand, constantly succumb to certain behaviors and the pressure and influence of these behaviors on them during this decision making process.
A. Behavıoral Causes And Effects
Instead of imposing sanctions, let’s look at the reasons why people are still anti-vaccine even in this period when technology and science are so advanced. While people are thinking, their thoughts are both their own opinions and are influenced by external environmental factors. There is a source of ourselves, that is human, and there is also a source of society. Conspiracy theories are examples of external environmental factor.
A.1 Herding Behaviour;
People belonging to a group or community are easily influenced by each other. It is an example of sheep jumping off a cliff by following each other. Anti-vaccination in a neighborhood affects the remaining residents. After that when you look at the data, number of people who do not want to be vaccinated increases day by day.
A.2. Framing Effect;
Another issue that will help the city fight the epidemic is how we say what. The framing effect is also related to conspiracy theory. It has directly relation between what and how we say. It is very important for people. It is very promising to say that nearly 80 percent of people survived thanks to the vaccine, while it is also pessimistic and negative to say that about 20 percent of people died after being vaccinated.
A- 80% of those who are vaccinated are alive and well.
B- 20% of those who were vaccinated died.
Besides anti-vaccination and vaccine supporters, there is also a group of people who are caught between the two ideas. Those in uncertainty. Those who both believe in the positive effects of the vaccine and do not close their eyes against the negative effects and cannot decide exactly what to do. Decision-making under uncertainty. This is the Minimax Regret Decision Criterion. In the slightest possible negativity about the vaccine, they will blame themselves, they regret getting vaccinated. Even in the slightest pain, they can attribute this to the vaccine and they can affect other uncertain people so it develops antivaccination but on the contrary, uncertain people who experience it positively after vaccination may support vaccination.
A.1.1. Cognitive Dissonance;
It includes conflicting attitudes, beliefs, or behaviors. in this case, people know that getting vaccinated is beneficial, but the side effects of the vaccine are scary. ‘’The vaccine protects against the disease, but the side effects are enormous’’.
A.2.1. Being Rational and Irrational;
It directly affect that society. Acting with a nudges and thinking structure decreases the living standards of not only that person but also everyone living in that society in steps that affect the health of the whole society, such as vaccination. A rational person, In economics, models are nothing more than stories about interactions between units called decision makers.
Rational people are the protagonists of most economic models and have choices regarding outcomes. He asks him which alternatives he has, explains the result to himself after the selection, evaluates each possible alternative, and finally chooses the alternative that leads him to a good result. The decision maker may encounter a problem. A decision problem is defined as a set of available alternatives. A rational decision maker has a clear sequence of results in his mind. We call this ranking preferences. When faced with a constructive decision problem when it is a rational decision, he or she chooses the alternative. It gives the best result according to their preferences.
Features of rational choices; completeness and transitivity. Since a rational person will always want to maximize profit, that person thinks about how life-saving the vaccine is and maximizes her own utility. Often times, people decide to act on their impulses and nudges. But people’s motives and decisions are not things that can change immediately. The idea of a person who believes in anti-vaccination and has based this on her own nudges foundations can hardly change. So aren’t there people who think rationally and are anti-vaccine?
A.3.1. A free riding effect;
Free rider is someone who benefits from something without effort or money. In other words, free drivers are people who use goods without paying for use. This is not to say that all rational people are not anti-vaccine. Of course, rational people can against vaccination. A rational person knows that vaccination of 60% of the population is an adequate level for public health and may want to be in the remaining 40% group. However, as the number of people who think like that increases, it will be impossible to reach the 60% level.
The rational person, who does not want to be stuck in this cycle, will decide to have the vaccine after listening to the advice of both the public health and the knowledgeable and expert people and passing through the mind strain. But it is very clear to see that people’s motives and decisions are not things that can change immediately. The idea of a person who believes in anti-vaccination and has based this on her own nudges foundations can hardly change.
A.1.2. Belief Perseverance;
It is the inability of people to change their beliefs even when they receive new information or facts that contradict or refute the anti-vaccine belief. In other words, faith persistence is the tendency of individuals to hold on to their beliefs even if they should not. We can also think of it as dogmatics. Even when you see lots of positive effects to get vaccine, but you close your eyes.
A.2.2. Ostrich Effect;
After finding enough evidence to support the antivaccination. person’s own thinking, he or she closes the doors and close his or her ears. A doctor on TV told me I shouldn’t get vaccinated, so I’m not getting vaccinated. It’s like cheating yourself. Someone told me this and yes it’s true now.
A.3.2. Confirmation Bias;
It is tendency to seek, interpret, prefer, and remember information in a way that confirms or supports one’s previous beliefs or values. Vaccines contain dangerous elements and harmful substances such as mercury and aluminum as preservatives. And people say that That’s why I do not get vaccine.
Not just a vaccine, smoking can be a good example for explaining behavioral effects. Smoking is harmful to health. A rational person knows that and does not smoke. But even if the irrational person knows that, that person rejects the harms of smoking and continues to use it. Maybe the people that person loves or around him continue to use. Even worse, that person stresses himself, thinking about the harm to his health, and still smokes because thinks that it will be possible to get rid of stress. It cannot get out of this cycle and causes mental and physical harm to itself.
A.1.3. Heuristic Methods;
Heuristic methods are useful in many situations, but can also lead to cognitive biases.
Let’s take the Corona vaccine; Believing that the vaccine takes 12 years to develop. They say that corona vaccines are more recently found and that they do not trust synthetic vaccines. They say that only according to the development levels of the countries, they do not trust the Chinese vaccine and they get the German vaccine.
We Have Two Types of Heuristics;
- Availability Heuristic; The mistake of thinking that vaccination was the cause of death for people who lost their lives after being vaccinated without looking for any reason. With two people casually dying last month, it’s no longer preferable to be vaccinated.
- Representativeness Heuristic; The fact that a person who refuses to be vaccinated is together with people but has not been sick may suggest that he will no longer be sick. Other people might think there’s no need to get vaccinated. That person believes the disease does not exist or does not affect him.
The risk hasn’t actually changed; It’s a misconception of finding. The prejudices made in a situation that directly affects public health, such as approaching with intuition and vaccination, will cause great harm to societies.
“Nothing will happen to me anyway.”, ‘’First, others get vaccinated, then we will. ”
Overconfidence is a bias that works negatively in many contexts. If we take the corona vaccine as a basis, it has been announced many times that especially the young population is much more resistant to the virus and even survived in the form of a mild flu. Therefore the young population relies on their youth. This overconfidence not only for younger vaccine opponents, but also in groups of middle age and older who are overly confident in their health. In fact, this overconfidence has more deadly consequences. This detrimental overconfidence also hurts society.
Every behavior actually originates from a thought and an effect. Therefore, the real reason cannot be revealed until this effect and source is not penetrated. Assumptions and solutions made without taking people’s feelings and thoughts into account are nothing. Policy design with classical approaches without considering behavioral aspects for years did not give any solution. Our most important weapon in the fight against a virus as the whole world lately is our vaccines. However, the increasing opposition to vaccines and, therefore, higher mortality rates cannot be ignored. Therefore, the policies we will produce against this and every similar problem should be with policy design using a nudge. Because every policy design we produce with this in mind will directly examine the problems with a behavioral dimension and design an outcome appropriate for it. And thus, an effective solution will be foundno matter what subject you want to be informed about.
Research by İpek ÖRNEKLER