Empathy and Framing Messaging to Change the Tide

They aren't stubborn and rebellious, they're human.

This article examines the how and why of vaccine hesitancy. It addresses the impact of social media and distrust of American institutions. The article suggests that the priority to encourage the hesitant and "definately nots" should be validating their anxieties, anger and fears, using communication strategies and finding ways decrease the influence of social media.


  • Specializes in Community Mental Health. Has 30 years experience.
They aren't stubborn and rebellious, they're human.

In spite of the gravity of the pandemic, the unvaccinated continue to hold a strong conviction that it is not the right decision for them. As of May 2021, 37% of the US had not received one vaccine despite it being available and accessible1. For them, their belief is as strong and ironclad as those who were first in line to be vaccinated.   Factors including their particular unease regarding the vaccine, increased exposure to the disinformation of social media, and sense of distrust in institutions of the United States have swayed their perception. The idea of persuading them with facts and scare tactics has not been successful. Nurses are the ideal source to empathize, utilize communication skills to educate and evoke a person’s awareness that getting the vaccine is the best way to end the pandemic2.

Information Sources Are Changing in the United States 

 A large number of Americans are increasingly turning to social media sites for their news despite the criticism of the sites posting disinformation. It is interesting to note that the idea of vaccine hesitancy being fueled by social media began before COVID-19 due to the resurgence of vaccine preventable diseases. According to an article posted in USA Today by Heidi Legg3 on May 4, 2021, there is a lack of trust in mainstream media.  She writes that the media which was once considered a pillar of democracy has become elitist, biased, opinionated, and fails to report all the news.  She reports that there is no transparency in funding and Americans need to know who is feeding them the news3

Social media is not subject to scientific vetting or journalistic integrity. Social media is characterized by personal opinion and experience. It also has the potential to reach large audiences and disseminate information rapidly4

 Studies found that anti-vaccine tweets were 4 –fold more likely to be re-tweeted than neutral tweets. Another study that analyzed 150 Instagram posts found that anti-vaccine posts had a significantly higher number of likes. Another study examined the role of non-human users. “Bots” are accounts that generate automated content and “trolls” misrepresent their identity and attempt to create conflict. Twitter uses a higher amount of bot accounts. The study determined that Twitter accounts ranked at a high likelihood of being automated bots posted significantly more COVID-19 related tweets than non-bot accounts4.

In addition, researchers found that within social media use, algorithms feed content based on the input of users. The user is fed with content derived from their browsing history which gradually became further and further from the truth. Information silos are the result. Experts interviewed stated that this phenomenon has happened to highly educated people5

Examining The State Of Mind Of The Unvaccinated. 

Heidi Larson of the Vaccine Confidence project is an expert on vaccine hesitancy. She offers that we should no longer focus on misinformation alone but regard it as a symptom of distrust.  She offers that the pandemic has brought to the forefront anxieties, anger, and fears that Americans have been harboring. Mandates and mitigation efforts were bringing to life the fears of government control, pharmaceutical mismanagement and greed, scientific misconduct, and the bias of the media as well as feelings of not being heard. She gives the recent recession, opioid crisis, defunct Congress as real events that fed the distrust. She suggests allowing those who refuse to be vaccinated to speak and be heard6.

A CBS documentary presented on 9/23/2021 described a phenomenon that occurred in a yoga and wellness community just after the beginning of the pandemic. It connects mindset to social media and vice versa. This community is known to be anti-science, anti-authority and seeks non-traditional treatment methods. Those interviewed were afraid of tyranny suggested by mask wearing which they saw as symbolism for silencing people and as they turned to social media to declare their discontent; anti-vaxers joined the discussions. The documentary pointed out that this community became a hot bed for spreading disinformation5.

What can nurses do to change the disinformation on social media? 

  • Begin disseminating messages on personal social media platforms  
  • Direct consumers to the CDC social media downloadable apps to provide users with access to credible, science-based health information when, where, and how they want it. (CDC facebook, Twitter, Instagram, LinkedIn) 
  • Encourage nursing professional organizations to take a stand on combatting disinformation about the virus on social media. 
  • Learn to equip society with the skills to discern between evidence-based and reliable and misleading or information.  
  • Direct consumers to websites of the CDC, the Immunization Action Coalition, Vaccinate your Family and the Mayo Clinic 
  • Consult the CDC Guide to Writing for social media

What can nurses do to change the mindset of the unvaccinated?  Communication is key. 

  • Use gain-framed messages that emphasize the benefits of adopting a recommended behavior. 
  • Offer novel information about the disease such as describing the longer-lasting and debilitating health problems 
  • Appeal to altruism and prosocial behavior by stating the consumer is also protecting his community 
  • When correcting misperception about the virus-first affirm their unease, give an explanation as to why disinformation was presented and give factual information
  • Recognize that one size does not fit all in vaccine promoting. Consider the emotional states of different audiences in communication efforts.  
  • Learning the technique of Motivational Interviewing-a communication framework that guides a person to identify their insecurities, be open to information then accept the information on their own terms. 


Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence


1COVID Data Tracker

2Using Best Practices to Address COVID-19 Vaccine Hesitancy: The Case for the Motivational Interviewing Approach

3Have you heard the news? But who owns what you're hearing and reading? We need to know.

4Social media and vaccine hesitancy: new updates for the era of COVID-19 and globalized infectious diseases

5How conspiracy theories "infiltrated" the wellness community

6Trust in Vaccines (includes Heidi Larson)

Hospital staff nurse for 23 years (medical surgical, telemetry, ICU). Have been in psychiatric nursing for the past 5 years working in community mental health.

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