Apathy’s Effect on COVID Vaccinations

By Caroline Barnhill

When you flip on the TV to hear a personal plea to schedule your COVID-19 vaccination, who are you more likely to heed? A top medical expert like Dr. Anthony Fauci, or a beloved celebrity associated with caring about health like Dolly Parton? Turns out, it depends on whether you are considered hesitant or apathetic from a marketing theory standpoint.

After the initial boom of COVID vaccines made their way across the country and into the arms of anxious Americans, the rate of vaccinations has fallen – leaving top health officials, politicians and even businesses to seek creative ways to encourage individuals to roll up their sleeves. Krispy Kreme donuts, anyone?

But is it hesitancy or apathy that is keeping people at bay? That is the question Poole marketing professor Stacy Wood, along with colleague Dr. Kevin Schulman, set out to answer – recognizing the most effective communications strategies to influence these two groups can differ drastically. 

Wood, whose expertise is in the area of marketing and consumer behavior, had an inkling at what they would discover. A paper on their findings, titled “When Vaccine Apathy, Not Hesitancy, Drives Vaccine Disinterest,” was published on June 2 in the Journal of the American Medical Association (JAMA).

We see vaccine hesitancy as a natural expression of a mindful emotional and cognitive response to assessing the risks and benefits of vaccination, and vaccine apathy as disinterest characterized by weak attitudes and little time spent considering vaccination altogether.

“From a marketing perspective, we often see various segments of the population exhibit slow innovation adopting patterns,” Wood explains. “Therefore the disinterest in the COVID vaccination is unsurprising. We see vaccine hesitancy as a natural expression of a mindful emotional and cognitive response to assessing the risks and benefits of vaccination, and vaccine apathy as disinterest characterized by weak attitudes and little time spent considering vaccination altogether.”

Their research discovered that while vaccine hesitancy exists across various socioeconomic groups, the reasons behind individuals’ hesitancy can be vastly different. For instance, adults younger than 25 may perceive vaccination as a low-priority task, whereas middle-aged working poor individuals may be overwhelmed by other, higher-priority stressors, such as food insecurity or family responsibilities, the paper explains.

The study was not without its challenges, Wood shares. Social desirability bias, which is the tendency to respond to questions in normatively appropriate ways, may mean individuals are embarrassed to report indifference as their reason for not receiving a vaccination. 

Current COVID-19 attitude surveys do not include responses clearly indicating apathy – such as ‘This doesn’t concern me’ or ‘Just not interested.’

“Since vaccine hesitancy is receiving a lot of media attention, some individuals may prefer to state their disinterest in getting a vaccine is because of an issue like safety or efficacy, instead of the more personal answer – that they just don’t care,” Wood says. “Current COVID-19 attitude surveys do not include responses clearly indicating apathy – such as ‘This doesn’t concern me’ or ‘Just not interested.’ Instead, as a potential proxy for apathy, a Pew survey conducted in February 2021, reported that of the 30% of U.S. adults who indicated they probably or definitely will not be vaccinated, 42% listed “Don’t think I need it” as a major reason for their decision.”

As part of their paper, Wood and Shulman give recommendations for persuading individuals who exhibit vaccination apathy to consider being vaccinated. The two used a marketing model, the Elaboration Likelihood Model (ELM), to form their recommendations, recognizing that individuals who are hesitant are high-involvement decision-makers, whereas those with apathy are low-involvement decision-makers.

“ELM demonstrates a counterintuitive phenomenon in that the less involved a person is with a choice, the less convinced they are by strong arguments based on logical or fact-filled appeals,” Wood explains. “Instead, it’s shown that these individuals are more persuaded by quick, catchy, affective or big picture appeals.” 

She adds that doctors and healthcare professionals – who are high-involvement, themselves – have a hard time switching away from the numbers and details to offer the big picture “catchy” reasoning that persuades the vaccine-apathetic. 

To engage the apathetic, Wood and Shulman offer a variety of communication tactics. For instance, aspirational celebrities might serve as a more effective source of message dissemination than a top medical expert. As for the message itself, messaging is more effective when it attracts attention and requires relatively low cognitive effort to process – such as using humor or catchy slogans – and includes novel elements, like appearing in an atypical place or using an unusual medium. Additionally, these messages need to reach people in everyday places, because those apathetic to COVID vaccinations are unlikely to go out of their way to seek vaccine information.

It is also worth noting that individuals who are apathetic about vaccines may have weakly negative attitudes toward vaccines in general, but they are not necessarily antivaccine.

“It is also worth noting that individuals who are apathetic about vaccines may have weakly negative attitudes toward vaccines in general, but they are not necessarily antivaccine,” Wood says. “In general, their attitudes, unlike those with strong antivaccine positions, are not strongly held nor highly defended.”

This isn’t the first look into COVID vaccinations conducted by Wood, a Langdon Distinguished University Professor of Marketing and executive director of Consumer Innovation Consortium at Poole College of Management, and Shulman, professor of medicine and, by courtesy, of economics, at the Graduate School of Business at Stanford University. In January, a highly-cited paper examining how consumers respond to change and innovation, titled “Beyond Politics — Promoting COVID-19 Vaccination in the U.S.,” was published in the New England Journal of Medicine. Since then, Wood has given advice on vaccination promotion to many national and international organizations such as the World Bank and the National Academy of Sciences.