Combating Vaccine Hesitancy with Vaccine-Preventable Disease Familiarization: An Interview and Curriculum Intervention for College Students

"[I]ncreasing familiarity with vaccine-preventable diseases leads to improved attitudes towards vaccination."

In 2019, the World Health Organization (WHO) listed vaccine hesitancy in its top 10 threats to global health. Vaccine hesitancy often arises from deep-rooted ideological beliefs and conspiracist ideational tendencies. As this kind of thinking has been shown to become further entrenched when those holding it are presented with contradictory information, correcting misinformation is often counterproductive. As such, these researchers sought to explore ways of improving vaccine-related attitudes of college students (future parents) in an urban vaccine-hesitant (VH) hotspot (Provo, Utah, United States - US) by assigning them to interview family or community members who had experienced a vaccine-preventable disease (VPD), as well as by providing them with classroom-based education.

Undergraduate students at a large private US institution were enrolled in a quasi-experimental survey-based intervention study. A total of 574 students volunteered to take a pre-interview survey during the Winter 2018 semester, when they were enrolled in 1 of 3 biology courses with varying levels of vaccination-focused education. Based on their pre-intervention vaccination attitude scores (VASs), students were designated either pro-vaccine (PV) (87%) or VH (13%) and assigned to the control group (autoimmune survey, n = 286) or the intervention group (VPD survey, n = 288). Of the students, 74% (n = 425) completed all requisite parts of the study (pre-interview survey, community/family interview, post-interview survey) and were included in the final analysis.

Before the intervention, student willingness to vaccinate current/future children was significantly different between VH and PV groups (scale of 1-5 from strongly disagree to strongly agree), with means of 3.84 and 4.92, respectively.

The study showed that vaccine attitudes improved when the participants gained a personal understanding of how VPDs affect individuals and communities. VH students enrolled in MMBio 240 (no vaccine curriculum) who were part of the intervention group (n = 19) showed a significant increase in VAS. Of these students, 68% (n = 13) had sufficient increases in their VASs to move from the VH group to the PV group. Conversely, VH students who were part of the control group (n = 22) had no significant increase in VAS. Only 27% (n = 6) of students in the control group increased their scores sufficiently to move from the VH group to the PV.

In the post-survey interview, students in the intervention group were asked to assess how much each of the following characteristics affected their opinion of vaccines: physical suffering, limited normal activity, limited interaction with others, impact on family and friends, and financial costs. VH students' post-intervention VASs were significantly and moderately correlated with physical suffering and limitation on normal activities.

Results indicate that intensive vaccine education on VPDs, in particular, may be even more effective at improving vaccine attitudes than interviewing individuals who have had a VPD. All VH students (n = 5) enrolled in MMBio 261 (intensive immune, VPD, and vaccine education) significantly increased their VASs regardless of survey intervention (p < 0.001). Four out of five VH students increased their VASs sufficiently to move from the VH category to the PV category. In contrast, all students in Bio 100 received brief instruction on how vaccines work, the rarity of vaccine side effects, and the benefits of herd immunity to society, but no specific conversation about VPDs. Among the Bio 100 students, there was no significant difference after the survey intervention between post-control group and post-intervention group VH students, or between post-control group PV and post-control group VH students.

In short, VPD interviews (intervention group) were most successful at swaying student vaccine attitudes when the coursework did not discuss vaccines or if the interviews had strong themes of physical suffering and limitations. The majority of students in the intervention group who became PV and the resulting increase in VASs mirrored those achieved through intensive education (MMBio 261). Thus, encouraging students to conduct VPD interviews may be an easy and effective intervention when the course has little to do with VPDs or lacks vaccine-related content. In courses that do address vaccines, it may be advantageous to first rigorously introduce students to VPD consequences before addressing vaccine safety and societal implications.

In conclusion: "Vaccine hesitancy is a complex, situation-dependent problem, and requires unique and tailored interventions. Interview-based interventions are easy to implement and can supplement courses or even community outreach programs seeking to address vaccine hesitancy. Predisposing students to think more favorably about vaccinations by openly discussing the consequences of vaccine-preventable diseases may improve their prospective individual and familial vaccine uptake. Future research should tease apart the contributions of science education and personal familiarity with VPDs towards improving vaccine attitudes in diverse populations."