Influenza vaccination uptake among health care workers (HCWs) protects patients and staff. Still, many health institutions’ coverage rates are unsatisfactory. Associate professor Laetitia Mulder and doctor Mariëtte Lokate (University Medical Center Groningen) aimed to test the effect of communicating moral appeals in increasing vaccination uptake in a real life setting.

Moralization of topics

Mulder: “I am interested in the effects of moralization of topics that are not necessarily regarded as moral. For example, it is intriguing to see how smoking has become moralized over the years, or how people are talking about obesity in moralizing language. I like to know how this affects people, both in positive and in negative ways. Vaccination is of particular interest as it contains both personal and social elements. This gives ingredients to moralize it. But is such moralization effective?”

Social decision

People are often unaware of the fact that vaccinating against the flu is not merely a personal but also a social decision. Especially for health care workers, vaccinating against the flu not only reduces the chances that they themselves get infected but also that they infect vulnerable patients. Also, it prevents the flu from spreading among colleagues.

Mulder and Lokate wanted to know if it helps to make people aware of these reasons. “To test this, we presented health care employees with a moral appeal about influenza vaccination. In this appeal, moral reasons to vaccinate (protecting patients and preventing an outbreak among hospital staff) were communicated. We found that such a moral appeal can indeed help to increase flu vaccination uptake among hospital employees, albeit the effect was modest (in our last study, the uptake increased from 60% to 66%, which is an 11% increase)”, Mulder explains.

Moral appeal

The research also revealed that campaigns about vaccination should not only focus on the personal reasons (not) to vaccinate, but also spend attention to the social reasons. This may also apply to other vaccinations than influenza, like vaccinations against COVID-19 or child vaccinations that fall under the Dutch National Immunisation Programme. As long as a vaccination also protects against people infecting each other, then vaccination becomes a social decision, and that needs to be mentioned.

Mulder warns against moralizing too strongly. “Other research has shown that when unvaccinated people experience moral reproach, they get less willing to vaccinate. Our moral appeal tried to prevent this by merely explaining the importance of vaccination considering the impact of influenza on others and the community. It therefore made the social nature of vaccination clear without directly accusing non-vaccinators of being immoral and evoking defensive reactions.”

“If communicated in a balanced way, the use of a moral appeal will contribute to an increase in vaccination uptake. In our research, it did so for 11%. This is encouraging considering that it can be combined with other interventions like providing information about the safety of vaccination, removing practical barriers, etcetera.”

The research furthermore showed that the moral appeal was most successful among health care workers who had not vaccinated before. This was despite the fact that this group contained relatively more vaccine skeptics (who were less responsive to the moral appeal). The appeal seemed to make less difference for health care workers who had more extreme (either positive or negative) opinions about vaccination. So, this suggests that moral appeals work best for people without strong opinions about the topic, and who have not felt the need yet to vaccinate in the past.

 For more information please contact Laetitia Mulder.