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The proliferation of anti-vaccination arguments online can threaten immunisation programmes, including those targeting COVID-19. To effectively refute misinformed views about vaccination, communicators need to go beyond providing correct information and debunking of misconceptions, and must consider the underlying motivations of people who hold contrarian views. Drawing on a taxonomy of anti-vaccination arguments that identified 11 “attitude roots”—i.e., psychological attributes—that motivate an individual’s vaccine-hesitant attitude, we assessed whether these attitude roots were identifiable in argument endorsements and responses to psychological construct measures corresponding to the presumed attitude roots. In two UK samples (total n = 1250), we found that participants exhibited monological belief patterns in their highly correlated endorsements of anti-vaccination arguments drawn from different attitude roots, and that psychological constructs representing the attitude roots significantly predicted argument endorsement strength and vaccine hesitancy. We identified four different latent anti-vaccination profiles amongst our participants’ responses. We conclude that endorsement of anti-vaccination arguments meaningfully dovetails with attitude roots clustering around anti-scientific beliefs and partisan ideologies, but that the balance between those attitudes differs considerably between people. Communicators must be aware of those individual differences.

We explore the common attributes of political conflicts in which scientific findings have a central role, using the COVID-19 pandemic as a case study, but also drawing on long-standing conflicts over climate change and vaccinations. We analyze situations in which the systematic spread of disinformation or conspiracy theories undermines public trust in the work of scientists and prevents policy from being informed by the best available evidence. We also examine instances in which public opposition to scientifically grounded policy arises from legitimate value judgments and lived experience. We argue for the public benefit of quick identification of politically motivated science denial, and inoculation of the public against its ill effects.

The proliferation of anti-vaccination arguments is a threat to the success of many immunization programmes. Effective rebuttal of contrarian arguments requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots—that is, the underlying psychological attributes driving a person’s belief—of opposition to vaccines. Here, through a pre-registered systematic literature review of 152 scientific articles and thematic analysis of anti-vaccination arguments, we developed a hierarchical taxonomy that relates common arguments and themes to 11 attitude roots that explain why an individual might express opposition to vaccination. We further validated our taxonomy on coronavirus disease 2019 anti-vaccination misinformation, through a combination of human coding and machine learning using natural language processing algorithms. Overall, the taxonomy serves as a theoretical framework to link expressed opposition of vaccines to their underlying psychological processes. This enables future work to develop targeted rebuttals and other interventions that address the underlying motives of anti-vaccination arguments. Angelo Fasce et al. conducted a systematic literature review and applied natural language processing methods to develop a taxonomy that relates anti-vaccination arguments to their psychological roots.

Background Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022–2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak. Methods Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework. Results Key informant interviews ( n  = 11) and five workshops ( n  = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities. Conclusions The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022–2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

This Comment piece summarises current challenges regarding routine vaccine uptake in the context of the COVID-19 pandemic and provides recommendations on how to increase uptake. To implement these recommendations, the article points to evidence-based resources that can support health-care workers, policy makers and communicators.

Background Health care professionals are in a key position to promote vaccinations. However, consulting vaccine-hesitant patients can be difficult, especially when patients bring up anti-vaccination arguments. Whereas prior research has identified essential skills for refuting anti-vaccination arguments, little is known about how to acquire these skills. Our aim was to determine if empathetic refutational interview text scenarios help health care professionals build confidence and abilities in countering anti-vaccination arguments. Methods We conducted an online randomized controlled experiment with UK and Finnish health care professionals in which we randomly assigned them to an empathetic refutational interview group ( n  = 167) or a control group ( n  = 180). Participants in the empathetic refutational interview group were presented with examples of the empathetic refutational interview approach, which encompasses the identification of attitude roots, affirmations, corrections of misconceptions, and provision of facts. Control group participants received a standard facts-based approach. We examined posttest use of empathetic refutational interview techniques and pre- and posttest perceived difficulty of refuting anti-vaccination arguments. Results Participants in the empathetic refutational interview group used more empathetic affirmations than control group participants. The empathetic refutational interview group and the control group did not differ significantly in how often they explicitly tried to identify attitude roots, correct misconceptions, and provide vaccination facts, nor in how difficult they found anti-vaccination arguments to be to refute. Conclusions Brief empathetic refutational interview text scenarios can increase health care professionals’ use of affirmations when discussing vaccines with patients. Additional materials are needed to efficiently teach refutations of attitude roots.

The generation and distribution of hyper-partisan content on social media has gained millions of exposure across platforms, often allowing malevolent actors to influence and disrupt democracies. The spread of this content is facilitated by real users’ engaging with it on platforms. The current study tests the efficacy of an ‘inoculation’ intervention via six online survey-based experiments in the UK and US. Experiments 1–3 (total N  = 3276) found that the inoculation significantly reduced self-reported engagement with polarising stimuli. However, Experiments 4–6 (total N  = 1878) found no effects on participants’ self-produced written text discussing the topic. The implications of these findings are discussed in the context of the literature on polarisation and previous interventions to reduce engagement with disinformation. A series of experiments tested an inoculation intervention to reduce engagement with affectively polarized content on social media. The intervention successfully reduced self-reported sharing of polarizing content but did not affect how users wrote about polarized topics.

IntroductionVaccines are our best defence against infectious diseases, yet uptake of childhood immunisation programmes has consistently declined in the UK, with growing concerns around socioeconomic inequalities. Liverpool, in particular, demonstrated some of the lowest uptake rates in England since 2019. In response, the Health Equity Liverpool Project (HELP) implemented a hyper-localised community-led initiative between September 2023 and June 2024 to tackle vaccine hesitancy. Activities included outreach events and school-based engagement across nine sites within Liverpool. Despite promising qualitative evidence, the intervention’s impact on childhood vaccine uptake has not yet been quantified. We aim to evaluate the population level impact of the HELP intervention on the uptake of five childhood vaccines (first and second doses of the measles, mumps and rubella vaccine (MMR1, MMR2), 6-in-1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type b and hepatitis B), pneumococcal conjugate vaccine booster dose (PCV) and rotavirus vaccine) using synthetic control methods.Methods and analysisWe will analyse publicly available quarterly vaccine uptake data (between April 2019 and March 2025) from the Cover of Vaccination Evaluated Rapidly programme for general practices (GPs) in England. The intervention group will be defined as practices located within a 1 km radius of the intervention sites. A synthetic control group will be constructed using non-intervention GPs matched on pre-intervention vaccine uptake, and linked demographic, socioeconomic and healthcare capacity covariates. Primary outcomes are the uptake of MMR1 and MMR2 vaccines. Secondary outcomes include the uptake of 6-in-1, PCV and rotavirus vaccines. Average treatment effects will be estimated as the post-intervention difference in uptake between intervention and synthetic control groups. Sensitivity analyses will examine spillover effects, alternative spatial definitions of exposure, the biasing effect of concurrent interventions and the feasibility of analysis at small area neighbourhood level.Ethics and disseminationThis study will be conducted as part of the ReCITE project, which has received ethical approval from the Liverpool School of Tropical Medicine Research Ethics Committee (Reference: 24–018) and is funded by the UK Arts and Humanities Research Council (Project Number: AH/Z505341/1). Findings will be shared with the project funder and submitted for publication in a peer-reviewed journal.

People’s negative attitudes to vaccines can be motivated by psychological factors—such as fears, ideological beliefs, and cognitive patterns—known as ‘attitude roots’. This study had two primary objectives: (1) to identify which of 11 known attitude roots are featured in individuals’ self-expressed reasons for negative vaccine attitudes (i.e., a linguistic analysis); (2) to explore how attitude roots present in self-expressed texts are linked to specific psychological measures. To achieve Objective 1, our study collected data from December 2022 to January 2023 from 556 participants from the US, who wrote texts to explain the reasons for their negative vaccine attitudes. The texts encompassed 2327 conceptually independent units of anti-vaccination argumentation, that were each coded for its attitude root(s) by at least two psychological experts. By allowing participants to spontaneously express their attitudes in their own words, we were able to observe how this differed from what participants reported to endorse when presented with a list of arguments. We found that there were four groups of attitude roots based on linguistic similarity in self-expression. In addition, latent class analysis of participants’ coded texts identified three distinct groups of participants that were characterised by their tendency to express combinations of arguments related to (1) fears, (2) anti-scientific conceptions, and (3) politicised perspectives. To achieve Objective 2, we collected participants’ responses to 11 validated measures of psychological constructs expected to underlie the respective 11 attitude roots, and used a correlational design to investigate how participants’ self-expressed attitude roots were linked to these measures. Logistic regressions showed that an expected psychological construct was the strongest, and significant, predictor for expression of three out of the four attitude root groups. We discuss the implications of these findings for health communicators and practitioners.

Background Healthcare professionals (HCPs) can play an important role in encouraging patients and their caregivers to be vaccinated. The objective of this qualitative study was to investigate HCPs’ perspectives on challenges in vaccine communication and unmet training needs in this domain. Methods Semi-structured interviews were conducted with 41 HCPs (mainly nurses and physicians) with vaccination roles (23 in England; 18 in France), gathering information on: (1) HCPs’ approach to vaccine conversations with patients; (2) Challenges of communicating about vaccines; (3) Vaccine-related training and learning resources available to HCPs, and; (4) HCPs’ training needs around vaccine communication. Results HCPs described a range of communication experiences that indicated insufficient time, information, and skills to confidently navigate difficult conversations with vaccine-hesitant patients. Communication skills were especially important to avoid conflict that could potentially damage the patient-provider relationship. Some HCPs interviewed had received communication training, but for most, this training was not specific to vaccination. Although general communication skills were transferable to vaccine conversations, most HCPs welcomed specific training and informational resources to support countering patients’ misconceptions or misinformation about vaccines. Conclusions HCPs would benefit from training tailored to address vaccine communication with patients, and this should be part of a systemic approach that also provides time and space to have effective vaccine conversations.