Increasing Vaccination Rates: Strategies Beyond Compulsory Vaccination

The findings of the review article are based on a comprehensive analysis of the current research literature on mandatory immunisation and alternative approaches to promote vaccination uptake. The team of authors collated data from international studies that shed light on the success and impact of different measures in different cultural and social contexts. They took into account psychological experiments and surveys as well as systematic reviews and meta-analyses. The researchers also drew on psychological theories and models, such as reactance theory and the 5C model, to better understand the cognitive and emotional mechanisms behind vaccine hesitancy. Through this combination of empirical data and theoretical approaches, the study offers sound recommendations that are based on solid scientific evidence and could be effective in different populations.

"Whilst mandatory vaccination can increase vaccination rates, it is a very far-reaching measure and is often met with opposition. This can lead to less acceptance and potentially negative reactions," says Cornelia Betsch. "There are good alternatives that can encourage vaccination uptake by addressing the psychological reasons for vaccine hesitancy and respecting personal choice." Central to the proposed alternatives are measures that target the psychological mechanisms of vaccination hesitancy. This is because many people harbour fears or reservations that can be alleviated through targeted education and individually tailored advice. Psychological models such as the so-called 5C model (trust, collective responsibility, carelessness, comfort and calculation) offer important insights for reducing vaccination refusal. One example of this is "empathic interviews", in which doctors specifically address the motivations and concerns of vaccination sceptics in order to strengthen motivation and promote an informed decision.

Financial incentives are another possible supplement to compulsory vaccination. These incentives, such as direct payments or lotteries, improve the individual cost-benefit assessment and have been shown in studies to be an effective means of increasing vaccination rates. However, such incentives should be used sensitively in order to take ethical concerns into account. This is because people with lower incomes may feel pressurised by financial benefits.

The study provides clear recommendations for medical practice and political decision-makers: Doctors should be as empathetic as possible to vaccination doubts and respond to the various social, cognitive and emotional aspects that contribute to vaccination scepticism. Decision-makers should consider integrating less restrictive alternatives into their catalogues of measures that include science-based approaches to promote vaccination readiness. Philipp Schmid, professor at Radboud University in the Netherlands and also a member of Cornelia Betsch's working group at the BNITM, summarises the study as lead author: "The toolbox presented offers numerous intervention options that can be flexibly adapted to the needs of the population – an essential prerequisite for achieving sustainably high vaccination rates and strengthening confidence in health measures in the long term."