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Dialogue between patients and healthcare professionals can be a good way to answer questions and clear up misconceptions for vaccine-hesitant patients. In this dialogue, it can be helpful to understand the underlying reason why a patient might be reluctant to get a vaccine. We call this underlying reason the ‘attitude root’. Attitude roots refer to deep psychological factors, such as a person’s level of trust or distrust, that shape and constrain people’s beliefs and attitudes.

This tool explains some of the most common attitude roots and how they may show up as arguments expressed by a vaccine-hesitant patient. It also identifies some of the most common themes related to each attitude root, so that we can address them.

Understanding the attitude roots of hesitancy also helps us guide our empathy with a patient. Empathy is an important component of communication, and one way in which we can show empathy is by affirming the reasons for a patient’s concerns. For example, we can acknowledge that there have been cases in which governments have shown themselves to be untrustworthy. This tool gives some examples of affirmations for each attitude root. We can use those examples to understand and empathise with how the patient is feeling about vaccination.

Finally, the tool provides refutations for common arguments and misconceptions that a patient may have. These refutations take into account the likely attitude root and try to correct misconceptions while still affirming the patient’s psychological predispositions.

Reactance is a well-known psychological construct which describes an individual’s tendency to defend their autonomy when they perceive that others are trying to impose their will on them.

Individuals who have high reactance may respond to any health advice as an infringement on their ability to choose an action for themselves. High reactance has been consistently associated with vaccine hesitancy.

Reactance manifests in arguments proclaiming that the decision of whether or not to vaccinate must be completely free and autonomous. Reactance tends to be associated with a high sense of personal autonomy and empowerment, and with a view of civil liberties that includes the right to act contrary to social norms and political injunctions.

Vindication of civil liberties

Vaccination is perceived as an authoritarian or totalitarian violation of civil liberties


Resisting coercion

Public health campaigns punishing and harassing people into getting a vaccine


Personal autonomy

Vaccine rejection being represented as a free, autonomous or empowered personal choice


Going against the herd

The vaccinated are ignorant, uncritical or eager to be shepherded by a paternalistic state