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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.

One of the strongest predictors of vaccine hesitancy is people’s general mistrust of authorities and those perceived as working for them.

The distrust is often expressed in claims about vested interests, or it reveals itself as a lack of knowledge about vaccinations.

It can be directed towards different targets, for example:

  • Health and medical professionals and organisations.
  • Pharmaceutical companies.
  • Governments.
  • Scientists.
  • The ‘medical establishment’.

It can also be directed towards the scientific process and to vaccines themselves.

Although distrust is related to conspiracist beliefs, arguments framed within this attitude root are distinct in that the reasons for distrust may be due to a person’s lived experience (e.g., having experienced discrimination in the healthcare system). Arguments stemming from distrust also need not relate to conspiracies. Instead, distrust often manifests as vague statements, full of suspicion and uncertainty, with conclusions drawn based on the source of the message.

Untrustworthy data

Vaccinations are experimental and based on incomplete or biased data


Systemic corruption

Healthcare authorities are corrupt and have conflicts of interest


Negligent healthcare

Health authorities are incompetent or uncompassionate


Marginalised groups

Powerful groups oppress the disadvantaged by imposing vaccination


It is just a theory

Scientific studies on vaccines are based on controversial theories


Financial interests

Information from companies about vaccines is motivated by financial interests


Exaggerated risk

Medical authorities are overreacting and overusing vaccines


Do your own research

Only one's personal research is to be trusted; listening to experts is for lazy people


Absence of liability

Pharmaceutical companies are not liable for vaccine damage