For journalists covering vaccines, advice on understanding hesitancy

Sheila Mulrooney Eldred

In 2019, the World Health Organization listed vaccine hesitancy as a major threat to global health. Vaccination is a cost-effective way of preventing disease, saving millions of lives every year, the organization said. But millions more could be saved with higher world-wide rates of vaccinations.

Media coverage plays a role in how the public perceives vaccines and vaccination, from the subtlety of how headlines described the development and authorization of COVID-19 shots to the way that journalists report on U.S. Health and Human Services Secretary Robert F. Kennedy Jr.’s recent directive to cancel funding for mRNA vaccine research. 

Media coverage can inadvertently amplify misinformation in many ways: by reporting on false claims by anti-vaccine activists without needed context, by selectively quoting only government sources, politicians or activists, and by failing to explain the scientific process and how scientific consensus is established, evolves and is updated.

Understanding different types of vaccine hesitancy and what drives them can help journalists cover the issue without perpetuating false narratives and in a way that better connects with an audience that may be caught up in the politicization of the issue. 

What is vaccine hesitancy? And is it a big deal in the U.S.?

Vaccines have been contentious in the U.S. to some degree since the first anti-vaccination society formed in 1879, but vaccine hesitancy is a newer phenomenon. The authors of a 2022 review article in The New England Journal of Medicine define vaccine hesitancy as “a state of indecision and uncertainty about vaccination before a decision is made.” People who are vaccine hesitant make up about 23% of the U.S. population per one study, while those who are anti-vax—totally opposed to vaccination—-are estimated at an additional 7% of the population. 

There is evidence that vaccine hesitancy is growing. Fewer American parents today think it is “extremely” or “very important” to vaccinate their children, according to a 2024 Gallup poll—with the percentage dropping from 94% in 2001 to 69% in 2024. And according to a 2023 Pew Research Center survey, American approval of vaccine requirements to attend school dropped from 82% in 2019 to about 70% in 2023.

How does news coverage affect this phenomenon? And what do reporters need to understand to do better?

Experts highlight that a false equivalence of scientific and anti-vax viewpoints in stories creates an inaccurate sense of how widespread antivax views are among Americans. Additionally, framing everyone who is vaccine hesitant as “anti-vax,” or totally against vaccines, can be inflammatory; instead, reporters should include nuance about individuals’ views on vaccines. 

The first thing reporters can do to cover vaccine hesitancy responsibly is to learn about the many factors that play into people’s decisions. When a journalist doesn’t fully understand the source’s hesitancy, it can lead to oversimplifying. And that can cause misplaced blame, explains Nathan Chomilo, an adjunct associate professor of pediatrics at the University of Minnesota Medical School.

If you attribute vaccine hesitancy to just one thing, like mistrust or distrust based on medical racism, for example, “then we’re just saying that those people are misinformed, and that we need to give individuals the information—and then it’s on them,” he said. “Versus understanding the number of things going into the choice and the impact of systems on their decision.”

Take homeless individuals, for instance. Chalking up low rates of vaccination in this community to anti-vaccine attitudes is not accurate, he said. Journalists need to take the pyramid of needs into account, understanding that people first seek food, shelter, and imminent safety before having the capacity to seek out preventive medicine—and then understand the practical and logistical barriers they may need to overcome to access vaccines. 

The biggest drivers of vaccine hesitancy include the following, but keep in mind that people may be influenced by a combination of these factors:

Misinformation and disinformation

Although no major world religion forbids vaccines—and most encourage them—the anti-vaccine movement has been successful in spreading fringe beliefs that often invoke religion. Anti-vaxxers are adept at spreading fear through social media, and using religious and philosophical language to encourage followers to refuse vaccinations.

Fear and distrust

New vaccines often prompt fear about side effects. That’s actually normal and appropriate, said Chomilo. Doctors should “make space for that deliberation,” he said. He’ll often share his own decision-making process in choosing to take the COVID-19 vaccine after learning more about mRNA vaccines and talking to experts and people he trusts.

In fact, he encourages reporters to frame this decision-making as deliberation, not hesitancy.

Historical distrust of government or medical institutions can also play a role in accepting new vaccines. This distrust is often rooted in concerns about racism. One study published in the journal Vaccines noted the connection: The more racial discrimination a person faces, the more vaccine hesitant they are likely to be. “The findings demonstrate that policy, systems, and environmental factors are critical to addressing vaccine hesitancy,” the authors wrote.

Political partisanship

In the U.S., vaccine hesitancy increasingly falls along political lines. A 2024 Gallup poll found that recent changes in thinking about vaccines is mostly confined to Republicans and conservative independents: The percentage of these voters who believe vaccination is “extremely important” fell by half since 2019, to just 26%. Five years prior, Republicans and Democrats held similar views, the survey showed. Republican party members often take their vaccination cues from elite members of their party, and as party views on vaccination have soured, affiliation with the Republican party is associated with lower rates of vaccination.

Practical barriers

Logistical barriers are often misperceived as hesitancy. When health reporter Ciara McCarthy of the Fort Worth Star-Telegram started reporting on vaccine rates in Texas, she discovered that many times, families were making choices based on practical, not philosophical, reasons.

“Experts on vaccine hesitancy recommended looking at whether it’s easier to get a vaccine or a vaccine exemption in your community,” she said. “If getting a vaccine exemption is much easier than getting a vaccine, vaccine exemption rates might not mean that families are opposed to vaccines, but rather that it was the easier option for them.”

In Fort Worth, she found that the vaccine landscape had changed and that it had become harder to get vaccines, she said. “I can’t say with confidence that that’s the driver behind every community’s declining vaccination rates,” she said, “but it’s worth asking if there are access issues that are affecting vaccination rates.”

These practical barriers include everything from price to location to hours of clinic availability to disability access to having interpreters available, Chomilo said. In Minnesota, a team that led a mobile vaccination project surveyed the migrant workers who got shots there.

“What they found is that upwards of 90% of folks wouldn’t have gotten shots if it didn’t come right to them,” Chomilo said.

Emphasizing these logistics is a big part of the story, said Dr. Matt Motta, an associate professor at the Boston University School of Public Health—especially right now. Reporters should keep their eyes on such storylines, he said. With recent changes in membership of the Advisory Committee on Immunization Practices, for example, new vaccination guidelines could trigger insurance coverage changes that force people to pay out of pocket. And the price tag for a single vaccine could be prohibitive—Motta notes he once paid $200 for routine COVID-19 and flu vaccines.

Tips for covering vaccine hesitancy

Understanding vaccine hesitancy helps reporters craft better questions that get to the heart of why a community may appear to be vaccine hesitant. With that understanding, reporters should approach sources empathetically, knowing there may be a range of reasons that people feel unsure about vaccines.

A few best practices to keep in mind when you are reporting: 

• Don’t imply that those who are vaccine hesitant are simply misinformed, even though misinformation might contribute to hesitancy.
• Address points of misinformation individually, with scientific evidence, and without undue criticism of those who believed it in good faith.
• Recognize that questions about vaccination—from safety to side effects—are a normal part of deciding whether to get a vaccine and should be framed in stories as deliberation rather than anti-vaccine sentiment.
• Highlight interconnecting factors that may cause vaccine hesitancy, including racist behavior by medical institutions and financial barriers. Remember that financial and logistical barriers to obtaining vaccination may initially appear as vaccine hesitancy, and ask questions to tease out these differences.

Sheila Mulrooney Eldred is a freelance health journalist based in Minneapolis. She has written about vaccines for NPR and The New York Times, among other national and local publications.