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Fear of side effects – often fueled by social media and anecdotal stories from friends – and concern about a perceived loss of personal freedom were among the key reasons people refused the COVID-19 vaccine, according to a new study led by researchers from ����ֱ�� University of California. The study was designed to gain in-depth understanding of adults' attitude, motivation, and justification for COVID-19 vaccine hesitancy.

The study – “They’ll take a gun to me before I get that shot”: Rationalization, emotions, and misinformation in COVID-19 vaccine hesitancy” – was published in June’s . The ����ֱ�� authors include Dr. Michaela George, assistant professor of Global Public Health; Dr. Benjamin D. Rosenberg, assistant professor of Psychology; Dr. Patti L. Culross, department chair and assistant professor, Global Public Health in the School of Health and Natural Sciences; and Dr. Rosalie Chen, assistant professor of Psychology in the School of Liberal Arts and Education.

The majority of research on vaccine hesitancy during the pandemic has primarily relied on quantitative survey data. This qualitative study adds nuance and depth to the growing literature on COVID-19 vaccine hesitancy by examining motivations and beliefs of individuals who have decided to remain unvaccinated against COVID-19, note the authors. 

“Understanding the motivations for remaining unvaccinated during COVID-19 informs the messaging for future public health emergencies,” Dr. Culross says. 

The research team conducted 18 interviews with unvaccinated adults throughout 2021–2022. The interviews consisted of 20 questions regarding participants' perceptions of the COVID-19 vaccine and their intentions to get vaccinated.

Results from the interviews revealed four overarching themes in participants' explanations: rationalization; identity, beliefs and potential modifiers; emotional responses; and information sources. Taken together, these four themes highlight two extensive  motivations for participants remaining unvaccinated against COVID-19: fear of vaccine side effects and negative responses to perceived affronts on freedom.

“We found that rationalizing the decision to remain unvaccinated was a combination of several factors including emotions, identity and misinformation,” Dr. George says. “The finding I consider the most fascinating is the othering - many of our participants did not identify as an “anti-vaxxer” but had a problem with this specific vaccine.”

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Fear of vaccine side effects suggests that the participants took a “prevention focused approach” to decision making – striving for safety and remaining vigilant to avoid poor outcomes.

Participants also voiced varying rationales for remaining unvaccinated, including preferring alternative methods, herd immunity, and mitigation of responsibility. Roughly two-thirds of participants argued in favor of natural or herd immunity against COVID-19 in lieu of vaccination. Many participants also stated a preference for “natural” remedies to treat or prevent illnesses, with participants over the age of 45 emphasizing alternative treatments and younger participants emphasized “living a healthy lifestyle.”

The concern about loss of bodily autonomy aligns with other studies linking feelings of freedom loss with COVID-19 vaccine hesitancy, the authors note.

According to the study: “Participants cited the COVID-19 vaccine as another representation of the perceived limitations to their freedom that were imposed upon them throughout the pandemic (e.g., lockdown, social distancing, masking). Many participants expressed anger and frustration with pressure from external sources to get vaccinated; in turn, to reassert behavioral freedom, their stance only became more steadfast.”

Findings include:

• More than 90% of participants expressed greater fear of potential vaccine side effects than from contracting COVID-19. Social media and anecdotal stories from social circle members bolstered these fears.
• Nearly three-quarters of participants made attempts to differentiate themselves from the anti-vaccination movement or conspiracy theorists, framing the COVID-19 vaccination as particularly risky and untrustworthy.
• Over half of the female participants stated concerns about how the vaccine could impact their fertility and reproductive system. Several participants discussed a fear of making the wrong choice as justification for delaying vaccination.
• Every participant expressed mistrust at least once in their interviews. Media fear mongering, as well as historical instances of corruption, were frequently cited. Many participants cited continually changing public health messages as a source of their mistrust and enduring vaccine hesitancy.
• Over 90% of participants cited reactance over perceived violations of their personal freedom as a motivator and enhancer to their vaccine hesitancy. These aggravating violations ranged from social and media pressure to get vaccinated, mask and vaccination requirements, and social distancing requirements.
• Multiple participants cited that they would consider vaccination if their employer or educational institution mandated it. Female participants often cited the possibility of vaccinating in the context of parental or familial roles.
• Roughly 80% of participants cited anecdotal stories about vaccine side effects. All participants reported connections to both vaccinated and unvaccinated people, but all had at least one close relationship with an unvaccinated person.
• All participants mentioned COVID-19 media sources, including mainstream news, social media, doctors, online articles, and social media platforms. Only two participants mentioned discussing COVID-19 with their doctor.

Study co-authors also included Savannah Dale and Lauren Kirkland, both students at Claremont Graduate University.