Recognize that Communities have Different Relationships with Vaccinations

In some societies, people may be fearful of vaccines, but have a strong trust in authority. In others, mandatory vaccinations have created distrust of government authorities. In others, decades of mistreatment and exploitation have resulted in a profound lack of trust in new medical treatments.

Specific messages will resonate differently in different types of societies. One of the ways we can anticipate how messages will resonate is to assess whether we are communicating in a “tight” or “loose” society. 
Language, metaphor, messages, even imagery look different and have different salience within different societies. Tight and loose societies have different regional norms, relationships with leaders and cultural relationships with government. This construct of “tight” and “loose” refers to the extent a society tolerates deviance and norms. A “tight” society will have low tolerance for deviance and strong social norms, while a “loose” one will have a higher tolerance for deviance and weaker social norms

For example, Kurt Gray points to liberal “hippies” as an example of a culturally “loose” group which have lower levels of vaccine uptake, and says: “Even people who are super loose, kind of the hippies, are a great example because they defy the norms of even a relatively loose society. [To reach them] go to communities, and [target] the people they trust. They’re not immune to social influence [and messaging them with] ‘You’re freely choosing to do whatever you want, and this is why [a vaccine is] a reasonable choice,’ [rather than] ‘You should do this.’”

Societies have different relationships with authority. Paul Slovic and his colleagues did a study of trust in authorities comparing the United States and France in the context of trying to understand why nuclear power was so successful in France, but was rejected in the United States. There was no difference in perceived risk between the two countries, but in France, people trusted the experts and authorities, whereas in the US, they had much lower levels of trust. 

In a society like France that is skeptical of a vaccine, but has high trust in authority, relying on government spokespeople and advocacy will be more likely to be effective. 

Historically in the African American community concerns about experimentation are founded and symbolized by the Tuskegee Syphilis Study.

— Sandra Quinn, Ph.D., Professor and Chair of the Department of Family Science at the University of Maryland
Researchers have observed that in countries—like the UK —where vaccines are not legally mandated, there’s less politicization of vaccination, and greater trust than in the US, France and Germany.

These kinds of cultural differences are one of the reasons that strategies that are highly customized to individual groups can be so effective. Emily Brunson, MPH, Ph.D., Associate Professor of Anthropology at Texas State University,
pointed out that during H1N1, there were several Somali communities across the United States where there were concerns about forcing in the vaccine and whether it was halaal, or permissible according to Islamic law. In Seattle-King County in Washington State, local outreach was able to address that issue and increase vaccination rates for H1N1, and then move forward with other vaccines as well. Success like this requires having strategic public health outreach and having good connections with communities.


Understand whether the community in which you are communicating is “tight” or “loose.”

Take into account the relationship people in your community have with authority and frame the message accordingly.

Where possible, get deeply immersed in both online and geographic communities to understand their specific fears and concerns.

Recognize that particular communities have significant and valid reasons to be fearful of new medical interventions and address these transparently.