Should adults get flu shots? Treating patients’ misperceptions is key


  • New research suggests data and pamphlets alone are ineffective at encouraging adults to get flu shots
  • Enormous strides in studying how errors and biases affect decision-making offer insights that may help boost vaccination numbers
  • Behavioral economists recommend communication strategies that humanize the effects of flu and employ a more personal, concrete approach

Deciding to get a flu shot may seem simple, but communicating about it is not, new research suggests.

Federal health officials are already urging all Americans to get their flu shots as soon as possible. Yet the number of people who receive flu shots remains low, with less than one-third of adults between the ages of 18 and 49 getting vaccinated.

“Flu is serious. Flu is unpredictable,” Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention, told reporters last week during a joint briefing with the National Foundation for Infectious Diseases. “Flu often does not get enough respect.

Unfortunately, there’s no clear prescription for how health care providers and public policy officials can effectively encourage patients to hit the flu clinic. Filling the communication gap are patients’ personal beliefs and biases about the vaccine’s effectiveness and impact on their own health.

“Many people refuse to get vaccinations due to misconceptions, such as flu shots are ineffective, cause people to get sick, or are unnecessary for healthy people. These beliefs minimize the benefits of vaccination and tip the scale in favor of not getting a flu shot,” says Wake Forest University’s Frederick Chen, an expert in the economics of public health.

The public health costs are staggering. Each year, between 5 and 20 percent of Americans are infected with influenza. The infectious virus lands more than 200,000 people in the hospital and causes thousands of deaths. The economic impact has been estimated at more than $80 billion a year.

“There seems to be this sentiment in the public health community that to combat these misconceptions we should give people more information, more statistics, and more data about flu vaccines, but recent studies have shown that this approach can have a backfire effect,” said Chen, an associate professor of economics. “Vaccine skeptics inundated with pages of written information about why the vaccine is effective or safe might become more skeptical, not less.”

Chen’s most recent paper, published by Health Promotion International and co-authored with Ryan Stevens in the department of economics at New York University, combines behavioral economics and psychology to offer suggestions to boost flu shot numbers. Recognizing that people’s situations and understanding of flu shots can differ widely, Chen and Stevens recommend methods that humanize the issue and employ a more personal, concrete approach.

Suggestions include:

  • Mobilize community volunteers — Connect real people with positive outcomes from flu shots as they talk one-on-one about the benefits of vaccination with neighbors. The idea is based on door-to-door canvassing campaigns which have proven highly effective in increasing voter turnout, especially when canvassers are friends or people from one’s own community.
  • Invest in public service ads and videos — People sharing stories about how they stayed healthy after a flu shot should be more memorable and have better impact on decision-making than reading a pamphlet.
  • Partner with celebrities — Well-known figures have the potential to raise awareness on health issues. Katie Couric’s live colonoscopy on NBC’s TODAY Show 16 years ago led to a 20 percent increase in the number of colonoscopies performed in the following months.
  • Make it personal — Asking people to recall the last time they were sick or someone close to them was sick with the flu is potentially much more effective than public health messages that simply tell people to “take time to get a flu vaccine.”

Chen says recent research in behavioral economics and psychology shows that misconceptions can arise when people construct ‘stories’ in their mind to help make sense of the world. These stories, which may not be accurate descriptions of the world, can nevertheless influence people’s decision-making.

“We can see when the vaccine fails to protect us because we get sick and feel terrible but we can’t see anything different from our normal healthy state when it works,” said Chen. “Because negative experiences with flu vaccinations are more noteworthy and newsworthy than the positive experiences, if we are exposed to more negative stories than positive ones through our family members, friends, the media, and online, that may cause us to believe that flu shots aren’t all that effective when in fact a good match between vaccines and the flu virus reduces our risk of catching the flu by 60 percent.”

Behavioral economists and psychologists have made enormous strides recently in studying how errors and biases arise when people process information and how these affect decision-making.  Based on this research, adopting a more personal and humanistic approach that makes it easier for people to relate to the flu and its consequences could increase vaccination rates and reduce the societal cost of influenza.

Chen’s earlier research focused on “Why we roll the dice on flu shots.”

Categories: Faculty