A Cure for Vaccine Hesitancy Could Start in Kindergarten

The book Splat the Cat Goes to the Doctor and the nursery rhyme “This Is the Way We Brush Our Teeth” are typical examples of media that teach the essentials of health to U.S. kindergartners. But lesson plans for children, even at this age, might benefit from going beyond entreaties to brush the outside, the inside and on top (the part where you chew).

The pandemic has set off a discussion about integrating teachings about public health in the K–12 curriculum as an accompaniment to lessons about personal hygiene. Such small steps might foster a mindset in the next generation that overcomes resistance to vaccines and other basic protections targeted at countering further waves of the COVID-causing coronavirus or entirely new pandemic pathogens.

In a March report, Getting to and Sustaining the Next Normal: A Roadmap for Living with COVID, some 50 contributors, including epidemiologists, virologists and policy experts, highlight the importance of early education for public health. The report calls for K–12 education to depoliticize health issues, promote health equity and disease prevention, provide information about navigating the health care system and even foster an understanding of simple ethical issues.

Dolores Albarracín, one of the report’s authors and director of the Annenberg Public Policy Center’s Science of Science Communication Division at the University of Pennsylvania, is an expert on communication and persuasion practices in the public health arena. She is also co-author of Creating Conspiracy Beliefs: How Our Thoughts Are Shaped (Cambridge University Press, 2021). Scientific American spoke with Albarracín about how public health basics for young learners could shape attitudes toward vaccination, masking and other measures

How did you get involved with the idea of teaching public health basics at the K–12 level?

It became obvious during the pandemic that some serious soul-searching needed to be introduced into the bigger educational picture. There was a need to create trust in members of our society who are in charge of health and teach students basic aspects of the pandemic—not just health education but some basic science education. I think we’re seeing the results of deficits in this type of knowledge in the adult population. And some of these might be better addressed earlier rather than later in life.

Moving forward, we could think about an educational model that might reduce this kind of vulnerability. So, for example, you could have modules telling students why health shouldn’t be politicized. And this could be taught in the same way that climate change has been infused into the curriculum in a lot of places. The goal is to instill the right norms early on.

Would even kindergartners understand the nuances of such lessons?

Not necessarily the whole set of arguments, but you could certainly teach kindergartners basic skills such as proper handwashing and mask wearing while also instilling a sense of community. You can teach kindergartners to wash hands for themselves while explaining how what they do helps others as well. If you create pro-public-health norms early on, introducing the wearing of masks would be easier.

What else could we do with schoolchildren?

Many people in the U.S. are excluded from adequate health care, and this makes it difficult to have trust in the system. How do we fix trust? We might have a health care module in the curriculum to assist children in becoming familiar with hospitals and other aspects of health care. Teaching kids how to navigate health care and what to do if they are mistreated or discriminated against would reduce maltreatment and empower citizens.

Are ethical issues surrounding public health teachable at these young ages?

This would be similar to the way you teach children not to hit others or not to steal from others. Children have a sense of fairness and other ethical principles beginning fairly early in life. Schools do address social and ethical issues, so discussing these principles in the context of a pandemic would be similar.

Is it socially acceptable to infect others, and when might our actions or inactions harm others? You could even teach these ideas with a religious slant. In a religious school, you could ask, “Is that the Christian thing to do?” [or] “What would Jesus do?” And actually HHS [the U.S. Department of Health and Human Services] has interesting podcasts along these lines that interview ministers about whether vaccination is the religiously appropriate behavior during this pandemic.

Masks and vaccines have been highly politicized. Would some parents oppose lessons on masking and vaccination?

Parents might oppose it, but intergenerational conflict happens all the time, and children have been part of the solution by teaching parents about climate change. A similar approach may be taken for public health.

For the kids, part of the curriculum could be understanding what pathogens are, different solutions such as preventive treatments and the mechanism for different vaccines. Once you have a good knowledge base, it’s harder to then inject far-fetched misconceptions. People believe in these misconceptions partly because they don’t have a mental model of how infection and immunity work. So the goal would be to build those models early on.

You’ve talked about how public health should be based on the science of communication and behavioral change, not just intuition. What are some of the key social science findings that are applicable in conveying information about public health?

It’s important to place this in a broader context, as far as what we’ve seen during the pandemic, relative to what happened with HIV. With HIV, experts were convened early on, and it was decided that we had to get people to change their behavior. There were large-scale investments and interventions beyond just public service announcements.

Training people in behavioral skills or counseling them to deal with their anxiety is different from simply saying, “You should vaccinate” or “Let’s not hold large gatherings with unvaccinated people.” To actually train the skills that can help people adopt those behaviors, you need to demonstrate and get people to experience how to refuse invitations when they are not safe. One could organize workshops in schools, places of worship and different contexts that are more involved than just a 30-second public service announcement. By the same token, to reduce people’s tendency to engage in avoidance behaviors such as risky socializing in the middle of a lockdown, you might need to use techniques drawn from psychotherapy to reduce avoidance and increase commitment to a long-term goal.

Are there lessons from the HIV epidemic that could be applied to the current or future pandemics?

Yes. In the COVID pandemic, we went straight for biomedical innovations—the idea that getting a vaccine would take care of the problem—only to realize that we still have the problem of getting people to use it. We haven’t seen enough investment in other types of programs that would try to achieve changes in behavior. For HIV patients, there was, and still is, a high investment in case management, counseling and various forms of interaction, as well as following up with people and attempting to sustain changes over longer periods of time.

Do you envision case managers going out into the community when families are still healthy and there is no public health emergency?

The case managers would get to know the families and their various health concerns. They would facilitate access to various programs, services—both social and health-related—and stay in touch. And then they would be the point of contact for extended discussions about vaccines, potential side effects and appointments.

You have done extensive research on effective health messaging. What are some of the insights you’ve gained?

Well, firstly, we know from a bigger body of science that information alone rarely changes behavior. So here we’ve been thinking that if we inform people sufficiently about a vaccine and its virtues, that that will be enough, and it’s not. Information—or misinformation—by itself does not necessarily have that large of a behavioral impact. It’s necessary to go into emotional issues, values and self-control, as well as behavioral measures, to get people to execute behaviors that would be beneficial for them. For example, if people lack transportation or fear that vaccine side effects will result in a new bill to pay, they will not vaccinate even if you correct misinformation.

Are there any new techniques that you are investigating?

There are several quite new things that we’re doing in the HIV arena that involve, for instance, extracting possible public health messages from social media in an automated real-time way.

We’re taking the whole pool of health messages on Twitter and Instagram and, out of those hundreds of thousands of messages related to HIV, extracting some that have the potential to guide appropriate behaviors. And then those are sent to health departments. So it’s a way, for instance, of creating and having content that’s community-based—in real time and always up to date.

All this is done through machine learning that detects messages that are appropriate for gay and bisexual men and thought to be actionable and persuasive. Then we test how these messages do in the population, and we also test whether health departments disseminate them.

We are also examining the impact of deviating attention from the misinformation and putting other issues on the agenda. It turns out that highlighting the pros of adopting a behavior is at least as effective as countering the negatives—and less threatening to people’s social identities.