Conspiracy narratives and vaccine hesitancy: a scoping review of prevalence, impact, and interventions
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Believing conspiracy narratives is frequently assumed to be a major cause of vaccine hesitancy, i.e., the tendency to forgo vaccination despite its availability. In this scoping review, we synthesise and critically evaluate studies that assess i) the occurrence of vaccine-related conspiracy narratives on the internet, ii) the prevalence of belief in vaccine-related conspiracy narratives, iii) the relationship between belief in conspiracy narratives and vaccination intention or vaccination uptake, and iv) interventions that reduce the impact of conspiracy narratives on vaccination intention.
In July 2022, we conducted a literature search using three databases: PubMed, PsychInfo, and Web of Science. Following the PRISMA approach, of the 500 initially identified articles, 205 were eligible and analysed.
The majority of identified studies were conducted in Europe and North America, were published in 2021 and 2022, and investigated conspiracy narratives around the COVID-19 vaccination. The prevalence of belief in various vaccine-related conspiracy narratives varied greatly across studies, from 2 to 77%. We identified seven experimental studies investigating the effect of exposure to conspiracy narratives on vaccination intentions, of which six indicated a small negative effect. These findings are complemented by the evidence from over 100 correlative studies showing a significant negative relationship between conspiracy beliefs and vaccination intention or uptake. Additionally, the review identified interventions (e.g., social norm feedback, fact-checking labels, or prebunking) that decreased beliefs in vaccine-related conspiracy narratives and, in some cases, also increased vaccination intentions. Yet, these interventions had only small effects.
In summary, the review revealed that vaccine-related conspiracy narratives have spread to varying degrees and can influence vaccination decisions. Causal relationships between conspiracy beliefs and vaccination intentions remain underexplored. Further, the review identified a need for more research on interventions that can reduce the impact of conspiracy narratives.
Vaccines are cost-effective and successful health tools that prevent vaccinated individuals from developing potentially serious illnesses and help protect entire communities by reducing the spread of pathogens [1]. In 2019, the World Health Organisation (WHO) identified vaccine hesitancy—the reluctance or refusal to vaccinate despite the availability of safe and effective vaccines [2]—as one of the top ten threats to global health [3]. On the one hand, growing vaccine hesitancy threatens to reverse progress made in tackling vaccine-preventable diseases. In fact, countries that were close to eliminating diseases like measles show a resurgence despite the availability of safe and effective vaccines [3]. On the other hand, vaccine hesitancy can hinder the containment of new pathogens like the coronavirus when people refuse vaccination [4, 5]. Thus, it is important to investigate the drivers of vaccine hesitancy to reduce their impact.
One identified driver of vaccine hesitancy is conspiracy belief [6,7,8]. Conspiracy beliefs are commonly defined as beliefs that multiple actors meet in secret agreement in order to achieve a hidden goal [9]. More specific, conspiracy narratives – also known as conspiracy ‘theories’ – are characterised as oppositional, describe malevolent or forbidden acts and ascribe agency to a small group of conspirators [10]. These beliefs have long been part of human interaction and occur often during societal crisis situations like pandemics [11]. During the past 20 years, interest in research on conspiracy beliefs has increased [10].
One of the most common ways to get in touch with conspiracy narratives is through social networks [12]. Since social media has become an important source for health information [13], it also plays a crucial role in the spread of anti-vaccination conspiracy narratives [14]. On Web 2.0, users are enabled to quickly develop and share any content. Thus, content from users on platforms like Facebook, Twitter, and YouTube can include false information and conspiracy narratives that can influence readers’ attitudes, e.g., their vaccine intention [15]. Moreover, a systematic review of anti-vaccination content showed that anti-vaccination posts are frequently more popular than pro-vaccination posts and that anti-vaccination accounts create their posts in a way that effectively grabs attention [14]. The state of research indicates that anti-vaccination content on Web 2.0 has the potential to increase vaccine hesitancy through the often uncontrolled spread of conspiracy narratives.
Research reveals that conspiracy beliefs can influence health behaviours and thus have serious consequences for individuals and societies [10, 16]. For example, people may refuse vaccines because they believe anti-vaccine conspiracy narratives like “vaccines are harmful, and this fact is covered up” [6]. The refusal threatens not only the individual’s health but also that of society, as it jeopardises the desired herd immunity [17].
Recently, during the COVID-19 pandemic, the relationship between conspiracy beliefs and health-related behaviours such as following safety guidelines and getting vaccinated became apparent [18]. A systematic review of literature investigating the association of conspiracy belief and vaccine willingness during the COVID-19 pandemic provides a picture consistently showing a negative relationship between the two concepts [19].
As interest in the impact of conspiracy narratives has increased in recent years, there have already been efforts to reduce their significance. But as conspiracy narratives are unfalsifiable [9], a simple counterargument against a narrative might not be enough. Refuting a conspiracy narrative could be perceived as evidence for the cover-up, and the sender of a counterargument could be perceived as an accomplice of the conspiracy [20]. Indeed, a recently published systematic review on the efficacy of interventions in reducing conspiracy beliefs indicates that only a few of the evaluated interventions had medium or strong effects [21].
Content retrieved from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-20797-y.
