Vaccine Hesitancy and COVID-19: A Social-Ecological Approach to Regulation

Mr Sam Roach1

1Queensland University Of Technology, Brisbane, Australia

Longitudinal studies indicate that the Australian public has become increasingly hesitant about receiving the COVID-19 vaccines.  Historically, Australia has implemented coercive policies to improve vaccination uptake. For example, the No Jab, No Pay and No Jab, No Play policies influence behaviour by withholding financial benefits and services.  This approach is indicative of a ‘Behavioural Model’, which provides that public health issues can be addressed by directly convincing individuals to adopt different behaviours.

Such policies give rise to issues related to fairness and efficacy. In particular, lower socioeconomic households are disproportionately impacted, and comparatively lower uptake has been observed in higher socioeconomic households.  Further, many individuals choose to vaccinate because they are reliant on these benefits,  whereas their views on vaccination remain unchanged.

The Social-Ecological Model differs from the Behavioural Model, as it recognises that individual decision-making does not occur in a vacuum. It provides that there are five social and environmental determinants of health decisions,  including:

  1. the structural environment;
  2. materialistic and societal conditions;
  3. networks related to the society and community in which one lives;
  4. individual habits; and
  5. age, sex and genetics.

Excluding age, sex and genetics, policies can be implemented to alter each of these determinants.  A legal response to vaccine hesitancy, which is based on the Social-Ecological Model, has the potential to influence individual views on vaccination, thereby improving coverage, without relying on coercion. This may overcome the issues that have been observed in policies based on the Behavioural Model.


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