Immunity Debt or Vaccination Crisis? A Multi-method Evidence on Vaccine Acceptance and Media Framing for Emerging COVID-19 Variants

"We demonstrate that the framing theory provides a mechanism for considering how to pitch effective community health news."

The anti-vaccine movement, the emergence of new COVID-19 variants (e.g., Delta and Omicron), and "immunity debt" caused by lack of exposure to regular bacteria and viruses have raised doubts about the possibility of a worldwide vaccine-induced herd immunity. Although COVID-19 vaccination has proven safe and effective against COVID-19, acceptance of these campaigns has been problematic, including in developing nations such as Pakistan. High levels of distrust in the government and foreign-funded health initiatives, religious beliefs, and low levels of health access have contributed to COVID-19 vaccine hesitancy. In addition to framing theory, this study draws upon the issue attention cycle and health belief model (hereafter HBM) to investigate the effect of media framing on public acceptance of COVID-19 vaccination in Pakistan. It also provides evidence-driven recommendations for health journalists and public health practitioners to leverage health news to improve public acceptance for COVID-19 vaccines.

As the researchers explain, framing theory describes how health issues are "framed" to provide specific meanings, situational insights, and applicable cues with the purpose of raising health awareness. Moreover, media framing helps the public outline problems and prepares them to adopt appropriate responses. Framing theory proposes that the probability of a framing effect on individuals' evaluation of an issue involves three cognitive mechanisms: availability, accessibility, and applicability:

• The availability framing effect happens when the individual has retrievable memory about an issue such as the coronavirus. Individuals with higher intensity of belief, due to prior availability of information, will be affected more by the message using availability frames.
• During a pandemic, media coverage about health issues increases many-fold to improve public responsiveness to the crisis. Framing theory affirms that repeated media coverage (frequency) can affect judgments by enhancing the accessibility of beliefs. For example, the media's framing of messages that COVID-19 infection is risky will induce risk perception among the community. Consequently, the content analysis in this article explores which beliefs have been made accessible through news framing.
• Past health communication literature has affirmed that factors such as argument, message relevancy, and fear appeals can increase the likelihood of health messages being deemed applicable. Thus, drawing on the health behaviour theories (e.g., HBM), the researchers explain that information can serve as a cue to trigger a health behaviour (e.g., vaccination). Other psychological factors, such as perceived risk or benefit, are also central in shaping the behavioural outcome. Thus, the COVID-19 news framing effect may be mediated through these psychological factors involved in a deliberative process. Psychological theories such as terror management theory (TMT) note that the information processing of risk-oriented information yields more applicable outcomes. To illustrate this phenomenon, TMT notes that when people encounter fear or anxiety due to information, they adopt actions in compliance with safety.

Part 1 of the study employs content analysis to find frames regarding COVID-19 in the leading press of Pakistan. In this research, four leading Pakistani newspapers - "The Nation", "Dawn", "Jang", and "Naw-e-Waqt" - were selected for analysis between March 2020 and August 2020, the peak of the (first) COVID-19 wave in Pakistan. The dominant frames in media coverage of COVID-19 identified through this process were:

1. Consequence: This frame emphasises the consequences of the illness, including human life; social impact is the focal point of the story.
2. Uncertainty: Uncertainties may be portrayed regarding any aspect of the epidemic, including the cause, cure, and possible spread. Also included is the portrayal of the disease as something obscure that needs more exploration and assessment by the government or scientific bodies.
3. Action: The story focuses on any action against the disease, including anticipation, potential, solution, and strategies.
4. Reassurance: The story communicates the possibility that people should not be stressed or worried about the effects of the disease. Additional stories cover the readiness and successes of authorities in fighting the infection.
5. Conflict: The story is about arguments, disagreements, and different ideas among news sources. Alternately, it could be discussion and debate on how to combat the disease effectively.
6. New evidence: This frame is related to new findings and results or explores new evidence that helps advance the understanding of the disease. It also discloses new strains of the infection, new ways the disease can spread, and new technologies to prevent, cure, and/or treat the disease.

Overall, the study analysed 1,187 news stories, finding that the Pakistani press more frequently used the uncertainty, conflict, consequences, and action frames than the new evidence and reassurance frames.

Next, the researchers conducted six quasi-experiments to examine and compare the message influences of the six frames that emerged in part 1. In total, 720 adults (male = 409, 56.80% and female = 311, 43.20%) were recruited from December 12 2020 to May 15 2021 through online announcements. The respondents were then assigned to view a particular COVID-19 news framed message. Six original news stories delineating six different frames were chosen for this task. Media attention (MA) was measured through a "semantic differential scale". After viewing the particular news frame, respondents were provided with the statement: "I pay attention to news related to COVID-19 because I think it is____." The statement was followed by three items to rate their assessments. The benefit perception (BP) and the public acceptance of the vaccination (PAV) campaign were each measured through three items.

The findings suggest that risk perception partially mediates the relationship between MA and PAV under the conditions (frames) of consequences, uncertainty, and action. Risk perception due to remedies suggested in the media fully mediated the relationship between MA and PAV under reassurance and new evidence frames. The researchers were surprised to find that BP only mediates the relationship between MA and PAV when the framing was focused on the consequences of COVID-19.

In terms of implications of these findings, the researchers point to other studies positing that messages framed as fear are the most viable communication strategy in combating vaccine hesitancy among the public. The present study finds that community acceptance for the vaccine is influenced by media framing, especially media framing of COVID-19 using uncertainty, action, and consequence frames. Hence, the researchers suggest, media can be effectively used to mobilise community support for the COVID-19 vaccine. Specifically, they write: "policymakers can select the fear appraisal public service messages through the traditional media to instill greater public acceptance for COVID vaccines. For this purpose, strategically designed public service messages about the COVID-19 vaccine may be disseminated through traditional media more frequently to encourage public acceptance of the COVID vaccines."

In conclusion: "in COVID-19 hazard circumstances, the public is anxious about their susceptibility to getting the disease and likely to adopt the available actions (e.g., vaccination)....In sum, media framing messages instilling fear and vulnerability promote a greater acceptance of COVID-19 vaccination."