Expectations Versus Fantasies and Vaccine Hesitancy: How Suffering From COVID-19 Versus Suffering From Vaccines Interact.

ABSTRACT

BACKGROUND: Previous research on COVID-19 vaccination highlights future thoughts associated with possible Coronavirus infection and vaccine side effects as key predictors of vaccine hesitancy. Yet, research has focused on independent contributions of such future thoughts, neglecting their interactive aspects. PURPOSE: We examined whether thoughts about two possible COVID-related futures (suffering from COVID-19 and vaccine side effects) interactively predict vaccine hesitancy and vaccination behavior among unvaccinated and vaccinated people. Importantly, we compared two forms of future thinking beliefs or expectations (likelihood judgments) versus fantasies (free thoughts and images describing future events). METHODS: In Study 1, we conducted a longitudinal study with an unvaccinated group (N = 210). We assessed expectations versus fantasies about the two COVID-related futures as predictors. As outcome variables, we measured vaccine hesitancy, and 9 weeks later we assessed information seeking and vaccine uptake. Study 2 was a cross-sectional study comparing vaccine hesitancy of an unvaccinated group (N = 307) to that of a vaccinated group (N = 311). RESULTS: Study 1 found that more negative fantasies about COVID-19 impact and less negative fantasies about vaccine side effects interactively predicted lower vaccine hesitancy and more vaccine-related behaviors among unvaccinated people; no such interaction was observed between respective expectations. Study 2 replicated these results of Study 1. Additionally, for vaccinated people, low expectations of negative COVID-19 impact and high expectations of negative vaccine impact interactively predicted higher vaccine hesitancy, whereas no such interaction was observed for respective fantasies. CONCLUSIONS: Research on vaccine hesitancy should explore interactions between future thinking about disease and about vaccine side effects. Importantly, there is much to be gained by distinguishing expectations versus fantasies vaccination interventions aiming to boost vaccine uptake among unvaccinated people should tap into their negative future fantasies regarding both disease and vaccine side effects.

In two correlational studies, we investigated the relationship between future thoughts about two possible COVID-related futures­suffering from COVID-19 and vaccine side effects­and vaccine hesitancy. Prior research has emphasized thoughts about these potential risks as significant predictors of vaccine hesitancy but has focused on their independent contributions, neglecting their interactive nature. Our research examined the interaction between the thoughts about disease and those about vaccine side effects, highlighting the two forms of future thinking expectations (likelihood judgments) and fantasies (free-flowing thoughts and images describing a future event). In a longitudinal study (Study 1) with an unvaccinated group, we found that more negative fantasies about COVID-19 disease and less negative fantasies about vaccine side effects interactively predicted lower vaccine hesitancy and more vaccination behavior. There was no interaction between the expectations. Study 2, a cross-sectional study comparing another unvaccinated sample to a vaccinated sample, revealed a divergent pattern in the two groups; negative fantasies, not expectations, interactively predicted vaccine hesitancy among unvaccinated people while expectations, not fantasies, did so among vaccinated people. The research suggests the importance of considering interactions between future thoughts about disease and vaccine side effects in understanding vaccine hesitancy and distinguishing expectations and fantasies.