Application of Prospect Theory in COVID-19 Vaccine Intentions
- Rouyu Yap
- Mar 14
- 3 min read
Introduction
Would gain and loss frames have effectively improved COVID-19 vaccine intentions during the COVID-19 pandemic?
Prospect Theory can be applied to improve vaccination campaigns by understanding that:
People evaluate vaccination decisions based on perceived gains and losses rather than absolute outcomes.
Message effectiveness varies based on individual factors - hesitant people respond better to loss frames while those at high perceived risk prefer gain frames.
Cultural differences matter - individualistic societies respond to personal benefit messaging while collectivist cultures favour community-focused approaches.
Tailored communication strategies based on these insights can significantly improve public health outcomes.
Key Ideas
Understanding Prospect Theory in the Context of Vaccination
Prospect Theory (Kahneman & Tversky, 1979) suggests that people evaluate decisions based on perceived gains and losses rather than absolute outcomes.
The framing of information influences behaviour:
Gain frames emphasise the benefits of action (e.g., “Getting vaccinated will protect you and your loved ones”).
Loss frames highlight risks of inaction (e.g., “Not getting vaccinated increases your risk of severe illness and death”).
In healthcare, people are generally risk-averse when faced with potential gains and risk-seeking when faced with potential losses.
Applying this to vaccine hesitancy:
If vaccination is seen as low risk with high benefits, people prefer gain-framed messages.
If vaccination is seen as risky with uncertain benefits, loss-framed messages may be more effective.
Baseline Vaccine Intentions and Framing Effects
Prospect Theory predicts that framing effects depend on prior attitudes toward vaccines.
Studies show that hesitant individuals (those with low baseline vaccine intentions) are more likely to be influenced by loss frames.
Example: A study in Pennsylvania healthcare workers found that loss-framed messages doubled vaccine registration rates compared to the control group.
The fear of missing out on protection or experiencing severe illness drove behaviour change.
Conversely, people with high vaccine intentions showed little change in response to either frame.
Example: A Swedish study found that gain and loss frames had no significant impact on individuals already willing to vaccinate.
These individuals had already decided, so framing had little influence.
Perceived Risk & Severity of COVID-19
People assess risk differently based on their perception of the risk of getting infected and the severity of the symptoms of COVID-19.
Low perceived risk of COVID-19 → Loss frames more effective
Younger adults often viewed COVID-19 as a mild illness, making them less likely to vaccinate.
A Japanese study found that loss-framed messages emphasising the societal impact of low vaccination rates increased vaccine intentions among young adults.
High perceived risk of COVID-19 → Gain frames more effective
Older adults and people with pre-existing conditions saw themselves as more vulnerable.
A study found that gain-framed messages reinforcing personal health benefits led to greater willingness to vaccinate among older adults (e.g. reducing severe illness and death).
Cultural Influence: Collectivism vs Individualism
Individualistic cultures (USA, UK, Netherlands) → More responsive to individual gain/loss framing (e.g., “Protect yourself”).
Collectivist cultures (Japan) → More responsive to collective gain/loss framing (e.g., “Protect your community”).
Example: A US study found that people with conservative ideologies responded better to individual-focused messages, while liberal individuals were more influenced by collective messages.
Limitations
Vaccination is a high-risk preventive behaviour, unlike wearing a seatbelt or exercising.
There are 2 main health-related behaviours: detective and preventive.
Detective is usually at higher risk than preventive behaviours.
This unique nature makes it more difficult to make accurate predictions according to the general concepts in Prospect Theory and framing
Fear-based messaging (loss frames) can backfire, increasing resistance due to psychological reactance (a defensive reaction to perceived coercion).
All of my research used participants' self-reported vaccine intentions as the outcome, but in reality that doesn't always translate into actual vaccine uptake.
Other factors influence vaccine uptake, such as misinformation, access to vaccines, and distrust in government or pharmaceutical companies.
Conclusion: Would gain/loss frames have been effective?
Partially
Loss frames were effective for hesitant individuals and those who felt low risk from COVID-19.
Gain frames worked better for those who perceived high risk from COVID-19.
However, other psychological and social factors played a role, suggesting that framing alone is not enough to overcome vaccine hesitancy.
For future vaccine campaigns, tailoring messages to different populations (based on risk perception and cultural values) would maximise effectiveness.
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