Public health leaders should invest in long-term work with communities to develop trust and support more effective vaccination communications, according to a new report analysing London's Why We Get Vaccinated campaign.
The campaign was evaluated by language experts at the universities of Nottingham and Cardiff, who examined how people understand vaccination messages and how language can influence attitudes towards vaccines. Their findings highlight the importance of inclusive wording, community involvement and clear, evidence-based communication.
The evaluation combined a representative YouGov survey of 2,016 London adults, 12 focus groups involving 52 participants, and linguistic analysis of how people talk about vaccination and interpret health messages. The survey classified 62.75 per cent of respondents as vaccine confident, 30.75 per cent as vaccine ambivalent and 6.20 per cent as vaccine hesitant.
Led by Svenja Adolphs, Professor of English Language and Linguistics at the University of Nottingham, Co-Investigator Dr Sara Vilar Lluch of Cardiff University, and Research and Innovation Associate Dr Emma McClaughlin in the School of English at Nottingham, the research highlights the importance of distinguishing between people who are opposed to vaccination and those who have unanswered questions or concerns. Vaccine-ambivalent people remain engaged with vaccination but may be uncertain about effectiveness and side effects, making them an important audience for future interventions.
The findings also show that vaccination decisions are shaped by trust, perceptions of risk, lived experience and the language used to communicate health advice, rather than awareness alone. Experiences during the Covid-19 pandemic, and relationships with institutions can also influence trust in vaccines.
"This research shows that the impact of vaccination campaigns depends on how messages are understood by different communities. Linguistics offers powerful evidence for the value of developing communication in partnership with communities that reflects people's experiences and concerns, making it more inclusive, relevant and effective."
The research was conducted through an Arts and Humanities Research Council (AHRC)-funded project, in partnership with NHS England London, the UK Health Security Agency (UKHSA), London Councils, the London Association of Directors of Public Health (ADPH London) and the Office for Health Improvement and Disparities (OHID London), working alongside London communities and community organisations.
Professor Kevin Fenton, Regional Director of Public Health at the Office for Health Improvement and Disparities (OHID London), said: "Vaccination remains one of the most effective ways to protect people's health and increasing uptake is a key priority for London. This guidance, co-produced with communities, draws on learning from the Why We Get Vaccinated communications campaign to help local leaders apply those insights in future immunisation campaigns, improving uptake and helping to reduce health inequalities across London."
Results revealed that participants preferred inclusive wording such as 'Why do we get vaccinated?' over 'Why should you get vaccinated?'. Messages perceived as patronising, moralising, vague or overly focused on fear were less well received.
Instead, participants wanted clear, transparent information about vaccine effectiveness, side effects, research and testing, and why vaccines are recommended.
The report recommends sustained investment in public trust, community co-production of interventions, and greater use of linguistic analysis to test how messages are interpreted. It also calls for clear evidence about vaccine safety and effectiveness, communication through trusted messengers, appropriate multilingual approaches and better evidence about why people delay or decline vaccination.
Kirsten Watters, Immunisations Lead and Vice Chair of the London Association of Directors of Public Health (ADPH London), said: "Building trust with communities is fundamental to facilitate engagement and participation. The practical tips within this guidance will help all health system partners to deliver campaigns that work for communities and builds trust which will support all future campaigns and work too."
The findings have implications beyond London, offering lessons for public health leaders seeking to address uncertainty, misinformation and unequal access to health information.
The report, The 'Why We Get Vaccinated' immunisation campaign: lessons for those designing, delivering and commissioning vaccination communication, can be found here.
