Nothing to lose, everything to gain: Loss-framed vs gain-framed approaches to winter vaccination messaging

As the leaves fall, the flurry of autumn/winter advertising landing in our inboxes and onto our social media feeds seems to intensify. Whether it’s Starbucks convincing you that pumpkin does indeed belong in a latte, or Amazon gearing us up for the Big Black Friday event, the change in seasons is synonymous with some of the biggest advertising events of the year.

And, as the temperature turns, there’s another organisation also hoping to get our attention - the NHS.

Triple threat

Each year the health service has a busy Q4 persuading the public to get vaccinated, but this year, the stakes feel higher than ever. Coined the “tripledemic,” the NHS is warning the public of three threatening viruses in circulation: Covid-19, influenza (flu), and respiratory syncytial virus (RSV). All are considered major risks, particularly to the elderly, pregnant women, young children and those with long-term health conditions.

And, with a reported drop in vaccine uptake last winter across all eligibility groups, the NHS certainly has cause for concern. Last winter, just four in 10 people with long-term health conditions were immunised against flu, and only one in three pregnant women were protected. According to the NHS, this low uptake correlated with a “sudden increase” in hospitalisations just before Christmas and later in January.

You win some, you lose some

Despite the nation now being somewhat accustomed to messaging around the benefits of vaccination following the pandemic, there clearly persists some reluctance to getting jabbed – but why?

Well, much of this boils down to social and cultural factors. Vaccine uptake can be affected by perception of risk, low confidence in medical institutions and even inconvenience. Resistance is also higher in minority ethnic groups because, as outlined by NHS England and Improvement, “historical discrimination, racist ideology and immoral experimentation on people of colour” is considered to have driven a lack of trust in medical professionals.

While these contexts will continue to contribute to vaccine hesitancy, new research has emerged suggesting that communications can also play a major role in people’s perception of vaccines, and thus their willingness to get immunised.

In their Covid-19 study, scientists from China argue that ‘message framing’ is key to altering people’s beliefs around vaccinations. They propose that, when it comes to immunisation campaigns, “loss-framed messaging” should be the focus, as opposed to “gain-framed messaging.” But what does this actually mean?

Simply put, a loss-framed message highlights the consequences of not engaging in a behaviour. A doctor will say that not quitting smoking could cause lung cancer, for example. Comparatively, a gain-framed message will emphasise the benefits of undertaking a particular behaviour. So, exercising regularly reduces the risk of developing type 2 diabetes.

When it comes to vaccination campaigns, the NHS has often stressed their benefits – they tell us that vaccines protect us and our loved ones, and as this Covid-19 poster demonstrates, they give us “hope”.

However, now that the Covid peak has passed, arguably so has the public’s urgency to get jabbed.

During the pandemic, the communicated benefits of vaccination were not just health-related – as Professor Chris Whitty told us from the lectern each night, vaccination was the route out of lockdown. For those who felt immune, or apathetic, towards the health risks posed by Covid, this gain-framed message was a rather effective one.

We’re now considered, however accurately, to be in a ‘post-Covid’ era and, as such, it wouldn’t be unreasonable to think there is some degree of indifference toward preventative vaccines. Indeed, for those feeling healthy and well without their flu or Covid jab, do the benefits feel that much of a gain?

Researchers also believe that gain-framed messaging is much more effective when people perceive the behaviour change (ie getting vaccinated) to be completely safe. However, they suggest that vaccines are still considered risky by many, particularly given the slew of online misinformation. In this case, communicated benefits of vaccines are overridden by patient anxieties.

Winter warning

This year, there has been a notable amount of ‘loss-framing’ in winter vaccine messaging. For example, a Department of Health press release created a flurry of headlines, as it suggests that 18,000 flu-related deaths were related to a fall in jab uptake.

Earlier this year, the government’s ‘If they’re not vaccinated, they’re not protected’ marketing campaign also employed the loss-frame strategy. In the video advert, children tell their parents that, “Our generation’s risk of illnesses like measles and whooping cough is rising,” because of low immunisation rates.

What is critical to remember in all health communications is that a ‘one size fits all’ approach never works. Perceptions of vaccines and the willingness to be immunised will vary from each individual and community, and messages will need be tailored accordingly. Here, meticulous community engagement, particularly with marginalised and underrepresented groups, will be key.

What is evident, however, is that this year the NHS has taken no risks, clearly communicating the benefits of immunisation as well as the dangers of inaction. For now, we wait to see the results.