November 28, 2020

Transparency Is Necessary but Not Sufficient to

Reduce Skepticism About a COVID-19 Vaccine

Michael Bang Petersen*, Alexander Bor, Frederik Jørgensen & Marie Fly Lindholt

Department of Political Science, Aarhus University

*Corresponding author: michael@ps.au.dk

Abstract:

Health authorities emphasize the importance of "radical transparency" in communicating about

future COVID-19 vaccines to counter conspiracy-based skepticism. While this resonates with
research that highlights uncertainty as a major psychological predictor of conspiracy-related beliefs,
no systematic evidence exists regarding the effectiveness of transparency as communication strategy.
This study tests the effects of transparent communication about a COVID-19 vaccine using a pre-
registered experiment fielded to large, representative samples of Americans and Danes (N > 6,800).
The evidence confirms that positive but vague vaccine communication does not increase vaccine
support but rather infuses attitudes with conspiracy-related beliefs. Against the hopes of authorities,
however, there is little evidence that transparency alone can reduce vaccine skepticism, unless this
transparency discloses a highly safe and effective vaccine. Additional analyses suggest that this
reflects that vaccine skepticism is not grounded in psychological uncertainty but in deep distrust of
authorities, which impedes the effectiveness of their communication.

Acknowledgements:

The analyses presented in this paper are preliminary and have not yet been peer reviewed. The study
has been conducted as part of the "HOPE - How Democracies Cope with COVID-19"-project, funded
by The Carlsberg Foundation with grant CF20-0044 to Michael Bang Petersen. The funders had no
role in the conduct of this research.

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The World Health Organization (WHO) has emphasized that a vaccine against COVID-19 is a “vital

tool” to counter the current pandemic (WHO, 2020a) and, accordingly, unprecedented amounts of

resources are invested in the race towards the development of a vaccine. Yet, the challenges of a

vaccine-based solution to the COVID-19 pandemic does not end with the development of an approved

vaccine. Put bluntly, a rapidly developed vaccine will have no effect if citizens across the world are

not willing to get vaccinated. Given that the SARS-COV-2 virus is highly contagious, researchers

currently estimate that to reach herd immunity up to 82 percent of a population may need to get

vaccinated (Britton et al., 2020; Sanche et al., 2020).

The key challenge is that most countries, as of late 2020, are very far from reaching this

threshold, even if all people who wanted would have access to a vaccine. International studies

document that, depending on the specific samples, question-wording and response options, in some

Western democracies as little as 40 percent of the population is willing to get vaccinated (Callaghan

et al., 2020; Lazarus et al., 2020; Lindholt et al., 2020). The COVID-19 pandemic may not be

contained until health authorities (and other actors) find a way to counter this widespread vaccine

skepticism.

Ensuring sufficient uptake of vaccines – without mandatory vaccination programs – is a non-

trivial task even in normal circumstances. While vaccines may be among humanity’s greatest

technological achievements, the idea to voluntarily expose ourselves to a virus (even if in a weakened

form) goes against deep-seated intuitions of pathogen avoidance (Mercier, 2020). Moreover,

vaccination constitutes a classical social dilemma: herd immunity is a common good enjoyed even

by free-riders who refuse to get the vaccine (Böhm et al., 2016).

At the same time, there is growing evidence that skepticism towards COVID-19 vaccines is

also fuelled by distrust in the authorities and beliefs in conspiracies (Browne, 2018; Freeman et al.,

2020; Palamenghi et al., 2020). While the authorities struggle under the burden of pandemic

2
management, some citizens question the intentions and competences of authorities (Bartusevicius et

al., 2020). This may be particularly poignant in countries where the pandemic was politicized, leading

to large partisan divides on proper form of action (Freeman et al., 2020). Furthermore, distrust in the

authorities may be exacerbated by feelings of uncertainty and concern, which are widespread during

the pandemic (Bartusevicius et al., 2020). Thus, the COVID-19 pandemic poses both “realistic”

threats (leading to concerns about health and the economy) and more “symbolic” threats (leading to

concerns about democratic freedoms) (Kachanoff et al., 2020) and people who are concerned whether

the government has their best interest in mind (e.g., having failed to protect their health, financial

well-being or freedom) may also doubt whether the government is competent in authorizing novel

vaccines (Browne, 2018; Freeman et al., 2020; Palamenghi et al., 2020).

Distrust and uncertainty, however, may not just have direct effects on vaccine skepticism. A

key concern is whether these factors creates further ripple effects by providing a fertile ground for

conspiracies (Douglas et al., 2017; Marchlewska et al., 2018; Van Prooijen & Jostmann, 2013). A

Nature editorial has warned against “a pandemic of vaccine misinformation” (Nature, 2020) and the

WHO similarly warns against the “infodemic” of conspiracy theories and misinformation circulating

during the COVID-19 pandemic (WHO, 2020b).

The most prominent proposed solution to this perfect storm of vaccine skepticism is “radical

transparency”. Health authorities, academics and the biomedical industry advocate for completely

transparent health communication about COVID-19 vaccines’ approval procedures, efficiency and

side-effects (Nature, 2020; Mahase, E., 2020; see also Bélisle-Pipon et al., 2017; Dayrit et al., 2020).

While transparency is normatively important in itself (Bélisle-Pipon et al., 2017), it is also hoped to

reduce skepticism by addressing its underlying psychological causes. Transparent communication

may increase the perceived legitimacy of government decisions (Tyler 2006), could alleviate

heightened needs for cognitive closure (i.e., low abilities to cope with uncerainty; Marchlewska et al.

3
2018), and buffer against conspiracy theories claiming that official authorities are hiding important

information. In short, citizens may need an information “vaccine” that inoculates against skepticism

before they are ready to get inoculated against the virus itself (Van der Linden et al., 2017; Cook et

al., 2017). Indeed, a study of a vaccine controversy in the Philippines argued that increased

transparency in the early phases of the campaign might have hindered the spread of misinformation

and increased the campaign’s success (Dayrit et al., 2020).

The core purpose of the present study is, first, to examine how transparent communication

relative to vague communication about a vaccine influences public vaccine support and, second,

whether transparent communication inoculates the public against conspiracy-oriented counter-

communication. The above arguments notwithstanding, it is also important to note that some studies

have raised concerns that transparent provision of safety information can increase public vaccination

concerns (Byington, 2014), especially if negative information about the efficiency, side effects and

other features of a COVID-19 vaccine become transparently disclosed (Motta, 2020). While initial

announcements for some vaccines against COVID-19 are highly promising (Cohen, 2020), this

question is of particular relevance during the COVID-19 where there are many unknowns about the

duration of protection and the risk of long-term side effects. Accordingly, negative information may

need to be disclosed as vaccines are rolled out.

On this basis, a final purpose of the present study is to assess whether additional official

communication can buffer the potential adverse effects of transparently revealing information about

a COVID-19 vaccine. In this regard, prior studies in public legitimacy find that policies with negative

repercussions are viewed as more legitimate to the extent that people feel that their uncertainties are

explicitly acknowledged (Tyler, 2006). In the context of a vaccine against COVID-19, the

management of concern and uncertainty involves both acknowledgement and action: Acknowledging

the uncertainties that citizens may legitimately feel (Blastland et al., 2020) and stating what specific

4
actions have been taken to address these concerns. Regarding the latter, vaccine developers have

taken care to test vaccines in large trials (Doshi, 2020) and, hence, provide certainty about the

effectiveness and short-term side-effects.

Overall, the present study was thus designed to test four predictions:

− Prediction 1: Compared to vague information, transparent positive information about

a COVID-19 vaccine will increase support for the vaccine (support of its approval and

use etc.).

− Prediction 2: Compared to vague information, even transparent negative information

about a COVID-19 vaccine will increase support for the vaccine (support of its

approval and use etc.).

− Prediction 3: Transparent information (positive or negative) about a COVID-19

vaccine will inoculate against the negative effects of conspiratorial information about

a COVID-19 vaccine (i.e., a Conspiracy Induction) on vaccine support.

− Prediction 4: Compared to vague information, any potential negative effects from

transparent information about a COVID-19 vaccine on vaccine support can be

buffered by exposure to health communication that acknowledges public vaccine

uncertainty and describes concrete steps taken to decrease this uncertainty (i.e., a

Certainty Induction).

In addition, in a series of post-hoc analyses we explore the role of associations between vaccine

support and a range of individual difference variables highlighted in the above: Individual differences

in abilities to manage uncertainty, political mistrust and perceived threats associated with the COVID-

19 pandemic as well as political and demographic differences.

5
Methods

The study was pre-registered at Open Science Framework (OSF) and the study received ethical

approval from the ethics review board at Aarhus University. The pre-registration, materials, data and

command files are available here at OSF.

Data collection

Between October 14 and October 21 2020, prior to the release of any information about the features

of vaccines against COVID-19, a sample of 3,436 Americans and 3,427 Danes were invited by the

survey agency YouGov to participate in a survey on attitudes towards a fictitious vaccine against

COVID-19. The sample size was determined on the basis of a power analyses that showed that a

combined sample of 6800 would provide us with 90% power to detect a true effect size of Cohen's d

>= 0.1 for Prediction 1 and 90% power to detect a true effect size of Cohen's d>= .12 for Predictions

2 and 3. The samples were quota-sampled on gender, age, geographical location, education and, in

the US, race to match the respective populations on these sociodemographic variables. These two

countries reflect countries where the pandemic has been less and more politized, respectively

(Jørgensen et al., 2020).

Experimental design

Using a factorial experiment, participants were randomly assigned to receive different information

about a new fictional vaccine against COVID-19, referred to as COVACID. To create a judgmental

anchor for both the features of COVACID and the transparency of the provided information,

COVACID was compared to transparent and factual information about the seasonal vaccine against

the common flu. The experiment had a 3 (Information: Transparent positive / Transparent negative /

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Vague) × 3 (Induction: Control / Conspiratorial / Certainty) full factorial design. The first

experimental factor described the effectiveness, the side effects and the duration of tests of

COVACID. The Transparent positive condition described the COVACID to equal in all aspects to

one of the world's most used vaccines, the vaccine against the common flu. Negative information

implied that COVACID was less effective, had more side effects and a shorter test period than the

vaccine against the common flu. The Vague information condition suggested publicly available

information that does not allow for precise comparisons with common flu shots, but the authorities

stated that COVACID is “sufficiently effective”, has “acceptable” side effects, and that test period

was “adequate”.

The second experimental factor manipulated whether participants see any additional

information about the context of COVACID. Participants in the Certainty Induction condition read

that the authorities explicitly acknowledge concerns about a novel, hastily developed and approved

vaccine, which therefore was tested on a much larger sample than seasonal flu vaccines. Participants

in the Conspiracy Induction condition learned that conspiratorial views about the vaccine’s approval

circulate on social media. Participants in the control group received no additional information.

No deception was involved in the study and participants were debriefed subsequently and

provided links to the most recent official information about vaccines against both the flu and COVID-

19. Table 1 provides an overview of the experimental conditions and full wordings are available in

Appendix A1.

Upon completion of the dependent measures (see below), participants completed two

manipulation checks that allow us to assess the success of the first experimental factor, i.e., the

manipulation of the descriptions of the COVID-19 vaccine. Specifically, respondents were asked

about their degree of agreement with two statements: (1) "The description of the COVACID vaccine

was more negative than the description of a regular flu vaccine." and (2) "The description of the

7
COVACID vaccine was more vague than the description of the regular flu vaccine." Consistent with

the pre-registered expectations, the Transparent Negative Condition was assessed as significantly

more negative than the two other conditions combined (r=.29, p<.001) and the Vague Condition was

assessed as significantly more vague than the two other conditions combined (r=.22, p<.001).

Following the pre-registration these manipulation checks were conducted for respondents in the

Control Condition of the second experimental factor.

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Table 1. Overview Over Experimental Conditions.
Imagine that the US health authorities approve a new vaccine against COVID-19 next year. We will call the
vaccine COVACID. To help you assess the new COVACID vaccine it will be compared to one of the most
Intro
commonly used vaccines: the vaccine against the common flu. Every year, almost 50 % of all Americans
receives a flu vaccine.
[Transparent Negative Info.]
1. Protection: A flu vaccine
protects about 70 out of 100 who
receive the vaccine. [...]
COVACID offers less protection
against COVID-19. This means
that 50 out of 100 obtain effective
protection.
2. Side effects: The side effects of
Experimental Factor 1
a flu vaccine are mainly mild or
moderate. [...] Serious side
effects like respiratory problems
are rare and may happen to 1 out
of 10,000. COVACID implies a
greater risk of side effects. This
means that 1 out of 1,000 may
experience serious side effects
such as respiratory problems.
3. Test period: [...] New vaccines
are normally tested for one year
or more before being approved.
COVACID has been tested for a
shorter period. Therefore, only
side effects up to six months are
known.
[Control Condition]
Experimental Factor 2
Notes. Text is for the US version of the survey experiment. Text in italics are shared across conditions.
For brevity some of the shared text is not shown (indicated by [...]). Full wordings are available in
Appendix A1.
[Transparent Info.]
1. Protection: A flu vaccine protects
about 70 out of 100 who receive the
vaccine. [...] COVACID offers the
same level of protection against
COVID-19. This means that 70 out
of 100 obtain effective protection.
2. Side effects: The side effects of a
flu vaccine are mainly mild or
moderate. [...] Serious side effects
like respiratory problems are rare
and may happen to 1 out of 10,000.
COVACID implies the same risk of
side effects. This means that, for
example, 1 out of 10,000 may
experience serious side effects such
as respiratory problems.
3. Test period: [...] New vaccines
are normally tested for one year or
more before being approved.
COVACID has undergone a normal
test period. Therefore, side effects
up to one year are known.
[Certainty Induction]
4. Vaccine trial certainty: To obtain
an exact image of the side effects of
a vaccine, vaccines are tested on a
large group of people before being
approved. Flu vaccines are normally
tested on 5,000 people. It is normal
that people will be unsure about a
new and quickly developed vaccine.
COVACID has therefore been
tested on 50,000 people, or 10 times
as many as normally. This is done to
obtain a very precise image of the
vaccine despite the conditions
during the pandemic.
[Vague Info.]
1. Protection: A flu vaccine
protects about 70 out of 100 who
receive the vaccine. [...] The health
authorities have not disclosed exact
information about how effective
the COVACID vaccine is, but they
state that it is sufficiently effective.
2. Side effects: The side effects of a
flu vaccine are mainly mild or
moderate. [...] Serious side effects
like respiratory problems are rare
and may happen to 1 out of 10,000.
The health authorities have not
issued information on the exact
side effects of COVACID but note
that the side effects are considered
acceptable.
3. Test period: [...] New vaccines
are normally tested for one year or
more before being approved. The
health authorities have not
disclosed the exact degree to which
long-term side-effects are known
but note that the temporal
perspective is adequate.
[Conspiracy Induction]
After approval of COVACID, there
has been considerable public debate
about the vaccine and the
transparency of the authorities’
information. On social media
people have argued, among other
things, that “the authorities attempt
to force a vaccine on us and hide all
relevant facts about it. They lie
about all its side effects to stimulate
the economy. Once again, the
power-greedy elite demonstrates its
complete disregard for ordinary
Americans’ health and safety.”
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Dependent measure

After exposure to the information about the vaccine, participants were asked their agreement with 12

statements about the COVACID vaccine (e.g., "I support the health authorities’ approval of

COVACID", "I would get vaccinated with COVACID if my GP recommended it", "I would not feel

safe getting a COVACID vaccine" and "I feel that the authorities are withholding important

information about COVACID"). Full wordings are available in Appendix A2. The pre-registration

divided these statements into multiple different scales (see Appendix A2) but an exploratory factor

analysis shows that a single latent variable explains 87 % of the total variance in all of the items and,

for the sake of simplicity, a summary scale of all 12 indicators is created with a high level of reliability

(US: a=.90; DK: a=.92). The measure, Vaccine Support, is recoded to vary between 0 and 1 with

higher values indicating greater support and positivity for the COVACID vaccine. Appendix Figure

A2 and Table A2 provides separate analyses for each of the separate scales. The results from those

analyses do not differ substantively from the results presented in the main text.

Individual difference measures

Finally, the study obtained five psychological individual difference measure and four

sociodemographic individual difference measures. We explore their associations between Vaccine

Support and four individual difference measures. As to the psychological measures, we collected,

first, Webster & Kruglanski's (1994) scale of the Need for Cognitive Closure, which taps an

individuals' ability to cope with uncertainty and is a major psychological predictor of conspiracy

beliefs. The scale is reliably measured in both the United States (a=.72) and in Denmark (a=.73).

Second, Dekker & Meijerink's (2012) scale of political cynicism, which is a major political predictor

of conspiracy beliefs (Swami et al., 2010). This scale is also reliably measured in both the United

10
States (a=.70) and Denmark (a=.86). Third, Kachanoff et al.'s (2020) scale of threats from the

COVID-19 pandemic. Consistent with the Kachanoff et al. (2020), we created two separate scales, a

scale of perceived symbolic threats (e.g., agreement with the statement that the coronavirus outbreak

is a threat to "the rights and freedoms of the U.S. population as a whole ") (aUS=.85; aDK=.81) and a

scale of realistic threats (e.g., agreement with the statement that the coronavirus outbreak is a threat

to " "your personal health") associated with COVID-19 pandemic (aUS=.75; aDK=.66). Finally, we

obtained a 10-point measure of ideological self-placement on a scale from left to right. In terms of

sociodemographics, we collected gender, age and education as well as vote choice in the last election

for president in the United States and parliament in Denmark, which was recoded into a dichotomous

variable reflecting a left-wing or right-wing vote choice. All individual difference measures are

standardized as z-scores and higher values reflect higher need for cognitive closure, higher cynicism,

higher perceived threat, a more right-wing orientation, being female, being older, being more

educated and voting for a right-wing party, respectively.

Statistical analyses

Consistent with the pre-registration, all predictions are tested using ordinary least squares regression

on the pooled sample of Danes and Americans with two-sided p-values and post-stratification on the

variables used for quota-sampling. We also explore the predicted effects in each sample separately.

As specified in the pre-registration, participants also completed three attention checks that asked them

to recall the specific features of COVACID. The planned inclusion criterion was to only include

participants who provided correct answers to two of the three measures. However, by mistake the

attention checks did not include the correct options for the "Vague Condition" and, accordingly, we

test the predictions on the full sample. It is possible to assess how many failed the planned inclusion

criteria in the other conditions. This amounts to 13 and 12 percent of the participants in those

11
conditions for the United States and Denmark, respectively. While analyses of the effects of those

conditions suggest that exclusion leads to evidence of stronger communication effects (see Table A1

and Figure A1), the effects do not change in terms of substance or statistical significance depending

on whether these participants are included or not. Nonetheless, compared to the planned analyses,

this change implies that the conducted analyses reflect a more ecologically valid test where

communication competes with attention, as is the case in real-world communication settings.

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Figure 1. Predicted Vaccine Support Across All Experimental Conditions and Samples.

Notes. Ns = 3,436 (United States) and 3,427 (Denmark). Predicted values are calculated using OLS

regression to regress Vaccine Support on the two-way interaction between the two experimental

factors. Vaccine Support is coded between 0 and 1. Whiskers represent 95 % confidence intervals.

13
Results

Does transparent positive information about a COVID-19 vaccine increase vaccine support? Yes.

Consistent with Prediction 1, Transparent Positive Information relative to Vague Information

significantly increases vaccine support overall (b=.07, p<.001) and in both the United States (b=.09,

p<.001) and Denmark (b=.06, p<.001). Figure 1 provides predicted values from regression analyses

on the basis of the entire 3×3 factorial experimental design and as is evident support for the

transparently described COVID-19 vaccine is higher across all samples and other conditions.

Does transparent negative information about a COVID-19 vaccine increase vaccine support?

No. Against Prediction 2, Transparent Negative Information relative to Vague Information decreases

vaccine support overall (b=-.02, p=.001). When the samples are assessed separately, this slight

decrease is significant in Denmark (b=-.03, p=.001) but not in the United States (b=-.01, p=.14).

Does transparent positive information about a COVID-19 vaccine inoculate against

conspiratorial information? No. As a first step, we observe that the Conspiracy Induction decreases

Vaccine Support significantly (b=-.02, p=.002), compared to the average of the other conditions in

the second experimental factor. Subsequently, we regress Vaccine Support on the two-way interaction

between the Transparent Positive Information condition and the Conspiracy Induction, excluding

participants who were exposed to the Transparent Negative Information condition or the Certainty

Induction. Against Prediction 3, there is no evidence that transparent information relative to vague

information significantly diminishes the effect of the Conspiracy Induction overall (b=-.01, p=0.61)

nor in United States (b=.001, p=0.95) or Denmark (b=-.02, p=0.40).

Does transparent negative information about a COVID-19 vaccine inoculate against

conspiratorial information? No. Specifically, we regress Vaccine Support on the two-way interaction

between the Transparent Negative Information condition and the Conspiracy Induction, excluding

participants who were exposed to the Transparent Positive Information condition or the Certainty

14
Induction. Against Prediction 3, there is no evidence that transparent negative information relative to

vague information significantly diminish the effect of the conspiracy induction overall (b=.02, p=.18)

neither in United States (b=.04, p=.08) nor in Denmark (b=-.01, p=0.53).

Does health communication that acknowledges uncertainty buffer against the negative effects

of negative transparent communication? No. As a first step, we observe that the Certainty Induction

significantly increases Vaccine Support (b=.02, p<.001) compared to the average of the other

conditions in the second experimental factor. Subsequently, we regress Vaccine Support on the two-

way interaction between the Transparent Negative Information condition and the Certainty Induction,

excluding participants who were exposed to the Transparent Positive Information condition or the

Conspiracy Induction. Against Prediction 4, there is no evidence that the Certainty Induction

significantly diminishes the negative effect of Transparent Negative Information relative to Vague

Information overall (b=.001, p=.94) nor in United States (b=.02, p=0.26) or Denmark (b=-.02,

p=0.30). Similar results are obtained when the Transparent Information condition is examined rather

than the Transparent Negative Information condition (bOverall=-.02, p=0.20; bUS=-.01, p=.79; bDK=-

.04, p=0.08).

What individual differences drive vaccine skepticism? Turning to exploratory analyses, we

analyze the bivariate associations between our individual difference measures and Vaccine Support.

Specifically, we regress Vaccine Support on each of the individual difference measures in separate

bivariate regression models for each sample and measure. We pool the results across all experimental

conditions. The results are shown in Figure 2. The results show that vaccine skepticism is not driven

by a Need for Cognitive Closure (bUS=-.001, p=.63; bDK=-.001, p=.65) nor by concerns related to the

realist threats from COVID-19 (bUS=-.004, p=.30; bDK=-.003, p=.46). There is only little evidence

that people on the ideological (bUS=-.009, p=.02; bDK=-.009, p=.02) or electoral (bUS=-.01, p=.63;

bDK=-.02, p=.002) right-wing respondents are less supportive of the COVID-19 vaccine. Nor

15
demographics are consistently important: Being female is inconsistently related to vaccine support

across the countries (bUS=-.05, p<.001; bDK=.03, p<.001). In United States, there is some evidence

that education is important (bUS=.02, p<.001; bDK=.01, p=.04) and, in Denmark, age is a relatively

strong predictor (bUS=.01, p<.05; bDK=.04, p<.001). Overall, however, the key drivers of vaccine

skepticism are concerns about the symbolic threats from COVID-19 (e.g., its potential impact on

democratic freedoms; (bUS=-.04, p<.001; bDK=-.06, p<.001) and, in particular, a general distrust of

the political system reflected in the variable of political cynicism (bUS=-.04, p<.001; bDK=-.07,

p<.001). Overall, political cynicism is the strongest predictor of vaccine skepticism across the United

States and Denmark. In Appendix Figure A3, we replicate these finding when we assess the bivariate

correlations for each of the pre-registered dependent variables.

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Figure 2. Associations Between A Range of Individual Differences and Vaccine Support.

Notes. N= 3,427 for all US analyses, except Vote where N = 2,079. N = 3,436 for all Danish analyses,

except Vote where N = 3,004. Associations reflect unstandardized OLS regression coefficients

calculated from bivariate regressions. All correlates, except for the female and vote dummies, are

centered on their mean with standard deviation 1. Higher values on Ideology and Vote Choice equals

more right-wing ideology and vote choice, respestively. Whiskers represent 95 % confidence

intervals.

17
Does the transparency and negativity of vaccine information moderate the association between

political cynicism and vaccine support? On the basis of the analyses of individual difference, we

examine whether the strength of the association between the most predictive individual difference

i.e., political cynicism and vaccine support is influenced by vaccine communication. Specifically, we

regress Vaccine Support on the two-way interaction between political cynicism and the conditions of

the first experimental factor separately for each country. To zoom in on the effects of the descriptions

provided in the first set of experimental conditions, we only include respondents in the Control

condition of the second experimental factor. The results are shown in Figure 3. The analyses show

that the association between political cynicism and vaccine support does not differ significantly

across conditions in Denmark. In the United States, however, political cynicism is significantly less

associated with vaccine support when Americans are exposed to transparent positive information

relative to both transparent negative information (b=.04, p=0.04) and vague positive information

(b=.05, p=0.006).

Does vaccine support differ across countries? Yes. As a final exploratory analysis, we

examine whether vaccine support is significantly higher in one of the countries. Specifically, we

regress Vaccine Support on the dichotomous country variable, pooling across all experimental

conditions. This analysis reveals that there is a sizeable and significant difference in vaccine support

corresponding to an effect size r=.27 (p<.001) with Danes being more supportive of the potential

COVID-19 vaccine. Consistently with the identified role of political cynicism, Danes are also, on

average, significantly less cynical than Americans, corresponding to an effect size of r=-.37 (p<.001).

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Figure 3. Associations Between Political Cynicism and Vaccine Support Across

Communication Types About the COVID-19 Vaccine.

Notes. Ns = 3,436 (United States) and 3,427 (Denmark). Entries are unstandardized OLS regression

coefficients calculated from models where Vaccine Support is regressed on the two-way interaction

between experimental condition and Political Cynicism. All variables range between 0 and 1.

Whiskers represent 95 % confidence intervals.

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Discussion

Against widespread hopes among health authorities, researchers and vaccine developers, the present

results demonstrate that transparency is not sufficient to reduce skepticism about a COVID-19

vaccine. First, transparency does not in itself decrease skepticism about a COVID-19 vaccine. This

is only the case when the transparent communication discloses that the features of the COVID-19

vaccine in terms of effectiveness and safety is on par with one of the most widely used vaccines, the

flu vaccine. Second, the negative effects of transparently describing a less effective and less safe

vaccine cannot be buffered by additional health communication that acknowledges public uncertainty

and describes the steps taken to increase certainty. Third, we found no empirical evidence for the

central hope among those stressing the importance of transparency: That transparency in itself

inoculates against conspiracy-based counter-communication misinformation.

At the same time, the present results clearly buttress the concern among health authorities,

researchers and vaccine developers that conspiracy-based vaccine skepticism is a fundamental

challenge towards reaching herd immunity against COVID-19 via vaccinations. Thus, the largest

predictor of vaccine skepticism in both the United States and Denmark was individual differences in

political cynicism, i.e., beliefs that political elites are corrupt and incompetent. Individual differences

in the ability to manage uncertainty, in contrast, did not significantly relate to vaccine skepticism

despite the fact that much of the theoretical argument for the importance of transparency revolves

around this exact concept.

These findings on individual differences may also explain another observation: The small

causal effects of health communication observed in the present findings. Even a considerable change

in transparently-described effectiveness and vaccine safety (compared to vague positivity) only

increased vaccine support with, on average, 7 percentage points. This small effect could reflect, first,

that skepticism is not, in fact, driven by feelings of uncertainty and, second, that it is difficult to reach

20
politically cynical citizens via communication. If these segments do not trust the authorities, they will

also not trust the content of their communication and, hence, assess the vaccine more on the basis of

their cynical predispositions than on the basis of the features of the vaccine. A potential silver lining,

however, is the observation that in the United States, where both cynicism and vaccine skepticism is

higher, transparent and positive information about a potential vaccine did, in fact, turn the association

between cynicism and vaccine skepticism insignificant.

These findings notwithstanding, the present findings also clearly speak against

communicating about future COVID-19 vaccines in positive but vague terms. Participants in the

present study thus reacted just as negatively towards vague, positive communication as they did

towards clear communication that revealed the negative attributes of a vaccine. Furthermore, support

for vaccines described in positive but vague terms was highly associated with beliefs related to

political cynicism. In a nutshell, people seem to assume that vague language, even if positive, serves

as an attempt to hide away a negative set of vaccine attributes. Finally, it is relevant to note that when

the two transparently-described vaccines are directly compared (see Appendix Table A1), the

estimated difference in vaccine support amounts to an average of 14 percentage points when

respondents that failed the attention check has been excluded, but only 9 percentage points when all

respondents are included. If communication about the characteristics of a vaccine does in fact reach

citizens, this suggests that these characteristics can have a substantial impact on vaccine uptake.

Overall, these results underscore that transparency is necessary but not sufficient to reduce

vaccine skepticism. The results highlight that both transparent communication and the exact features

of future COVID-19 vaccines are crucial from the perspective of securing public support for potential

COVID-19. While health communicators and authorities have little influence over the attributes of

the vaccines on offer, the findings, first, highlight the importance of vaccines with significantly

positive attributes in terms of effectiveness and safety and, second, the importance of communicating

21
clearly and transparently about these attributes. Yet, even as very positive news about the vaccines is

currently being announced (Cohen, 2020), the present findings will be a cause of concern for health

authorities and health communicators across the world. The pandemic has been a catalyst of political

polarization and protest across a large number of countries (Bartusevičius et al., 2020). If the

management of the pandemic has eroded political trust in specific countries, the present findings such

that the arrival of the vaccine will not bring an automatic end to their troubles. Instead, these countries

will now face an uphill battle to beat distrust-based skepticism of the vaccines and, according to the

present results, the main available tool of health communication has little power of the truly skeptical.

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25
 APPENDIX

for

"Transparency Is Necessary but Not Sufficient to Reduce

Conspiracy-Based Skepticism About a COVID-19 Vaccine"

Contents
A1. Wording of Experimental Conditions ........................................................................................... 2
A2. Measures ....................................................................................................................................... 4
Table A1. Predicted Vaccine Support. Comparing Transparent Negative and Transparent Positive
Information and Inclusion and Exclusion of Respondents with Failed Attention Checks. ................. 6
Figure A1. Predicted Vaccine Support Across Experimental Conditions. Pooled Samples and
Exclusion of Respondents with Failed Attention Checks. ................................................................... 7
Figure A2. Predicted Vaccine Support Across Experimental Conditions with Pooled Samples. ....... 8
Table A2. Overview of Regression Analyses Underlying Figure 1 and Figure A2 .......................... 10
Figure A3. Bivariate Correlations in Pooled Samples Between Various Codings of Vaccine Support
(Pre-Registered and Not) and Individual Differences........................................................................ 11

1
A1. Wording of Experimental Conditions

Intro Text
Imagine that the US health authorities approve a new vaccine against COVID-19 next year. We
will call the vaccine COVACID.

To help you assess the new COVACID vaccine it will be compared to one of the most commonly
used vaccines: the vaccine against the common flu. Every year, almost 50 % of all Americans
receives a flu vaccine.

First Experimental Factor

Transparent Negative Vague Positive Transparent Positive
Condition Condition Condition
1. Protection: A flu vaccine 1. Protection: A flu vaccine 1. Protection: A flu vaccine
protects about 70 out of 100 protects about 70 out of 100 protects about 70 out of 100 who
who receive the vaccine. It who receive the vaccine. It receive the vaccine. It protects
protects young and healthy protects young and healthy young and healthy people better
people better than older and people better than older and than older and vulnerable people.
vulnerable people. vulnerable people.
The health authorities have not
COVACID offers less COVACID offers the same disclosed exact information about
protection against COVID- level of protection against how effective the COVACID
19. This means that 50 out COVID-19. This means that vaccine is, but they state that it is
of 100 obtain effective 70 out of 100 obtain effective sufficiently effective.
protection. protection.
2. Side effects: The side effects of
2. Side effects: The side 2. Side effects: The side a flu vaccine are mainly mild or
effects of a flu vaccine are effects of a flu vaccine are moderate. The most common side
mainly mild or moderate. mainly mild or moderate. The effects are soreness of the
The most common side most common side effects are injection site. Less common side
effects are soreness of the soreness of the injection site. effects are discomfort, fever and
injection site. Less common Less common side effects are muscle pain, which normally
side effects are discomfort, discomfort, fever and muscle disappear within 1-2 days without
fever and muscle pain, pain, which normally treatment. Serious side effects like
which normally disappear disappear within 1-2 days respiratory problems are rare and
within 1-2 days without without treatment. Serious may happen to 1 out of 10,000.
treatment. Serious side side effects like respiratory
effects like respiratory problems are rare and may The health authorities have not
problems are rare and may happen to 1 out of 10,000. issued information on the exact
happen to 1 out of 10,000. side effects of COVACID but
COVACID implies the same note that the side effects are
COVACID implies a greater risk of side effects. This considered acceptable.
risk of side effects. This means that, for example, 1
means that 1 out of 1,000 out of 10,000 may experience 3. Test period: Vaccines are
may experience serious side serious side effects such as normally tested over an extended
effects such as respiratory respiratory problems. period in order to reveal both
problems. short- and long-term side effects.
New vaccines are normally tested

2
 3. Test period: Vaccines are
normally tested over an
extended period in order to
reveal both short- and long-
term side effects. New
vaccines are normally tested
for one year or more before
being approved.
3. Test period: Vaccines are
normally tested over an
extended period in order to
reveal both short- and long-
term side effects. New
vaccines are normally tested
for one year or more before
being approved.
for one year or more before being
approved.
The health authorities have not
disclosed the exact degree to
which long-term side-effects are
known but note that the temporal
perspective is adequate.

COVACID has been tested COVACID has undergone a

for a shorter period. normal test period. Therefore,
Therefore, only side effects side effects up to one year are
up to six months are known. known.

Second Experimental Factor

Control Induction Certainty Induction
[No text] 4. Vaccine trial certainty: To
obtain an exact image of the
side effects of a vaccine,
vaccines are tested on a large
group of people before being
approved. Flu vaccines are
normally tested on 5,000
people.
It is normal that people will
be unsure about a new and
quickly developed vaccine.
COVACID has therefore
been tested on 50,000 people,
or 10 times as many as
normally. This is done to
obtain a very precise image of
the vaccine despite the
conditions during the
pandemic.
Conspiracy Induction
After approval of COVACID,
there has been considerable public
debate about the vaccine and the
transparency of the authorities’
information. On social media
people have argued, among other
things, that “the authorities
attempt to force a vaccine on us
and hide all relevant facts about it.
They lie about all its side effects
to stimulate the economy. Once
again, the power-greedy elite
demonstrates its complete
disregard for ordinary Americans’
health and safety.”

3
A2. Measures

Vaccine Support

Based on the description of COVACID on the previous screen, to what extent do you agree with the
following statements? We know that it may be difficult to answer the questions based on the
description and we therefore ask you to simply answer the first answer that comes to mind.
1. I support the health authorities’ approval of COVACID.
2. I do not think COVACID should have been approved.
3. I would encourage health staff to get vaccinated against COVID-19.
4. I would encourage people who are particularly vulnerable to COVID-19 to get vaccinated with
COVACID.
5. I would encourage close relatives to get vaccinated.
6. I would get vaccinated with COVACID if my GP recommended it.
7. I think most people would feel safe getting a COVACID vaccine.
8. I would not feel safe getting a COVACID vaccine.
9. I would need to get more information on COVACID before deciding whether to get vaccinated.
10. I feel well informed about COVACID.
11. I feel that the authorities are withholding important information about COVACID.
12. I think the authorities are lying about COVACID.

Response scales are seven-point scales with the following anchors: "Strongly disagree" (1),
"Neither disagree nor agree" (4), "Strongly agree" (7).

For the preregistered variables, items 1+2 underlie Approval, items 3-6 underlie Use, items 7+8
underlie Safety, items 9+10 underlie Information and items 11+12 underlie Conspiracies. Items are
reversed as appropriate.

Manipulation checks

How much do you disagree or agree with the following statements?

1. The description of the COVACID vaccine was more negative than the description of a
regular flu vaccine.
2. The description of the COVACID vaccine was more vague than the description of the
regular flu vaccine.

Response scales are seven-point scales with the following anchors: "Strongly disagree" (1),
"Neither disagree nor agree" (4), "Strongly agree" (7).

Attention checks

How many achieved effective protection against COVID-19 with the COVACID vaccine?

1. 50 out of 100
2. 70 out of 100
3. 90 out of 100

4
4. Don’t know / don’t remember

How many experienced serious side effects of the COVACID vaccine?

1. 1 out of 1000
2. 1 out of 10,000
3. 1 out of 100,000
4. Don’t know / don’t remember

How long was the test period for the COVACID vaccine?

1. Six months
2. One year
3. Eighteen months
4. Don’t know / don’t remember

5
Table A1. Predicted Vaccine Support. Comparing Transparent Negative and Transparent

Positive Information and Inclusion and Exclusion of Respondents with Failed Attention

Checks.

(1) (2)
Respondents Excluded All Included
***
Transparent Positive 0.139 (0.008) 0.094*** (0.006)
***
Constant 0.501 (0.006) 0.512*** (0.004)
Observations 2920 4583
2
R 0.090 0.047
Notes. Entries are unstandardized regression coefficients from OLS regression analysis with
standard errors in parentheses. Baseline condition is "Transparent Negative Information". All
variables are scored between 0 and 1. * p < 0.05, ** p < 0.01, *** p < 0.001

6
Figure A1. Predicted Vaccine Support Across Experimental Conditions. Pooled Samples and

Exclusion of Respondents with Failed Attention Checks.

Control Conspiracy Induction Certainty Induction

US + DK US + DK US + DK

Transparent
Positive

Vague

Transparent
Negative

0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1

Notes. N = 5,200. Respondents who failed the attention check in the Transparent Positive and
Transparent Negative Conditions have been removed. No respondents have been removed from the
Vague Condition. Predicted values are calculated using OLS regression to regress Vaccine Support
on the two-way interaction between the two experimental factors. Vaccine Support is coded between
0 and 1. Whiskers represent 95 % confidence intervals.

7
Figure A2. Predicted Vaccine Support Across Experimental Conditions with Pooled Samples.

A. Dependent variable: Support of Vaccine Approval

Control Conspiracy Induction Certainty Induction

US + DK US + DK US + DK

Transparent
Positive

Vague

Transparent
Negative

0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1
Support of Vaccine Approval

B. Dependent variable: Support of Vaccine Use

Control Conspiracy Induction Certainty Induction

US + DK US + DK US + DK

Transparent
Positive

Vague

Transparent
Negative

0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1
Support of Vaccine Use

C. Dependent variable: Feelings of Safety About Vaccine

Control Conspiracy Induction Certainty Induction

US + DK US + DK US + DK

Transparent
Positive

Vague

Transparent
Negative

0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1
Feelings of Safety About Vaccine

8
E. Dependent variable: Feeling of Having Sufficient Vaccine Information
Control Conspiracy Induction Certainty Induction

US + DK US + DK US + DK

Transparent
Positive

Vague

Transparent
Negative

0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1
Feeling of Sufficient Vaccine Info

F. Dependent variable: Endorsement of Conspiracy Beliefs about the Vaccine

Control Conspiracy Induction Certainty Induction

US + DK US + DK US + DK

Transparent
Positive

Vague

Transparent
Negative

0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1 0 .2 .4 .6 .8 1
Endorsement of Conspiracies About Vaccine

Notes. Ns = 3,436 (United States) and 3,427 (Denmark). Predicted values are calculated using OLS

regression to regress each of the five pre-registered dependent variables on the two-way interaction

between the two experimental factors. Dependent variables are coded between 0 and 1. Whiskers

represent 95 % confidence intervals.

9
Table A2. Overview of Regression Analyses Underlying Figure 1 and Figure A2

Model (1) (2) (3) (4) (5) (6)

Vaccine
DV Support Approval Use Safety Information Conspiracies
(overall)
-0.027* -0.040** -0.041** -0.037** -0.000 0.004
Transparent Negative
(0.011) (0.014) (0.014) (0.013) (0.013) (0.015)
0.083** 0.112*** 0.081*** 0.082*** 0.082*** -0.063***
Transparent Positive
(0.011) (0.014) (0.014) (0.014) (0.013) (0.016)
-0.013 -0.006 -0.018 -0.010 -0.006 0.021
Conspiracy Induction
(0.011) (0.013) (0.015) (0.014) (0.013) (0.015)
0.023* 0.044** 0.017 0.014 0.018 -0.026
Certainty Induction
(0.011) (0.013) (0.014) (0.013) (0.013) (0.015)
Transparent Negative ´ 0.021 0.021 0.021 0.021 0.002 -0.038
Conspiracy Induction (0.016) (0.019) (0.020) (0.019) (0.018) (0.021)
Transparent Negative ´ 0.001 -0.003 0.010 0.006 -0.008 0.009
Certainty Induction (0.016) (0.019) (0.020) (0.019) (0.018) (0.022)
Transparent Positive ´ -0.008 -0.025 -0.004 -0.015 -0.004 -0.004
Conspiracy Induction (0.016) (0.019) (0.021) (0.019) (0.018) (0.022)
Transparent Positive ´ -0.020 -0.033 -0.022 -0.021 -0.014 0.011
Certainty Induction (0.016) (0.019) (0.020) (0.019) (0.018) (0.022)
0.529** 0.566*** 0.611*** 0.503*** 0.358*** 0.473***
Constant
(0.008) (0.010) (0.010) (0.010) (0.009) (0.011)
Observations 6863 6863 6863 6863 6863 6863
R2 0.038 0.048 0.027 0.027 0.023 0.011
Notes. Entries are unstandardized regression coefficients from OLS regression analysis with
standard errors in parentheses. Baseline conditions are "Vague Information" and "Control" for the
first and second experimental factor, respectively. All variables are scored between 0 and 1. * p <
0.05, ** p < 0.01, *** p < 0.001

10
Figure A3. Bivariate Correlations in Pooled Samples Between Various Codings of Vaccine

Support (Pre-Registered and Not) and Individual Differences.

Vaccine Approval 0.86

Vaccine Use 0.89 0.74

Vaccine Safety 0.84 0.67 0.69

1.00
Vacine Info 0.72 0.51 0.50 0.58

Vaccine Conspiracy -0.73 -0.59 -0.48 -0.54 -0.48

0.80

Cognitive Closure -0.04 -0.04 0.06 -0.04 -0.05 0.16

0.60
Political Cynicism -0.32 -0.23 -0.22 -0.26 -0.23 0.40 0.07 0.40
Symbolic Threat -0.27 -0.21 -0.17 -0.22 -0.15 0.38 0.19 0.37 0.20
Real Threat -0.08 -0.06 0.06 -0.11 -0.18 0.18 0.17 0.22 0.40
0.00
Ideology -0.04 -0.02 -0.05 -0.02 0.05 0.09 0.10 0.05 0.25 -0.16
-0.20
Vote Choice -0.03 -0.01 -0.06 -0.00 0.07 0.05 0.01 0.09 0.19 -0.18 0.60
-0.40
Female 0.01 0.00 0.00 0.02 0.03 0.01 -0.02 0.05 0.03 0.02 0.01 -0.01

-0.60
Age 0.12 0.11 0.12 0.10 0.07 -0.07 -0.09 0.03 0.05 -0.04 0.12 0.08 0.07

-0.80
Education -0.01 -0.01 0.01 -0.03 -0.05 0.01 -0.07 0.14 -0.00 0.11 -0.11 -0.12 0.02 -0.08

-1.00
Vaccine Support

Vaccine Approval

Vaccine Use

Vaccine Safety

Vacine Info

Vaccine Conspiracy

Cognitive Closure

Political Cynicism

Symbolic Threat

Real Threat

Vote Choice
Ideology

Female

Age

11