order to create a virtuous cycle where increasing take-up shifts norms and encourages more take-up. The fact the social norms treatment’s effects were primarily to be found in subsets of the survey sample (particularly women) suggests there is scope for developing more effective normative appeals. It is possible that different types of information may be more effective in transmitting a norm-based message, and there is a strong case for further research in this area. However, it may well be that some sectors of the population will ultimately need to see firsthand their family, friends and others in their community receiving the vaccine before norms become truly effective in shaping attitudes. Although this would be a discouraging finding for those who hope to use information interventions to help increase vaccine uptake, it would be a positive finding in another sense: vaccinating those who are already willing to be vaccinated may itself help to change the attitudes of others as they see their fellow community members safely taking the vaccine.

Thirdly, health workers have a prominent role to play in increasing people’s willingness to receive a vaccine for COVID-19. The phone survey illustrated that around 80 percent of respondents said they would be more willing to get the vaccine if health workers recommended it, which is a much higher share of respondents than those that would listen to the recommendations of others, such as family and friends or religious leaders. Importantly, the phone survey showed that the way people would like to receive this information is face to face, suggesting that communication from local health workers will have the biggest influence on people’s take-up of the vaccine. In addition, the online experiment’s results, and the failure of Treatment A, which presented the views of “national and international experts”, strongly suggest that generic advice from experts will not serve as an adequate substitute for specific matter of fact advice received from trusted local health workers. One potential complicating factor facing authorities is that vaccine hesitancy is comparatively high among health workers (Pogo et al., 2021). This suggests that high priority should be given to educating local health workers about the benefits of the COVID-19 vaccine (including the low risk of side effects) so they can become advocates in their community for vaccination.

While the focus of this paper is on vaccine hesitancy and the potential for communications to increase vaccine take-up, it is important to acknowledge that individual-level decisions around vaccine take-up represent only one barrier to vaccination. Structural barriers, such as travel time to a facility, ability to take time off work to recover from side effects, and logistical challenges involved in planning and scheduling vaccinations are an important impediment. Historically marginalized populations, including poor and rural communities, may express low COVID-19 vaccination intentions due to their assumptions about how these structural factors impact their access; thus policies should explicitly address how they will overcome these issues.

# <u>6.2 Issues that are unlikely to be major contributions to vaccine hesitancy</u>

This study illustrates that three areas that are often cited as contributing to vaccine hesitancy may play less of an instrumental role than commonly thought. First, misinformation about COVID-19 on social media does not appear to be a major driver of vaccine hesitancy in PNG, despite misinformation being present online. The phone survey showed that the vast majority of respondents did not rely on the internet as their main or most trusted source of information about the COVID-19 vaccine. In addition, there was no relationship between willingness to get the vaccine and relying on the internet as a trusted source of information about the COVID-19 vaccine. Therefore, these results suggest that it is likely other factors are driving widespread vaccine hesitancy. As such, policy makers both within the government 24