Since the COVID-19 pandemic, there has been a decline in U.S. vaccine uptake, while widespread misinformation and distrust make it challenging to craft effective public health responses. In a new paper, University of Illinois Urbana-Champaign researchers discuss three case studies exemplifying different vaccine attitudes and behaviors. Their findings underscore the need for flexible approaches to reach diverse audiences with disease prevention strategies. 

The three cases were selected from a larger study of parents and childcare providers, conducted to investigate their experiences during the COVID-19 pandemic and their adherence to public health guidelines.

“We were looking at different clusters of responses in our data set, and we selected three individuals who represented different types of decision making for vaccine uptake. They range from distrustful and resistant, through reluctant, to accepting and adopting,“ said lead author Jacinda K. Dariotis, professor in the Department of Human Development and Family Studies and director of the Family Resiliency Center, both part of the College of Agricultural, Consumer and Environmental Sciences at Illinois. She is also a Health Innovation Professor in the Carle Illinois College of Medicine.

“We really wanted to come in from a place of curiosity and get to the heart of what motivates people. Sometimes it’s past experiences or concern for vulnerable individuals, and it can be rationally or emotionally driven. We wanted to understand people’s value system, and their risk and reward structure,” Dariotis stated.

Taking this approach to research – nonjudgmental curiosity and respect that participants are experts of their own experience – fosters trust and hearing the voices of those with non-normative beliefs and behaviors, she noted.

The research team examined three case studies: 

• The first case study is a 56-year-old divorced White female who has a 15-year-old son with special needs. She worked as a nurse when the COVID-19 pandemic began, but quit her job to avoid complying with the vaccine requirement. She believed that both she and her son had experienced adverse reactions to past vaccines, and she did not trust the safety of COVID-19 vaccines. Her spiritual belief system and community provided support for her decision not to vaccinate and to trust in the body’s natural immune system. She did, however, wear facemasks and practice social distancing.
• The second case study is a 51-year-old Black divorced female with two adult children. She is the director of a childcare center, and she is a proponent of childhood vaccines. She also received the COVID-19 vaccine but reported feeling forced due to employment mandates. She experienced health issues that she attributed to severe side effects from the vaccine, which made her more critical of these vaccines, but she still supports other vaccinations.
• The third case study is a 38-year-old married White male with four children. He works in risk management, and he is a strong proponent of vaccines. He uses data, science, and risk tolerance to guide his decisions about vaccination uptake. He and his family members all received COVID-19 vaccines and boosters as they became available. He believes that people will make rational decisions when provided with sufficient information.

“Each of these people comes from a different perspective, and we need to respect their individual decision-making processes. But it’s important to note there are also similarities across them. They all want to do what they believe to be the best thing for themselves and their families,” Dariotis stated.

There isn’t a one-size-fits-all solution to public health challenges, she noted. Understanding people’s value systems, and their risk and reward considerations, can help inform policy recommendations. Precision prevention in public health – tailored communication campaigns, services, and programs – is needed.

“Some people won’t be receptive to certain things, and that’s perfectly within their rights. There is more than one way to be protective and keep people safe. We have to look at how people want to live, what their goals and intentions are, and then help them figure out how to make that happen,” Dariotis concluded.

The researchers plan to conduct additional analyses of the dataset in forthcoming papers.

The paper, “Distrust, trauma, doubt, and protective reactions to coronavirus disease 2019: Cautionary tales and lessons to learn for future pandemics: A case report,” is published in the Journal of Medical Case Reports [DOI:10.1186/s13256-025-05162-w]. Authors include Jacinda Dariotis, Dana Eldreth, Stephanie Sloane, Iffat Noor, and Rebecca Lee Smith.