“What Do I Need to Say to Make You Trust Me?”

Influences of Competing Permission Structures on COVID-19 Vaccination Decision-Making

Abstract

The COVID-19 pandemic has transformed digital health communication, particularly on social media, where individuals increasingly engage in public negotiation over vaccination decisions. Drawing from a multi-year study of social media and interview data, this manuscript identifies how four dominant permission structures—vaccination as social responsibility, economic imperative, personal freedom, and method of institutional control—have both facilitated and constrained vaccination decision-making and communication practices. Based on these findings, this manuscript provides actionable strategies for tailoring public health messages to align with audience values, such as community care, economic recovery, or personal autonomy, while avoiding framings that may inadvertently exclude, alienate, or disenfranchise marginalized groups in matters of personal and public health.