Misinformation about vaccines has real-world consequences. It can shape people’s decision about whether to protect themselves or their loved ones from vaccine-preventable diseases. And when vaccination rates fall, diseases return.
However, changing people’s minds can be difficult. Health professionals often say they lack the skills and time to handle misconceptions about vaccines. The traditional approach is to push back with facts or to give patients an information leaflet.
But there may be another way, based on decades of psychological research – and inspired by Jiu Jitsu, a martial art. Jiu Jitsu equips people to use their opponent’s force against them. By viewing vaccine misinformation as a powerful opponent, health professionals can learn to work with people’s motivations rather than against them.
What is JITSUVAX?
JITSUVAX is a 4.5-year EU project that ended last month (September 2025). It is one of several European initiatives aiming to address low vaccine uptake.
Not only have researchers published a comprehensive resource for tackling misinformation, but they have devised a training course in Empathetic Refutational Interviewing (ERI) proven to increase vaccine appointment bookings.
These tools are the result of an in-depth literature review, interviews with doctors, nurses and others, and real-world testing of the ERI approach to vaccine conversations. ERI builds on a technique called motivational interviewing and extends this to include refutation (showing that something is false, and providing an alternative, factual explanation).
Working with six established research teams, the JITSUVAX team developed what they call Empathetic Refutational Interviewing (ERI) – a technique healthcare professionals can learn and practice in the clinic. It is a more personalised and effective approach, with field tests showing a 28% increase in vaccine appointment bookings after following the ERI framework.
Dr Dawn Holford, a psychology lecturer and researcher at the University of Bristol, says health professionals can take account of an individual’s existing perspective to ensure the patient absorbs and retains an updated view on immunisation. In practice, this means understanding the core drivers – or attitude roots – of a patient’s reluctance to have recommended vaccines and engaging with them on their own terms.
‘Rather than providing information [alone], the ERI takes an empathetic approach, using people’s motivations and tailoring counter-arguments to align with what a person feels,’ says Dr Holford. ‘For example, their arguments may be rooted in fear or morality or in their perception of risk. Effective refutation is about more than sharing facts; it must be something that sticks in the memory.’
4 Simple Steps to Better Vaccine Conversations
- Elicit concerns
- Affirm the person
- Correct misconception
- Inform with facts
The Empathetic Refutational Interview (ERI) provides a clear path to engaging with patients about vaccination – particularly if the patient has adopted misconceptions that shape their decision-making.
The healthcare professional begins by asking open questions and actively listening to the answer. This helps to identify the root of the belief. The crucial next step is to offer some affirmation to build trust: There may be a grain of truth in what the patient is saying, even if they have combined it with incorrect information or reached a conclusion not grounded in evidence.
Misconceptions can then be addressed in a personalised manner, based on the fundamental attitude root or outlook that’s driving the patient’s decision-making. A healthcare professional would then correct the misinformation and provide facts.
JITSUVAX researchers piloted the training package last year in which they teach the principles of ERI and then give healthcare professionals an opportunity to practice what they have learned. A new not-for-profit social enterprise will take the training work forward, ensuring that JITSUVAX has a legacy that goes beyond the lifetime of the EU-funded project.
Alongside the ERI training programme, JITSUVAX has published a freely-available vaccine attitudes resource to help guide vaccine conversations. The tool allows users to browse 11 attitude roots that underpin anti-vaccine sentiment.
For example, click on ‘unwarranted beliefs’ to see a range of specific issues people sometimes raise when pushing back against a vaccine recommendation. From there, read about where this thinking comes from, and choose a theme – such as overmedicalisation or nature is best. For each of these 60 themes, the site explains why someone may feel this way; whether there is any truth in what they are saying; and what to say to a patient who is fixated on this belief.
Because empathy is so important, JITSUVAX offers a calm and reasoned approach to meeting the patient where they are. For example, a healthcare professional can frame vaccination as a way to support the body’s natural immune system while acknowledging that many modern medicines originated from natural remedies. ‘Vaccinations are nature at its best,’ as the site puts it.
‘Once a healthcare professional listens to the patient’s concerns, they can acknowledge the truth of what they are saying,’ Dr Holford says. ‘This builds trust and allows them to refute the misconception.’
In some instances, this may involve thinking through a problem together so that the individual feels respected. Crucially, when refuting a falsehood, the health professional must offer an accurate, relatable explanation that addresses the patient’s concern.
The ERI has been shown to build trust and – unlike more confrontational approaches to handling anti-vaccine arguments – has a low risk of damaging the doctor-patient relationship. After all, a GP or nurse may hope their patient protects against flu or measles, but they might also need to manage that individual’s diabetes, blood pressure or mental health.
‘The goal is trust,’ Dr Holford explains. ‘It’s not a one shot thing. If the patient is not ready [to book a vaccine appointment] at the end of the conversation, that’s okay. They might come back to discuss it again, and that’s a positive outcome in itself.’
While it may take longer than reciting facts or handing out leaflets, ERI supports ongoing dialogue, creating opportunities for further discussion. ‘It takes as long as you’ve got, even if it’s just a couple of minutes,’ she told Vaccines Today. ‘It’s not the end of the conversation. If you hand over a leaflet and the patient is turned off, they won’t want to repeat the experience. It’s better to show you are making a good faith effort to understand the patient’s position.’
Explore more:
- Discover – JITSUVAX
- Vaccine misinformation: how to tackle the ‘infodemic’ – VaccinesToday
- How local communities shaped ‘Cranky Uncle Vaccine’ game
