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Randomized Controlled Trial
. 2025 Aug 18;15(1):29830.
doi: 10.1038/s41598-025-09462-5.

Psychological inoculation improves resilience to and reduces willingness to share vaccine misinformation

Ruth E Appel  1 , Jon Roozenbeek  2   3 , Rebecca Rayburn-Reeves  4 , Melisa Basol  5 , Jonathan Corbin  4 , Josh Compton  6 , Sander van der Linden  5
Affiliations
Randomized Controlled Trial

Psychological inoculation improves resilience to and reduces willingness to share vaccine misinformation

Ruth E Appel et al. Sci Rep. .

Abstract

Vaccine misinformation endangers public health by contributing to reduced vaccine uptake. We developed a short online game to reduce people's susceptibility to vaccine misinformation. Building on inoculation theory, the Bad Vaxx game exposes people to weakened doses of manipulation techniques commonly used in vaccine misinformation and to strategies to identify these techniques. Across three preregistered randomized controlled trials (N = 2,326), we find that the game significantly improves participants' ability to discern vaccine misinformation from non-misinformation, their confidence in their ability to do so, and the quality of their sharing decisions. Further, taking the perspective of a character fighting as opposed to spreading misinformation is more effective on some outcome measures. In line with the learning goals of the intervention, we show that participants improve their ability to correctly identify the use of specific misinformation techniques. This insight is important because teaching manipulation technique recognition is not only effective to help evaluate information about vaccines, but also more viable than trying to debunk myriads of constantly-evolving myths. Our findings suggest that a short, low-cost, gamified intervention can increase resilience to vaccine misinformation.

Keywords: Gamification; Inoculation theory; Misinformation; Technique recognition; Vaccine.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: All experimental protocols were approved by the Stanford University Institutional Review Board (protocol number 59740), the Cambridge Psychology Research Ethics Committee (application numbers PRE.2021.010, PRE.2021.065), and the Duke University Campus Institutional Review Board (protocol number 2021–0209). Consent to participate: Informed consent was obtained from all participants. Consent for publication: Participants consented to their data being used for research publications.

Figures

Fig. 1
Fig. 1
Game characters: The four characters that represent the misinformation addressed strategies throughout the game.
Fig. 2
Fig. 2
Game user interface: User interface of the Bad Vaxx game used for the experiments.
Fig. 3
Fig. 3
Cohen’s d by treatment and outcome from a network meta-analysis across Studies 1 to 3: Forest plot for a network meta-analysis of all outcome measures.
Fig. 4
Fig. 4
Manipulation technique recognition in Study 3: Overall and pairwise comparison of the effect of the Bad Vaxx game on Manipulation Technique Recogni- tion.
Fig. 5
Fig. 5
Experiment design overview.
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