Dr. Dawn Holford stood at the threshold of a simple but powerful insight: when health workers listen with genuine empathy before correcting misinformation about vaccines, people listen back. This discovery has now become the foundation of a new social enterprise scaling across the United Kingdom to transform how vaccine conversations happen.
The spinout, called JITSUVAX Training, emerged from years of research at the University of Bristol into a deceptively elegant question: what actually drives vaccine hesitancy, and how can we overcome it? The answer has emerged through rigorous science and is now reshaping how health workers approach their most difficult conversations.
At the heart of the breakthrough is an approach called the empathetic refutational interview, or ERI. Dr. Holford's international study, published in Public Health journal, found that nearly 70 percent of vaccine-hesitant participants preferred empathetic engagement from health care professionals over being simply presented with facts. That margin of preference—nearly two-thirds favoring the listening-first method—became the moral and scientific case for training.
ERI works through four key steps: eliciting a person's specific concerns, affirming them as an individual, correcting misconceptions, and then informing with facts. Underlying all of it is an understanding of what researchers call "attitude roots"—the psychological drivers that make someone hesitant in the first place. It's the difference between dismissing someone's worry and actually understanding it.
When the University of Bristol and Dr. Emma Anderson, a chartered health psychologist, piloted the training across London in 2024, more than 100 health workers—nurses, midwives, and other vaccination professionals—participated. The results were striking. Before training, health workers reported being "somewhat confident" in these conversations. Afterward, they described themselves as "highly confident." Knowledge of the ERI framework nearly doubled, from 37 percent to 76 percent. Most remarkably, the proportion of health workers demonstrating genuine empathy and rapport-building skills tripled.
"There was strong demand for the training across London, drawing in a wide range of health professionals, and it was clear how much they valued being able to respond to different vaccination concerns in a more tailored way, so people feel listened to," said Dr. Leonora Weil, who led the program as Director at the NHSE London Legacy and Health Equity Partnership. In follow-up surveys, most respondents reported actually using what they'd learned when talking with patients.
The timing matters. Childhood vaccination coverage has declined gradually over the past decade nationally and internationally. Recent measles outbreaks have underscored the consequences. Yet instead of lecturing people harder, this research suggests a different path: meeting hesitancy with genuine psychological insight and human connection.
Dr. Holford reflected on what came next: "Some health workers also tried to pass on skills they learned to other colleagues, but said they had limited capacity to teach others, which highlighted the need for a more sustainable solution to keep the training going." That observation sparked the creation of JITSUVAX Training as a non-profit social enterprise launched in summer 2024, now offering ERI training nationwide to local authorities and NHS services.
What began as university research into why people distrust vaccines has become a scalable system for changing minds—not through coercion, but through the simple power of being truly heard.