“The best thing to do is to get as many people vaccinated as quickly as possible,” said immunologist Anthony Fauci, , the director of the National Institute of Allergy and Infectious Diseases and the chief medical adviser to the United States president, of achieving herd immunity.
Early on during Covid-19 vaccine trials, surveys showed that more than two-thirds of adults globally said they were willing to get the jab when a vaccine became available. In South Africa one poll showed similar results, yet so far only about 32% of the population have actually followed through with getting at least one vaccine dose.
There is some good news, though.
Many people described as “vaccine hesitant” are not outright resistant to getting the jab, but are simply waiting for the right nudge, according to a report in the New England Medical Journal. Of the almost 140 000 people surveyed, 40% had already been vaccinated and 11% were hardline refusers, who said they were very unlikely to get the jab. This means close to half of the sample were sitting on the fence.
Here are six things to consider to help turn the “vaccine ready” into go.
1. Know who you’re talking to
To persuade people to get vaccinated, messages have to be tailored for the intended audience.
For example, a study in the United Kingdom showed that people who are vaccine ready and actively looking to get the shot may be receptive to messages about the public health benefits of being vaccinated — meaning they want to get vaccinated to protect themselves and others. In contrast, people who are hesitant appear to be less interested in the greater good and respond better to learning what’s in it for them.
A 2021 study in the United States had a similar result. Messages focused on personal benefits were more effictive in convincing people to get vaccinated.
2. Get the word out — quickly
A study published in the journal Nature in August found that the timing of vaccine messages can boost appointments and subsequent vaccinations. In this study, participants in the US were randomly assigned to one of two groups and were then sent a text message inviting them to schedule their vaccine appointment shortly after they became eligible to register.
One group received the message one day after they became eligible for getting their shot and the other group got the message eight days after they could make an appointment. Both messages included a link to a website allowing the recipients to book vaccine appointments. The earlier prompt nudged 1.5 times as many people to make appointments than the later one.
Simply making the booking also boosted follow-through. Nearly 90% of participants who made a booking after receiving the nudge kept their appointments — and almost everyone who received their first dose also booked for their second.
This points to the importance of encouraging people to schedule their first shot. A similar trend was seen in an earlier study designed to boost uptake of the flu vaccine. Vaccination reminders sent to people before their regular, unrelated primary healthcare visits increased vaccination rates by 5%.
3. Allay people’s fears — first with empathy, then with evidence
The flip side of the unprecedented speed with which Covid-19 vaccines were rolled out is that it has contributed to questions being raised about their safety.
Studies about people’s attitudes towards vaccines, from countries as diverse as Jordan and the US, show that fears about ingredients, safety and what many perceive as rushed approval processes deter people from getting vaccinated.
Inadequate data and a general lack of transparency about Covid-19 vaccine trials, coupled with murky procurement agreements between governments and pharmaceutical companies, further fuel reluctance to get the shot.
Although there is overwhelming evidence that the vaccines are safe and effective, it is important to acknowledge that people’s fears are valid. Showing empathy when talking to people who are reluctant or uncertain may help to make them more receptive to balanced, evidence-based messages.
It’s equally important to be honest about issues such as the common occurrence of minor side-effects — and to use evidence to contextualise the extremely rare risk of severe side-effects. For instance, the scaremongering media coverage about blood clots developing after getting the Johnson & Johnson (J&J) or AstraZeneca vaccine created the impression that blood clots occur far more often than what they actually do.
International medicine regulators’ investigations showed that the risk of developing a blood clot after getting the jab was very low — less than one in a million for J&J and between four and six in a million for AstraZeneca. Typically a very rare adverse event after taking a medicine is defined as affecting fewer than one in 10 000 people, but in this case the chances of developing blood clots were deemed really slim, and the vaccines were cleared for use after the temporary pause.
4. Don’t be afraid to drop a name or two
If Elvis could do it, so can you.
In 1956, the then rising rock ’n’ roll star Elvis Presley appeared on public television getting his polio shot at a time when vaccine uptake was precariously slow. The Elvis effect seemed to have helped to spur US teenagers to launch campaigns to recruit their friends. Vaccinations surged, and by the next year active cases of polio had dropped from 15 140 to 5 485. Five years later, fewer than 1 000 cases were reported.
Studies about social influence on boosting the uptake of flu vaccines suggest that talking about other people getting their shots might help to improve the uptake for Covid-19 vaccines too. It need not be only social influencers; even examples from a peer group can help to nudge people to get on board.
5. Don’t focus on hardline refusers; try to convince those sitting on the fence
A small percentage of people say that they will never get the jab and studies suggest that chances are slim that they will change their minds. In the US, this number is about one in eight people; in South Africa it’s about one in 15 (although the proportion may differ in pockets of the population).
Actual uptake among vaccine-ready people can change over time, but hardline anti-vaxxers almost never change their minds. It’s more effective to focus on people who are vaccine ready and receptive to new information.
6. Understand people’s realities
Historically, vaccination campaigns focused on busting myths and providing evidence-based information about vaccine safety and benefits. Yet opposition to Covid-19 vaccines (and also non-pharmaceutical interventions such as wearing masks and social distancing) seems more strongly rooted in people’s lack of institutional trust, and even a mistrust of government in general when faced with a large-scale epidemic.
A separate but valid issue is a distrust of vaccines that stem from historical injustice and inequality. For example, American intelligence services used a vaccination campaign in Pakistan as a cover to capture Osama bin Laden, which affected subsequent vaccination drives in that country.
Historic racism has also contributed to lower trust and has been so pervasive that the effect is seen even among healthcare workers. Low levels of trust are compounded by people still experiencing obstacles when trying to get medical care for Covid-19.
In the end, turning nudges into numbers may be more about how we talk to the unvaccinated than what we say.