What are the best approaches to engage the vaccine-hesitant now?

Had to do it.
Had to do it.
Image: Reuters/Octavio Jones
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As of Aug. 9, just half of Americans are fully vaccinated against Covid-19 putting the US far behind other developed countries.

Whether you’ve personally lobbied vaccine-hesitant friends and family or are merely shaking a fist at the horrifying news out of hospitals filling up fast again in places like Texas and Florida, it has probably dawned on you that there is no silver bullet that will nudge large numbers of the unvaccinated to roll up their sleeves.

Instead, behavioral scientists say it needs to be a multi-pronged approach that could include a broad array of tactics, including mandates in workplaces, government incentives such as direct payments, and the threat of having to pay more for health insurance when you decide to resist vaccination.

Some people might only feel comfortable with tough vaccine policies once the vaccines have full FDA approval; others may be able to be swayed before then. If you’re hoping to see vaccination rates tick up, here’s what experts say can still be effective at this stage of the pandemic:

Make vaccines mandatory at workplaces of all sizes

Businesses of all sizes have already joined the push to win over the vaccine-hesitant by enacting vaccine mandates. They won’t convince everyone. In a new survey from Qualtrics, 44% of US workers said they would consider leaving their job if their employer required the jab, meaning companies with mandates will risk losing staff at a time when retaining and hiring frontline workers is challenging.

However, the mandates should also work to push up vaccination rates—and not only because of people who want to keep their job, or not be visibly singled out for weekly testing and PPE requirements (although the stigma that creates is also powerful).

Employer mandates also give cover to people who thus far have been unwilling to get inoculated because of social pressure, says Alison Buttenheim, a public health and behavior science researcher at the University of Pennsylvania who has spent years studying vaccine hesitancy.

“If you’re in a community where people aren’t getting vaccinated and people might look at you funny if you do, or you’re not really supposed to talk about it,” she says, people can tell their friends or family, “My job is requiring it. I’m just going to do it because I want to keep this job.”

To be sure, Buttenheim feels that the group of people who would appreciate the excuse to blame the boss is actually small. (Besides, only a fraction of the total unvaccinated population in the US might face any kind of ultimatum from their boss, as Quartz has reported.)

Make the vaccines even more accessible

Though it may not feel like it to people who live in areas where vaccine pop-up clinics have appeared in subway stations and community centers, there are places in the US where it’s still inconvenient if not impossible for some people to reach a clinic, says Buttenheim. “Part of closing the gap now is making sure we’re meeting people’s logistical and structural needs,” she says. Some people don’t have child care covered for the time it would take to go get vaccinated or they don’t have a car to get to the pharmacy a few miles away, and there’s no public transit, she adds. Other people may feel they can’t take time off after the second dose because they wouldn’t get paid or they feel pressure not to miss a day. “The only hesitancy there is hesitancy around fitting this into my life,” says Buttenheim.

For others, vaccine clinics that cater to certain populations, such as the homeless, the neurodiverse, or the needle-phobic, can also have a small but important impact.

Hold repeated conversations with vaccine-hesitant peers and family

Within the remaining group of the truly vaccine-hesitant, the strategy that appears to be effectively changing minds is caring, repeated conversations. “It’s slow, and it’s not super sexy,” says Buttenheim, but ongoing conversations “with a trusted peer who can listen to where you’re coming from, and acknowledge your concerns are valid, and perhaps quite slowly chip away at outstanding concerns you might have” appear to our best hope at changing minds.

Karen Ong, creative director at Marketing for Change in Alexandria, Virginia, says her agency is concentrating its efforts on supporting “vaccine champions,” those people who have friends and family who have delayed vaccination because of fears or unanswered questions. Ong and her team are creating talking points, with suggested conversation openers and closers, that go beyond “generic FAQs,” she says, to help people respond to specific issues with empathy and compassion, not judgment.

“If people have these conversations in the wrong way, the population who’s vaccine-hesitant could get more dug in,” she says. “They’ll say, “I’m never going to do it. Even if I do change my mind, this is so much a part of who I am now that I’m not going to do it,'” says Ong.

“We want to create less of those people and more of the people who are truly hesitant for their own reasons,” and still open to getting inoculated, she adds.

Share pro-vaccination messages from Republican influencers

Vaccination has been greatly politicized in the US, with more Americans in red states saying they’re unlikely to get vaccinated. One recent analysis from CNN comparing the US and Canada, a similar country where the science of vaccination has not become a highly partisan issue, demonstrates how damaging political messages have been in the US, says Jay Van Bavel, associate professor of psychology and neural science at New York University. In Canada, a much higher percentage of voters for the right-of-center Conservative party were willing to get vaccinated compared to Republican voters in the US.

Now, to help change the minds of those Americans who have resisted vaccination or fallen victim to political disinformation, it could help to enlist a political leader trusted by Republican voters, according to a new study from Stanford University researchers. “For example, if someone like Trump came out it was more vocal and supportive of the vaccine, there’s a number of people who are supporters who would be persuaded to get it,” says Van Bavel.

In a recent New York Times op-ed, Alex Azar, who oversaw the Operation Warp Speed vaccine development program under former US president Donald Trump also called upon “all party leaders and conservatives to double down on encouraging vaccination.” He wrote, “I’m glad former President Donald Trump got vaccinated, but it would have been even better for him to have done so on national television so that his supporters could see how much trust and confidence he has in what is arguably one of his greatest accomplishments.”

Spread the message that getting vaccinated is the norm

Research also suggests that “making it clear that the norm is to actually get the vaccine” is effective, says Van Bavel. But this is one area where the media has unfortunately not been helpful by focusing too much on the unvaccinated minority. “A lot of people think that their neighbors aren’t getting [the vaccine], or if they’re in a little echo chamber on social media, they might not realize that most of the people they know might have gotten it, but haven’t said anything,” says Van Bavel.

Personalize text messages for your Covid-19 vaccine

In a large, real-world study published earlier this year, researchers tested how well text-message reminders could encourage people to get a flu shot. The goal was not to change the mind of skeptics, but to encourage the people who intended to get a shot to follow through, as lead author Katy Milkman, a behavioral scientist at the Wharton School of the University of Pennsylvania, has explained.

Scientists from several universities experimented with various sorts of messages, including some that were funny or had interactive components, which were sent to roughly 700,000 people within different health systems in the US. They discovered that a message saying “Your flu shot has been reserved for you,” was most successful at bumping up the number of people who got vaccinated. In total, the researchers decided that simple text message reminders could increase uptake by up to 11%.

Behavioral scientists at UCLA recently tested the same idea by texting people who had yet to get their Covid-19 vaccination with messages that also implied vaccine ownership. They tweaked the messages slightly to say things like “The vaccine has just been made available for you,” or “Claim your dose today.” It worked, doubling the number of people who booked an appointment for a Covid-19 shot within six days of receiving a text message (13%), compared to those who had not (7%.)

Keep sharing stories of deathbed regret

The media has published countless stories about people who had chosen not to get vaccinated and, in some cases, had spread anti-vax messages before contracting Covid-19. In these accounts, the severely ill and dying have shared messages of regret over their decision and urged people not to make the same mistake.

Those hard-to-miss headlines may feel ethically questionable at times, but they should also be effective in convincing the unvaccinated to get a shot, according to behavioral science. “We like stories better than we like data,” says Buttenheim, “and we really don’t like the feeling of regret.”

Research shows that regret aversion is so strong that people will actually take action to prevent feeling remorse later, she adds.

Appeal to a sense of collective purpose

Van Bavel recently finished a vaccine behaviors study involving surveys with 50,000 people around the world. It found that appealing to things like national identity predicted compliance, he says. So messages that emphasize that vaccination is a national goal that everyone should benefit from should boost vaccination uptake.

His work, which will be published within weeks, jibes with research on persuasion that shows people will respond to messages about their moral obligation to look out for others. “Right now, the debate has been around ‘My rights, my body,’ and it has not been around the real issue for most people: You don’t want to infect other people,” like the immunocompromised and children, says Van Bavel.

What the US got wrong about vaccine hesitancy

News about how much easier it is to become infected with the delta variant has led to an uptick in vaccinations in recent days. The focus on delta also has inspired Buttenheim and other researchers to experiment with new messages about the difference between being sick when you’re vaccinated (which typically means milder symptoms) and getting sick when you’re not vaccinated (which is far more likely to lead to hospitalization, long-term health consequences, or death.)

It’s a kind of “choose your own adventure” concept, she says, but so far they haven’t seen any obvious signs that the messaging is working.

That data will still be useful, naturally, particularly in combination with other small studies. However, says Buttenheim, one way the US has failed in the battle against vaccine hesitancy is by not doing enough research to discover what does work.

“We’re not studying what works in a careful, rigorous way, such that we have to look back and say, ‘You know, this worked better than that, or this worked for this group and not for that,’” Buttenheim says. Public health officials are understandably too swamped to spend time testing different messages with different groups of people. Still, as a result, she says, we won’t have a huge body of new evidence to tell us how to handle the next pandemic.