If protection against an infectious disease weren’t motivation enough, the Georgia-based company PruittHealth is offering a Waffle House gift card to every frontline worker who gets the COVID-19 vaccine. PruittHealth, which operates nursing homes and assisted living facilities throughout the Southeast, is trying to incentivize vaccination among employees who might otherwise opt out. “If that doesn’t get you in line,” said Governor Brian Kemp of Georgia in a news conference, I don’t know what will.”
Free breakfast might persuade some vaccine-reluctant people to take the plunge, but according to behavioral scientists, it might be more effective for Kemp to roll up his own sleeve and get the vaccine on live TV. Having a community leader model desired behavior is one of several evidence-based strategies that experts recommend using to overcome vaccine hesitancy.
To gain control over the pandemic and return to something resembling pre-COVID life, public health leaders emphasize the importance of reaching herd immunity. The safest, fastest and most reliable path to herd immunity is through widespread vaccination. Right now, the most immediate barrier to getting the majority of Americans inoculated is a low supply of vaccines. But even after vaccine production ramps up, and distribution improves, we may still face another hurdle: too many people saying no. While many people are anxiously awaiting V-day — in some cases traversing cities in hopes of lucking into leftover doses — not everyone’s desperate to get their shot(s). In fact, vaccine resistance appears to be fairly common.
A national survey conducted in December by the Kaiser Family Foundation found 27 percent of the general public to be vaccine-hesitant, meaning people who say they’re unlikely to get the COVID vaccine even if it’s free and scientists say it’s safe. Thirty-five percent of rural Americans said they either wouldn’t or probably wouldn’t get the vaccine, compared to 26 percent of urban residents. Even among healthcare workers surveyed, 29 percent said they probably wouldn’t get vaccinated. The top three vaccine concerns expressed by respondents were side effects, government mistrust and the vaccine being so new. While it’s possible that vaccine attitudes have shifted in the last month, the survey results are supported by reports of healthcare workers across the country refusing vaccination.
“Vaccine hesitancy is a continuum,” says Gretchen Chapman, professor of psychology at Carnegie Mellon University where she studies decision-making. Many people who are hesitant to get the COVID vaccine aren’t necessarily opposed to vaccinations in general. “[They] may have some concerns or don’t want to be the first in line, which could be viewed as completely reasonable given how new this vaccine is.”
She likens that form of caution to waiting to buy a just-released smartphone or embrace novel technology, the way many people did when ride-sharing first emerged. “That strategy of hanging back and seeing how it works for others before you join on average is a fairly good strategy to follow in a lot of parts of life,” she says. “It just so happens that in this particular situation it’s counterproductive from a public health standpoint. It’s causing a problem.”
How to talk to the vaccine-hesitant
How can we persuade people who want to wait and see, not to mention those who’d rather pass on vaccination altogether, to get in line with the rest of us? Experts say that successful efforts to combat vaccine resistance typically employ a few evidence-based strategies, and that the same guidance applies to everything from national public health campaigns to dinnertime debates with skeptical relatives.
Drive home facts with thoughtful, consistent messaging
When it comes to the safety and efficacy of the COVID vaccines (Pfizer and Moderna, specifically), the data is compelling. “The protection is far better than anyone anticipated,” Paul Sax, an infectious disease specialist at Harvard, wrote recently in the New England Journal of Medicine. “Which is why many of us specialists in infectious diseases, virology immunology, and public health become downright giddy when asked to discuss the vaccine’s efficacy.” (“Giddy” is not a word you see often in the NEJM.) As for questions we can’t answer yet, such as about the vaccine’s safety years down the road, Sax points out that long-term side effects with vaccines are rare in general.
But, in most cases, Chapman notes, facts alone have limited persuasive power. “It’s not always the case that presenting people with factual evidence is going to turn them around. Changing beliefs and changing behavior — there’s no easy recipe for doing that. We’re all very good at motivated reasoning and coming to believe the things that are consistent with what we wanted to believe.”
The best way for these conversations to begin is with listening, Chapman says, whether a state health department is building an educational app for historically vaccine-hesitant communities, or you’re trying to set the record straight about vaccine side effects during an informal chat with a friend. What are the person’s (or group’s) vaccine concerns? Can they be addressed directly? The answers to these questions should inform how vaccine information is communicated.
For example, one commonly raised concern about the COVID vaccines is how quickly they were developed and approved. The term “Operation Warp Speed” probably hasn’t helped. Coined by the previous administration to describe an accelerated production strategy, the term only fueled worries about rushed development and insufficient clinical testing, likely helping to undermine public trust.
“Obviously there’s no getting around the fact that it’s a new vaccine,” says Chapman. “But the reason that we could develop vaccines in 10 months was in part because there’s a decade of research on mRNA vaccines as a category, and if those vaccine developments hadn’t been ongoing for years, this warp speed thing wouldn’t have worked.”
Consistency is also important in messaging. Confusing guidance on masks at the start of the pandemic, followed by the absence of a unified message from government leaders, opened the door for people to ignore the strong scientific evidence that wearing masks significantly helps reduce the spread of the virus. The COVID vaccine rollout offers an opportunity to course-correct. “One thing we can learn is: It’s important that people at all levels of government are giving the same, evidence-based message,” Chapman says.
Of course, evidenced-based guidance may change if new evidence comes to light. That’s how scientific knowledge works, and you don’t need to pretend otherwise in order to advocate for listening to the science.
Invoke the power of peer pressure
“Everybody’s doing it, you should too” might not be a sophisticated line of reasoning, but psychologists and middle-schoolers alike can vouch for its effectiveness. If an airtight argument doesn’t compel someone to get vaccinated, there’s still a chance that seeing people get the vaccine, as well as hearing about their experiences, might do the trick.
“Conforming really does feel good,” says Catherine Sanderson, professor of psychology at Amherst College and author of Why We Act: Turning Bystanders into Moral Rebels.
A classic study on reusing hotel towels illustrates how health messaging can appeal to our desire to conform. In the study, guests were shown two versions of a sign asking them to reuse their towels to reduce water consumption. One message was just about saving the environment: “You can show your respect for nature and help save the environment by reusing your towels during your stay.” The other one was less pure: “Join your fellow guests in helping to save the environment. Almost 75 percent of guests who are asked to participate in our new resource savings program do help by using their towels more than once.”
The second message prevailed. “They found that people don’t care about Mother Earth,” says Sanderson. “What they care about is that other people care about Mother Earth. See the distinction?”
The allure of conformity is strongest for groups we identify with and care about, Sanderson says. So scrolling through vaccine selfies is more likely to sway someone if the arms in the photos belong to the right people.
Target local messengers
One way to motivate vaccination among particularly hesitant groups is to leverage the influence of trusted community leaders. In rural areas with low vaccination rates, Sanderson suggests local ministers. “You need to have role models who speak to a particular community [to say], ‘I’m a minister, I’m a Republican, I’m pro-life and I just got the vaccine.’’
Don’t ignore history
Black people are more likely than other racial and ethnic groups to contract, be hospitalized with and die of COVID. Yet, last month, about 35 percent of Black Americans said they didn’t plan to get the vaccine, according to the KFF.
Context always matters, and it’s especially important here.
For the Black community, vaccine hesitancy has deep roots, informed by first-hand experiences with a racially biased healthcare system as well as a history of nonconsensual participation in research, such as the 40-year-long Tuskegee experiment. Beginning in 1932, the United States Public Health Service deceptively enrolled hundreds of Black men in a study designed to “observe the natural history of untreated syphilis” under the guise of offering them free treatment for “bad blood.” The participants, who didn’t know they were in the study, weren’t offered treatment for syphilis. At the same time, they were discouraged from seeking outside medical care. Most participants had died, many from syphilis-related causes, by the time news of the experiment went public in 1972. The US government issued a formal apology in 1997.
The Tuskegee experiment is an egregious example of Black people being exploited in the name of science research, but it’s not the only time it’s happened.
“Those fears are well-founded,” says Sanderson, and this is another area where messages from trusted spokespeople can be powerful. “Kamala Harris is a particularly important role model in this way,” she says, referring to the vice-president’s televised vaccination. “I think if we can see other examples of people who are leaders in particular communities including communities of color, that would be profound.”
Dr. Robert Drummond, a Black urgent care physician based in Los Angeles, has been leading regular Instagram Live sessions to educate the public about the vaccine and related topics, with an emphasis on reaching the Black community. He answers questions — Is it true that the vaccine can cause sterilization in females? (No.) — and responds to news of the day. Among the topics he covers are the vaccine’s various side effects and why they happen. One follower posted that she was not planning to get the vaccine because of “trust issues,” but now, since watching his videos, she and her family plan to get it.
As more of us get vaccinated and regain freedoms the unvaccinated can’t enjoy, hesitancy might decrease. “It may be that time is on our side,” Chapman points out. “Over time, each of us is going to know more and more people who have been vaccinated as the rollout continues. Vaccine hesitancy may drop a bit more as people see it more and more normalized and more people getting it.”