Opinion: Engage ‘willing skeptics’ to help increase Covid-19 vaccination rates

More than 250,000 people in the U.S. alone have died from Covid-19 this year. Researchers at the Institute for Health Metrics Evaluation estimate that 1 in 4 deaths could be avoided in the next three months if people take wearing masks in public more seriously. In spite of early fumbles and mixed messages from local governments, the messaging around masks from public health officials eventually became clear.

Yet many people follow this recommendation only sometimes, or not at all.

As vaccine developments come in rapidly, the messaging around vaccines must accomplish what the messaging around masks could not: convince people to adopt a safe and effective Covid-19 vaccine.

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That, however, may be a problem. Recent surveys by Pew Research and Gallup found that only 51% to 58% of respondents said they would get a Covid-19 vaccine if it were available today, well below the minimum 70% threshold needed for herd immunity.

The immediate challenge ahead, then, is not trying to vaccinate 100% of the population but persuading just 12% to 19% of those taking a wait-and-see approach — the additional number needed to reach herd immunity — to get vaccinated. To bridge the gap, we need to pivot from presenting facts about the vaccine to persuading people that the choice to get immunized against Covid-19 aligns with their world views.

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When the vaccine is presented as the right choice based on its clinical and biological merits alone, we fail to make inroads with those who distrust these vaccines or the process to developing them. In a hyper-polarized news environment, people aren’t persuaded by facts alone, especially when the facts are about a new, rapidly developed vaccine. Perception isn’t objective because we filter the world through our values and beliefs. That means it is important to present these vaccines as logical extensions of individuals’ belief systems that fit within their existing mindsets.

This isn’t a new concept. For example, in 1986, the Texas Department of Transportation sought to reduce litter on its roadways. For years it tried standard beautification messages like “Keep America Beautiful.” To the 18- to 35-year-old men responsible for the bulk of the litter problem, the messaging failed to resonate with their worldview. When the litter problem showed no signs of improvement, officials switched the messaging to lean on a tried-and-true value: Texas pride. They replaced the word “litter” with “mess” and coined the phrase “Don’t Mess with Texas.” After just five years of “Don’t Mess with Texas” signs on every Texas highway, roadway littering had fallen by 72%.

When it comes to a vaccine, many people have inklings about what the most resonant mindsets among reluctant people might be, but we’re not yet sure. More work is needed. We believe that the following four steps are a good place to start.

Step 1: Launch a survey to identify “willing skeptics.” According to adoption theory, individuals are most likely to listen to the opinions of people who are one step ahead of them on the adoption curve. A devoted carnivore, for example, might be receptive to an advocate of “Meatless Mondays” about eating less meat, but brush off a strict vegan.

To identify skeptical individuals who are most likely to be swayed about getting a Covid-19 vaccine, a national survey could be launched to collect people’s attitudes on the vaccine and their general willingness to adopt new technologies. From the results, it would be possible to create a psychographic profile of five to eight unique segments. From these it would be possible to identify the “willing skeptics” — the group of people tilting in the direction of getting vaccinated who may be able to influence those who are further away from choosing to be vaccinated. Persuading this group will have the most success convincing the larger skeptical population.

Step 2: Conduct semi-structured interviews with willing skeptics to gather their stories around health. Understanding individuals’ true mindsets around vaccine adoption requires pushing beyond obvious questions. To reveal underlying — perhaps subconscious — beliefs, willing skeptics should be asked to share stories about a range of health topics. Tell me about a time you felt really healthy. What is the dumbest thing you’ve ever seen someone do when it comes to their health? What’s your guiltiest pleasure? Conduct eight to 12 of these semi-structured interviews to uncover these stories and the recurrent themes that arise to reveal what deeply held beliefs drive the way people feel about vaccines.

Step 3: Analyze patterns in the stories people tell to pull out common mindsets around health. To distill dominant mindsets and values, the interviews should be analyzed for common themes, conflicting beliefs, and topics. Tools like semiotic analysis and Brennerian framing analysis can help identify patterns to be used as guides for developing resonant solutions.

For example, take the common retort, “I’ll wait and see if the vaccine works” that many vaccine skeptics make. Alone, it is too vague because it doesn’t tell us what they need to see. But hearing multiple stories about when waiting worked out well might lead to common visuals or narratives that willing skeptics will tune into and share with others.

Step 4: Design solutions and messaging that speaks to common mindsets, then run experiments on a small scale and iterate on the solutions before scaling them. Once the key mindsets and beliefs have been identified, it will be possible to generate a broad and diverse set of solutions. At this point, quantity yields quality. Some ideas will be bad, but they may inspire better ideas: “traveling vaccinators who go door-to-door” might be a terrible idea to avoid long wait times, but it may lead to “mobile clinic trailers that set up in the parking lots of community centers.”

From this information it should be possible to define a set of criteria that willing skeptics require for a good solution and use it to cull the list down to the five most promising options. Launch a series of experiments in key geographical areas and, using collected metrics and feedback, revise the concept or communication strategy. Separate and scale the best ideas from there.

As we embark on one of the largest public health initiatives in U.S. history, it’s time to pivot from presenting facts about Covid-19 vaccines to persuading people to get immunized. Rather than telling people to get vaccinated, it’s essential to listen to the willing skeptics and understand their hesitations.

We believe this approach will increase the number of people who will choose to get a Covid-19 vaccine when they become available and hopefully close this chapter of American history much sooner.

Joseph S. Salama is a senior consultant at Jump Associates, a strategy and innovation consultancy in the Bay Area, and an adviser for the University of California, San Francisco’s Health Hub. Jenna Borges is a consultant at Jump Associates and a cofounder of Swiv. Ryan Baum is a principal at Jump Associates and teaches needfinding at Stanford University’s Hasso Plattner Institute of Design.

Source: STAT