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Calling the (behavioural) shots over vaccines

- Leigh Crymble

It will take 67% of the population to be vaccinated to reach herd immunity; here is how those still reluctant can be persuaded to join in.

And so it will soon begin: mass vaccination. Let us fast-forward a few months and assume tens of millions of Covid-19 vaccines have arrived in SA. By this stage, too, we’ve all been allocated our rollout phase based on age, occupation and health status.

The big tasks of adequate supply, appropriate storage and streamlined distribution aside, there is still one piece of the vaccination puzzle that needs to be solved — and quickly. We need to convince the majority of the SA population, about 40-million people, to get it.

Medical experts agree that when about 67% of our population have been vaccinated (most likely through the double-dose option), we will reach herd or population immunity and the virus will be brought under control. While many of us are ready to line up for our shot of freedom, others will take a little more convincing before they roll up their sleeves.

The art of persuasion is something behavioural scientists are very familiar with. A central tenet to behavioural theory is libertarian paternalism; that it is both possible and ethical to guide someone’s behaviour while still respecting their freedom of choice. This is a critical component to our national vaccination rollout strategy. Health minister Zweli Mkhize has stated publicly that no-one will be forced by the government to get the vaccine.

Moving away from mandatory and giving people the freedom to choose is necessary for constitutional rights, but if too many South Africans choose not to have the vaccine, it could end up crippling us.

While figures vary, roughly 40% of South Africans are either undecided or against Covid-19 vaccination. Some have been misled by 5G conspiracy theories and cultural taboos, while others are nervous about the vaccine’s safety due to its record-breaking timeline. While its rapid development was certainly an accomplishment to be celebrated, fake news about vaccines not having gone through the proper testing process has led to widespread concern — not least helped by the semantic choice of the US vaccine development programme, Operation Warp Speed.

Having studied past vaccination efforts (smallpox, polio, influenza, HPV), behavioural experts offer proven insights to nudge people towards more positive vaccine mindsets.

Their first tip? Forget the extreme anti-vaxxers: they’re too far gone to convince otherwise.

Luckily for us, this group makes up a very small population, both in SA and around the world, so their non-compliance, while not ideal, is a negligible factor. Instead, we need to focus our attention on “the movable middle”, the unsure folks split between science and scepticism.

Here are some suggestions to help with this:

  • Forget just facts, tell stories. Message framing is one of the most important considerations to nudge vaccine adoption, as through storytelling we make experiences more personal and relatable. We now have a unique opportunity to merge that year-old “lives vs livelihoods” debate with the solution to saving both. We must reframe vaccinations as the powerful tool to help us achieve this: an indispensable tool to protect our health at the same time as support the recovery of our economy. Here, the golden thread of community, ubuntu, solidarity and patriotism must be highlighted with tangible reference to people’s lived experiences rather than data-heavy pharmaceutical facts. “Let me tell you why I am getting vaccinated” is a powerful statement to drive uptake.

  • The Elvis effect. An effective behavioural change campaign relies on three factors: social influence, social norms and vivid examples. As far back as 1956 the world was facing the threat of polio and had the similar challenge we have now of vaccine hesitancy. It was thanks to social-proofing that vaccination uptake increased, with celebrities such as Elvis Presley having his vaccine live on TV. This inspired reluctant American teens to get inoculated, which resulted in the upward trend of vaccination numbers. 

Influential endorsements of the Covid-19 vaccine have already begun, with key public figures in the UK and US showing their support. Once rollout begins, social media posts from our front-line health-care workers getting vaccinated will help increase buy-in and build public confidence. This messenger effect is a core component to encouraging vaccine adoption. We are heavily influenced by who communicates to us, so a range of messengers — doctors, government officials, family, friends, influencers, business leaders — across a range of communication channels is important.

  • The “limited edition” of health-care. Without question we want enough vaccines, and we want them as soon as possible. But we can use the interim shortage to our behavioural benefit. People place more value on what’s in demand and there is huge power in scarcity. Positioning the vaccine as a scarce resource is one way to motivate people to get vaccinated. Once we know more about the rollout plans we can create some sort of waiting list. This becomes a way to get people invested in getting vaccinated and serves as a pre-commitment mechanism whereby people won’t want to lose their place in line — driving more urgency.

  • Always add fun. Gamification helps make tasks more fun, which drives uptake. Game-based features through digital apps, WhatsApp channels or USSD platforms can serve as both a source of awareness to educate, as well as encourage engagement through built-in quizzes or media. We should develop dynamic, digital vaccine counters that can be displayed across TV, websites and digital billboards. The effect of a count up to reach a target — or even a count down showing how many people are still needed to reach the 40-million mark — will help encourage people to participate. Inter-provincial challenges or company competitions with leader boards are other interactive approaches to both normalise and promote mass vaccination.

  • Everyone loves an incentive. Linked to the previous point on fun, incentives and memorabilia have their own part to play in vaccine persuasion — but adding incentives needs to be done cautiously. Research has shown that offering financial rewards to vaccine fence-sitters can have an adverse effect: people trust them less. Incentives can be intrinsic (making it easy for people to share online that they got the vaccine for social kudos); or extrinsic (such as automatic Discovery Vitality points for getting the vaccine).

Another idea gaining traction internationally is to gift those who get the vaccine with a branded memento as a piece of Covid-19 history. As an example, a UK-based brewery called BrewDog is offering a special commemorative beer with quirky labels to make them a desired collectable.

Getting the vaccine to SA is just half the battle — we now have to gently push people to take it. In addition to actively fighting vaccine myths, fake news and misinformation, it’s time to work towards changing our national vaccine narrative to encourage mass uptake. Using insights and nudges from the behavioural science toolkit is an effective way to achieve this.

Leigh Crymble is a doctoral student at the University of Witwatersrand specialising in behavioural linguistics. This article was first published in Business Day.