Skip to Main Content
Contribute Try STAT+ Today

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.

advertisement

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.

advertisement

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.

  • At VacSeen.org, we’re exactly focused on this wait and see crowd. We encourage adoption of COVID-19 vaccines by making the vaccine visible on the street. We make and deliver blue wristbands, and 50% of proceeds go to the United Nation’s COVID-19 Solidarity Response Fund for WHO.

    Support the movement and pre-order your wristband at https://vacseen.org

  • You have outlined a very big problem. With the current COVID situation, everyone is ready to start rolling out vaccines. But we need the big picture, ultimate goal right before us (herd immunity).

    These types of problems are tricky — the immediate approach seems easy and it tend to overshadow the thinking “… what may go wrong…”. So the four point approach you have identified is extremely important to consider.

    Very good post. Keep it up!

  • The troubling thing about this story is that the focus is on the skeptical person. The reality is that the science and the statistics is not convincing enough. Better disclosure and more data needs to be studied before a vaccine is rolled out.

  • The Astrazenica/Oxford vaccine is 100% effective in preventing negative outcomes and is a standard protein vaccine like those that have been used for decades. As protein, this vaccine can be shipped and stored under standard conditions, and administered like any other vaccine in any clinical setting.

    Being the type of vaccine that has been used on large human populations and for decades, the Oxford/Astrazenica vaccine is infinitely safer than the Pfizer mRNA-based vaccine, which has never been used in long-term human trials.

    The Pfizer mRNA-based vaccine appears to have high efficacy because it uses a different mechanism than a normal protein vaccines like Astrazenica’s. The Astrazenica drug is a protein which drives normal human immunity. However, with the Pfizer mRNA vaccine, instead of immune cells taking up viral protein that was injected into our blood, our immune cells, along with our other cells, take up the vaccine mRNA from the blood and then these cells MAKE the viral protein on their own. In addition to the possible negative consequences of the Pfizer vaccine driving human cells to make viral proteins, the mRNA breaks down very easily and there is not a system in place to easily transport or give the Pfizer mRNA vaccine to a lot of people, whereas our normal healthcare structure could get the Oxford/Astrazenica vaccine to everyone, as it can be stored and given in any doctor’s office.

    It would take longer and cost more for Astrazenica to make enough doses of the protein vaccine than it will for Pfizer to make the mRNA vaccine, but we know the protein vaccine is safe and our medical infrastructure is set up to deliver it. In contrast, the Pfizer vaccine is more readily available, at Pfizer, but can’t easily be shipped and given to patients, and we literally have no idea what the long term consequences of being given mRNA and boosting immunity via this biological pathway might be.

    But the US made its bet with Pfizer, many politicians invested their money with Pfizer, and American’s will be asked/told to take an experimental drug, the long-term consequences of which aren’t known, because people will make a lot of easy money off of their vaccinations, and because the US government made a bet months ago that Pfizer’s drug would be faster/better, and they are going to go ahead with their bet and what they see as American capitalism/exceptionalism, no matter what the data actually shows or how dangerous it might be. The one plus is that it is easier and faster to make the mRNA vaccine. But, as it breaks down at room temperature, lots of doses may be lost in transport and storage, or they may be inactive by the time the vaccination is given as we may not be able to quickly develop a way to give 300 million people a drug that has to be stored at -80 degrees centigrade.

    Pushing the Pfizer vaccine is no different than when the government told people they didn’t need to wear masks – it’s a faster way to get the economy open again than waiting for Astrazenica to make enough doses of their vaccine, but it’s not safer. Plus the government is essentially invested in Pfizer and not Astrazenica. However, throwing away the billions given to Pfizer and waiting for the Astrazenica vaccine would be the much more prudent and safer approach.

    • Please disclose your relationship with Astrazeneca. While we wait for something better, we’d better not wait to use what we have available to keep people from dying.

  • “In a hyper-polarized news environment, people aren’t persuaded by facts alone, especially when the facts are about a new, rapidly developed vaccine.”

    What “facts” are we talking about? For that matter, what “vaccine” are we talking about; and do you think all the vaccines are the same and pose the same risks?

    The Oxford/Astrazeneca vaccine has shown 100% efficacy in preventing serious symptoms, hospitalization and death from COVID-19. This vaccine is a protein vaccine similar to those that have been used for decades in the US, and, as such, is not expected to have any unexpected long-term consequences.

    However, the US invested in Pfizer which took an “easier” approach of developing a cheaper, though unproven, mRNA-based vaccine, which they were able to get out a few months before the Oxford vaccine became available.

    The US appears to be going forward with the Pfizer vaccine because the US invested in it’s development and in scaling up its production, despite the fact that the mRNA based Pfizer vaccine is already “surprising” scientists with its high efficacy, as they don’t know exactly how it works, much less what the long-term consequences might be.

    And here we have what I believe is supposed to be a science news web site providing the opinions of commercial advertisers/consultants on how we should convince people to take “the vaccine”, when there are multiple different vaccines and serious and different risks associated with each.

    The people who wrote this opinion piece apparently don’t have any “facts” at their disposal and don’t know the differences between one vaccine and the other. So they are really just saying people should “bandwagon”, or blindly go along with everyone else, like the writers themselves are apparently doing.

    This type of article is exactly why people should be very concerned. That we should all take the vaccine, any vaccine, is an extremely uneducated, unsupported, and unscientific “opinion”. Yet these authors published it with their names on it, and apparently are paid to advise others on what they apparently understand absolutely nothing about.

  • Skepticism is the very nature of science. If you don’t question, you aren’t a scientist — you are instead blindly faithful, and we call that something else.

    Appeal to the scientist with science, plain and simple. Good science — not the word of some politician without sound backing, nor some weakly constructed hypothetical model. Mere expertise is also not enough — science, and only science, not merely the word of someone who understands science, but may be choosing to not use it.

    It’s not hard to find.

Comments are closed.