When It Comes To Covid-19 Vaccination Adoption – It’s All About Human Behavior, Stupid

It’s 8 months into what should have been the back side of the coronavirus epidemic in the US, and unfortunately, the numbers suggest the country is moving in the wrong direction. Concerning reports of new cases and associated fatalities hit the headlines regularly. The latest stats suggest that the dominant virus is largely the Delta variant which emerged from India. It’s more contagious than the original virus emanating from Wuhan, seems to be localized in counties across the country with low vaccine rates, and most of the cases requiring hospitalization are among those that haven’t been vaccinated. While there are some breakthrough cases for already vaccinated people, those numbers are extremely low. Moreover, among those that have been vaccinated when they have contracted the Delta variant, symptoms are generally relatively mild, and don’t require hospitalization.

So, there is understandable anger among healthcare workers around the nation when confronted with the challenge of caring for these patients ‘who should have known better and gotten themselves vaccinated in the first place.’ Already burned out from a year of intense front-line defense before vaccines were readily available, these healthcare heroes have already put their lives on the line, and many are leaving the field altogether — burned out, frustrated, and unwilling to put themselves at risk for people who in their opinion haven’t taken care of themselves and have in the process put others at risk.

In the face of this, politicos, media pundits, and healthcare professionals share one thing in common — that is exhortations to get the unvaccinated vaccinated. They’ve resorted to selective advertisements, media blasts encouraging (or shaming) the unvaccinated to take the jab, politicians suggesting financial incentives for the vaccine hesitant (which naturally irritates those who signed up for the free vaccines without additional incentives), or political leaders directly exhorting people to sign up for the shot. Increasingly, companies are requiring employees to show evidence of having been vaccinated or risk job loss, and some restaurants, bars, and places of entertainment are requiring proof of vaccination as a ticket of admission. There are those in the country who strongly support such requirements — the greatest good for the greatest number — and others who strongly believe that individuals should have the right to choose whether or not to take the vaccine based on their personal beliefs and health status. To make matters more complex, kids are now returning to school — largely unvaccinated due to the age requirements for vaccination.

Meanwhile, most experts are wringing their hands about just what to do to get through the ‘last mile’ of vaccine hesitancy. Some have suggested more mass advertising as the solution. Clearly, advertisements have a place in influencing behavior among large groups of people. Witness the tobacco industry enticing us to part with our hard-earned cash to advance an image — even though the practice of smoking was clearly harmful. The infamous Marlboro man certainly reflected the social mores of the time and drove tobacco sales. Companies spend billions of dollars on a wide range of products, so, why won’t advertising work to convince the unvaccinated to get vaccinated? The answers lie in fundamental truths of human behavior.

The reality is that you can’t convince all the people all the time to do anything in particular, and you certainly can’t convince people who are not already pre-disposed to believe certain ‘facts’ to accept them on someone’s say-so. It is here that credibility is extremely important in driving influence.

Ironically, it’s not a lesson we need to learn specifically around vaccine hesitancy which comes in a number of distinct forms. It’s a lesson we should all know based on years of research and studying human behavior. Large swaths of the country have eagerly signed up for vaccines and have been responsive to general information about the safety and efficacy of the vaccines and the risks associated with contracting Covid-19. But the subsequent cohorts that have been reluctant to get vaccinated despite the unusually strong safety profiles associated with the major vaccines on the US market, are not going to react favorably to mass advertising and admonitions from political leaders who have been inconsistent in their reporting of statistics, their guidance, and their predictions. To the extent our nation’s leaders have lost the faith of the electorate, they will continue to lack credibility to close the vaccine adoption gap. And, there is no question that this country needs to close that gap.

The solution lies in a fundamental understanding of basic psychology. People earn the right to influence others — and get them to do something they wouldn’t otherwise do — as a function of their personal credibility and trust. Unfortunately, such influence takes place at an individual level, so the process is time-consuming and labor intensive. What this means is that closing the vaccination gap now will require a targeted effort at individuals in specific communities using personal, credible relationships to engage in discussions with people who have opted not to be vaccinated to date. Understanding why individuals have made the decision not to become vaccinated, providing credible knowledge to help them entertain alternative perspectives, and working through reluctance will begin to help individuals consider risks in new ways.

Who those trustworthy individuals are in given communities depends — it could be a personal physician, a trusted pharmacist, clergy, lay leaders, a friend who lives in the neighborhood. But it’s certainly not likely to be the talking head on television or a government official. So, the best approach to close the gap might be to invest focused dollars to enable local communities to have the conversations block by block to understand what’s getting in the way of being vaccinated and helping individuals to consider different choices. At the same time, we need to recognize that some will continue to opt out — no matter how credible and trustworthy the other is. And there is an irony in such an approach. It is this grassroots approach that is eerily consistent with grassroots organizing that politicians have done so well for decades. It’s time we get on with the work.

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