In May 2020, excitement was already brewing over the start of vaccine trials to tackle Covid-19. The chances of rolling out a vaccine within a year were slim, but less than 11 months after an almost global lockdown, several vaccines are ready and many more are nearing approval.
While some critics argue this is alarmingly fast, officials have assured the public that the vaccines have gone through the same rigorous approval processes as past vaccines, and have been proven both safe and effective. The haste has been welcomed by others, who recognise that the sooner we vaccinate enough of the population, the sooner we can return to precedented times (please).
To achieve herd immunity, at least 7 out of every 10 people need to be vaccinated, a goal which will require national governments to overcome a number of significant barriers. While many of these hurdles involve more practical limitations such as supply chain delays, there are certainly others which could benefit from the help of behavioural insights.
One such obstacle could be vaccine hesitancy, defined as a “delay in acceptance or refusal of vaccines despite availability of vaccine services” (1). The World Health Organisation (WHO) describes vaccine hesitancy as “one of the top 10 threats to global health” (2). Even if supply chain issues are avoided, this may hinder progress towards herd immunity.
Vaccine hesitancy has received attention in the past. One notable case involved Andrew Wakefield, a discredited researcher who fraudulently published an article linking the MMR vaccine to the development of autism in 1998. The publicity surrounding this article built up significant momentum and was partly responsible for a sharp global decline in vaccination rates, as well as several resurgences in measles cases around the globe.
Given the pervasiveness of social media, it’s very likely that these sentiments will be able to spread further and faster online (3). With roughly half of the global population on social media, as well as millions stuck inside in lockdown on their phones, the spread of disinformation is potentially highly contagious. As far back as February 2020, the WHO expressed concern over the risk of an “infodemic”.
So, how can behavioural science help us fight the infodemic, tackle the rumbling army of anti-vaxxers, and nudge those on the fence into the clinics?
Considering the SAGE working group’s 3 Cs of vaccine hesitancy may help (4).
Confidence
People’s confidence in the safety and efficacy of the vaccine, as well as the institutions promoting and providing them, can influence vaccine uptake. Attitudes are a significant predictor of intentions to be vaccinated (5), so behavioural interventions to shift these attitudes are likely to result in changes to vaccination intentions. Among those in the UK who stated that they would not get vaccinated (19% of respondents), one reason given was having heard rumours on social media, such as the vaccine being contaminated by the virus (6).
It is unfair to assume that all concern over vaccination is unreasonable, or has arisen from the spread of disinformation. These concerns may be assuaged through a more straightforward approach, with clear and simple messaging about the risks and benefits of the vaccination. However, some research suggests that misinformation can overpower these campaigns (7). How then, can we fight against the rising tide of disinformation at such a crucial time?
One potential approach borrows from the methodology of vaccines themselves. Inoculation theory aims to protect people against disinformation by exposing them to it in very small doses under experimental contexts, allowing them to build up resilience. Roozenbeek and van der Linden developed an online game where participants were placed in the role of a fake news producer. Learning about techniques used by the creators of disinformation (such as polarisation, emotive language and impersonation of authority figures) allowed participants to build “cognitive immunity” against real-world disinformation.
Complacency
Complacency creeps in where the perceived risks of Covid are low, especially when combined with people’s acclimatisation to the new normal and growing fatigue over tough restrictions. One solution might be to use incentives. Studies asking people to reflect on prosocial incentives to perform a behaviour have potential. For example, male teenagers were more willing to receive an HPV vaccine when asked to consider the protection of future partners (8). The Behavioural Insights Team highlight that while these studies do find a small effect, interventions using incentives targeting people’s self interest are (unfortunately) more effective.
While the unique context of the pandemic may heighten prosocial incentives, interventions providing financial incentives or even restrictions placed on those without the vaccine (without a good reason for exemption) may prove more effective. Whispers of vaccination passports will certainly provide enough incentive for some. Interventions could also leverage social norms or social networks, perhaps awarding badges to show others that they’ve been vaccinated (9), or by using gossip to spread information about the vaccines (10).
Of course, people’s intentions must outweigh the hassle of getting vaccinated, or else vaccine uptake could still not be high enough.
Convenience
Using behavioural insights, the practical barriers to getting vaccinated can be lowered or even eliminated. The UK has already initiated evening and weekend clinics to remove some of the friction associated with going into a clinic during working days, and can go even further by continuing to increase the number of locations. One option which is frequently used, and often very effective, is making vaccinations the default option. Having people make an active choice to not be vaccinated has been an effective method in the past not only because it is easier to get the vaccine, but also because it implies a social consensus that getting the vaccine is the right thing to do.
Simple text reminders combined with additional messaging have worked well in other contexts (11). They could work here too, and are very cost-effective. Perhaps a text reminder to book an appointment, accompanied by useful information about nearby clinics or direct links to booking platforms, might reduce friction enough to increase vaccination rates. They could even signpost information about peer sentiments, highlighting positive attitudes to vaccination and so encourage others to follow suit.
Before the vaccines, the BIT stated that behavioural insights was our best defence against the pandemic. Even now they have arrived, the role of behavioural insights is far from finished and remains essential to let us out of lockdown.
Flo Cochrane and Sam Lloyd
President of CUBISS, Co-Founder and Publicity Officer
(Edited by Jasmine Lee, Secretary of CUBISS)
References
Vosoughi, S., Roy, D., & Aral, S. (2018). The spread of true and false news online. Science, 359(6380), 1146-1151.
SAGE WORKING GROUP
Vosoughi, S., Roy, D., & Aral, S. (2018). The spread of true and false news online. Science, 359(6380), 1146-1151.
Polonijo et al., Socioeconomic and racial-ethnic disparities in prosocial health attitudes: The case of Human Papillomavirus (HPV) vaccination in adolescent males. J Health Soc behav, 2016
Iten, A., Bonfillon, C., Boymond, S., Siegrist, C. A., & Pittet, D. (2015). Improving vaccination against seasonal influenza among healthcare workers, 1994-2015. Antimicrobial Resistance and Infection Control, 4(1), 1-1.
Banerjee, A., Chandrasekhar, A. G., Duflo, E., & Jackson, M. O. (2019). Using gossips to spread information: Theory and evidence from two randomized controlled trials. The Review of Economic Studies, 86(6), 2453-2490.
Hallsworth, M., Berry, D., Sanders, M., Sallis, A., King, D., Vlaev, I., & Darzi, A. (2015). Stating appointment costs in SMS reminders reduces missed hospital appointments: findings from two randomised controlled trials. PloS one, 10(9), e0137306.
Comentários