Early on during COVID vaccine trials, surveys showed that more than two-thirds of adults globally said they would be willing to get on board when a vaccine became available. (Anthony Quintano, Flickr)
  • Describing people as “vaccine hesitant” can be misleading, as many people may actually be “vaccine ready” and simply waiting for the right circumstances to get their jab.  
  • Vaccination campaigns which promote how getting vaxxed will benefit individuals rather than “the greater good” are more effective to convince people who are neutral or hesitant about vaccines. 
  • Hardline vaccine refusers likely will not be persuaded by better information or evidence, and also seem less likely to wear masks, social distance or adopt any other behaviours to protect others.

“The best thing to do is to get as many people vaccinated as quickly as you possibly can.” So said infectious diseases expert Anthony Fauci when Bhekisisa asked him about the goal of achieving herd immunity – when a large enough portion of a population acquire immunity against a disease, either from prior infection or from vaccination, to break the chain of transmission. 

Early on during COVID vaccine trials, surveys showed that more than two-thirds of adults globally said they would be willing to get on board when a vaccine became available. This was promising, but willingness to get vaccinated doesn’t necessarily translate into actual uptake. Also in South Africa at least one poll showed similar results, yet so far just over 32% have actually followed through with getting at least one vaccine dose

[WATCH] What is herd immunity anyway? Here’s how many people South Africa should vaccinate

There is some good news, though.

According to a report in the New England Medical Journal many people described as “vaccine hesitant” are in fact not outright resistant to getting the jab, but simply waiting for the right nudge. Of the almost 140 000 people surveyed, 40% had already been vaccinated and 11% were hardline refusers, who said they were very unlikely to get the jab. This means close to half of the sample were sitting on the fence — “vaccine ready” and waiting. 

Here are six things to consider to help turn ready and steady into go.

1. Know who you’re talking to

To persuade people to get vaccinated, messages have to be tailored for the intended audience.

For example, a study in the UK showed that people who are vaccine ready and actively looking to get the shot may be receptive to messages about the public health benefits of being vaccinated – meaning they want to get vaccinated to protect themselves and others. In contrast, people who are hesitant appear to be less interested in the greater good and respond better to learning what’s in it for them.

A 2021 study from the US had a similar result: messages focused on personal benefits had the most impact in convincing people to get vaccinated. Although we might wish for a society that prioritises the wellbeing of others, it might serve us well for now to be somewhat less ideological and focus instead on individual benefits – for the greater good.

2. Get the word out – quickly

Striking the iron while it’s hot works.

A study published in the journal Nature in August found that the timing of vaccine messages can boost appointments and subsequent vaccinations. In this study, participants in the US were randomly assigned to one of two groups and were then sent a text message inviting them to schedule their vaccine appointment shortly after they became eligible to register.

One group received the message one day after they became eligible for getting their shot, while the other group received the message eight days after they could enroll. Both messages included a link to a website allowing the recipients to book vaccine appointments. The earlier prompt nudged 1.5 times as many people to make appointments than the later one. 

Simply making the booking also boosted follow-through. Nearly 90% of participants who made a booking after receiving the nudge kept their appointments – and almost everyone who received their first dose also booked for their second.
This points to the importance of encouraging people to schedule their first shot. A similar trend was seen in an earlier study designed to boost uptake of the flu vaccine. Vaccination reminders sent to people before their regular, unrelated primary healthcare visits increased vaccination rates by 5%.

3. Allay people’s fears – first with empathy, then with evidence

The flip side of the unprecedented speed with which COVID-19 vaccines were rolled out, is that it has contributed to questions being raised about their safety.

Studies about people’s attitudes towards vaccines, from countries as diverse as Jordan and the US, show that fears about ingredients, safety and what many perceive as rushed approval processes deter people from getting vaccinated.

Inadequate data and a general lack of transparency about COVID-19 vaccine trials, coupled with murky procurement agreements between governments and pharmaceutical companies, further fuel reluctance to get the shot. 

[WATCH] Mia Malan speaks to Chales Wiysonge on evidence-based ways to address vaccine hesitancy

Although there is overwhelming evidence that the vaccines are safe and effective, it is important to acknowledge that people’s fears are valid. Showing empathy when talking to people who are reluctant or uncertain may help to make them more receptive to balanced, evidence-based messages. 

It’s equally important to be honest about issues such as the common occurrence of minor side-effects — and to use evidence to contextualise the extremely rare risk of severe side-effects.

For instance, the  scaremongering media coverage about blood clots developing after getting the Johnson & Johnson (J&J) or AstraZeneca vaccine created the impression that blood clots occur far more often than what they actually do.
International medicine regulators’ investigations showed that the risk of developing a blood clot after getting the jab was very low — less than one in a million for J&J and between 4 and 6 in a million for AstraZeneca. Typically a very rare adverse event after taking a medicine is defined as affecting fewer than one in 10 000 people, but in this case the chances of developing blood clots were deemed really slim, and the vaccines were cleared for use after the temporary pause.

[WATCH] COVID jabs & severe side effects: These numbers will help you keep calm

4. Don’t be afraid to drop a name or two

If Elvis could do it, so can you.

In 1956, the then rising rock ’n’ roll star Elvis Presley appeared on public television getting his polio shot at a time when vaccine uptake was precariously slow. The Elvis effect seemed to have helped to spur US teenagers to launch campaigns to recruit their friends. Vaccinations surged, and by the next year active cases of polio had dropped from 15 140 to 5 485. Five years later, by 1962, fewer than 1 000 cases were reported. 

Studies about social influence on boosting the uptake of flu vaccines suggest that talking about other people getting their shots might help to improve the uptake for COVID-19 vaccines too. It need not be only social influencers; even examples from within a peer group can help to nudge people to get on board.

5. Don’t focus on hardline refusers; try to convince those sitting on the fence

A small percentage of people say that they will never get the jab – and studies suggest that chances are slim that they will change their minds. In the US, this number is about one in eight people; in South Africa it’s about one in 15 (although the proportion may differ in pockets of the population).

Actual uptake among vaccine-ready people can change over time, but hardline anti-vaxxers almost never change their minds. So trying to persuade committed anti-vaxxers is likely a waste of time and money; it’s more effective to focus on people who are vaccine ready and receptive to new information.

6. Understand people’s realities

Historically, vaccination campaigns focused on busting myths and providing evidence-based information about vaccine safety and benefits. Yet opposition to COVID-19 vaccines (and also non-pharmaceutical interventions such as wearing masks and social distancing) seems more strongly rooted in people’s lack of institutional trust, and even a mistrust of government in general when faced with a large-scale epidemic. 

A separate – but valid – issue is a distrust of vaccines that stem from historical injustice and inequality. For example, American intelligence services used a vaccination campaign in Pakistan as a cover to capture Osama bin Laden, a nugget used effectively by the Taliban to discredit subsequent vaccination drives in that country. 

Historic racism has also contributed to lower trust in many communities of colour – and has been so pervasive that the effect is seen even among healthcare workers. Low levels of trust are compounded by many of these communities still experiencing obstacles accessing necessary medical care for COVID-19.  

In the end, turning nudges into numbers may be more about how we talk to the unvaccinated than what we say.

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