The behavioural barriers that covid vaccines must break
We should devise policies and campaigns that could overcome any reluctance to get a covid jab
PremiumWe have reached a crucial stage in covid pandemic management. Multiple companies have developed a vaccine in record time. With several innovations in supply-chain management, all that is possible is being done to take the vaccine to people around the world. But the most critical question is, are people looking forward to get vaccinated?
There will, of course, be a set of those who will voluntarily get vaccinated without much persuasion. However, a recent report showed that, between July 2018 and May 2019, only 47% of adults in the US got a flu shot. It is imperative that a far greater proportion of people, globally, are willing to take a covid vaccine for the world to achieve much-needed mass immunity levels. Achieving those numbers will not be easy.
Already, several ‘experts’ have appeared on social media offering opinions of why a covid vaccine is not required, questioning its efficacy and, worse still, warning of vaccination side effects. This false propaganda will only increase in the next few weeks. The fact that many of the vaccines developed have to be taken in two doses adds to the problem. As seen in the case of medication for tuberculosis and several other diseases, as the number of doses goes up, the chance of the whole course of medication being completed decreases proportionately. Ensuring adherence to medical advice is a tough problem of human behaviour.
The pet solution suggested by many policymakers for all behavioural problems is to develop awareness campaigns. While public campaigns that talk about the benefits of a vaccine, explain its procedure and allay any fears of it will surely be a good starting point, that will not be enough. Most human behaviour problems occur not because of lack of awareness. They happen because of an awareness-action gap. That is, awareness not translating into action. Humans are not always rational beings, as we consider them to be. So just awareness alone will not be enough to motivate people to walk to a nearby health facility and get vaccinated.
Those who are not interested in getting themselves vaccinated should not be seen as a single homogenous group. There are different behavioural barriers in the way. People with each such barrier should be treated as a separate segment, and each group needs to be managed differently. The majority of our people are numerically ill-literate. So communication that cites medical facts, numbers and percentages will not make for good persuasive communication. What could help break behavioural barriers and induce changes in behaviour are emotional appeals.
Most people are now highly fatigued, having adopted various new forms of behaviour in the last few months. If getting vaccinated is seen as yet another new task to be done for the country to fight the pandemic, there is a likelihood that people will want to skip this onerous ordeal. Instead, people should be commended for taking the necessary precautions and putting in so much effort to maintain a clean-slate during the pandemic. Vaccination should be positioned as an ideal culmination of their months of effort, as a finale of sorts. The vaccine can be framed as a once-and-for-all substitute for the inconvenience of wearing masks and adopting other burdensome behaviours against covid-19. The promise of a tangible and immediate benefit, like not having to wear a mask, would be far more persuasive than an intangible future benefit, like protection from the virus.
Vaccination in most countries is seen as an act that is done to protect children from diseases. In general, children are considered more vulnerable to illness, and concern for them tends to be higher among households. So, while grown-ups may be more likely to catch covid, it might not be advisable to focus a vaccination campaign on them. Instead, communication should project a covid vaccine as protection for the entire family. This column had earlier suggested that Community of Practice, a group of people who share a concern or a passion for something they do and who interact regularly, are ideal targets for many a behaviour change initiative. It will be a good idea to get the leaders of such groups to take responsibility for getting everyone under their influence vaccinated. It would be easier to build group responsibility towards the vaccination project than relying on individual-level responsibility.
One might assume that talking about the easy availability of vaccines might encourage higher participation in a vaccination programme. Rather, this strategy might be counterproductive. Too much freedom will create a sense of complacency and raise the tendency to endlessly postpone the decision to get vaccinated. It would be better to announce a certain time period beyond which vaccines will not be easily available, or beyond which their prices will increase. This ‘limited offer’ feel will create the requisite sense of urgency to get vaccinated. Studies by Dan Ariely and Klaus Wertenbroch have shown that externally imposed restrictions are the best bet to minimize the tendency to procrastinate. All countries around the world are accustomed to creating such temporal and locational restrictions for their election processes. India did an excellent job of this strategy during its Aadhaar-card enrolment process.
Over the past few months, we have done many things to curb the spread of the covid pandemic. But none might be more crucial than the last-mile exercise of managing a vaccination programme well.
Biju Dominic is the chief evangelist, Fractal Analytics and chairman, FinalMile Consulting
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