The world showed a vignette of covid vaccine hesitancy
4 min read 22 Mar 2023, 11:26 PM ISTVariations and similarities in behaviour both hold valuable lessons for us to tackle the next such emergency
PremiumEven as the world marked the third anniversary of covid’s declaration as a pandemic by the World Health Organization, many unanswered questions remained. Among the most significant is why did so many people hesitate to take a covid vaccine despite its availability and their high initial intent? The answer will determine how well the world faces the next pandemic. To better understand the contours of the vaccine hesitancy problem, FinalMile Consulting did extensive research across the US, India, Pakistan, South Africa, Kenya, Burkina Faso and Côte d’Ivoire.
Many around the world saw covid vaccination as just a medical decision. But in reality, it was a complex socio-political, psychosocial and economic decision. In Pakistan, there was a change of government, and in Burkina Faso, there was a military coup while the pandemic was on. This political instability affected public trust in their administrations and so also in directives from governmental agencies asking people to get vaccinated. Even in the US, with its highly evolved health care system, the context of the 2020 presidential elections and opinions of political leaders did impact many an individual’s decision to take a jab or not. But in Pakistan, there were already negative perceptions vis-a-vis vaccines among large numbers on account of misperceptions of the country’s polio vaccination drive. These misgivings got transferred to the covid vaccine too. A vaccination certificate, more than being an assurance of being protected from severe covid, was seen as a passport to move around freely during lockdowns, and many were willing get vaccinated specifically to enjoy these freedoms.
The mental model assumed for vaccine administration in most countries was one that’s better suited for children. For a child’s vaccination, parents give doctors control to make appropriate recommendations and the schedule is adhered to without resistance. But when it comes to an adult, the mental model at work was sure to be different, and it was. As observed, it was mostly a post-hoc decision, one taken after an event. If a dog bites you, or you get bruised by a rusted piece of metal, one takes the appropriate vaccine. But during the covid pandemic, when adults were asked to get vaccinated as a preventive measure, the narrative did not fit well with existing mental models. So vaccination became a more deliberate decision process with many questions around it.
While dealing with vaccine hesitancy, there was also a tendency to treat all those who were hesitant as anti-vaxxers, those conspiracy thinkers who were dead-set against taking any vaccine whatsoever. But the truth is that vaccine hesitancy was displayed along a continuum, ranging from a mere delay to complete avoidance. There were many who believed in the efficacy of the vaccine, but just hesitated a bit to take their shot. This was a clear case of an intent-action gap. The next segment was of those who knew the benefits of the vaccine, but were scared to take it because of ambiguity over its side effects. At the extreme end of this vignette were anti-vaxxers.
A one-size-fit-all strategy of broad communication does not work in such a situation. Instead, separate vaccine exhortation strategies should have been developed to tackle specific barriers in each major segment.
During the pandemic, countries used both carrot and stick tactics to initiate the desired behaviour. In Pakistan, those who were coerced to take a vaccination under the threat of losing their jobs were more upset with the after-effects of the shot than those who were not prodded to take it. Some states in the US tried to game the incentive programme by making the vaccinated eligible for special lotteries. Not only did these lures do little to encourage vaccination-elective behaviour, but they also ended up trivializing the whole vaccination effort. What worked instead were strategies designed to offset the vaccine’s cost or arrange free travel for people to vaccination centres.
Vaccination was ultimately a decision of risk versus reward. People across various countries were wore masks, maintained social distance and washed their hands frequently. It was difficult to convince citizens that they needed to take vaccination shots over and above their existing safety practices. A few odd stories about vaccinated people getting infected by covid and fears of vaccine side-effects made matters difficult in many places. In this muddled information context, the status quo of staing unvaccinated was considered a safer decision by some. Research also confirmed that as people hesitated for a longer time to take their vaccination, their tendency to justify inaction added to the strength of their resistance.
This covid vaccination experience will have a significant influence on all vaccination decisions in the future. It might no longer be a passive decision, one largely taken blindly on the recommendation of a health worker. It could become a much more active decision. Questions about the vaccine’s efficacy and side effects will probably be discussed threadbare before a final call is taken on it. Policymakers across the world should be ready to face this scenario.
As we studied vaccine hesitancy across several countries, we found differences in behaviour based on country-specific contexts, but also several behaviours that were common. But the biggest realization of this research project was that the last mile for even the greatest technological innovation is adoption, which is a conundrum of human behaviour. Unless you solve this problem, innovations could bite the dust.
Biju Dominic is chief evangelist, Fractal Analytics, and chairman, FinalMile Consulting.
