Home / Opinion / Views /  Boosting vaccination rates: Lessons from behavioural economics
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Over the years, economics has changed: no longer concerned only with arcane mathematical models of purely rational agents, it has begun to increasingly capture the behaviour of people and societies. These insights and models have formed a new field: behavioural economics. Today, this increasingly pervasive field is changing governance and business alike, informing public policy, healthcare decisions, and corporate strategies. By better modelling so-called irrational behaviours, it is easier to improve user experiences and ensure increased consumer satisfaction.

One domain in which behavioural economics has the potential to revolutionise policy is the global Covid-19 vaccination drive. There is remarkable variety in the responses of citizens around the world, both within countries and between them. In the UK, an immensely successful vaccination drive saw almost 60% of citizens with the first dose of the vaccine by June 2021. This exhibits remarkable speed when compared to neighbouring countries like France (39%) and Germany (45%) at that point. 

While factors like vaccine availability indubitably played a large role in this success, we’ve seen that vaccination rates have often been constrained by sluggishness amongst the populace rather than a scarcity of vaccines. The UK overcame this by incorporating two key insights from behavioural economics: the default effect is powerful and choice architecture matters.

The default effect captures how people like to stick with the default option. The leading cause of this is the cost of decision-making: even if someone wants to get vaccinated, it is costly to think about when they would be free to set an appointment, for instance. Instead, they remain with the default: no appointment. It is important to acknowledge that this cost matters. To get vaccinated in India, you had to log on to an online portal, fill out a form, and provide details of your identity documents or wait in line for hours. 

In the UK, however, the National Health Service contacted every citizen personally, inviting them to book their appointment through a link or phone number. Those that did not respond got a follow-up phone call offering assistance. The UK tried to disable the default effect by proactively contacting citizens and changing the choice architecture, simplifying the decision by offering instant support.

Changing choice architecture has proven immensely helpful with organ donation drives, which are strikingly similar to vaccine drives. An Ipsos survey tells us that in India, 74% of people are willing to donate their organs; however, according to the WHO, fewer than 0.1% actually do. Once more, we can point to the default effect to explain this. 

India, like many other countries, operates an opt-in system where people must explicitly agree to donate their organs, typically while applying for a driving license. The tick-box to confirm your consent is empty at first, establishing a default option - no - for those who are in a rush or simply don’t want to think about it too much. Even if everyone would like to donate their organs, many end up not ticking the box for one reason or another. Understanding the power of choice architecture, countries like Colombia and Wales have switched from a system where citizens opt-in to donate organs after death to a system where people can opt-out. After Wales switched from opt-in to opt-out in 2015, there was an increase in consent rates from 58% to 77% over four years.

By modifying how a choice is presented, we can preserve autonomy while nudging people towards a public goal such as disease immunity. Now that booster shots are becoming increasingly important with the onset of the Omicron variant, it is imperative that we learn from the past. In this case, behavioural economics informs us that if you want to increase vaccination rates, you should make it as easy as possible for them. Use phone calls, emails, and letters to invite people to take the vaccine. Don’t fall victim once more to the default effect.

The author is part of a team of researchers at University of Oxford conducting an experiment in behavioural economics. Click here to be take part in their survey and win prizes up to 50,000.


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