4 min read.Updated: 02 Apr 2021, 05:42 AM ISTShonar Lala
Despite the proven benefits, vaccination hesitancy seems high in India, going by numbers as much as anecdotal evidence. Perhaps an explanation for this lies in behavioural science.
April is indeed the cruellest month, with covid rearing its ugly head yet again and the possibility of renewed lockdowns looming upon us. But is a lockdown the way to go? Research in the past year has shown that while front-loading a lockdown is optimal, blanket lockdowns are in fact less effective in developing countries. Ideally, lockdowns should be targeted at vulnerable groups. Rather than weak restrictions on the ‘many’, there should be strong restrictions on a ‘few’. The deleterious effects on poverty, inequality, mental health and other measures of well-being have also been well documented.
Lest we despair, let’s remember that unlike last year, public health officials have another, more nuanced, weapon in their arsenal—vaccination.
A vaccination strategy can help in two equally vital ways. The first would be to very quickly reduce covid hospitalizations and fatalities. Multi-country trials of Oxford/AstraZeneca’s vaccine (Covishield in India) have shown that 22 to 90 days after a single dose, its efficacy in reducing symptomatic infections has been 76%. Even more reassuringly, there were no hospital admissions—or deaths—in the immunized group. Data from US trials confirm these findings. Comparably, the makers of Covaxin report an interim efficacy of 81% in Phase 3 clinical trials. A swift vaccination programme could, within a few weeks, reduce the burden of care, and the devastation wrought, on patients, families and our health care system. The second effect of vaccination would be to reduce covid transmission. While not preventing it altogether, evidence suggests that a single dose of the Oxford/AstraZeneca vaccine has an efficacy of 63.9% against an infection by covid, symptomatic or asymptomatic. Thus vaccination can not only obviate hospitalization but can also lessen transmission.
Similar data is emerging on other vaccines such as BioNTech-Pfizer’s and Moderna’s. The risk of covid infection two weeks after a single dose appears to be 80% less, according to a Centers for Disease Control study in six American states. Countries that have led the curve in vaccination, such as the US and Israel, are now beginning to see hopeful dividends in terms of reducing covid cases. In India, the private sector quickly delivered the world’s new ambrosia and the government, correctly, began vaccination efforts with healthcare and front-line workers before opening up to seniors and those with comorbidities, and now to all those above 45.
But, surprisingly, of an estimated 100 million seniors in India, only 30 million have been vaccinated so far. Supply does not appear to be a problem. Vaccination centres in Mumbai, for instance, had thousands of slots wide open this past week. Anecdotal evidence suggests that medical workers and those with ill health have also resisted the jab. These are the most vulnerable groups. What explains this vaccine hesitancy?
Policymakers could take heed from the lessons of behavioural science, which has tried to explain some of the befuddling illogicalities of human nature. For example, when making a choice, we tend to overweight options that are certain and underweight those that are uncertain, what Daniel Kahneman and Amos Tversky called the ‘certainty effect’. In deciding about a vaccine, people tend to overweight the probability of the certain option, i.e., taking the vaccine and its side effects, and underweight the uncertain part, the probability of falling sick from covid.
Then there is the ‘availability effect’ which results in human brains making decisions based on the most recent data or what they recall most easily. This may happen if we receive multiple WhatsApp forwards about a vaccine and make a judgement based on that recent news item rather than on the fuller body of evidence. We may also be guilty of status quo bias, the inertia that leads us to preserve the status quo—in this case, stay unvaccinated.
‘Conforming’ with our peers is another well understood bias that affects human behaviour and explains why social media campaigns to post one’s vaccination status have gone viral.
How do we counter these biases that arise, as Richard Thaler and Cass Sunstein explain in their influential book Nudge, from differences in the brain’s automatic, unconscious cognitive system—and its reflective, deductive one? By harnessing them.
Providing easily accessible, frequent information comparing the slim probability of adverse side effects to the very real probability of adverse events from covid would help reduce the certainty and availability bias. Vaccination should become the default option and appointments automatically scheduled with messages, calls or posted lists. People would then be reluctant to go against the status quo. Leveraging the power of peer persuasion in a media blitz that portrays ordinary people of different socio-economic backgrounds and community influencers would help persuade the unconvinced.
Easter weekend brings with it eligibility for the largest segment of the population yet, those aged over 45. Let’s fervently hope that vaccinations can be ramped up and become the norm and not the exception, so that India may decisively turn the tide in its war against the covid pandemic.
Shonar Lala is a development economist who has worked at the World Bank and the International Initiative for Impact Evaluation