It will inject a microchip so Bill Gates can track your every move; it will turn you into a monkey; it will alter your DNA; it will allow Russia to spy on you.
These are just a few of the crazy conspiracy theories circulating on social media about the COVID-19 vaccine. Governments are not only waged in a war against the virus but a battle with misinformation as they look to roll out vaccines.
While in the UK the Government is battling against ‘vaccine hesitancy’ over more legitimate concerns around safety and critics arguing regulators have approved the Pfizer BioNTech vaccine too quickly.
Indeed, in a recent study by the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, only 54 per cent of UK respondents said they would definitely take the COVID-19 vaccine and this dropped to 47.6 per cent after viewing misinformation on social media. And people from lower income, black and ethnic minority backgrounds were least likely to go and get vaccinated.
So how do Governments overcome these barriers and persuade the public that the vaccine is safe and they need to be vaccinated?
This is where insights from behavioural science can help Governments’ messaging and present a more powerful and persuasive case for vaccination. This will take more than logistics and simple messaging, only with a behavioural approach as part of the programme will the system deliver the 80 per cent coverage needed to gain herd immunity.
As part of the UK’s National Health Service’s (NHS) COVID Behaviour Change Unit I have been detailing the behavioural science insights that policymakers will need. We have developed evidenced-based behavioural policies for each of the priority groups: care home residents and the over-80s, health and care workers, the over-65s and young people.
Our research has found that across all the population cohorts there are significant potential barriers to taking the vaccine, ranging from anxiety to determined resistance, mild scepticism to overt mistrust, and disinterest to conscious non-compliance. For instance, young people are highly sceptical and more likely to believe false information, such as that seen on social media that the vaccine includes a microchip to track your every move or that it contains lung tissue from an aborted foetus.
By using the MINDSPACE framework – a simple tool to diagnose problems and create interventions – we detailed a litany of nudges that should be used to persuade the doubters and hesitant to take the vaccine for eahc group.
Care home residents and over-80s
The barriers to take-up in care homes is the anxiety about being one of the first to take the vaccine, a feeling that they are the country’s guinea pigs.
There is also a question of trust, many of those in the 11,000 care homes across the UK have mental health issues or complex medical needs, with 40 per cent of residents suffering from dementia, and so they rely on the familiar faces of staff.
This is where the messenger effect can help. A well-researched phonemenon is how we trust the message being delivered more when the person conveying it is like us or an authority figure. Thus, it would be best if care home staff were trained to administer the vaccine or known GPs, but if this can’t be done then trusted members of staff should accompany the immuniser. Align known staff with ‘strangers’ to reassure residents. Also use known local GP surgery staff and other known community staff.
Salience – where our behaviour is influenced by what seems relevant to us and to our personal experiences – is also a powerful nudge. Thus, accessible and evidence-based messaging about the positives that over-80s and care home residents are among the first to be vaccinated can be more persuasive with celebrities they trust. This has already been done with Great British Bake Off judge Prue Leith and there should be more.
It is vital that having the vaccination is a good experience because of our propensity to accept any default setting and the influence of ‘affect’, where our emotional associations can powerfully shape our actions. This is especially important as everybody will require a second dose. So, being clear on any potential side-effects and providing leaflets and good communication on how to deal with them is crucial.
We respond well to incentives, so rewarding those vaccinated with a badge will appeal to our powerful ego, which can also be nudged by providing care homes with a certificate from an official body recognising when all residents have been immunised.
Social norms are also powerful drivers of behaviour, thus, producing a chart that the public can easily follow showing how many people have been vaccinated each day will active this and show we are all in this together.
Health and care workers
As you would expect, our research has found that health and care staff have a strong desire to return to their pre-pandemic roles and this can be used as an incentive.
A clear plan with time frames should be distributed across digital media showing when health services will start to return ‘to normal’.Health and care workers have been through a lot of stress coping with the pandemic and many have voluntarily gone beyond Government guidelines in isolating themselves from family and friends. To reward such sacrifices and incentivise takeup of the vaccine ‘staff and family parties’ should be organised.
This is a knowledgeable group and research on other vaccines has shown nurses and doctors are more willing the more information they read on it. Thus, evidence on the effectiveness of the vaccination should be provided across hospital and workplace communications and a dedicated webpage, with contributions from relevant experts and organisations such as the National Institute for Health and Care Excellence (NICE). The messenger effect can also help with this by using hospital CEOs, medical and nursing directors to champion the vaccine and take it first.
Hospital leaders can also be used to activate another powerful force – commitment, where we seek to be consistent with our public promises, and reciprocate acts. They can send a clear message that the vaccination programme is about staff health, and not workforce numbers, to show they care and are committed to their wellbeing.
Is the fear of the vaccine greater than the fear of the virus? This is a consideration for the over-65s and particularly relevant for black and ethnic minorities (BAME) who were perceived as higher risk but have not caught the virus.
Indeed, research shows vaccine hesitancy is higher among BAME groups and lower income households and with diminished levels of education.
Using trusted channels such as faith groups, charities and community groups is important as well as using messaging that taps into the affect bias to evoke an emotional response, such as “over-65s are over three times more likely to die if you get COVID than someone younger than you”. And use traditional media such as newspapers, billboards and broadcast alongside digital channels.
Use salience by emphasising that the vaccine will allow the ove-65s to return to their normal activities, social life and see their children and grandchildren. They also need reassuring that there will be enough vaccine for their family and friends so they are not taking the dose away from someone who needs it more. This will appease their ego.
While a single webpage on the NHS explaining what to expect when having the vaccine, possible side effects, and how to manage them can help alleviate their fears.
This group ranges from teenagers to 29 and they are least likely to become severely ill, which may lead to a complacent attitude to receiving the vaccine. However, if herd immunity is to be achieve it is vital they participate.
Social media is a key communication channel for them so employing the messenger effect with influencers to champion the vaccination is vitally important. Research has shown how much of an impact social media influencers’ opinions have and it will help dispel the plethora of misinformation and conspiracy theories.
Trust of politicians and leaders is low among young people and so they are more susceptible to misinformation. Any false stories gaining traction on social media need to be identified and countered head on through clear evidenced-based messages from influencers.
Young people have been denied a lot of freedom, with their social life being severely impacted. Returning to this can be used as an incentive with the introduction of vaccination passports for universities, work, attending sports events and going to clubs and concerts.
Alongside these incentives messaging needs to acknowledge the impact the virus has had on this group. Explain why they are lower down the vaccine roll-out and back-up the statements with science, actual research numbers and a link to 'geting your life back'.
Use of affect – where our emotional associations can powerfully shape our actions – can also be used with this cohort by emphasising the regret they would feel if they were not vaccinated and subsequnetly infected loved ones.
By using behavioural science insights each potential barriers can be identified, understood and mitigated with tailored strategies for the different population groups. This will give the UK a much better chance of reaching herd immunity and bringing an end to the pandemic.
Ivo Vlaev is Professor of Behavioural Science and part of the UK National Health Service’s (NHS) COVID Behaviour Change Unit. He teaches Mobilising Resources and Incentives for Healthcare Innovation on the Executive MBA Healthcare Specialism. He also lectures on Judgement and Decision Making on the MSc Finance.
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