Beyond Politics — Promoting Covid-19 Vaccination in the United States - nejm.org

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Segment public according to identity barriers Qualitative research or text mining of social media to determine why patients feel vaccination runs counter to their identity. Create targeted messaging based on relevant barriers, such as a “Go out with a bang, but don’t die this death” campaign for groups with a Covid-defiant identity. Find a common enemy Message testing to determine what common enemies resonate across two polarized groups. Look for an enemy that prompts more animosity than the opposite group does.

• If a common enemy is poverty or recession: “This economy needs a shot in the arm. We can do that.”

• If a common enemy is those who don’t believe in America: “Think we can’t vaccinate 300 million people in 3 months? Watch us.”

Use analogy Develop a list of appropriate analogies for critical facts, processes, or statistics and share them through health care channels. Encourage trusted medical providers to prepare their own analogies for common vaccine questions. Use analogies to augment more complicated discussions of fact.

• Use process analogies (e.g., if asked how the vaccine works, say “mRNA is like a teacher that shows the body how to make the antibodies that fight off Covid.”)

• Use statistical analogies (e.g., “You’d be more likely to get hit by lightning than to die from Covid after getting vaccinated.”)

Increase observability Make it easy to see, in person or online, who has been vaccinated.

• Offer a wearable token — a bracelet, sticker, or pin — that can be observed by others.

• Offer social media frames and banners (e.g., “I’m a First Responder and I’m Vaccinated”).

• Partner with celebrities, respected local leaders, and members of all parties to show them, on old and new media, being vaccinated.

Leverage natural scarcity Use a national or state referendum to decide who gains access to the vaccine first, or request community input through surveys. Frame the chosen “first receivers” — whether the elderly, first responders, teachers, or essential workers — as nationally valued and honored. Predict and address negative attributions Monitor media to quickly identify negative attributions. For segment-specific attributions, partner with community leaders or influencers to identify and counter negative attributions.

• If delays in vaccine accessibility are being attributed to government incompetence, use daily briefings to show a complicated “air traffic control map” tracking freezer trucks.

• If prioritized deployment of vaccines in historically disadvantaged neighborhoods is being attributed to a belief that these populations are expendable “lab rats,” include these communities’ trusted local leaders in prioritization discussions.

Prompt anticipated regret Develop and use communications to remind people of a low-probability but high-stakes outcomes and the resulting strong emotions.

• Train family practice staff to use questions and statements such as:

• “What would change in your family if you became a Covid long-hauler and had permanent lung or heart damage?”

• “I’ve seen the crushing guilt of families that lose someone to Covid after not being quite careful enough — don’t do that to yourself.”

Avoid conveying piecemeal risk information Coordinate press releases with stakeholders to avoid letting bad news trickle out and making it seem worse than it is. If a delay seems likely, wait until you have a clear sense of the new situation and present any bad news up front and, ideally, just once. Promote compromise options Find ways to promote a sense of control by offering multiple vaccination choices; introduce other actions to frame vaccination as a middle or normal choice. Train cold-call promoters or survey takers to ask people if they will get the vaccine later, get it now, or get it now and sign up to donate plasma. Create FOMO motivations Frame vaccination as a desirable opportunity not to be missed. Find and provide rewards for vaccine completion.

• Partner with employers to give employees a day off to be vaccinated.

• Create a campaign to promote the idea that families should stagger vaccinations so that each “hero” gets a day in bed with snacks and binge-watching movies.

• Use monetary incentives (tax deductions or insurance refunds).

• Encourage celebrities to hold future free events for vaccinated fans.

Combat uniqueness neglect Work with health care providers to identify patient groups that might feel they have special conditions unlike “ordinary” people.

• Train medical personal to identify uniqueness neglect (e.g., patients might say, “The vaccine is fine, but it won’t work for me.”)

• Offer safe (even if largely unnecessary) modifications to standard vaccine delivery (e.g., topical analgesics before injection; getting the shot late in the day).

Neutralize the case versus base-rate heuristic Communicate with clinicians and other front-line health personnel about the base-rate fallacy. Build and use collection of positive anecdotes.

• Encourage clinicians to counter patients’ anecdotal “bad reaction” stories with “good reaction” stories rather than statistics.

• Ensure that DHHS briefings and websites include a continuous collection of real people’s stories about good vaccination experiences.

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Beyond Politics — Promoting Covid-19 Vaccination in the United States - nejm.org
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