How incentives can combat vaccine hesitation

Developing a vaccine in record speed turns out to be the easy part of ending the Covid-19 pandemic. Getting everyone vaccinated is another story.

When the head of a public health institute in the US wanted to better understand vaccine hesitation, he turned to one of the most influential Republican pollsters in America, Frank Luntz. 

It was an exercise in cutting though the politicisation of health messages, Dr Brian Castrucci told Jesse Mulligan.

“Right now, in America most things are being politicised. And we saw early political divides around stay at home orders and mask wearing. And so, at some point, if you want to figure out how to talk to people, you need to know the experts who know how to do it.”

Early on in the piece the US took a binary approach, he says.

“You were either going to die of the virus or you were going to die of the economic fallout. And it's not binary right?”

As soon as an issue becomes political and tribal, it ceases to be a public health crisis, he says.

And so Castrucci got in touch Luntz to help work out how to talk to people more effectively.

One of the phrases they avoided, he says, is ‘vaccine hesitancy’.

“We want to talk about vaccine concern. This is a brand-new vaccine to a novel virus and if you have questions or concerns about taking it, then that's normal. You should have some questions, you should have some concerns. That's okay and I want us to lead with a very simple kind of phrase of; I understand that you have questions about the vaccine. How can I help you? How can I answer those questions for you?

“Doesn't that sound so much more welcoming than people calling each other names and ridiculing each other for taking or not taking the vaccine?”

A partisan mind set has bedevilled the US response to Covid-19, he says.

“When you go see your own doctor, you don't want him or her checking what the local mayor or county commissioner has to say about your health right?

“If you have a heart attack, you don't go running for a politician, and it should be the same thing with Covid and it wasn't, and you know what it cost us, hundreds of thousands of lives in the US.

“Covid-19 might be the cause of death, but partisanship is a contributing cause of death for every single one.”

Luntz was very keen to get on board with the project, he says.

“The idea here is we could put aside our political and partisan differences to focus on a public health crisis.”

Between them they organised a series of focus groups, specifically involving those who were unsure about Covid-19 vaccines.

“The most important focus group that we did was people who were initially sceptical of getting the vaccine, who then chose to get it. And it came down to a couple things, it came down to giving people the facts, it came down to peer pressure, if you will, from their friends and family who had gotten the vaccine.

“And the idea that we did not cut corners, we cut red tape, when it came to making these vaccines safe. Those messages were really helpful for people and helped them move from somewhat concerned to confident.”

One of the first things they did in the focus groups was ask what word came to mind when participants heard the word Covid-19. Republican and conservative focus groups felt the virus was overblown, he says, and yet the vaccine was scarier to them than the actual virus.

“There was some question as to whether we'd be able to move people from concern to confident. But when you bring in physicians, people want to hear from their primary care physician their own doctor, they want to hear from friends and family, they want to hear from religious leaders.

“And when you give folks the facts that tens of thousands of people were in these vaccine trials, that we know that they're safe, that Johnson and Johnson paused vaccine distribution because of six cases, that that helped to build confidence.”

It was facts that cut through in these groups in the end, he says.

“You have this novel virus and a novel vaccine and people have to make that leap. They have to feel comfortable, they have to feel that it's safe and facts help with that.”

They asked Republican Senator and physician Bill Cassidy to address the focus groups, Castrucci says.

“He said when you get in your vehicle to drive somewhere, you don't only put on your seatbelt when you know you're going to crash, you put on your seatbelt every time so that if there's a crash, you have less risk of injury. That's what a vaccine is in this case.”

Although people sought out facts the messenger was also important, he says.

“There was an ad that ran in the US with all former living presidents, except President Trump. And the focus group found it manipulative. And we said ‘what if President Trump was there?’ They said, it's still manipulative.”

It was trusted friends and medical experts who cut through, he says.

Another Republican politician also helped with fact-based messaging, he says.

“Chris Christie is a masterful politician. And he just sat down like he was in a New Jersey diner and he just started talking to people and said listen I got it and the person who was worse off than him was someone who was young, healthy and ran every day.

"And it was the randomness of Covid, we don't know who it's going to impact, we don't know if I'm going to get it and I'm going to be fine, but you're going to get it and you're going to be sick. And we don't know why.

“And so, you can choose to protect yourself. If I told you you could reduce the likelihood of ever getting into a car accident by even a couple percentage points, you probably would do it.”

The kind of collective message that has resonated in New Zealand was less effective in the states, he says.

“We are very focused on individualism and liberty, especially at a time where we've been politicised the political divide which does somewhat distribute based on strong beliefs of community versus strong beliefs of individualism.

“And so those who really value individualism and liberty, the idea that you were doing it the country, for someone else didn't resonate.”

What did resonate was people being able to resume activities they loved, he says.

“That's what motivated people getting back to what they love, not necessarily some, you know, heightened sense of country.”

 Incentives also proved to be effective, he says.

“Generally, incentives can work. We have a Krispy Kreme Doughnuts, which is a national chain in the US, giving everyone a free doughnut if they show their vaccine card, something as simple as that they can help motivate people.

“We found that as baseball season was starting, and some people chose to get vaccinated because they wanted to go see a baseball game. And it was these little things that can help you just make that decision.”

He says the Covid-19 experience in the US is a monument to “poor public health communication.”

“We need to be just as good at promoting health as those who are trying to erode health with their messaging. Coca Cola spends $4 billion every year globally on advertising.

“My messaging has to be better on substantially less money.”