Using a behavioural science approach to increase COVID-19 vaccination uptake

It’s February 2021 and the COVID-19 vaccine is nearly on our doorstep for most Australians. What an incredible medical feat, when at this same time last year, the pandemic was starting to grip the world.

10 minute read
Target readership: governments and COVID-19 vaccination hubs

We now face a new challenge – COVID-19 vaccine uptake. In Australia, the vaccine is voluntary and we therefore rely on the majority of our 25,74,288 population to willingly roll-up their sleeves to take not just one, but two doses. According to experts, we need to hit 60-70% of the population before effectiveness can be measured.

This is potentially one of the biggest behavioural challenges of our time. If too few people are immunised, the value of the vaccine will be limited—and we will continue to face our current situation of yo-yo lockdowns, border closures, social isolation, economic casualties, and sadly, people falling ill and dying. Behavioural science can help.

As natural as it would be to concentrate on communicating the key details of the what/when/where/why/how of the Australian Government vaccine national roll-out strategy, we must also give attention to how Australians will make their decision, the context in which they will make it, and other persuasive actors in the system.

It will be up to the state governments and the hundreds of service providers to do the heavy lifting here. Relying on scientific information, transparency and encouragement is only the start. Below are some important and practical behavioural insights that should be part of the effort to achieving high and equitable vaccination uptake.

  • Create social proof – research shows that people look to their personal networks for cues about how to behave, affecting everything from wearing face masks, to panic buying after lock-down announcements. Without enforcement of the COVID-19 vaccination, social norms will be a powerful tool to encourage large-scale uptake.

Health authorities and vaccination service providers can therefore try and leverage the wide support of the COVID-19 vaccine (79% of Australians are willing). Public-service messages highlighting the popularity of vaccination would not only be accurate but should increase demand.

Example: if you want to target residents in a low vaccination uptake suburb, tell them that 8 out of 10 (use correct stats) have been vaccinated in their neighbouring suburb or the state, and include directions to their nearest vaccine hub.

Another example is using graphs that show the increase in vaccination uptake in their local area. When you have three data points, this becomes a trend. By displaying this trend, people are shown to participate and consequently to project the trend in the future. This is about leveraging future social norm that people want to be part of. International research suggests that younger people (on average) are very attentive to new norms. They don’t want to be on the wrong side of a future social norm.

  • Make it regular and amplify – information is perceived more trustworthy the more frequently it is heard. For example, the more you see a brand, or a hear a song, the more familiar it becomes – and subsequently, the more you remember and like it. A phenomenon known as the ‘mere exposure effect’. Collecting and communicating social proof routinely will be key to successful uptake. While one-off interventions might yield some affects, they will quickly decline.

Example: co-ordinate with stakeholders who represent all segments of the community to help repeat and amplify your social proof messages, leveraging all communication channels.

  • Make it visible – the more visible we can make vaccination, the greater chances of generating positive influence and acceptance. By seeing other people being vaccinated, can spur others to follow, especially for those who are hesitant. Making it visible also contributes to creating social proof.

Example: take advantage of the most visible real estate on store fronts of vaccination centres (e.g. pharmacy, medical clinics, hospitals), to promote vaccination. This provides daily visual reminders to passers-by. Where possible, make the promotion stand-out by using bright colours, minimal text, use visuals and large displays. Clarity and simplification are key here. For some medical centres and pharmacies, they might need to review the provision of their current information displays – inside and outside their stores – to draw attention to vaccine availability, and minimise information overload.

  • Make it positive – while the pandemic isn’t fun, leaders can produce a sense of optimism, unity and hope with some positive behaviours. The COVID-19 vaccine is an opportunity to respectively apply this powerful motivator.

Example: consider encouraging federal, state and council representatives to use their public position and social platforms to post a personal video or photo of themselves on social media being vaccinated, using the hashtag #thecovidshot. To amplify this social initiative, community ethnic group leaders should also be encouraged to take part.

  • Enlist early a range of community leaders – majority of people see government health leaders as a credible authority, and equally they see those leaders and influencers within their demographic and ethic groups as reliable guides and role models.

Engaging with target community leaders is possibly one of the most important strategies for state government health authorities to ensure equitable vaccine uptake. These efforts can play a role in building wide-spread community trust in the vaccination program and informing the design and delivery of responsive and respectful communications. We can take early lessons from the UK, where vaccination figures have found a disparity of over 20% between elderly white patients and elderly black patients being vaccinated. Similarly, African Americans were among the least likely to want the COVID-19 vaccine.

Example: identify and form a team of ethnic community leaders from government, businesses, non-profits, and religious groups to synchronise relevant social proof messaging and visuals. While resourcing might be constrained to co-ordinate these efforts, focus on those minority groups that have the lowest uptake. The 2020 flu vaccination uptake figures could be used as a proxy to guide initial segmentation until COVID-19 vaccination uptake figures become available. Access to this data and learning in real-time about what works and what does not work will also be vital.

  • Workplace leadership – leaders within each workplace can play a significant role in encouraging vaccination among their employees. The way leaders communicate is equally important to what they say. They must genuinely show they care first, which can be achieved by:
    • aligning messages with the values of employees (e.g. family and friends)
    • appreciate there will be different views about the COVID-19 vaccination among employees
    • continually reinforce that we are facing this pandemic together – no one is alone
    • continually encourage employees to choose to be vaccinated – don’t tell them.

By aligning these messages with the positive impacts of supporting yourself and your colleagues, will help build intent among employees. Additionally, detailing the closest vaccination centres to the workplace will help address that ‘last mile’ of converting intent to action.

One thing is for sure, seeing broad scale community vaccination will calm many people’s fears about safety. This will not automatically translate to people rolling up their sleeves though – the intention is there, but there might be something in their environment that prevents people from following through. This intention-action gap is very real, and it occurs in all aspects of our lives. So this challenge is important to address.

The difference between what people say they want to do, and what they actually do.

Intention-action gap

Tackling vaccine misinformation will be another challenge, an important task for all Australian health authorities. Behavioural science can help here too, and we will focus on the intention-action gap and misinformation in our next articles.