How do we get America vaccinated?

To get to herd immunity, we need to take a psychobehavioral approach, tackle people’s barriers and get local

This story was developed based on our interactive data visualization, which you can experience here.

The U.S. is facing the greatest public health challenge of a generation: getting at least 70% of the population vaccinated against COVID-19, even as demand has dropped considerably in recent weeks. How can we do it?

It starts with answering three key questions:

Who is/isn’t likely to get the vaccine? Why are they likely/not likely to get the vaccine? How do we respond?

Looking at Demographics Isn’t Enough

Segmentation is the practice of dividing a population into approachable groups in order to create more personalized interventions. Traditionally in public health, segmentation has focused on demographic traits such as gender, geography, race, party and income.

The circles displayed show the demographic breakdowns of respondents to our survey of U.S. adults about the COVID-19 vaccine.

The problem: Demographic targeting helps identify the who. However, it doesn’t help answer the why and the how.

Graphic illustrating how traditional demographic segmentation looks only at demographics, including gender, geographic region, race, political party, and income.

Previous studies of COVID-19 vaccine confidence have focused on demographic groups — finding that women, rural residents, Black individuals, Republicans, lower-income individuals and essential workers tend to express lower likelihood of vaccine uptake.

But people are more complicated than their gender, race, political party, or where they live. Targeting solely based on demographics misses the underlying barriers shaping a person’s intention — barriers that are malleable and multidimensional.

Graphic illustrating how previous studies of COVID-19 vaccine confidence have focused on demographic groups — finding that women, rural residents, Black individuals, Republicans, lower-income individuals and essential workers tend to express lower likelihood of vaccine uptake.

We Need to Target People’s Barriers and Beliefs

Psychobehavioral segmentation instead divides people into groups based on their barriers and beliefs — those things that influence why they express reluctance to get vaccinated.

In a recent survey of U.S. adults, we identified five psychobehavioral personas for the COVID-19 vaccine. As you can see, each segment includes at least some of every demographic included in the survey.

Graphic illustrating how each one of Surgo Ventures COVID-19 vaccine personas (The Enthusiasts, Watchful, Cost-Anxious, System Distrusters, and COVID Skeptics) includes at least some of every demographic.

The Five Vaccine Personas in the U.S.

Our survey found that 39% of Americans are highly likely to get the vaccine, with the remaining 60% falling into four less likely segments, with a variety of concerns and barriers shaping their likelihood.

On one end of the vaccine likelihood spectrum we have The Enthusiasts, who are ready and willing to get the vaccine, and on the other end we have The COVID Skeptics who are guided by misinformation and unlikely to get vaccinated.

Graphic illustrating how many unvaccinated U.S. adults fall into each vaccine persona: Enthusiasts 39%, Watchful 20%, Cost-Anxious 14%, System Distrusters 9%, and COVID Skeptics 17%.

These Personas Differ in their Likelihood of Getting Vaccinated

Each of these personas express different likelihood of getting vaccinated on a scale up to 10.

Three of these segments (labeled “The Persuadable”) can likely be convinced to take the vaccine, due to barriers they have that we believe can be overcome with the right interventions.

Graphic illustrating that three of the personas — The Watchful, Cost-Anxious, and System Distrusters — can likely be convinced to take the vaccine. And each persona has the following likelihood of getting a vaccine (out of a 1–10 scale): Enthusiasts 9.37, Watchful 4.91, Cost-Anxious 4.16, System Distrusters 3.91, COVID-Skeptics 2.34.

Tackling Barriers = Reaching Herd Immunity Faster

But it all depends on how well we address key perceptual and structural barriers that affect their intention to get vaccinated.

We must prioritize these barriers to vaccination. Without doing so, we’re in danger of not reaching herd immunity.

Graphic showing the key barriers that each vaccine persona faces. Enthusiasts’ main barrier is appointment availability. Barriers for the Watchful are community norms and vaccine safety. Barriers for the Cost-Anxious are financial cost, time, and vaccine safety. Barriers for the System Distrusters are trust, access and inequity, and vaccine safety. Barriers for the COVID Skeptics are deeply held beliefs around COVID-19 and vaccine safety.

Customized Solutions for Each Persona

Here is a roadmap for the types of interventions we can use to address the real or perceived barriers for each vaccine persona.

We will also need to get local. Because people’s lived experiences are so critical, each intervention should be developed with a person’s own localized context in mind.

Graphic showing example targeted solutions to overcome barriers to getting a vaccine. For the Enthusiasts make it easy for them to get a vaccine, for the Watchful make it visible that others are vaccinated or have positive intent to be. For the Cost-Anxious bring vaccines to people and offer paid time off. For the System Distrusters listen and learn and partner with trusted community organizations. For the COVID Skeptics don’t try to debunk; instead enlist trusted figures to pursuade.

Identifying Segments and Implementing Local Solutions

How do we use our segmentation approach in local communities?

With the help of machine learning, we start with an online tool that easily identifies a person’s vaccine persona, with more than 90% accuracy.

Using the tool in their own communities allows local decision-makers, health care professionals, and community health organizations to easily identify the vaccine personas they must persuade, using targeted, evidence-based solutions to do so.

Graphic showing how we use this segmentation approach in local communities. 1. Develop a vaccine typing tool to identify vaccine personas. 2. Identify which segment a person belongs to. 3. Deploy localized customized interventions.

How the Segments Shift over Time

Behaviors and motives can change. Similarly, people can move within the personas as their attitudes toward the vaccine, reasons for hesitancy, and barriers to uptake shift over time.

When we administered our first survey in January 2021, the responses were as follows:

Graphic showing the results of Surgo Ventures’ first survey in January 2021: Enthusiasts were 39% of the unvaccinated U.S. adult population, Watchful were 20%, Cost-Anxious were 14%, System Distrusters were 9%, and COVID Skeptics were 17%. One percent of the U.S. adult population was vaccinated.

And when we administered the survey again in March 2021, the vaccine personas had shifted. The greatest movement was among the Watchful and the Cost-Anxious. The System Distrusters and the COVID Skeptics were largely unchanged, remaining unconvinced about getting the vaccine.

Graphic showing the results of Surgo Ventures’ second survey in March 2021: Enthusiasts were 22% of the unvaccinated U.S. adult population, Watchful were 6%, Cost-Anxious were 9%, System Distrusters were 7%, and COVID Skeptics were 16%. 40% of the U.S. adult population was vaccinated.

The Time to Act is Now

We must act now to reach a minimum threshold of 70% vaccinated in the U.S.

To do so, we must not only prioritize the Persuadable and focus on dismantling the barriers that stand in their way. We must also convince at least some proportion of the COVID Skeptics. Not easy, but not impossible if we work in a targeted way!

Graphic showing the future state when 70% of the U.S. population is vaccinated and there are only small percentages of unvaccinated in each persona.

Together, we can build greater COVID-19 vaccine confidence. Chances are, we all know people in our communities who fit these personas. It’s important that everyone — not just the health care professionals or the policymakers — work together and do their part to build greater vaccine acceptance in the U.S.

Visit www.precisionforcovid.org /vaccinebarriers to see the complete interactive data visualization.

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Design and Visualization: Daisy Chung
Grateful for design inspiration from Federica Fragapane.

Research: This work was made possible by everyone at Surgo Ventures, including but not limited to: Sofia Braunstein, Grace Charles, Lindsay Coome, Henry Fung, Eli Grant, Bettina Hammer, Aysha Keisler, Hannah Kemp, Rohan Kumar, Bethany Hardy, Neela Saldanha, and Sema K. Sgaier.

We are grateful for expert feedback and comments on this work from Sandra Quinn and Stephen Thomas (Maryland Center for Health Equity, University of Maryland), Janell Byrd-Chichester (and team at NAACP), Michael Hallsworth (Behavioral Insight Team, North America), Heidi Larson (The Vaccine Confidence Project), Stephen Phillips (COVID Collaborative), Megan Ranney (Brown University).