Six ways to better understand COVID-19 vaccine hesitancy

The biggest challenge in this pandemic will be a behavioral one.

You would think that Americans would be highly enthusiastic at the prospect of a COVID-19 vaccine. Indeed, research shows that public enthusiasm for a vaccine is generally highest during a pandemic. But surprisingly, public opinion surveys show this is not the case: as many as one in three Americans are currently saying they will not get a COVID-19 vaccine.

This is a big problem, because a COVID-19 vaccine is only useful if we can achieve herd immunity — meaning we will need between 55 and 80 percent of the U.S. population to get vaccinated.

As we’ve seen with social distancing and mask wearing, our biggest challenge to overcoming this pandemic has been, and will continue to be, a behavioral one. And right now we have a rare window of opportunity to better understand the “why” behind people’s hesitancy to get the vaccine, so we can design interventions to help change their minds.

Here’s how we can do it:

  1. Learn your customer. First, we need to recognize a key principle of both behavioral science and marketing: develop a deep understanding of your customer. We can’t just lump people who are hesitant about taking a COVID-19 vaccine into one “anti-vax” bucket. We also need to avoid relegating people to their demographic categories: there is no one strategy that will work for all Black people or for all White people; or those over or under a certain income level.
  2. Ask the right questions. This means we need to ask different questions in our public opinion research. It starts with confirming not just whether someone will take the vaccine, but if they won’t, why not. It means digging deeper into what people perceive are the benefits to getting a vaccine, and what kinds of risks are they the most worried about. And we can’t be satisfied with just “yes” responses — we need to ask when, and under which circumstances, exploring whether and to what degree people’s perceptions of safety and efficacy matters, to what degree convenience will play a role, who might be the most likely to persuade them, and how confident people are in the public health system overall.
  3. Probe for perceptions about the different forms a vaccine could take. With COVID-19, we are seeing a new issue of vaccine “selectivity.” We don’t know what kind of COVID-19 vaccine will ultimately be used — so we need to start gauging people’s perceptions about the various forms a vaccine could take. This will allow us to capture valuable data to identify potential product design-specific barriers. For example, there may be more than one vaccine approved and deployed in the U.S., and if those vaccines are fundamentally different in their formulations or schedules, that could impact attitudes. We should be gauging people’s perceptions about RNA vaccines, which the world has never developed before. Will people take them, or will they want to wait a few months to see if there are adverse long-term side effects?
  4. Segment your audience. With the data we generate by asking more specific questions, we can then start segmenting our vaccine-hesitant audience — identifying “personas” of Americans, defined by their underlying reasons for not wanting to get vaccinated. Their attitudes can be a function of perceptions, biases, the contexts within which they live, or even the places where they live. For example, we may find large vaccine-hesitant populations in Oregon, but the reasons could be different across or even within counties. Knowing that vaccine resources will be limited, it’s important to start identifying now exactly where — down to the community level — we’ll need to target our audiences with the right messages to help ensure uptake. And messages will need to be persona-specific — whether for a middle-aged woman with underlying chronic disease putting her at high risk, or a 20-something college student living in a highly populated area who doesn’t see harm in waiting until the experts have worked out the kinks.
  5. Use online platforms to pressure-test messages. Distributing our messages online will be equally important. A recent study of 1,300 Facebook pages revealed that the engagement and follows on anti-vaccine pages were increasing more rapidly than pro-vaccine pages, indicating the potential for these anti-vaccine forums to dominate online discussion. These types of platforms lend themselves to quick and easy message-testing that can shift hearts, minds, and potentially behaviors.
  6. Learn from other countries. We can also learn from other countries about how to successfully engage and persuade communities. Sierra Leone’s ebola vaccine trial is a good example. In 2015, local community liaison teams actively engaged communities through public meetings while social scientists assessed community members’ perceptions to improve compliance of the trial. Denmark’s efforts to increase HPV vaccination rates through focus groups, storytelling, and an award-winning public media campaign are also worth noting.

Now is not the time to sit back and passively wait for a COVID-19 vaccine to be approved. Unless we act today to understand what’s driving COVID-19 vaccine hesitancy and take a behavioral science approach to targeting our messages to the right audiences using the right channels, we’ll be no closer to a life that even mildly resembles our pre-pandemic days.

This piece was made possible by everyone at the Surgo Foundation, including but not limited to (in alphabetical order): Sofia Braunstein, Sema Sgaier, and Bethany Hardy.



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