Making vaccines convenient and accessible helps minimise the impact of vaccine hesitancy


Wendy M. Grossman
Wendy M. Grossman is founder and (twice) former editor of The Skeptic, and a freelance writer.

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A recent research paper seems to provide the best-ever motivation to get a COVID-19 shot: the virus can lurk in penile tissue and cause erectile dysfunction. I feel this story deserves wider publicity.

As soon as trials began, both the British and American press began fretting about vaccine resisters. Six months ago, when supplies were thin and demand was high, it didn’t matter. Now that supply is adequate and new, more infectious variants are turning up, finding solutions is more urgent. In surveys, 28% of Americans say they will wait and see or only get vaccinated if required to do so. The remaining 14% say they won’t do it at all. UK hesitancy numbers are much lower, and dropping.

Many of us struggle to understand why anyone would resist, given the last year’s events. But humans are notoriously bad at assessing risk. It’s easy to believe that smart and careful should be enough to keep us safe from infection, and if it isn’t, we simply had bad luck. Getting vaccinated, though, is an active choice, and if something goes wrong, it means we chose wrong.

“Vaccine hesitancy” is a deceptively unitary term for a phenomenon with many causes. Access to vaccines is uneven; Bolton MP Yasmin Qureschi has complained about the unfairness of calling hospitalised Covid patients “hesitant” when the centralised vaccination site was prohibitively difficult for many to reach and too time-consuming for those on zero-hours contracts. In non-white communities, historical distrust of doctors and medical researchers is best mediated by community leaders and engagement with their concerns. Other populations who fear the vaccine because it’s new ought to see their concerns dissipating naturally now that millions have been vaccinated with very few problems.

Logistical deterrents are being fixed by better access; Bolton and numerous US cities are sending out vaccinations buses. “It was convenient,” one woman told MSNBC when asked why she’d said yes the day the mobile team knocked on her door.

Some US states are trying blatant bribes. New Jersey is offering a free beer with every shot, West Virginia promises a $100 savings bond to each vaccinated resident between 16 and 35, and Maryland is giving $100 to vaccinated state employees. In the Ohio lottery five vaccinated people will win $1 million each.

A pharmacist explained his most effective approach. “I call and say I have a vaccination reserved for you. People hate giving up something that’s reserved for them.”

A pharmacist explained to Full Frontal with Samantha Bee his most effective approach. “I call and say I have a vaccination reserved for you,” he said. “People hate giving up something that’s reserved for them.”

The psychology underlying that story reminded me of a 1980s astrology study in which Shawn Carlson found that the more personalised students believed their horoscope to be the more highly they rated it.

Psychological manipulation has been embraced by Silicon Valley ever since 2008, when Cass R. Sunstein and Richard H. Thaler published their book Nudge. Their basic idea was that you could – like when the magician says “Take any card” and you somehow always pick the card they intended – engineer free choice so that people make the “right” decisions. Professionals in the field they dubbed “choice architecture” rearrange foods in student cafeterias so the healthy items are prominent, rethink security policies so it’s easier to do the safe thing than the risky thing, and, more sinister, create the web’s “dark patterns” that make it much harder to cancel a subscription than to sign up for one.

The UK government embraced this approach, setting up the Behavioural Insights Team in 2010. The “nudge unit” has run trials of messages designed to push people to pay taxes and fines and supplied cheap labour to encourage people to clear out and insulate their lofts. Early in the pandemic, it created the hand-washing advice that, we now know, was more or less useless since the virus spreads through the air.

No strategy yet discussed would work on a vaccine-resistant friend in the northeastern US who believes her stash of garlic, vitamin D, vitamin C, homeopathic remedies, and high-quality local hospital means “I’m not afraid of a mild flu-like illness.” She admits that eventually she will give in under pressure of either travel requirements or family pressure.

This friend is finding a wide variety of answers when she asks people why they got vaccinated. Some want to travel, some hope to be free of fear, some want to return to normal.

“You must feel so liberated,” a different friend emailed when I got my second shot. And no, not really. Even with the easing restrictions, many things I like are still closed and likely to remain so for a while, and in so many parts of the world the virus still rages out of control. So no, not liberated.

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