Meet the Four Kinds of People Holding Us Back
From Full Vaccination
By Sema
Sgaier May 18, 2021
Nicholas
Konrad/The New York Times
Getting
everyone vaccinated in the United States has become much harder now that demand
for the Covid-19 vaccine is flagging. America’s vaccination strategy needs to
change to address this, and it starts with understanding the specific reasons
people have not been vaccinated yet.
The
conventional approach to understanding whether someone will get vaccinated is
asking people how likely they are to get the vaccine and then building a
demographic profile based on their answers: Black, white, Latinx, Republican,
Democrat. But this process isn’t enough: Just knowing that Republicans are less
likely to get vaccinated doesn’t tell us how to get them vaccinated. It’s more
important to understand why people are still holding out, where those people
live and how to reach them.
Why are
people where you live still not getting vaccinated? Select your state below.
After
conducting a national survey of U.S. adults, we grouped people into distinct
profiles based on their shared beliefs and barriers to getting the vaccine.
This approach, borrowed from the marketing world, is called psychobehavioral
segmentation. It will allow health officials to target their strategies in ways
that ignore demographic categories, like age and race. In the United States, we
used this approach to identify five distinct personas: the Enthusiasts, the
Watchful, the Cost-Anxious, the System Distrusters and the Covid Skeptics.
People in
each segment share some beliefs and barriers about Covid-19 vaccination. And
each persona includes at least some of every demographic: Republicans, Black
people, the middle class, young people and others.
Here are
the groups health officials need to reach — and how to reach them, based on their
fears, concerns and barriers.
Covid Skeptics
Covid
Skeptics are at the far end of the spectrum as the least likely to get
vaccinated. The primary barrier for people in this group are their specific,
deeply held beliefs about Covid-19. Everyone in this group believes at least
one conspiracy theory related to the pandemic, whether it’s that microchips are
implanted with the Covid vaccine; Covid-19 has been exploited by the government
to control people; or that the pandemic was caused by a ring of people who
secretly manipulate world events.
We found
Covid Skeptics are common in Arkansas, North Dakota and Nevada. Considering
that 84 percent of this group believe that the government is exploiting
Covid-19 to control people, leaders of vaccination campaigns should consider
tapping nonpolitical figures to mobilize this group. Doctors are trusted by 50
percent of this group, while scientists are trusted by 32 percent. They could
also use religious leaders, who may resonate best with 9 percent of group
members who say the vaccine goes against their religious beliefs.
The key to
engaging this group will be to avoid trying to debunk what they believe;
rather, experts need to listen, acknowledge how they feel and then share the
facts. Our research finds that emphasizing that vaccination is their own,
personal choice — one that can help them protect friends and family members —
can also work.
Cost-Anxious
The
Cost-Anxious worry about the time and potential expense of getting vaccinated
(even if it is actually free). We learned they’re dominant in states like
Mississippi, where they make up 23 percent of the population, which is not
surprising due to the state’s high poverty rates and low Medicaid coverage.
Public
health experts have stressed the need to bring vaccines to the people; with no
group is this truer than for the Cost-Anxious. Holding vaccination clinics in
non-health-care locations that people frequent — like workplaces, religious
venues, day cares, supermarkets, bars and restaurants — will be critical.
For this
group, vaccination campaign leaders should stress that vaccination is totally free
and encourage local businesses to provide paid time off for both doses.
System Distrusters
The System
Distrusters believe that the health care system doesn't treat them fairly.
Most, but not all, members of this group are people of color, and they prevail
in Washington, D.C., Maryland and Georgia.
It will be
important for public health officials to hold conversations — formal or
informal — with trusted members of their own communities to air concerns and be
transparent about efforts to vaccinate underserved communities. People in this
group have low expectations that other members of their communities will get
vaccinated, so making vaccinations of people they know as visible as possible
will be important. Tracking and illuminating efforts to ensure the vaccine
rollout is equitable and sharing that with the community is key.
The Watchful
The
Watchful are holding out to see what kind of experience their friends or
neighbors have with the vaccine before committing themselves. They dominate in
Delaware, making up 17 percent of the state’s population, as well as 12 percent
in Hawaii and Rhode Island.
Behavioral
science researchers know that establishing norms can lead to acceptance of
products and could help persuade the Watchful. Encouraging those who are
vaccinated to show their vaccination status with pride, both online and
offline, can nudge their family, friends and networks to follow suit. The
Watchful are already likely to wear masks, showing an intent to comply with
social norms, so they may respond to similar altruistic messages about
vaccination and get vaccinated to protect others.
For this group,
experts should consider allowing for a “vaccinate later” option. Behavioral
science suggests that people prefer moderate or “compromise” options over their
extreme counterparts. Being able to opt-in to vaccines down the road may
provide a comfortable alternative for this group.
With only
60 percent of U.S. adults having received their first shot, we are still far
from President Biden’s target of 70 percent by the Fourth of July. This
national average also hides an important truth: The country is a patchwork,
with states like Vermont tracking higher (with 78 percent of adults having
received their first dose) and states like Mississippi tracking lower (42
percent of adults). Therefore, we can’t rely on a one-size-fits-all approach.
President
Biden’s aggressive Fourth of July goal will be tough to meet without
understanding what drives lower vaccine confidence and where various strategies
to combat it will be most effective. And we can’t stop at the state level; we
need to go county by county and ZIP code by ZIP code, offering specific,
localized solutions to convince the holdouts. It will also be important that
everyone — not just the health care professionals and the politicians — do
their part. It won’t be easy, but it must be done to ensure that more people
get vaccinated.
People
illustrations by Jorge Colombo. Graphics by Stuart A. Thompson. Note: The
proportion of vaccinated individuals in each state is the proportion of
individuals who have received at least one dose of a Covid-19 vaccine as of May
5, 2021.
Dr. Sema K.
Sgaier is a co-founder and the C.E.O. of Surgo Ventures and an adjunct
assistant professor at the Harvard T.H. Chan School of Public Health.
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