Reaching collective immunity to COVID-19 through vaccination is one of the biggest challenges the world has ever come up against. But a vaccine is only as effective as the number of people who take it, and recent research we’ve conducted at GWI indicates that current levels of takeup won’t be sufficient.
Never mind the logistics of distribution – convincing people to get their shot will take one of the biggest advertising campaigns of any kind. In the US, the nonprofit Advertising Council is already preparing a $50 million initiative.
As with any ad campaign, choices will have to be made on which media to buy, what messaging to use, and which audiences to prioritize – none of which can be done without robust profiling. Any campaign will need to target groups of people that occupy a world unfamiliar to many marketers and journalists.
Here we’ve pulled out some key implications from recent research across 8 countries* to figure out the public mood regarding vaccinations, with some suggestions on how to target the vaccine-hesitant and the vaccine-skeptical.
*The 8 countries surveyed were Brazil, China, Germany, India, Italy, Japan, UK, and the US.
- 66% of internet users say they will get a vaccine – below most estimates of the level needed to achieve collective immunity. Western countries have higher rates of vaccine refusal.
- 12% are vaccine-hesitant, meaning they’re not sure if they will get one. Their fears mostly arise through caution and anxiety, but the right messaging from the scientific community and public figures will make headway with them.
- 11% are vaccine-skeptical, saying they won’t get one at all. They’re distrustful of institutions, so best reached through trusted messengers within religious and family units.
- The biggest worry about COVID-19 vaccines is their potential side effects.
- Hardcore anti-vaxxers are a small minority. Most people who feel hesitant or skeptical about getting their shot hold particular reservations about this vaccine, not vaccines as a whole. But they are still susceptible to anti-vax messaging.
Vaccine uptake is currently too low to ensure herd immunity.
Across those 8 countries, 66% of internet users plan to receive a COVID-19 vaccine, with an additional 11% saying they would, but only if they needed it to work or travel. Takeup ranges from over 80% in Brazil, to less than 60% in Germany and Japan.
Estimates vary, but most suggest that at least 70-80% of a population needs to be vaccinated to achieve collective immunity. In countries where vaccine refusal is highest, a significant challenge lies ahead. And not all of those who plan to receive it will do as soon as it’s available to them. A third say they will “wait a while” before they get the shot.
Convincing people to get inoculated is one thing, but so too is ensuring that they receive it at the earliest opportunity.
Some may interpret “waiting a while” as ensuring the most vulnerable groups receive the vaccination first. But there’s a potential risk in what we might call “vaccination procrastination”. We saw something similar with the H1N1 pandemic, whereby uptake for vaccination against it was low because many felt its dangers had been overblown. So even the most willing to receive a COVID-19 vaccine will need reminding to get it on their to-do list.
There’s another risk with this “wait-and-see attitude”, which is that misinformation can gain ground in the interim. Timing is therefore critical in any messaging, and so too is anticipating fluctuations in public mood during the rollout.
The sheer number of vaccinations means there will be statistical coincidences whereby recipients become unwell or even die shortly after getting their shot, for entirely unrelated reasons. It doesn’t require a great leap of imagination to see how some would seize this as evidence that the vaccine is harmful.
There’s precedent for this in infant vaccinations. As many of them are administered in the same life stage where SIDS (also known as cot death) is most likely to occur, some have tried to use this as evidence of an inherent risk of vaccination, when it’s a coincidence generated by the numbers involved. This has to be anticipated, and responses to such an event should be prepared early, a tactic gaining popularity under the term “prebunking”.
Western countries are more likely to refuse a vaccine.
Across the 8 countries we surveyed, 11% said they wouldn’t get a vaccine at all. Germany had the most refusing to take the vaccine at 24%, while India and Brazil had the least, at 5% each. This tallies with the observation some have made that high-income countries are more complacent with regard to infectious diseases, whereas others are more acutely aware of their dangers.
12% in our surveyed countries (and more than 20% in Japan) aren’t sure if they will take it or not.
These groups – what we have called the “vaccine-skeptical” and the “vaccine-hesitant” respectively – will be the key ones to address.
Our research has produced insights into how and where to reach them, which we detail below – beginning with the vaccine-hesitant.
The vaccine-hesitant: cautious suburban parents, looking for transparency on the science.
Compared to the general population in these countries, the vaccine-hesitant group skews female and toward Gen X (those aged between 38-56). Over half are parents, 45% hold a college degree, and they’re more likely to live in the suburbs.
Their ambivalence toward vaccination isn’t defined so much by feelings about it as a practice, but more inward-facing feelings of caution and anxiety.
These are people who don’t describe themselves as willing to try things before others or make decisions quickly; they tend to follow the crowd.
They are, however, quite health-conscious, so it may be a case of establishing to them that the potential harm of COVID-19 is much greater than the potential harm of a vaccine. With many being parents, worry on behalf of their children will be at play as well.
As you might expect, the vaccine-hesitant are often less worried about the COVID-19 outbreak, and fairly optimistic about containing it. One way of getting them on-side is reminding them that containing it cannot happen without them, appealing to their sense of responsibility and giving them an investment in the process.
Both the vaccine-hesitant and vaccine-skeptical camps agree on the biggest sticking point about getting the shot, which is anxiety about any potential side effects, or a feeling that it’s unsafe (usually because they don’t think it was thoroughly tested).
With such scrutiny on the COVID-19 vaccines, it’s vital that any minor side effects that arise from the injections, like soreness or fever, aren’t seized upon as evidence that they’re harmful.
There has to be transparency on how people’s bodies might react, even if it’s benign.
24% of the vaccine-hesitant are also worried about cost, so that has to be part of the conversation too. Particularly in low-income countries, some may defer getting the vaccine because they assume they can’t afford it.
What would most convince the vaccine-hesitant to get their shot is transparency. They want to see more about how the research to produce it worked, what the approval process consists of, what its possible side-effects may be, and to better understand how it works inside the body.
Much debate in recent weeks has focused on using public figures as early adopters of the vaccine, whether it’s politicians, athletes, or actors. But what could be more effective in winning the trust of the vaccine-hesitant is bringing forward doctors, scientists, and clinical trialists to give clear explainers.
This could be done in a formal way, using heads of health departments, or more casually, by drawing on the energy of the healthcare workers that command thousands of followers on social media.
Vaccine-hesitants are easier to persuade; it’s vital to reach them first.
We can get more insight into what drives the vaccine-hesitant by making use of our recontact methodology. As our sample for this study was taken from respondents we’ve already interviewed in our Core research, we can overlay them against more than 40,000 extra data points. By investigating more about their feelings, online habits, and media preferences, we can gain more insight into how they might be convinced.
We find further evidence of the vaccine-hesitant being easily swayed in the ways they tend to discover new products. They’re more likely to hear about brands and products through message boards and word-of-mouth recommendations, whether in-person or on social media. So they clearly look to guidance from others.
Applying that logic to COVID-19 vaccination, it will be important to circulate testimonials from the first recipients (which could include clinical trialists), particularly where side effects may be concerned.
While celebrities may not be the deciding factor in persuading them to get vaccinated, they will help keep it front-of-mind.
The vaccine-hesitant are more likely to be interested in celebrity gossip and to talk about celebrities online, so public figures will at least help guide them to a decision.
It also presents a chance to reach them on two fronts, through collaborations between celebrities and scientists, in the mold of Dr. Anthony Fauci’s live-chats with Steph Curry and Kim Kardashian. These are likely to land effectively – assuming the names chosen are ones that will resonate with the audience.
Their interest in celebrities also reminds us of a potential scenario whereby public figures with large platforms put themselves on the wrong side of the debate, as tennis player Novak Djokovic did when he supported anti-vaccination sentiments (later clarified) during a social media livestream in April 2020.
There’s an onus here on social platforms and publishers to act quickly when those with big followings distribute misinformation about vaccines, or otherwise prevent it proactively.
The vaccine-skeptical: short on trust and hard-to-reach.
Compared to their hesitant counterparts, the vaccine-skeptical group initially looks like a much tougher nut to crack.
The vaccine-skeptical also skew female, though they’re on average slightly older than the vaccine-hesitants.
There are crucial differences between them; the vaccine-skeptical over-index for living in rural areas, and they’re less likely to have a college degree. 43% are in the low income bracket. They’re more likely to be concerned about how their personal data is used online by both governments and companies than the average person, suggesting a shortfall of trust in official institutions.
A third of them say that nothing would persuade them to get the shot, compared to 14% of vaccine-hesitants. This does mean, though, that two-thirds of them feel they could be persuaded.
They’re not particularly worried about COVID-19, and show this by being more comfortable with indoor dining and large indoor events. They’re also quite pessimistic about the prospect of containing COVID-19 at all.
That combination – of not worrying about the pandemic, and being pessimistic about controlling it – is reminiscent of the “it’s only as bad as the flu” line of thinking, that the disease isn’t particularly harmful and is something we just need to learn to live with.
To be clear, multiple studies have shown that COVID-19 is much more lethal. And unlike influenza, there is no preexisting immunity, and there’s also the threat of new mutations. But many still use the risks of the flu as a model for COVID-19.
Some vaccine-skepticals (16%) don’t think a vaccine is necessary at all.
For these holdouts, messaging about the vaccine’s importance has to happen hand-in-hand with reminders about the threat of the virus.
Their feeling that COVID-19 isn’t much of a threat hints at problems to come, not just among the vaccine-skeptical, but the general population too. If we assume vaccinations proceed without much trouble through the first half of the year, and that incidences of the virus decrease, it’s easy to imagine some beginning to wonder if vaccines are even necessary.
We saw hints of this in 2020, as some questioned the effectiveness of mask wearing and social distancing as successive waves of COVID-19 cases waxed and waned.
The length of time needed to achieve full coverage means “vaccine complacency” could rear its head. Vaccine uptake was low after H1N1, and annual flu shots often miss their benchmarks. If case numbers happen to decrease, some may assume that vaccines have already “done the job”.
COVID vaccine refusers shouldn’t be confused with hardcore anti-vaxxers.
If you imagine the kind of people who would refuse a COVID-19 vaccine, chances are you think of a very vocal anti-vaccination lobby, one composed of conspiracy theorists and quack doctors.
But our research shows that this only accounts for a sliver of the vaccine-skeptical camp.
Among those who don’t plan to get a COVID-19 vaccine, only a minority (13%) say it’s because they’re against vaccination as a whole. We shouldn’t conflate hardcore anti-vaxxers with this broader group that has more specific reservations.
Some may be trusting of vaccines on the whole, but less trusting of this vaccine in particular.
Everyone, regardless of whether they’re pro- or anti-vaccination, is most concerned about the potential side effects. But what most distinguishes the vaccine-skeptical is their lack of faith in the scientific process.
They’re much more likely to believe it was developed “too quickly”, or that it is potentially unsafe. The same reason why vaccine development is such a cause for celebration – its speed – is also what gives some people pause. Whereas the scientific community may convince the vaccine-hesitant, they’re less likely to make headway with the vaccine-skeptical.
Another important finding is that the vaccine-skeptical are more likely to go out of their way to avoid advertising. So not only are they physically hard to reach (with many living outside of cities) they’re also advertising-averse and skeptical by nature.
Here our recontact methodology offers a path forward; with many more data points to call upon, we can tease out more details about their personalities and how they live their lives.
In doing so, we can get an idea of which levers to pull.
Aim for trusted messengers to win over the vaccine-skeptical.
Faith defines the vaccine-skeptical, with 44% saying it is important to them. Local religious leaders will therefore have a big role to play in generating trust.
They aren’t the biggest consumers of media, but if you exclude China (where offline media is less relevant) from the analysis, they watch 15 minutes more of broadcast TV per day than the average person. So traditional TV will be an effective means through which to reach them.
The same, though, also applies for anti-vaccination messaging. Much scrutiny is placed on social networks as a gateway to anti-vax material, but traditional media can’t be overlooked either, especially as reports have shown that local TV is where many turn to for news about the pandemic.
Much of what the vaccine-skeptical does online is driven by search engines, especially when discovering (or researching) products and services.
Search providers have already created new resources to connect users with authoritative information about the pandemic, and their homepages can be important in the vaccination drive as well. Could they flag available time slots for inoculation? Could map tools nudge them to nearby medical centres?
One particular way of packaging a pro-vaccination message is suggested in our attitudinal data.
The vaccine-skeptical are more likely to describe themselves as traditional, and 48% are interested in history.
As they’re generally suspicious of science, particularly some of the newer methods used to create COVID-19 vaccines, it may be worth looking backwards, to public health campaigns of the past. They could be drawn on as a source of pride and to show that while the turnaround may be quicker, vaccine rollouts are part of a tradition.
One example could be the programs devised to drive uptake of polio shots in the 20th century. Polio vaccination was different from COVID-19 in some ways – for one, the young were prioritized rather than the elderly – but it offers illuminating lessons and things to anticipate.
Even then, anti-vaccination literature was extensive, with pamphlets calling the Salk vaccine “heinous” and “fraudulent”, and radio host Walter Winchell claiming it “may be a killer”. Such messages had an impact on takeup, and show the potential damage that can be caused if discussion becomes polluted.
Based on how the vaccine-skeptical tend not to describe themselves, we can also suggest angles less likely to land.
They’re much less likely to say that “feeling accepted by others” and “helping others before themselves” are important values to them, so that kind of social persuasion is unlikely to work.
71%, though, say that spending time with family is important. So what may work instead is leveraging more trusted opinions from within family units, building on the personal relationships they prioritize.
Reaching the vaccine-skeptical may involve speaking to their children (or grandchildren), and using those social networks to promote the message.
They’re unlikely to be convinced by politicians queueing up to receive the shot. Trusted messengers like religious leaders and family members are much more likely to bring them on board.
One challenge is complete; a new one begins.
When we at GWI began dedicated research into COVID-19 in March 2020, people may have hoped, but few seriously expected, that vaccines would become available by the end of the year.
But – and we know this is a phrase you’re sick of hearing – the hard work really does only begin now.
History shows how effective public health campaigns can be when they strike the right chord. “Don’t die of ignorance” has had a lasting impact on sexually transmitted diseases in the UK, while “coughs and sneezes spread diseases”, originally devised during the Spanish flu pandemic, has become part of common language a century after it was coined.
The scientists have done their bit, and will continue to do so. But they can’t do it alone. The next few years will need the input and expertise of those in advertising, marketing, public relations, media, journalism and more to build the biggest public health campaign the world has ever seen.