To Convince Vaccine Skeptics, Use Empathy, Information and a Re-Start, Experts Say

Thursday, December 10, 2020

DURHAM, N.C. – With multiple COVID-19 vaccines on the way in the United States, public health officials now face the daunting challenge of convincing skeptics to actually get the vaccine.

Three Duke experts in public health messaging, leadership and human behavior spoke with journalists Thursday in a virtual media briefing about challenges and solutions.

Replay the briefing on YouTube.

Here are excerpts:

ON REACHING PEOPLE WHO DON’T FOLLOW PUBLIC HEALTH RECOMMENDATIONS

Dan Ariely, psychologist, behavioral economist

“Doing something now, after a really, really long time of not doing a lot, is not easy. We have to work against a lot of forces. The first thing we need to do is put a time separation between the past and between the future. There’s lots of negative trends in life. There’s not upward trends. If we want an upward trend, what we need to do is stop, reflect and start fresh. Think of something like the Day of Atonement, or the Catholic confession. We need to create a new contract.”

“If you think about people’s personal experience, it would basically teach us that it’s not a good idea to follow the guidelines. Think about something like texting and driving. Imagine if you think to yourself the probability of texting and driving and something bad happening is 1 percent. So one day you drive and you’re tempted by your phone, and you text, and nothing happened. So you update your belief and say maybe it’s not one percent, it’s more like .75 of a percent.”

“COVID-19 is a terrible tragedy but on an individual level, if you one day walk without a mask, or you’re not careful and nothing bad happens to you, you learn the wrong lesson and you learn it again and again. It’s a low probability event. So we need very different tools. We can’t hope that people’s personal experience will teach them this is a good idea.”

“We need social understanding that this is the right behavior. We need people to say to each other, … ‘I’m sorry, I don’t feel comfortable. Would you mind putting a mask on?’ It has to be friendly enforcement of everything we do.”

ON WHAT MESSAGING WORKS, WHAT DOESN’T

Gary Bennett, professor of psychology and neuroscience

“Browbeating doesn’t work. It’s also not useful to imagine that all of the kinds of change we’re trying to promote is within the control of the individuals. Organizations, leaders have a role to put together policies and systems and structures that will make it easier for individuals to adhere to recommendations.”

“There is a widespread perception that education is a cure-all. If we just told people more about the condition, if we just helped them understand how significant an event this is, they would change. That kind of notion doesn’t work.”

“We want to do a lot less telling people what to do, and show them examples of how they can do it. It really starts with leaders; it’s really critical they model the types of recommendations they’re making.”

“If you’re a business leader, having your handwashing stations, having your sanitizing stations, having a testing protocol, those are all really critical components.”

“I’d argue we also have to have empathy for the complexity of this moment.”

“What we aspire to is a world in which everyone feels they’re doing the right things by following the guidelines. That’s about having very clear goals and being very consistent with them. Be really, really careful to encourage people and not to browbeat them when they have not adhered.”

ON THE IMPORTANCE OF HIGH VACCINATION RATES

Lavanya Vasudevan, assistant professor of family medicine and community health

“In my opinion, our best hope of getting the pandemic under control is to get high rates of vaccinations. Vaccines aren’t going to be our only way out of this pandemic, but I definitely believe they will be a very important component.”

“Public health is all about collective action. There is no ‘public’ in public health without public participation.”

“Having effective vaccines like we have right now are critical. But vaccines themselves don’t save lives; vaccinations do.”

“We need to focus all our efforts on doing everything we can to get people vaccinated. My hope is that as the vaccination campaigns unfold in the UK, Canada and here in the U.S., we will see the vaccine acceptances go up. There’s no excuse for losing more lives to this pandemic once we have an approved vaccine.”

ON THE BEST VACCINE PUBLIC RELATIONS CAMPAIGNS

Lavanya Vasudevan

“The two things that come up are the need for information and the need for trust. Information alone is not enough; it is important that the information has certain characteristics. The more personalized information is, the more it answers the questions that people have, as opposed to it being generic, (the better it is.)”

“Who is providing that information? If you just have information coming from a source you don’t know or trust, that information is not going to go very far.”

Gary Bennett

“Vaccine hesitancy is going to be a primary risk factor for COVID deaths in the next year. This is one of the most important public health challenges for our time.”

“For me, the mistrust is a primary challenge that we’re going to be dealing with. The reasons for mistrust vary considerably across the population. They happen to be particularly high in populations that have the highest rates of COVID. So it would be a mistake to imagine a kind of one-size-fits-all public service campaign as a solution. It will take a much more nuanced strategy.”

ON ONE WAY TO MAKE IT EASIER TO BE VACCINATED

Dan Ariely

“If I could design a system to increase vaccination, one of things I’d change is, I’d change the default. Right now when you wake up in the morning, the default is that you’re not vaccinated and you need to do something to get vaccinated. This creates a bias against doing it. I would love to schedule for each citizen an appointment for vaccination. I’d still allow the citizen to opt out. But instead of saying, ‘I want in,’ … they can opt out. That’s a shift in the way of thinking about this. I think more people would get vaccinated. The systems we create are incredibly important. Is it the easiest thing to do to get vaccinated?”

“So here we need to say, ‘How do we make it public? How do we make it visible? How do we make it the default?’ ”

ON REBUILDING TRUST IN GOVERNMENT

Dan Ariely

“Trust is one of those things that allow us to collaborate. If I think other people are not going to adhere to the COVID rules, I don’t have a reason to do it as well. It’s only if everybody does it that we all have the benefit.”

“I think a new president can get us to start a new contract with the government, basically saying let’s start fresh from now. Here are the rules. That president will also have .... to say, ‘I will communicate when things will go well and when things don’t go well.’ ”

“We can have a new contract, but it can’t be an empty promise. It has to be something with some power behind it.”

“We need better explanations for what the science is. Some people are afraid … of injections. What is this material that comes in? There’s all kinds of conspiracy theories around. I think we need to calm people down. Maybe we need to take this fear seriously, with respect, and explain what is an RNA-based vaccination? What does it look like? How does it work? What is the mechanism? We can’t do a Ph.D. in biology but maybe we need to work a little bit on helping people understand what this is all about.”

ON EMPATHY FROM LEADERS

Gary Bennett

“I think it’s critically important. An essential human need is to be seen and heard and understood. When leaders demonstrate that with their words, it’s an essential building block in establishing trust.”

“The challenge for leaders now is being vulnerable enough and wise enough to do the hard work of really understanding some of the reasons for the mistrust and how they may vary among different groups.”

“My recommendation to policymakers at moments like these is to really spend some time listening intently to various constituencies.”

ON LEADERS ADDRESSING VACCINE UNCERTAINTY

Gary Bennett

“The first thing is certainly not to try to be all-knowing. That generally fails. This is a critical challenge for most organizations at most times. It’s particularly true right now.”

“Frequent communication is absolutely critical, and the nature of that communication is critically important. Communication from leaders to others that is authentic, that is transparent as possible, that demonstrates empathy and knowledge … is really important.”

“One way of countering uncertainty is to provide certainty where certainty can be provided. Communicating what we know on a relatively expected and pre-defined timeline is really important.” 

“The challenge for leaders … in moments of uncertainty is that trust is in short supply. The return on investment for frequent communication is only realized at some point far in the future.”

Lavanya Vasudevan

“Trust cannot be earned overnight. It really takes long-term effort, building relationships to build trust.”

ON US VACCINE CAMPAIGNS AND DENIALISM

Lavanya Vasudevan

“We have the added challenge of being in a highly partisan environment, but I would argue that is not unique to the U.S. You see that in other parts of the world as well. In terms of what we need to communicate, this tailoring and personalization is extremely important.”

“We are seeing this huge wave of denial. Even though there were 3,000 deaths yesterday, there are huge numbers of people out there saying there is no COVID-19.”

“This is one of the issues we’ve had in this COVID-19 pandemic in general. We have made tremendous scientific progress given we knew nothing a year ago. But there are still gaps in information, and what happens when you have gaps, those gaps get filled in with things other than science. You have misinformation, myths. And when you have something in place, it’s harder to dislodge that and replace that with science and facts.”

ON CREATING VACCINE DEMAND

Dan Ariely

“I think we should use the scarcity as a way to create motivation. I’m imagining that we have a wait list. We let everybody sign up and wait. Even if 58 percent of people sign up, there will be a long wait list. It will look like everyone wants this.”

ON CONCERNS ABOUT LONG-TERM VACCINE EFFECTIVENESS

Lavanya Vasudevan

“With the number of deaths we have had – over 3,000 yesterday – even a vaccine that offers short-term benefits is worth it. That’s something we need to communicate. If it turns out the immunity is just going to last for a year and we’ll have to re-vaccinate, we’ll figure out a way to do that.”

ON SKEPTICISM OF HOW FAST VACCINES WERE CREATED

Gary Bennett

“We’ve gone from the bliss of a year ago to having a vaccine in a year. It only makes sense that people would imagine there’s something wrong with the speed of that timeline.”

“The fact is, we’ve known how to create these vaccines for quite a long time. The U.S. government invested a ton of money in providing readiness to be able to stand up vaccines like this.”

“Messaging that kind of thing now is unlikely to be heard in the way we would hope it to.”

“My concern is that in the politically fraught environment in which we live, it’s been impossible to describe the response, the public/private partnership that has resulted in these vaccines … in the way that we should. It’s on the order of the kinds of public works projects we saw in World War II.”

“It’s a fairly amazing undertaking. It’s been challenging to describe. I hope that changes.”

Dan Ariely

“People think of it as a year. It’s not a year. It’s been an ongoing effort for a very long time.”

“I think science has (not) done … a good job of promoting science. I think we should have had a celebration of all the people working so hard for such a long time to find solutions. It’s a great history of people working unbelievably hard … to try to figure this out.”

“So it’s not true to think of it as a year. It’s a breadth of effort.”

ON POLITICAL LEADERSHIP

Gary Bennett

“We had a moment back in February/March where there was a pretty good chance … that we could have significantly curtailed this pandemic. There are some arguments that say that President Trump is one of the few people who probably could have gotten it done in some respects because he could have spoken to a group of people who are particularly disaffected and less historically likely to (listen) to government messages.”

“We have another chance coming now with the vaccine. It’s the kind of thing that should be unifying to some degree really across this politically fraught divide we have right now.”

“It’s going to require really deft leadership that isn’t focused exclusively on hogging the mic at all times.”

ON WHAT YOU’D SAY TO A FRIEND WHO’S UNSURE ABOUT VACCINE

Dan Ariely

“I would say I think there’s no chance they will regret it, but, if they don’t take it they are either going to get sick or get other people sick, and they could regret it. I would ask them to imagine how they would feel if they passed COVID-19 to someone else. Just try to imagine how that would feel. Now tell me you shouldn’t do a lot to prevent that terrible feeling of regret that you didn’t take the vaccination earlier.”

Gary Bennett

“I usually ask people to get three people in your mind, over age 60, people you care about … now imagine that you have the ability to keep them from getting this disease. Help me understand why you wouldn’t choose to do the right thing. For me, this is about the communal impact and helping people to understand that even if you’re in a very low risk group, the decisions they make have potentially significant impacts.”

Lavanya Vasudevan

“I would actually try to understand what their positions on vaccines are and what their concerns are and try to respond to that directly.”

Faculty Participants

Dan Ariely
Dan Ariely is a professor of psychology and behavioral economics at Duke, and a founding member of the Center for Advanced Hindsight. He studies the irrational ways people behave and designs ways to make human behavior more rational.

Gary Bennett
Gary Bennett is a professor of psychology and neuroscience, global health and medicine at Duke University. He directs the Duke Global Digital Health Science Center and is also president of the Society of Behavioral Medicine.

Lavanya Vasudevan
Lavanya Vasudevan is an assistant professor in the Department of Family Medicine and Community Health and the Global Health Institute at Duke. She is also a faculty affiliate at Duke’s Center for Health Policy and Inequalities Research.

Duke experts on a variety of other topics related the coronavirus pandemic can be found here.

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