How to encourage inoculation after a vaccine is developed

Katherine Milkman, Angela Duckworth, and Mitesh Patel

Katherine Milkman, Angela Duckworth, and Mitesh Patel, Opinion contributors
Published 5:01 a.m. ET June 5, 2020 | Updated 6:40 a.m. ET June 5, 2020

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Pressure to create a coronavirus vaccine is increasing by the day, but for a safe vaccine to enter the market, it takes time.

USA TODAY

We've learned how to increase the chances adults will be vaccinated for the common flu. We need to put those methods into practice for coronavirus.

If a vaccine for the coronavirus became available, would you get it? A recent poll found that only 49% of Americans said yes.

While this may seem surprising, given how drastically COVID-19 has upended most of our lives, history suggests it shouldn’t be. Consider the flu vaccine. Nearly every drug store in the country makes getting a flu shot quick, cheap, and easy to do. And yet, since the Centers for Disease Control and Prevention first recommended we all get an annual flu vaccination, the percentage of American adults who have followed suit has never exceeded 45.3%.

Critical need for vaccination 

Why is it so critical that we do better with the COVID-19 vaccine? This novel coronavirus spreads much more quickly than the flu, is far more deadly, and will likely continue to propagate rapidly until we achieve herd immunity — when so many of us have antibodies against COVID-19 that a new case has a low probability of infecting others. The many experts say that between 60% and 80% of Americans must develop antibodies to the novel coronavirus to achieve this tipping point. 

With this in mind, enormous attention and funding have been focused on developing and mass-producing a vaccine. But a critical step has been largely overlooked: making sure most of the population actually gets vaccinated.

 (Photo: Getty Images)

As scientists working at the intersection of behavior change and public health, we know this story all too well. Billions of dollars are invested in miraculous new medical therapies and treatments, but wide-scale adoption is never achieved or, at best, takes years. So what can we do differently now?

Just as massive collaborative efforts are being mounted to develop a vaccine, we must rapidly test different approaches to increase vaccination uptake, recognizing why it’s likely to be difficult. Americans generally worry about vaccine safety, underestimate their risk of infection, and often fail to follow-through on their best intentions.

Reopening without a vaccine:Coronavirus vaccine not the end-all-be-all. We must have a plan for reopening without one.

Encouraging healthy decisions

The good news is we don’t have to start from scratch. We already have scientifically-tested ways to encourage people to make healthier decisions. For instance, prompting people to jot down the date and time when they’ll get a flu shot makes it more likely they’ll actually get vaccinated. We know that defaulting people into vaccination appointments is also effective. We know that simply reminding Americans to get vaccinated can change their behavior, and that incentivizing people to get a vaccine also works. 

But there are many more approaches to encouraging vaccination that haven’t been tested. Let’s use the upcoming flu season to figure out how we can do better.

Pharmacies, health insurers, and health systems have an opportunity to collaborate with behavioral scientists on massive research efforts to learn what works. We should be testing everything from cash rewards to psychologically wise reminders delivered by text, email, snail mail, and phone. And we should be running these studies at an unprecedented scale given the hundreds of thousands of lives and trillions of dollars we stand to lose if the pandemic isn’t stopped as quickly as possible.

In the war to establish herd immunity, developing a vaccine is only half the battle. We also need behavior change techniques to encourage an unprecedented number of Americans to choose vaccination when the time comes.

Katherine Milkman is a professor at the Wharton School of the University of Pennsylvania with a secondary appointment at the Perelman School of Medicine and is the co-director of the Behavior Change for Good Initiative. Angela Duckworth, a professor of psychology at the University of Pennsylvania, is the co-director of the Behavior Change for Good Initiative. Mitesh S. Patel is a professor at the Perelman School of Medicine with a secondary appointment at the Wharton School at the University of Pennsylvania, a staff physician at the Cpl. Michael J. Crescenz Veterans Affairs Medical Center in Philadelphia, and director of the Penn Medicine Nudge Unit.

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