How behavioral science can boost vaccination rates

A woman administers a COVID-19 vaccination. (Credit: Juanmonino for iStock/Getty Images)

While many people are eagerly awaiting their turn to get vaccinated against COVID-19, many others harbor doubts. Berkeley Haas Professor Jennifer Chatman knew that when it came to workers in nursing homes and other long-term care facilities, that hesitancy could be a matter of life and death for residents. 

Vaccine uptake is not a medical issue—it’s an issue that pertains to how much trust the staff have in management and the medical system,” said Chatman, a leading expert on organizational culture. “While we know that giving people accurate information on vaccine safety and efficacy is critical, information alone is not enough to change people’s behavior.” 

While we know that giving people accurate information on vaccine safety and efficacy is critical, information alone is not enough to change people’s behavior. —Prof. Jennifer Chatman

Chatman’s sense of urgency led her to join Sigal Barsade, PhD 94, a management professor at the University of Pennsylvania’s Wharton School and Penn psychology professor Angela Duckworth, to use their scientific knowledge in the fight to stem the pandemic. In just four weeks, they drew on the collective expertise of 15 leading researchers to produce the COVID-19 Vaccination Uptake Behavioral Science Task Force report.  

“Everyone put aside whatever they were working on to help,” says Chatman, who also tapped Berkeley Haas Prof. Emeritus Barry Staw for the task force. “It was an amazing collaboration completed in record time given the urgency of the situation: This is a crucial population, as they care for people who are among our most vulnerable to the ravages of COVID-19.”  

Shared with federal policy makers

The report was already presented at a meeting of 90 officials from the Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC), and shared widely within the agencies. It contains practical recommendations grounded in behavioral science insights on the psychology of motivation, teamwork, emotions, cognitive biases, influence, norms, and organizational culture.

While the primary focus is increasing vaccination rates in long-term care facilities—where initial vaccination uptake among staff was only 37.5% compared with 78% of residents, according to the report—the researchers note that the recommendations and insights may be adapted to many other organizations. The final report is available to the public

Acceptors, refusers, and the “moveable middle”

They categorized staff into three primary groups: Those who have already been vaccinated and can be tapped as powerful advocates; active vaccine refusers or detractors, whose negative impact should be minimized rather than amplified; and the large “movable middle”, who are hesitant, but can be persuaded. 

The many recommendations in the report are based around key behavioral strategies:

  • Empower vaccine acceptors as advocates: The researchers encourage facilities to identify staff who have been vaccinated and elevate them as ambassadors, rather than relying on management to deliver the message. Chatman recommends that facilities invest money in “offering acceptors/influencers incentives (or gifts of gratitude).” This may include paid time off, gift certificates, or an award or recognition. Another suggestion is making use of “convert communicators”—staff who had been reluctant to get the vaccine but had changed their minds. 
  • Make it easy: Facilities should do whatever they can to eliminate barriers for staff, “who are already burdened by difficult work conditions that have been intensified by COVID-19,” Chatman said. Tactics include making information on vaccination policies clear and accessible, holding follow-up vaccination clinics onsite, and giving staff paid time off to get the vaccine and to recover if they have side effects. 
  • Use social influence and boost motivation: As Barsade notes in the report, “Emotions influence people—not just cognition.” A peer-to-peer influence strategy is more effective than a top-down approach, and facilities should pay special attention to who is delivering messages. Ambassadors should be staff who are respected by their peers, and should match their co-workers’ demographics. “Get some of those who were vaccinated to talk to those who are still resisting. A good way to do this may involve sharing their own side-effects of the vaccination as well as their reduced fear of ending up in an ICU on life support,” Staw wrote. Messages emphasizing the common good can be a powerful motivator, as are messages emphasizing social justice.
  • Build trust in vaccine safety: While clear information about vaccine efficacy and the rigorous testing it underwent is critical, that should be supplemented with authentic peer-to-peer conversations. Chatman suggests ensuring at least one core employee in each group is vaccinated first. “To combat employee mistrust of employers (and health officials), have (qualified) co-workers administer vaccines to one another, keeping employee level as similar as possible between vaccine administrator and vaccine target. Similarity = trust,” she wrote. In an organization where trust is low and staff feel exploited by their employers, it may be best to decouple the vaccine completely from the workplace, and arrange for offsite vaccinations.
  • Limit the damage of vaccine detractors: “ Avoid amplifying unfounded concerns by engaging with highly hesitant individuals one-on-one,” the report recommends.  

For every strategy, the researchers emphasized that managers must consider the organizational culture, and strategies and recommendations are meant to be combined and layered, depending on the situation. 

“A (facility’s) culture, particularly the extent to which it has emphasized norms such as pulling together for the greater good, inclusiveness, and respect among staff and between staff and management, will influence how much effort the organization will need to exert to increase vaccine uptake among staff,” Chatman emphasized.

Read the full report here.