How to Achieve COVID-19 Vaccine Adoption to Open the Economy

After spending more than $10 billion to speed Covid-19 vaccine development, the country now faces the ambitious task of distributing the medicine to hundreds of millions of people desperate to return to normal life. 

Kevin A. Schulman, faculty of Stanford Medicine’s Clinical Excellence Research Center and professor in the Stanford Graduate School of Business, believes the public health community has much to learn from the hard-fought success of consumer products that also faced daunting challenges, many of them cultural ones. Schulman and Stacy Wood, marketing professor at North Carolina State University’s Poole College of Management, detailed this research in a paper published this week in The New England Journal of Medicine. 

“As with many disruptive trends and the innovations they spawn, Americans’ attitudes toward Covid-19 and related health behaviors have been shaped by a complex combination of information, relative benefits, and social identity,” they write in “Beyond Politics — Promoting Covid-19 Vaccination in the United States.” Incomplete information about the safety and efficacy of the vaccines has certainly contributed to the challenge.

What this means is that a one-size-fits-all approach to promoting the vaccine is likely to fail, and marketing researchers have countless examples to prove it. “From electrifying homes to developing personal computers, history has shown that ‘if you build it, they will come” makes a terrible marketing plan,” they write.

"Medicine frequently segments patients by demographic or socioeconomic traits, but a striking aspect of the public response to the pandemic has been the association of anti-Covid efforts with personal identity, especially political identity.

Observability is another key tactic: As the iPod launch taught all marketers, making things observable is a great strategy to accelerate uptake of new products. This is a challenge for a product like a vaccine, so the authors suggest physical markers like hero bracelets that vaccinated people can wear or digital markers for social media profiles for vaccinated people to help convince others to participate.Instead, Wood and Schulman outline twelve strategies and tactics to be tailored and prioritized according to specific populations, all with the goal of achieving widespread vaccine adoption.

Take for example the well-worn strategy in consumer marketing known as the promotion of “compromise options.” This is based on research that shows people tend toward nonextreme choices, leading most customers to choose the middle option when presented with choices. It’s no accident, for example, that Starbucks sells far more medium-sized, or “grande,” lattes than any other size, or that health insurance companies sell more mid-level plans than low-cost basic or full-featured platinum ones.  

Why would medicine be any different? Yet most of the time, patients are offered just two choices: have a treatment or not, get the vaccine or decline it. Instead, the authors suggest, make the vaccination decision a three-option choice, such as get the vaccine now, sign up to receive it a bit later, or not get it at all. Or all three options could include getting the vaccine, yet on three possible timetables. “The key is to avoid depicting vaccination as the most extreme action in a range of choices,” the authors write.

An enormous challenge, of course, is the powerful force of self-identity, particularly in today’s divisive political landscape. Personal actions are fraught with meaning, something the medical community doesn’t always understand. “Medicine frequently segments patients by demographic or socioeconomic traits, but a striking aspect of the public response to the pandemic has been the association of anti-Covid efforts with personal identity, especially political identity,” the authors write.

Unfortunately, mask-wearing has become a symbol of weakness to many conservatives, and has become associated with liberal political biases. We risk conflating vaccine adoption with political identification if the communication strategy is not carefully developed. This could make it challenging for elderly conservatives who might see value in getting the vaccine yet fear being stigmatized in their community. An effective campaign needs to be tailored to address these barriers, perhaps focusing on the private nature of the decision to get vaccinated, while another campaign might aim to convince the defiant that there are better ways to prove one’s fearlessness than dying alone of Covid-19. “Marketers need to find narratives that allow people to change their minds without losing face,” said Wood, the paper’s primary author.

The researchers also recommend leveraging natural scarcity, another time-honored marketing approach. Avoid focusing on the logistical problems of vaccine delivery and instead emphasize that early access to the vaccine is symbol of national value. “If you’re talking to vulnerable older people, make it a sign of respect, a sign of love, a sign of value,” Wood said. “Going first can make you feel like a hero if messaged properly, or it can make you feel like a guinea pig if we’re not careful.”

Another often overlooked approach is the importance of using simple language and understanding that normal, intelligent adults may need help assessing probability and risk. Being aware that social media is filled with misinformation, we should carefully consider countering negative stories garnering attention not with statistics but with a positive story told with heart.

“I would argue that we need to build on the existing research on marketing and consumer behavior in order to achieve this great task in front of us,” said Wood, who presented the research to Stanford Medicine Grand Rounds this week at Schulman’s invitation. Convincing as many people as possible to accept the vaccine is critical if we hope to return to normal life anytime soon. Wood and Schulman are convinced time-honored consumer marketing tactics will help get us there.

“Vaccine adoption will be one of the biggest challenges we have ever faced as a country," Schulman said. We need a communication strategy as scientifically based and as diligently crafted as the strategies which were successfully deployed to bring the COVID-19 vaccines to fruition.” 

Beyond Politics — Promoting Covid-19 Vaccination in the United States

Stacy Wood, Ph.D and Kevin Schulman, MD.

From the Consumer Innovation Collaborative, Poole College of Management, North Carolina State University, Raleigh (S.W.); and the Clinical Excellence Research Center, Department of Medicine, and the Graduate School of Business, Stanford University, Stanford, CA (K.S.).

This article was published on January 6, 2021 at NEJM.org.  https://www.nejm.org/doi/full/10.1056/NEJMms2033790