Nudging Our Way to Vaccination

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As two vaccines begin to roll out, the angst previously directed at when this will happen is being quickly transferred to questions of how, and to whom. A new opinion piece suggests some nudges that might make the process of delivering more than a half-billion jabs possible.

The more than half-billion number represents twice injecting 262 million Americans, roughly 80% of our current population. But I digress. Here are the suggestions.

Make the Vaccine Free and Easily Accessible

In business-speak, free and accessible reduce the “friction” of a transaction. The vaccine is free, but the injection may be subject to a small charge. If the insurers and providers follow the guidelines for injections of medications to Medicare recipients, that would add 6% or $1.20. There could be additional charges by providers, especially if the injection includes some form of examination, or in medical terms, “evaluation and management.” There could be a $25 charge in those instances, and since vaccination will be early in the year, that will come out of your deductible. I would suggest that the government pick up the vaccine and vaccination tab, maybe setting a one-time higher payment of more than 6%.

The other question here is accessibility. The first wave is going out to health care workers who cluster at hospitals and long-term care facilities and to the patients that likewise cluster to those facilities. So gathering the patients together is not such a lift. But how to get to the subsequent waves of the mobile is another question. The neighborhood pharmacy is a good bet, along with reasonably large medical practices. It is hard to see how a practice of two or three physicians will have the ability to get and give the vaccine. Remember, the shelf life is short, so we are talking about appointments, not walk ins. I would suggest we also consider using schools to vaccinate the students and their parents. We did that with the polio vaccine, and it worked well.

Make Access to Valued Settings Conditional on Getting Vaccinated

The poster child here are employees seeking to return to the valued setting they call work. Employers can require vaccination as a term of employment as long as there are “exceptions for concerns related to disabilities and religious beliefs and reasonable alternatives to continue to work for those who refuse to vaccinate, such as working from home.” If vaccination for seasonal flu is the model, most employees will either be vaccinated or find an exemption, but there is always a percentage that will get fired.

This applies more to elective valued settings, like dining out, or getting on a plane or cruise ship. That will mean that everyone will need to carry a vaccination certificate. I think that for many small businesses already on the financial edge, this will not be a nudge for them.

Use Public Endorsements From Trusted Leaders to Increase Uptake

We already have three Presidents lined up, and Dr. Fauci is ready to roll up his sleeve. This actually can be useful, especially for communities that are vaccine-hesitant. Religious institutions are going to have an opportunity to step-up in this setting.

Provide Priority Access to People Who Sign Up to Get Vaccinated Before Vaccines Are Widely Available

Everyone likes to get to the front of the line. This should be a crowd-pleaser for those most fearful of COVID-19 and trusting in science, but they would be in the line regardless. But offering them an early spot might be the nudge that gets the herd moving in a particular direction. In a Disney World sort of way, all the best rides have a long line, so if you can find a way to get to the front quicker, why not. As the authors write,

“Marketing research has shown that people tend to covet items that are difficult to obtain or that they perceive others as being able to access first.”


Transform Individual Vaccination Decisions Into a Public Act

This is a variation of the “I voted” sticker. It is a way of demonstrating affiliation. It was used during the polio vaccinations as public meetings were used to discuss participation. It was difficult to say no in front of the other parents, and some bioethicists feel putting people “on the spot” is ethically wrong. It is also a nudge that can go the other way. If wearing a mask is a political statement, we should be wary of creating a situation where vaccination is considered more about free speech than public health.

We have a bit of a road ahead of us.

Source: Behaviorally Informed Strategies for a National COVID-19 Vaccine Promotion Program JAMA DOI: 10.1001/jama.2020.24036