The increase in the percentage of people vaccinated against Covid-19 to achieve collective protection goes beyond syringes and ampoules; it depends on psychology, say scientists from several of the world’s leading universities, which over the past year have stepped up studies on the effect of behavior on public health.
“Accepting vaccines in this pandemic is an unprecedented challenge,” say scientists in a recently released report by the WHO Technical Advisory Group on Perceptions and Behavioral Sciences for Health, and the difficulty is not only the need to vaccinate most of the world’s population.
The fact that some vaccines use unprecedented technology (which can lead to previously unknown barriers) and that among the priority groups that need to be protected against Sars-Cov-2 are also people who are not normally targeted by countrisides. vaccination – adults with pre-existing illnesses, for example, or even front-line health professionals.
“The biggest mistake governments make is to think of immunization efforts only and primarily as a campaign,” says Cass Sunstein, who heads the WHO advisory group. Director of the Behavioral Economics and Public Policy Program at Harvard Law School, Sunstein was a key advisor to former US President Barack Obama.
The strategies the government chooses can make the difference between obtaining or not obtaining so-called herd immunity – the percentage of people who need to be vaccinated to control contagion. In the case of Covid-19, scientists estimate it at around 70%, but in some countries the share of people wanting to be vaccinated is below this minimum.
Research from universities in Spain, the United States and the United Kingdom, published in the scientific journal Nature in October 2020, indicates that on average in 19 countries, 7 out of 10 say they are at least somewhat likely to accept safe and efficient ”. Membership, however, varies considerably from country to country: it is 89% in China, but it does not reach 55% in Russia.
The survey polled 13,426 people, in random samples, in June 2020. The numbers should be understood as a picture of this moment, however, and public opinion can change, say the study’s authors. “Anti-vaccine activists are campaigning in several countries and some even deny the existence of Covid-19. Health officials must be prepared to cope with hesitation and disseminate correct information, ”they write.
This is one of Sunstein’s goals. “Whether it’s Covid, sexual health, smoking or other health issues, human behavior is always at the root,” he said when he took over the group from the WHO. Last month, the organization released a report on how to use behavioral science to expand immunization coverage.
One of the most important factors is the creation of the structure that experts call East (an acronym in English for easy, attractive, social and timely), Sunstein told Folha. “If you can get the vaccine in a short period of time, free of charge, from the neighborhood pharmacy, the chances of getting the vaccine increase.”
These are measures that increase grip, especially for the non-resistant, who need a boost to move from intention to action. For those who are afraid of getting vaccinated, other interventions may be needed, such as making vaccination a requirement for travel or accessing benefits, employment or education.
“These are remarkably effective measures when they intervene directly in behavior, without trying to change the thoughts and feelings of individuals,” explains work by health behavior expert Noel Brewer of the University of Carolina. North.
Researchers reviewed recent studies in psychology, public health, medicine, nursing, sociology, and behavioral economics. They stress, however, that research on vaccine behavior is still limited in quality or quantity.
The study highlights how essential it is to spread understanding of vaccines before people develop false beliefs, “which, once established, can be difficult to correct.” The percentage of those who refuse vaccination completely is low (1% to 2% in high-income countries, according to several recent studies), but radical anti-vaccine activists are making noise and gaining visibility.
Brewer’s group says that while the mechanisms by which antivaxxers influence others have not been well studied, language seems to matter. “In simpler terms, they tell a good story, usually in the first person, while posts from official sources tend to be factual, enigmatic and forgettable.
Psychological studies indicate that anecdotes about an individual influence more than statistics on large populations, notes American studies. To have an impact, official vaccine communication must be clear, emotional, and tell easy-to-remember stories.
Science explains this battle: One of the psychological factors that affect human decisions is “anticipated remorse”: fear of repentance later. This can work against vaccination if people overestimate the risk of side effects from the vaccine. To act in favor of vaccination, it is necessary to stress that people may regret it if they avoid the injection and then fall ill or infect a loved one.
Another strategy, Sunstein suggests, is to employ reliable “validators” – religious or community leaders, artists, athletes – who can exercise their credibility on those who are concerned about the risks of vaccines. The WHO advisory group suggests that governments approach uncertainties about vaccines and possible side effects with anticipation and transparency: “If vaccination is started without this transparency, subsequent disclosure of side effects can definitely undermine confidence in vaccines. and persistent ”.
Additionally, Sunsfield says, it will be crucial to monitor the ongoing vaccination to study the different strategies and their impacts. “It’s a big mistake not to learn in real time what works and what doesn’t. This is important and will save lives if employees create a culture of learning and listening, ”he said.
What behavioral science suggests to increase vaccine adherence
ENVIRONMENT (increase the membership of those who have no prior restriction)
Location – the closer, known, convenient and reliable it is, the greater the acceptance. In the current pandemic, it is important to avoid overcrowding and contagion
Cost of vaccination – avoid travel expenses and schedules that hamper people’s work
Time spent – allow scheduling, avoid queues, extend schedules
Treatment – prepare healthcare professionals to welcome, ensure safety and answer questions about disease and vaccines
Information – disseminate educational, accessible and clear messages
Reminders – send emails, texts or phone messages to remind patients that they are about to be vaccinated
Standards – make vaccines the norm, so you have to decide if the person does not want to take them
SOCIAL INFLUENCE (helps convince people in doubt)
Positive visibility – reinforcing the fact that the majority want to be vaccinated, instead of focusing on the minority who refuse the vaccination. Publicize scenes of people vaccinated and place vaccination posts in visible places Window open – highlight changes in position in favor of the vaccine; hearing that others are adopting a behavior more and more prompts people to make the same arguments – training health professionals to recognize the reasons for vaccine resistance and to eliminate it; research also shows they are more likely to recommend vaccination when they have been vaccinated References – amplify support from opinion leaders – religious leaders, renowned scientists, community leaders Language – prioritize personal stories rather than general arguments based on statistics Objectives – highlighting vaccination has a collective effect and protects the most vulnerable
MOTIVATION (prevents the doubtful from giving up)
Anticipation – Confidence in the vaccine needs to be built up before people form an opinion against it. This involves managing expectations and clarifying doubts transparently, including side effects, well before the start of vaccination.
REGULATIONS (for those who are resistant to vaccines)
Mandatory requirement – make immunization a condition of travel, benefits, work or study. Research shows that strategies that try to change a person’s opinion have little effect
What makes vaccination difficult:
fear of contagion at the vaccination site influence of opinion makers against vaccination opposing opinion about the vaccine in groups in which the person participates (church, company, clubs, family circle or friends) excessive visibility of people or theories against the vaccine
Sources: Psychological Science and WHO Technical Advisory Group on Perceptions and Behavioral Sciences for Health