Is South Africa’s problem vaccine hesitancy, or is it simple vaccine procrastination?
A series of surveys have all confirmed that the majority of South Africans are pro-vaccine and, on paper at least, willing and eager to go out and get vaccinated for COVID-19. In practice, however, that enthusiasm has not been evident; less than a third of the population have received a vaccine and scarcely a quarter are fully vaccinated. There is room for considerable improvement in access and distribution, particularly in rural areas and townships and outside of working hours, but these shortfalls do not adequately explain the vast disparity between the 60% or 70% of respondents indicating an intention to get vaccinated, and the mere 31% having actually gotten at least one dose. Instead, it is clear that a large number of South Africans who want to get vaccinated and are able to do so, simply haven’t gotten around to actually doing it.
Bizarre as this phenomenon may seem, it has been observed before, and studied in considerable detail. In a series of papers dating back to the 1960s, Leventhal et al [[]] studied the willingness of Rutgers University students to get inoculated against tetanus. Flyers were distributed which highlighted the severity of tetanus as an illness and made clear the degree of protection afforded by inoculation. On one level, these flyers were highly successful; exit surveys later revealed that the majority of students were well-informed about the dangers of tetanus and willing to get inoculated against it. The majority also knew the location of the campus health center, where they could get that shot free of charge. Much like the South African situation, those students had access to the inoculation, knew where to get it, and fully intended to do so.
Only 3% of those students actually got inoculated if they were not also presented with a clear action plan for doing so. This shows clearly that intention and access aren’t necessarily enough to prompt someone into concrete action. Modifying the flyers to provide more specific information, such as opening times and a clearly marked map to the health center raised the uptake to 28%. This was mostly information the students already knew, and not really all that important to the task of getting inoculated; a student who just showed up at the campus health center would most likely have little trouble getting inoculated, even if they were not armed with all the fine details of the process for doing so. Nevertheless, having those fine details proved critically important to changing actual behavior.
The key takeaway from this is that the success of vaccine messaging in changing actions is an entirely separate matter to its success in changing attitudes. South African attitudes toward vaccination are already sufficiently positive for high vaccine uptake; what is needed, instead, is messaging tailored toward prompting actual actions. For that purpose, specificity matters. A billboard in Randburg that says “get vaccinated” would be less effective than one which says “get vaccinated in Randburg today,” even though the additional information is seemingly superfluous. A message that’s even more specific, such as “Get the Pfizer vaccine in Randburg today” may be more effective still, because people appear to be more likely to take action when the specifics of what they are doing are known to them. This example is far from optimized messaging, but you get the gist, and online advertising now has tremendous capacity for individually-tailored messaging.
Vaccine messaging thus far has mostly been formulated with the goal of changing attitudes toward vaccines, with generalized content. At this point, however, anti-vax and vaccine hesitant attitudes are likely to be quite deeply entrenched and messaging geared toward changing them is unlikely to yield much change in actual actions. The focus should shift on prompting concrete actions among those who have already decided they want to be vaccinated, but simply haven’t done so yet. Let’s leave vaccine hesitation aside for now, and address vaccine procrastination.
