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How to Persuade People to Vaccinate

Why people don't get their flu shots and what you can do about it
October 19, 2017 | Comments

Temperatures are dropping, pumpkin spice drinks are turning up again, and you’re grabbing your leather jacket. That’s right, fall has hit the East Coast, and among the things we can welcome back into our lives are not sweating through our morning commutes on the infernal summer subway, buying too much candy for the one or two trick-or-treaters who will actually come by our houses, and best of all: the flu. Yes, it’s back, and we shouldn’t be surprised, since flu season hits us pretty hard every year from October through March with January and February being the peak of flu season misery.

This year, we are really interested in understanding why so many Americans fail to get their flu shots. Now that we’re truly entering flu season, we’re seeing articles pop up everywhere about why you should get your flu shot, whether you’re pregnant or you’re just being encouraged to comply for the purposes of herd immunity, which is really a “greater good” argument.

In the midst of all this, we found that some of our closest, brightest, most well-educated friends were telling us they were opting not to get the shot this year. As we struggled to understand why these friends of ours would opt out when the flu is so nasty and the shot is so harmless, we realized that actually in general our public health system as a whole doesn’t have the best insight into why people don’t get their flu shot. We do, however, know that uptake of the seasonal flu shot is really abysmal.

So what do we know about why people don’t get the shot? And how can we encourage more people to get their seasonal jab?

Why don’t people get the flu shot?

We’ve written a lot about the international phenomenon of vaccine hesitancy and “anti-vaccine” sentiment with a particular focus on the ever-growing adherence to the false claim that the childhood MMR (measles-mumps-rubella) vaccine causes autism. Hesitancy and concern over the MMR vaccine tends to be due to a false perception that the shot is unsafe and causes serious, lifelong illnesses in young children (it doesn’t, but we don’t want to rehearse that here). In these instances, safety concerns dominate as the overwhelming set of motivations that ultimately result in refusal of the vaccine.

But when it comes to the flu shot, it’s unclear that safety concerns are driving most of the decisions not to get the vaccine. This just goes to show that our response to “vaccine hesitancy” needs to be tailored to each vaccine in question and the population we are targeting because the concerns and decision drivers will be different depending on these factors. In the case of the flu shot, the vast majority of people who should be getting the vaccine but refuse it are healthy adults. From an anecdotal standpoint, here are some of the main reasons we’ve heard when we ask people why they didn’t get their shot:

    • I don’t need it – I’ve never had the flu
    • I meant to but it just wasn’t a priority and kind of fell off my to-do list
    • I got the shot once and it made me feel sick / get the flu
    • The flu is not a big deal, I don’t care if I get it
    • The shot is not safe and could cause serious health problems
    • It doesn’t work anyway

It turns out our anecdotal observations seems to hold up pretty well in some of the published literature on this question. Some of the other reasons people cite for not getting the flu shot include: “If I get the flu I’ll recover quickly,” “I’ll wait until the flu hits my area,” and “I hate getting injections.”

How to convince someone to get the flu shot

So given these reasons, how do we actually get people to go out and get the shot? We still have more work to do to understand which of these reasons tend to dominate overall and in what populations, but even without this information, we can think of a few things to do in the meantime.

The first step is actually to categorize all of these contributors to failure to get the vaccine so that we can get a better understanding of what kind of interventions might work to counter them. After thinking about some of the major reasons cited for not getting the flu shot, we came up with two broad categories of reasons why people neglect to get the vaccine:

    1. Skewed Risk Perception / Risk Salience: This category has to do with the fact that people sometimes fail to get the vaccine because they have a skewed perception of their risk of getting the flu and the seriousness of the illness. It thus encompasses the following commonly cited reasons:
      1. I don’t need it – I’ve never gotten the flu
      2. It fell off my to-do list because it wasn’t a priority
      3. I’ll recover quickly / flu is no big deal


  • Perceptions about safety and efficacy: This category encompasses concerns about the shot’s safety and misperceptions about its efficacy, including:


    1. I got the shot once and it made me feel sick / get the flu
    2. The shot is not safe and could cause serious health problems
    3. It doesn’t work anyway

Let’s start with the second one first. In these cases, you have to be very careful because you’re dealing with people’s beliefs and, trust us, you may feel a bit angry when you hear someone claiming that the flu shot causes serious health consequences when you know that by not getting the flu shot that person might be putting themselves and others at serious risk. In these cases, depending on who the person is and what your relationship is, you should try motivational interviewing approaches first. Start by asking questions like: Why do you think that?

        • How/when did you form that opinion?
        • What would you need to hear to make you feel like you’d be willing to get the shot?
        • Can we look into this together?

The most important  thing when using this approach is to listen more and talk less. You really do want to know the answer to these questions – you are not asking them rhetorically but rather out of a genuine wish to understand how the person formed his or her ideas about safety and efficacy. You need to find common ground with the person, such as a willingness to read something you both agree is reliable on the topic together.

With the risk perception / risk salience category, on the other hand, you’re dealing with a group of people who may not feel particularly threatened by the vaccine but just lack the motivation to get it. Our default in these cases is usually to give people a lot of statistics about how harmful the flu is and how at risk they truly are. While people in these situations will listen to you and take note of what you’re saying, unfortunately those kinds of arguments are often not compelling enough to really motivate people to change their behaviors, even if they agree with you on an intellectual level.

So how do you get someone who’s not particularly motivated to go out and prioritize getting a flu shot? This is where social influence and social pressure techniques are especially useful. In fact, one of us recently did our own little experiment. A friend of Sara’s mentioned that she had never had a flu shot and had never gotten the flu. While she had nothing against getting the shot, she just didn’t feel that motivated to go get one because she didn’t think she would end up getting the flu.

Sara’s impulse was of course to start repeating from memory the entire CDC page on the importance of the flu shot. But then she had a different idea. She wondered if a social influence technique might work here. So she suggested to her friend that she and some of their other mutual friends were all going to get a flu shot at a local pharmacy before going to another mutual friend’s birthday party that evening. After getting the shot, they were all going to pick out a card for their friend whose birthday it was. Sara could sense an immediate change in her friend’s stance. “Oh really?” she said, looking like she was reconsidering. “Maybe I’ll join you.”

This kind of tactic is so powerful in these situations because the person has no underlying resistance to getting the shot and just needs some kind of extra motivation. Most people do not think of their life goals in terms of attributes they tend to take for granted like “good health.” But most people are motivated by other attributes that provide more obvious, immediate rewards and might not necessarily be a given, like maintaining significant close relationships with important peer groups. Since we are of course wired to adhere to our groups, social influence can be an extremely powerful motivator.

Despite this little homemade experiment, we recognize that we need much more information about why people resist flu vaccines and what really helps get significantly larger numbers of people to practice this important preventive health behavior.


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