How Not To Fight Vaccine Hesitancy: Lessons from Brain Science (and Nancy Reagan)
Can vaccine-hesitancy be overcome by essentially replacing “Just Say No” with “Just Say Yes”?
by Steve Genco, Kimberly Rose Clark, and Matthew Tullman
In 1982, First Lady Nancy Reagan visited the Longfellow Elementary School in Oakland California. When a schoolgirl asked her what she should do if she were offered drugs, the First Lady replied, “Just say no.” With those three words, one of the most ubiquitous Public Service Announcement (PSA) campaigns in modern American marketing was born. It was also one of the first truly multi-platform campaigns, encompassing TV and radio ads, op-ed pieces in major newspapers, dozens of appearances by Nancy Reagan on talk shows, cameos on popular TV sitcoms, and even a 1985 rock music video. Over 5,000 “Just Say No” clubs were founded in schools and youth organizations in America and around the world.
What was the impact of this massive PSA campaign? As a part of the Reagan Administration’s war on drugs, it had little effect on teenagers’ actual drug use, which had started to decline well before the campaign was launched. But it did feed into several attitudes and policies that are still with us today: a failure to distinguish between occasional and chronic drug use, a prioritization of criminalization over treatment, an excuse for excessive policing of minority communities, and a rationale for mass incarceration for minor drug offenses.
Perhaps the most lasting legacy of “Just Say No” was its reliance on a classic trope of American conservative thought: that individuals, not society, and definitely not government, are responsible for personal behavior and any outcomes of that behavior.
A corollary of that belief has been equally influential, if not more so: The way to get people to change their behavior is by reasoning with them. Once you’ve explained why it is in someone’s best interest to act in a certain way, you can rely on them to follow your logic and make the right choice. On the basis of that optimistic view of human rationality, innumerable PSA campaigns have been launched.
Fast Forward to 2021
Today we face a national crisis far more pressing than the one facing that little Oakland schoolgirl. In the midst of a global pandemic that has taken more than half a million American lives and nearly three million lives globally, effective vaccines have arrived in record time.
Yet many millions of Americans are unsure about taking them. For a wide range of reasons spanning many different communities, many US adults are currently expressing some degree of vaccine hesitancy. In a January 2021 Kaiser Foundation survey, 20% of respondents expressed either outright refusal to get vaccinated or a willingness to get vaccinated only if forced to do so. Although these numbers have been shrinking from month to month, they still represent a significant obstacle to achieving the 70%-80% “herd immunity” epidemiologists tell us is needed before the virus can be contained and we can resume some semblance of pre-pandemic normalcy.
Contrary to the conservative mantra of personal responsibility, the vaccine-hesitancy problem we face today extends far beyond individual choices.
Each person who fails to take the vaccine, each person who refuses to wear a mask, and each person who declines to respect social distancing, represents a real and existential threat not only to themselves, but also to their families, their communities, and, indeed, to the nation as a whole. As long as a large population of unprotected people continues to roam among us, new infections will spread, new and potentially more deadly variants will emerge. Our hopes for a timely exit from pandemic hell will be delayed, perhaps indefinitely.
Not surprisingly, a new generation of PSAs is starting to appear to counteract this threat of vaccine hesitancy. Can we be confident they will achieve greater success than “Just Say No”?
We are communication researchers who view advertising and marketing through the lens of brain science. Our perspective on the issue of large-scale persuasion is grounded in decades of research on how people think, make decisions, and act the way they do. In our professional work, we tap into insights about attention, motivation, emotion, and memory to understand how people learn, change their minds, and can be persuaded to try something new, or even something scary, like getting a shot you may not want to get.
This Is Your Brain on Vaccine Hesitancy
Recently, the first ad in a $50 million campaign to fight COVID-19 vaccine hesitancy in America was unveiled. It comes with an illustrious pedigree. Overseen by the Ad Council, the legendary industry group responsible for such classic public service icons and campaigns as Smokey the Bear, McGruff the Crime Dog, and “Friends Don’t Let Friends Drive Drunk”, the campaign is funded by corporate donors. According to press reports, it will soon be rolled out across multiple media platforms, including tailored ads for different at-risk communities, and will feature testimonials by celebrities, scientists, and members of the faith community.
Given this latest ambitious PSA effort by the Ad Council and its donors, it is important to assess the message being sent by these ads. Are they addressing people’s real concerns? Are they persuasive? Will these ads change minds? Let’s take a look.
The overarching slogan for the campaign is “It’s Up to You.” Is this what vaccine resisters (the folks we need to reach) want to hear? Will this positioning motivate them to act? For our part, we are concerned it may have just the opposite effect.
What are vaccine-hesitant Americans likely to think when they hear “It’s Up to You”? Some may detect an echo of “Just Say No.” Once again, we have a PSA campaign focused on personal responsibility as the driver of desired behavior change. Also, as with “Just Say No”, we have a slogan that essentially says each hesitant American needs to “man up” and do the right thing on their own. Implicit in the slogan is its unspoken counterpoint: Don’t expect the government, your community, or any local institution to help. It’s up to you and no one else.
Can vaccine-hesitancy be overcome by essentially replacing “Just Say No” with “Just Say Yes”?
In the current climate, there are reasons to believe it cannot. It is not hard to imagine a vaccine-hesitant American who has been cooped up in quarantine for a year having this reaction: “Don’t I have enough things to be responsible for right now? My job’s in the dumpster, my kids are stuck at home, I don’t trust the government. So now this is also on me?” Rather than convincing people to get vaccinated, this theme might provide one more reason not to.
Avoiding such unintended effects requires understanding and accounting for two cognitive processes well-known to brain scientists: priming and persuasion resistance. Priming is the process by which one thought leads to another, often implicitly (others might say unconsciously). So an ad campaign emphasizing “it’s up to you” might naturally prime “other things that are up to me,” which in turn might prime the thought “too many things are up to me, I don’t need to add this to the list.”
When designing any message meant to motivate, it is important to consider not just what the message says, but also what other thoughts it might activate. For example, one potential priming effect of “It’s Up to You” is its proximity to the “hands-off” approach taken by the Trump administration throughout the pandemic. “It’s Up to You” sounds very much like Trump’s overall approach to COVID-19, which could be succinctly characterized as “it’s not my problem, it’s yours.” Assuming the Biden team wants to distance itself as much as possible from the disastrous performance of the Trump administration, this slogan might prime people to believe that Biden’s approach is not much different from Trump’s, an inference that could seriously jeopardize the ad’s persuasive impact among non-Trump supporters who are vaccine-hesitant based on other concerns.
The second cognitive process relevant here, persuasion resistance, is a well-documented response to unwelcome persuasion efforts. It often appears in the form of counter-arguing. If you provide me with what you believe is a persuasive argument, I may just start thinking up counter-arguments to resist your persuasion attempt. In other words, if an ad lays the persuasion on too thick, it may backfire.
Let’s dig a little deeper. The initial Ad Council ad uses a question-and-answer format. This is common in persuasive advertising. First, a question is asked that the ad designer believes is on the minds of the ad’s target audience. Then an answer is provided that the ad designer hopes will relieve the concerns raised by the question.
The Q&A format is based on the same assumption that drove the “Just Say No” campaign: Our concerns about getting vaccinated are rational and can be addressed by logical arguments.
Ad researchers familiar with brain science know this is seldom the case. People are prone to use logical explanations to rationalize their actions after the fact, but such arguments are seldom the actual motivators of future behavior. What motivates behavior is the activation of needs that get translated into goals, which then drive goal-pursuit behavior, which then instigates actions to accomplish the goal.
In the initial Ad Council ad, this is the question asked:
“Should I get it? … And if I do, will I be able to go about life … without putting my family at risk?”
As with the “It’s Up to You” theme, this question primes a new concern: “Did you just say that getting the vaccine may put my family at risk?” Of course, getting the vaccine should do just the opposite. What’s going on here is another cognitive process called framing. This term refers to the very powerful effect the context of a persuasive argument can have on its audience. In this case, the vaccination has just been framed as a possible risk rather than a benefit. Every time this ad is seen, a mental association between risk and vaccination will be strengthened in long-term memory. Such associations are unlikely to help overcome vaccine hesitancy.
Part of the problem is that this question is too complex for efficient cognitive processing when it is presented in a short TV ad: It starts out with a simple, easy to understand question, but then branches into a hypothetical conditional, which then leads into a qualifying clause that requires revisiting the whole sentence to decode its full meaning. In the context of a 30-second ad, this violates a brain science principle known as processing fluency, a term used to describe the positive feeling of liking and familiarity we humans experience when we encounter things that are simple and easy to understand. Absent a direct motivational incentive (“why should this interest me?”), a complex question like this is unlikely to be fully absorbed by the viewer or listener. In practice, it will tend to be misunderstood or simply ignored, seriously hampering the ad’s persuasive intent.
In the final analysis, we are worried that this campaign, as represented by its initial offering, is emphasizing the virtues of personal responsibility without addressing the real motivations that underlie vaccine hesitancy in the US today. The Q&A format assumes that people are more rational than they really are. We like to think of ourselves as basically rational beings who sometimes act emotionally. But instead, brain science tells us we are basically emotional beings who sometimes act rationally. People speaking in focus groups or interviews may say they have questions, but more often than not, they do not. They have fears. They may believe those fears are embarrassing or silly, so they might not share them in focus groups or interviews.
If researchers cannot find the deeper motivations fueling vaccine hesitancy, any resulting ad campaign is unlikely to alleviate them. It might even exacerbate them.
Getting Hesitant People to “Yes”: Identifying Hidden Motivations and Focusing on Aspirations Over Fears
What would be a brain-friendly strategy for developing effective messaging to overcome vaccine hesitancy look like? Here are three steps we would recommend:
1. Know the enemy
Identify the real fears underlying vaccine hesitancy and understand who has them and why they have them.
Unfortunately, we cannot learn what really bothers people simply by asking them.
Sometimes people are willing to share this kind of information, but often they are not and will make up something that sounds plausible instead. Even more troublesome, people may not have conscious access to the deeper motives that are actually driving their attitudes and behavior. So researchers have to use techniques that get beyond expressed opinions to underlying motivations.
The motivations driving vaccine hesitancy, we now know after a year of COVID-19, are many and varied. Some people are afraid of the government. Some are afraid of needles. Some are afraid of side effects. Some don’t trust pharmaceutical companies. Some are confused by the new COVID-19 variants. Some still think COVID-19 is a hoax. These and many more fears and concerns need to be identified, cataloged, and prioritized. Researchers need to determine which are most prominent in which communities, so targeted messaging strategies can be devised on a community-by-community basis.
Getting to the deeper motives that underlie vaccine hesitancy will require engaging researchers who understand how implicit as well as explicit sources influence people’s views about getting vaccinated. Explicit sources include the things we say based on what “comes to mind” when we are asked to express ourselves on topics like vaccination. Implicit sources are harder to identify because we are not always aware of their effects on our attitudes or behavior. These motivators operate in the realm of “gut feelings,” moods, and implicit associations. Often they are not consciously accessible but can be reliably measured using tools such as implicit attitude tests and affective priming studies. These relatively new research techniques will help build a much more complete and accurate picture of the hopes and fears that drive vaccine hesitancy in different groups and communities across the country.
2. Write the story
There are two ways to write a story meant to change minds. The first is to address each source of hesitancy directly and present a reassuring counterargument. This is what traditional PSAs usually do. The basic problem with this approach is that it puts people’s fears, rather than their aspirations, at the center of the message. Especially when received with low attention, as most ads are, this kind of story can actually reinforce people’s resistance to getting the shot because it reminds them of why they were hesitant in the first place. Priming and persuasion resistance are two potential enemies of this direct approach.
The second way to tell this story is to emphasize benefits to be achieved rather than fears to be discounted. The basic narrative is this: The pandemic has disrupted our lives. The vaccine is how we get our lives back. Whatever concerns we might have about getting vaccinated, they are minuscule compared to the benefits we will gain once we all get vaccinated. This story doesn’t ignore the fears and concerns leading to vaccine hesitancy; rather, it relies on understanding them to craft a positive message that envisions a future in which they have been overcome.
Framing the story this way leverages recent findings in motivational research that demonstrate how people are motivated not only by external threats and rewards, but also by innate internal needs that we all share.
As first documented and later validated in an approach called self-determination theory, researchers have discovered that all humans appear to be universally motivated by three internally-generated psychological needs which, when met, yield enhanced self-motivation and mental health, but when thwarted, lead to diminished motivation and well-being. These three innate needs are autonomy (the need to feel self-directed and in control of one’s actions), competence (the need to feel accomplished and capable), and relatedness (the need to feel connected to others).
Innate psychological needs can be translated into achievable post-pandemic goals which, in turn, can be depicted in messaging as benefits people can gain once everybody gets vaccinated. For example, here are four messaging themes that tap into innate needs to encourage people to overcome vaccine hesitancy. Once different sources of hesitancy have been identified in different at-risk groups, different themes can be adapted to address each group’s specific concerns:
- Freedom. We all have a need for autonomy. Get the shot so you can start doing the things the pandemic has kept you from doing.
- Control. We all need to feel in control of our lives. The pandemic has produced chaos in your work, your home, and your community. Get the shot to take back control of your life.
- Protection. We all care about our family and friends. Get the shot to protect your loved ones and those closest to you in your community.
- Missing out. Don’t let the rich and powerful jump in line ahead of you. There is a vaccine out there waiting for you. If you don’t get it, somebody else will.
3. Be creative, then test, test, test
Recruit the best minds in the research and advertising industries to produce messaging that drives home this forward-looking story in a moving and memorable way. Then test, refine, and test again.
The story that America needs to hear is that getting vaccinated is the only way we will ever get back to the lives the pandemic has stolen from us. This story will need to evolve over time.
Stories that work today may fail in a few months as the remaining audience narrows down to the most resistant among us. More generally, messaging needs to evolve over time because people tend to construe persuasive information differently when it relates to an imminent decision versus a distant one. As vaccines become more available and the decision to vaccinate becomes less theoretical and more immediate, people’s calculations tend to shift. According to an approach called construal theory, distant decisions are more likely to be impacted by messages that emphasize why a particular choice is best, but as decisions get closer in time, people are more receptive to messages that stress the pragmatics of how to get vaccinated.
Constant monitoring, testing, innovating, and retesting must accompany the messaging program from beginning to end.
Where Do We Go From Here?
The science of persuasion and influence has come a long way since Nancy Reagan advised that Oakland schoolgirl to “just say no.” Thanks to many findings and insights from the brain sciences, only a few of which we’ve been able to touch upon here, scientists and communication researchers now know much more about how and why people can be persuaded to overcome behavioral hesitancy than we did just a few years ago. There are new tools in the communication researcher’s toolbox that can be deployed to understand people’s motivations and craft messages that will encourage positive and socially beneficial choices.
Persuasion is neither simple nor easy. Reminding people of their personal responsibility to overcome vaccine hesitancy is unlikely to be effective in our current environment, in which people’s personal responsibilities are already stretched to the breaking point. Identifying and counter-arguing every expressed source of hesitancy with rational reasoning may seem a logical way to proceed, but it does not align with what science tells us about how people actually make decisions and change their minds. Humans are strivers. We are motivated more by opportunities to achieve our goals than by admonitions to overcome our fears. We are less rational than we wish we were, but we are not irrational. We are instead what might be called intuitive thinkers: We rely on feelings and implicit associations more than we realize, but these behavioral guides generally get us where we need to go. Those who want to persuade us need to address us as we really are, not as they wish we were.
Designers of PSA campaigns aimed at overcoming vaccine hesitancy need to learn and adopt the language and insights of brain science.
They need to understand and embrace concepts like priming, persuasion resistance, processing fluency, implicit attitude testing, self-determination theory, construal theory, and more. They need to see that effective persuasion is often less about getting people to do what they don’t want to do and more about helping them do what they already want to do.
The COVID-19 pandemic is an existential threat to each of us, our communities, our economy, and our way of life. The task of overcoming vaccine hesitancy is too important not to get right.
Steve Genco is a marketing consultant, Managing Partner at Intuitive Consumer Insights, and author of Intuitive Marketing (2019) and Neuromarketing for Dummies (2013). He is an infrequent contributor to Better Marketing on Medium.
Kimberly Rose Clark is a Decision Neuroscientist, Lecturer in Psychological & Brain Sciences at Dartmouth College, and Founding Principal at Bellwether Citizen Response, a research and consulting firm focused on advancing advocacy and behavior change.
Matthew Tullman is a Behavioral Psychologist, Co-Founder & CEO of Merchant Mechanics, and Founding Principal at Bellwether Citizen Response.
