Increasing access to vaccines globally is a priority to end the COVID-19 pandemic faster. However, the vaccination campaign will only be successful if people take the vaccine. It has been known since deployment in high-income countries that vaccine hesitancy is a significant barrier to vaccine uptake and there is evidence that similar attitudes are prevalent in many developing countries.
The standard approach to reducing vaccine hesitancy is the deployment of mass communication and community engagement. These are clearly important tools for conveying reliable information and building public confidence, but it could be useful to rely more on behavioral knowledge to increase immunization. After all, people don’t always make the most rational decision for their health. Our research suggests that entertainment media and lotteries are scalable, inexpensive, and tested innovations that deserve to be considered in the COVID-19 response.
Edutainment and social networks
Edutainment, short for entertainment education, is the placement of public health messages in mainstream entertainment. Edutainment formats can reach individuals on a deeper level, unlike information-only campaigns. The World Bank’s study of the MTV Shuga television series reveals that immersion in the program and emotional connections with the characters were important mechanisms behind the significant impacts of this HIV and gender-based violence knowledge, attitudes and behaviors.
This communication format, which works on several media and geographical areas in the space of HIV prevention, is increasingly used for social media campaigns. For example, in India, World Bank research shows that edutainment delivered through social media can reshaping gender attitudes and reduce the social acceptability of violence against women. Who carries the message is also important in addressing vaccine reluctance. In Indonesia, vaccination messages on Twitter were 70% more likely to be transmitted when written by celebrities. In India, SMS Covid-19 with You Tube links from Nobel laureate Abhijit Banerjee increased symptom reporting, social distancing and hand washing. The impacts were similar for those who had not received the SMS in the treated communities, suggesting significant information overflows (and the power of college celebrities!).
Development partners should consider using edutainment and social influencers more regularly in their behavior change campaigns. Social media being the main source of information on COVID-19 and disinformation / disinformation, and given the very low cost of social media campaigns, this dissemination mechanism must be better exploited in development.
People regularly inflate small probability events, a behavioral bias on which lotteries are based. In rich countries, many authorities are experimenting with incentives for COVID-19 vaccination: free beer, donuts or even money. Cash incentives are unlikely to be affordable in middle- or low-income countries. But lottery incentives conditional on adoption of vaccination might be achievable.
Lotteries have been used to encourage the adoption of healthy behaviors. The chance to win a car as a raffle prize was part of the promotional campaign Tuberculosis screenings in 1957 in Glasgow. HIV prevention lottery incentives have also been used for HIV prevention in Lesotho and have been shown to be effective in reducing the incidence of HIV.
Lotteries with high prizes attract the attention of the public. Additionally, incentivizing COVID-19 vaccination with lotteries should indeed be much cheaper than with cash incentives: In Ohio, the governor held 5 weekly lottery draws in which vaccinated people are entered to win a prize of $ 1 million, disbursing $ 5 million to entice a population of 11.6 million. For this same amount, a $ 100 individual cash incentive that was proposed in West Virginia can only target 50,000 people.
In low- and middle-income countries, lottery prizes could likely be significantly less than $ 1 million. In Lesotho, the HIV prevention lottery used much smaller prizes ($ 100 or $ 50).
Vaccine hesitation has proven difficult to tame and ready-made strategies will be needed to reduce it. Rigorous research suggests that working with celebrities and providing lottery tickets can be part of these strategies.