What can Elmo teach us about COVID Vaccine Hesitancy?

Can a key factor driving consumer demand be enough to override irrational fears?

Amitha Kalaichandran, M.D.

December 20, 2020

Twenty-four years ago, on Black Friday in November 1996, hundreds of thousands of Americans stood eagerly in line for hours at Walmarts, and Kmarts around the country. Some even camped outside. Once doors opened, mass hysteria ensued. People were trampled. Punches were flung in fights that led to arrests. In the streets some ran frantically after delivery trucks. There were bomb threats. There was even a rumor that the infamous Gotti family tried to get in on the action.

All for a bright red furry creature with large bug eyes and a fuzzy egg-shaped orange nose. For Elmo. But not just any Elmo: an Elmo that could be tickled. When Tyco manufactured its Tickle Me Elmo no one could have predicted the demand. So, a scarcity situation emerged — only a few hundred thousand were manufactured ahead of Christmas. This scarcity caused irrational behavior. With a ramping up of manufacturing, a total of over one million were sold in 1996. Five times more were sold the following year. Then, after interest waned, demand waned.

The effect of scarcity is so effective that in Robert Cialdini’s seminal marketing book, Influence: The Psychology of Persuasion, it’s described as a tactic that can significantly alter behavior. Essentially ,when a resource is scarce, consumers want it even more. Cialdini cites the psychologist, Jack Brehme’s, theory:

“Whenever free choice is limited or threatened, the need to retain our freedoms makes us desire them (as well as the goods and services associated with them) significantly more than previously. So when increasing scarcity — or anything else — interferes with our prior access to some item, we will react against the interference by wanting and trying to possess the item more than before.”

This holiday season we don’t have Elmo. Instead we have two potential COVID vaccines, with one (by Pfizer/BioNTech) already being rolled out in the U.K. Demand for the vaccine this side of the pond, is bubbling (can you feel it?). Why? Because there has been enough in the Zietgiest around distributive justice: in other words, the fair allocation of the vaccine, and exactly who is entitled to get it first, when it is available.

To be sure, there will be enough of the vaccine to go around: the manufacturing of millions of doses of the Pfizer/BioNTech vaccine, and another one by Moderna. Operation Warp Speed, which is an initiative of the U.S. Federal Government, and the CDC, shares they ‘have enough COVID-19 vaccine doses for all people in the U.S. who choose to be vaccinated.” In Canada, where I live, the federal government has made a similar promise. But, in a year where uncertainty and unpredictability are the norm, “perceived” scarcity matters.

We’ve seen lines around the block to get tested for COVID, and we could see the same lines emerge for the vaccine. Perceived scarcity kicks in when our primitive instincts get triggered: Will my family be safe? Will I be safe? What can I do to ensure we get the vaccine?

With Tickle-Me-Elmo, scarcity caused people to behave irrationally. They put themselves and others at risk through their irrational behavior, taking actions most of us would never imagine doing in any other situation. That’s the power of scarcity, or perceived scarcity.

But can the same principle influence people to behave rationally, that is, can perceived scarcity help nudge those who are hesitant about the vaccine to actually get the vaccine? And if so, could this increased demand potentially override years of anti-vaccine sentiment?

Around 20% are vaccine hesitant in North America. For COVID specifically it might be a bit less — about 10%, which suggests a different balance of perceived risks and benefits. In a survey of 15 countries about 75% said would take the COVID vaccine once it became available, and the data was similar in a U.S. survey done in May. But statistics (and polling) sometimes lie — a study in Annals of Internal medicine pointed to about 60% interest in taking the vaccine when the survey was conducted in April. And this number is dwindling, to around 51% in the Fall, pointing to a worrisome trend after a summer of reckless abandon.

This is where behavioral science comes in. In a piece for the Economist last week, Professor at the Wharton School of the University of Pennsylvania, Katie Milkman, speaks to the issue of persuasion as it relates to vaccines, “we need to think not just carefully but creatively….the biochemists have done their part. It’s now time for the work of behavioral scientists to move the needle,” she wrote.

Previously I wrote about why parents might have qualms around vaccines — it’s not simply a knowledge issue, but rather it’s an interplay between information, values and other factors that govern influence and motivation (for instance mistrust in the medical system and the tendency to behave akin to our peers– the latter gets to social proof and the human tendency to conform to those around us).

Obviously, the stakes with vaccines, as opposed to a plush toy, are much higher. We know that the more people who get the vaccine, the better it is for all of us. The immunity of a herd is a utilitarian value. The most rational choice, in other words, is for everyone who qualifies for the vaccine to get it.

In response to the potential issue of scarcity, Milkman, who also co-directs The Behavior Change for Good Initiative at Wharton shared via email:

“I do think scarcity will help at least initially. But I don’t feel like we have any evidence to show whether it will be enough to propel those who are on the fence to decide to get a vaccine when the vaccine becomes widely available,” Milkman says, “I hope so but it’s just an empirical question at this point. My guess is that we’ll need a suite of other techniques to encourage vaccination and follow-through.”

Today we’re staring down over 1.5 million deaths worldwide; over 237,000 in the US alone. And now, at the beginning of December we’re witnessing some of the highest daily death rates since the pandemic was identified. Around 100 million Americans are expected to be vaccinated by February. According to Dr. Anthony Fauci, we need at least 75% of us to be vaccinated to help ensure herd immunity, if we assume the vaccine is at least 70% effective.

Given the tumultuous year we’ve had, this holiday season it’s less about getting our hands on the next trendy toy before it sells out. But perhaps the same perception of scarcity might be just the nudge we need to shift behavior and reduce mistrust around the COVID vaccine. So, when it’s your turn, use that nudge to get vaccinated. I mean even Dr. Elmo says so.

A physician, epidemiologist, wellness coach, and medical journalist with an interest in the intersection of health, innovation, and culture.

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