COVID-19 vaccination efforts have decelerated or plateaued in developing and developed nations alike. To deal with vaccine holdouts, leaders across the world have proposed concrete benefits such as monetary compensation and lotteries, as well as punitive strategies such as barring unvaccinated people from restaurants, flights, and public places. However, leveraging such reactive techniques broadly may be viewed as coercion, trigger legal and political challenges, and even fuel public distrust toward authorities and harden anti-vaccination beliefs. Furthermore, by shying away from intrinsic motivation, health leaders miss an opportunity to leverage an array of behavioral, motivational, and organizational strategies that are supported by decades of management research.
While full vaccination may seem like a lofty goal, it is not completely out of reach. The Indian district of Raigarh, which has a population of approximately 1.6 million (in the state of Chhattisgarh, where mean per capita income is $1,400 per year), was able to achieve 100% first-dose vaccination of all eligible, adult citizens without financial incentives or a governmental mandate. This made national headline news across India. Raigarh achieved this success despite severe resource limitations (including the sharp vaccine shortages throughout India in early 2021), and heterogeneity in geographical, ethnic, linguistic, social, and religious attributes, which added to the mission’s complexity.
Below, we share five actionable strategies learned from the Raigarh case study, which can help bolster vaccination rates in both resource-poor and well-resourced settings.
Target a Broad and Diverse Set of Local Leaders
Given the sheer scale of the vaccination effort, reaching everyone individually is infeasible. Local leaders carry the trust of their respective communities and serve as central nodes sitting between various sub-community networks, allowing them to spread information and influence behavior more quickly and effectively.
Moreover, systematically recruiting local leaders across the spectrum of political, communal, social, and religious strata is instrumental in influencing all groups, as diverse communities have differing viewpoints with diverse sets of leaders. For instance, in Raigarh, local agricultural leaders were strategically recruited to influence the farming communities, and religious clergy were appealed to motivate the religious communities. Genuine respect and open dialogue can turn local leaders into powerful allies for mobilizing the population.
Confront Information Asymmetry
In addition to having a trustworthy messenger, the consistency and relatability of the message about vaccination are critically important. A clear message (“get vaccinated”), presented through an influential messenger (e.g., local community leaders or a local celebrity’s vaccination selfie) crafts a powerful narrative that can overcome alternative sources of (often incorrect) information, particularly when presented in an appropriate local medium.
Stories of peers’ successful experience can help dispel common vaccine myths (e.g., infertility, paralysis, migraines) and enhance individuals’ motivation to learn more about that experience (consistent with research on the motivating effects of exceptional success).
Transparency and public confidence are also important. The team released information on vaccine stocks, allocation plans, and accomplishments through daily press releases, which were issued through the district health departments. Echoing research on operational transparency in various business and societal contexts, this strategy imbues a sense of positivity and confidence in the public and the media. It also removed policy opacity and promoted public trust.
Motivate Through Celebration
Echoing research on the importance of recognizing “small wins,” the vaccination team made it a rule to celebrate early successes throughout the vaccination effort. Celebrating the first 10% of vaccinators was seen as much more crucial than lamenting the 90% of non-vaccinators. For instance, communities who were early-adopters and first to participate in the vaccination campaign were publicly lauded. Similarly, to celebrate community milestones, the team deployed “gamification” strategies (which have been increasingly used to motivate health behaviors), including merit badges and leaderboards in order to both celebrate successes and motivate under-performers.
Mega vaccination drives in certain localities were another effective strategy to break inertia and reach the maximum number of people in the minimum amount of time. For instance, on June 26, 14% of the target population was vaccinated on a single day through a mega-vaccination event, an achievement that fueled the team’s efforts and pushed the district toward the “critical mass.”
Focus on Convenience
A one-size-fits-all approach often does not work for motivating behavior in large, diverse populations. However, one exception to this rule is the paramount importance of simplicity and convenience in driving consumer decisions and behavior. For example, the Raigarh vaccination team employed a strategy of “No Banker Hours” in offering vaccination appointments. The team customized service hours to the needs of the target community (e.g., more evening sessions for laborers and farmers). Similarly, resonating with studies showing that the proximity of vaccination networks contributed to higher vaccination rates, locating vaccination sites close to peoples’ place of work or residence were particularly effective.
Utilize Robust Monitoring and Rapid Course Correction
Finally, the Raigarh team focused on continually measuring and monitoring progress to make rapid adjustments if their efforts were not working as planned.
Monitoring local-level data allowed the team to maintain constant awareness of frontline, “on the ground” challenges and allocate resources on the fly, in a way not unlike the Lean philosophy that emphasizes that problems should be resolved at the lowest level and close to when and where they arise.
Haven’t We Tried These Strategies Before?
While certain strategies outlined above have been utilized across the U.S. and elsewhere, we have seen considerable variability and inconsistency in the way these kinds of strategies are used, which could be contributing to ongoing vaccination challenges. For instance, vaccinations rates continue to lag in some historically underserved Black and Hispanic communities, which may be due to a failure to engage leaders from racial and ethnic minority groups at a local level, as well as broader failures to dispel misinformation through social media and stick to a consistent federal narrative. Indeed, mixed-messages from the CDC, government officials, and organizational leaders throughout the pandemic also likely spilled over into vaccine adoption and hurt confidence among the undecided.
Though these five strategies are not a “magic recipe” for vaccination success — and there is certainly an important role for tools like the vaccine mandates implemented by some hospitals or corporations — the Raigarh success story highlights the incredible power of basic behavioral and motivational strategies in achieving success in vaccinating the population against COVID-19.