Vaccination is one of the most cost-effective and impactful public health interventions available – it is estimated that between 2 and 3 million deaths are prevented each year because of immunisation. However, more lives could be saved if more people were vaccinated. Each year, across the globe, children continue to die from outbreaks of diseases that can be prevented through vaccination, and uptake of new vaccines can be encouraged to counter emerging threats such as COVID-19.
Although the argument for vaccination is unequivocal from a public health perspective, at the individual level vaccination decisions can be complex and emotive. Some of the features of vaccines mean that people are at risk of bias about whether or not to choose vaccination for themselves or their children. For example, the benefits of receiving a vaccine are uncertain and occur at an undefined point in the future, whereas the potential downsides feel immediate and salient. Moreover, when many people participate, vaccines have the additional advantage of protecting the community as well as the individual, but this offers people the opportunity to be free-riders.
Behavioural insights are a valuable tool in encouraging vaccine uptake and maximising the benefits that immunisation can achieve. The ‘Increasing Vaccination Model’ is a helpful framework for categorising the barriers to vaccination and possible behavioural interventions. The evidence indicates that closing the ‘intention–behaviour gap’ in vaccination behaviour by improving ease of access (and thus removing practical barriers to vaccination) is the most effective type of intervention. In contrast, focusing on motivation or educational interventions appears to be less helpful.
Some studies have tried to change the way people think and feel about vaccines, but very few have been effective at changing people’s actual behaviour. Only a limited number of studies have explored the use of social norms interventions (e.g. telling people that others are getting vaccinated) to encourage vaccine uptake. However, correlational studies suggest that they might be effective.
Going forward, there are key opportunities to use a behavioural insights approach to increase vaccine uptake:
- Encouraging acceptance and uptake of COVID-19 vaccines when they are available. Developing one or more vaccines for Covid-19 is widely considered to be the only way we will return to some sort of normality. Alongside the crucial work to develop a vaccine, there should be ongoing research into how best to communicate about the vaccines’ development and encourage people to take up a vaccine once it is available. One recent survey found that 16 per cent of UK adults would ‘probably’ or ‘definitely’ avoid a COVID-19 vaccine. Compressed development timelines, misinformation and sensationalist media could all undermine confidence in a future vaccine.
- Developing, testing and scaling behaviourally informed solutions to encourage childhood vaccine uptake globally. Our recent report on vaccine update in low- and middle-income countries identified evidence gaps in the literature on what works to encourage vaccine uptake in these countries. There is a substantial opportunity to develop behaviourally informed solutions to increase childhood vaccine uptake and to use a behavioural insights approach to test, scale and increase the adoption of such solutions.