Patrick McKenzie on "vaccine hesitancy"
From the latest episode of Patrick McKenzie's podcast Complex Systems:
One point about vaccine hesitancy that I think is broadly underappreciated:
Consider the Pell Grant program in the United States. Pell Grants are essentially free money for college. Despite that, we never hear about “Pell Grant hesitancy,” yet every college knows it has to do a sales job to explain this to prospective students.
For example, they’ll say: "There are various ways to fund college. A loan you have to pay back. A grant, like a Pell Grant, is free money you don’t pay back. Here’s an application you need to fill out, and then the money will arrive." Even though it’s free money, colleges still invest in explaining and promoting it because people don’t automatically understand the program.
Now think about the COVID vaccine rollout. A lot of people, particularly in the professional-managerial class, assumed the vaccine was the most anticipated product release in human history. After a year of lockdowns and trauma, it seemed obvious that no one would need convincing to take it. But that assumption was wrong.
Much of what was perceived as vaccine hesitancy wasn’t driven by anti-science or deep-seated opposition. It was more like, No one has sat me down and explained why this benefits me. Many people assumed, If the vaccine were truly important, someone—my doctor, a public health official—would have told me by now.
This wasn’t well-calibrated to the reality of the U.S. healthcare system, which, for better or worse, didn’t believe it needed to sell the vaccine to individuals.
Now, of course, there was a partisan and politicized element to vaccine hesitancy. And it wasn’t a straightforward left-versus-right issue—it had a bit of a horseshoe effect, pulling in groups from across the spectrum. But a significant portion of the hesitancy stemmed from a lack of direct, clear communication, not outright opposition.
I was in the group of people who were eagerly anticipating the rollout of the vaccines in 2021. Looking through my message history in several group chats, I can find that at the start of April 2021, I repeatedly broadcast a message to my local friends to the effect of:
The vaccine is available to everyone age 16 or higher on [date]
VACCINES ARE FREE FOR EVERYONE and YOU DO NOT NEED HEALTH INSURANCE to get injected FOR FREE.
Additionally, there are two earlier tiers of groups that are eligible to get their vaccine on [date -14 days] and [date -7 days]; here is a link to see if you're part of one of the eligible groups
I received numerous replies to the effect of, "thank you for sharing this information with me; I just booked an appointment to get vaccinated, which is something that I would not have done in the counterfactual world where I did not see your message." (I do not think the person who lives in that counterfactual world -- and did not schedule the vaccination appointment -- fits the typical profile of what people think of "vaccine hesitant.")
There is probably a world in which these people got this same information from a public health official or a doctor. (Perhaps that world has higher state capacity and more efficacious institutions.) Instead, these people live in a world where they got that message in the group chat that used to be used to organize board game meetups.
The point that "the general rollout in mid April 2021 is for everyone 16 and up" seemed to be a piece of information that people got from me that they didn't get from other messaging channels.
Another critical point that several people appreciated having explicitly spelling out for them was "everyone can get jabbed for free; yes, this includes the uninsured, or people who don't know if they're insured because they're 25 and maybe that means they're on their parents' insurance but they kinda neglected to figure out that whole thing but also embarrassed to ask about it."
This was a vital bit of signal that seemed to get dropped from some of the messaging that made it to their ears, and it rhymes a bit with a parenthetical remark Patrick made outside the podcast audio:
You can understand why people are skeptical [of Pell Grants], too! “As if the federal government would give me tens of thousands of dollars, for free, with basically no checking. That certainly hasn’t matched any other experience in my life!”
Patrick also has a parenthetical note about why the US healthcare system needs to play a marketing role in "selling" the vaccine to individuals, despite their belief that that this was not necessary:
Pharmacies were the primary site that the vaccine was physically delivered at, and pharmacies are not specialized in demand generation for drugs. The pharma industry expects physicians to do that; that is why the physicians get visits by attractive people explaining the benefits of the new things on offer.
Two practical implications:
Society benefits from having functional institutions that can do things at scale, like informing the public of information that they need to know as a matter of public safety
In the absence of institutions, one of the fallbacks for important information making its way to the people who need it is "group chat message from the person who organizes the board game meetup I attended a year ago." This might practically describe you, dear reader. You may not wish to be burdened with this responsibility, but this is one mechanism by which you can be part of the change which you wish to see in the world.
I participated in this (admittedly small-scale) messaging effort in part thanks to the example set by other participants in local group chats which I am a part of, which have historically been the way that I have learned information, like "There is currently a boil order for [neighborhood]; here is a webpage with a map to see if you are affected. (Also, in case 'boil order' is a new phrase to you: there are worries about water contamination due to [reasons] and as such the health department is recommending that you boil any water that comes out of your tap before drinking it, even if it 'looks normal.')"
I feel that parenthetical point bears repeating. One point of frustration I personally heard from multiple people in 2020 was the number of occasions when public officials issued an order like "shelter in place" without further elaboration for the benefit of people who weren't already familiar with that precise piece of jargon.
You might think that people, upon encountering that sort of jargon, would perform a Google search to discover what exactly it is they are being instructed to do. But as someone who has ever worked in marketing and looked at sales funnel dashboard can tell you, there is zero chance that the conversion rate for this is 100%. Whenever you add the step of "do a google search to figure out what the public order is actually notifying you about," you are adding another layer to the funnel. And with each layer you add, you are losing some people.