The Psychology of Vaccination

Guy Kawasaki:
I'm Guy Kawasaki, and this is Remarkable People. You are listening to a special episode that involves not one but nine remarkable people. They are experts in fields, such as psychology, history, decision sciences and human behavior. They agreed to participate in this special project in order to help combat the Coronavirus.
I asked them to assume that we figured out the development, manufacturing, and logistics of vaccination, then I posed one question: how do we ensure as many people as possible get vaccinated?
Now in the off chance that vaccination isn't going to affect you at all - which can't be true - but let's just say that's true, then you can approach these interviews as very good advice about how to influence and persuade and change people's minds about anything. Let's begin.
First up is Bob Cialdini, also known as the godfather of Influence. He is the Regents' Professor Emeritus of Psychology and Marketing at Arizona State University. Bob received his PhD from the University of North Carolina and post-doctoral training from Columbia University. He has held visiting scholar appointments at Ohio State University, the University of California, the Annenberg School of Communications and the graduate school of business of Stanford University.
He has four books to his name, Influence: The Psychology of Persuasion. This is a book that changed my life. Pre-Suasion: A Revolutionary Way to Influence and Persuade, Yes! Fifty Scientifically Proven Ways to be Persuasive, and The Small Big: Small Changes that Spark a Big Influence.
Bob Cialdini:
My approach to answering questions having to do with influence has always been to ask myself, “What's already there in the situation with its engine running, waiting for us to align with the power that's already there, the stored energy that's been put there and in the people in that situation by evolution and by the socialization? It seems to me there are several of those in this case.
The first is there's limited availability. We have something of a scarcity; not everybody can get the shots, and the evidence is very clear that when there is limited access to something limited or number of available options or items, people get a little crazy to want that. We want more of those things we can have less of.
So one of the things we can do in describing, simply describing the state of affairs is honestly mention that there is a waiting list, that there is limited access to the supply that we do have. That should, by itself, increase inclination to want it. So that's one thing I think we're able to do.
Another is there will be an increasing number of people who take the vaccine and indeed there's even evidence now that there's an increasing number of people who are saying they do want to take the vaccine. There's new research - one of my team members is a participant in that research - that shows that when people see a trend, they assume that trend is going to continue in the same trajectory and soon everybody will be doing it.
So for example, we've done research showing if you tell people that only thirty percent of your colleagues “Try to save water at home,” and then we give them a chance to save water in another situation, they actually save less water because we've told them that seventy percent of people don't care about saving water. That's the principle of social proof. It's a mistake to do that.
But if we say, two years ago, twenty percent saved water in the home. Last year, it was twenty-five. This year, it's thirty percent. Now it's the same thirty percent. Now these people save more water than control groups or the other group as well, and here's a mistake that communicators, I've seen them making already with regard to the percentage of people who think that they will take the vaccine.
They said a couple of months ago it was forty percent. Now we're up to fifty percent - two data points represent a difference; three data points represent a trend.
What they should have said is, “Two months ago, it was forty. Last month, it was forty-five. This month, it's fifty,” and now, people will project that trend on into the future and want to get on board with the bandwagon. So that's another thing - it seems to me that's right there in this situation waiting to be used.
Here's another one, I just saw a piece of research. It's not even published yet. It shows that in rural areas, you're more likely to get people to decide to take a vaccine, an injection, for reasons having to do with helping others and protecting others rather than protecting themselves. It seems to me that if we can extend what happened with masks and social distancing, it was the rural areas where there was most pushback. There was a sense of, "Hey, I'm going to choose my own way. I'm going to be independent and autonomous and don't push me to choose these steps in those areas."
What we have to do is message about protecting those around you, not just protecting you as a result of that injection, that inoculation. Okay, and then there's one last one that it seems to… again, who are the people who are going to resist this? It is the most is probably the anti-vaxxers. How do you possibly get an anti-vaxxer to do this?
There's a tradition in the psychology of persuasion that's called the “convert communicator.” The individual who used to be who you are with regard to this issue, used to, in this case, believe that vaccines were problematic. That person who has been converted by seeing something that happens to them, maybe their child got measles and was rendered deaf or something like this, or their mother got the COVID disease, and that person, we have to recruit, find those individuals and give them voice. They're the ones who are going to convince the most difficult to convince.
Guy Kawasaki:
So by that, RFK Jr. would be a prime person?
Bob Cialdini:
He would be a prime person, but you have to say not just, “I used to believe that, then I saw the same thing that you are seeing and it changed my mind.” No, you have to say, “I used to believe what you believe and then I got a piece of personal information that changed my mind that you don't have. Let me tell you what that is and why you should move in the direction to save yourself from the costs of what I experienced.”
Guy Kawasaki:
Going back to your scarcity theory, so what happens if you do this too well and you convince people that so scarce that they say, "I have no chance in getting it because the frontline workers are getting it. The old people are getting it. People in nursing homes are getting it. I'm, like, tenth on the list. Forget it. I'll never get it.”
Bob Cialdini:
Here's what I think you do: you use the loss aversion and you say, "Don't lose your place in line. That's valuable to you. You've got the place in line. Don't let that go. Don't forego. Don't miss your opportunity.” Now you've got loss aversion going to it.
When I was first researching the principles of social influence, I would take training in various kinds of marketing organizations or sales organizations, incognito where they wouldn't know that I was used really just studying their tactics, and there was a portrait photography company that would offer at Walmart to come in and get a picture for ninety-nine cents and then they would try to upsell you to a whole raft of pictures of everybody, all the kids and all the family together and so on. If you didn't buy the whole package, they would say, "We're going to have to burn the pictures of your children in three days.”
“You're going to burn my children?! They’re going to be lost to me!?”
Your name is on those kids. You don't want those lost, right?
Guy Kawasaki:
Next is Gretchen Chapman. She is a professor of social and decision sciences at Carnegie Mellon University.
Prior to joining the faculty at CMU, Dr. Chapman was a distinguished professor of psychology at Rutgers University, where she served as the Department Chair of Psychology and acting co-director of the Center for Cognitive Science. She is the recipient of an American Psychological Association Early Career Award, and a New Jersey Psychological Association Distinguished Research Award. She is a former senior editor at Psychological Science, and a past president of the Society for Judgment and Decision-making.
Gretchen Chapman:
I have three answers. The first answer is: facts are not enough. The literature shows that interventions that try to change what people think and feel about vaccination have a mixed track record in terms of changing actual behavior. Obviously when there's a new vaccine and new information to be shared, it is really important to be transparent and clear and sharing that information but we shouldn't assume that just giving people the facts is going to change their behavior.
The second answer is Cialdini’s answer, which is to use social influence and social norms, and I think that may be working on our favor because of course, over time, more and more people are getting vaccinated. So right now, I don't know anyone personally. That's not true, I have one physician friend who has gotten vaccinated, but that's it in terms of my social network.
Over time, I'm going to know more and more people. So by the time it's my turn in line in May or something, I'll probably know a whole lot of people who have been vaccinated. So that descriptive social norm of other people doing it will facilitate my behavior.
The third answer is intervening on behavior directly. What can we do to make vaccination the easy path for people to take? How can we make it very convenient? How can we use effective reminders so people come back for the second dose? Can we preschedule people for appointments? Can we set up the environment or the decision structure so that vaccinating is the easy and obvious behavior to make.
It's challenging to figure out what those structures would be, but that is the kind of intervention that decision science shows is effective.
Guy Kawasaki:
Do you think that the hardcore anti-vaxxer is someone that can be influenced to get a vaccination or we should just give up on those people and try to get seventy or eighty percent, and they're the twenty percent that's not vaccinated?
Gretchen Chapman:
Yeah, anti-vaxxers are not twenty percent. Anti-vaxxers are maybe one percent. If we look at childhood vaccination, less than one percent of children in the US received no vaccines. So if we use that as our definition of someone who was very strenuously, principally, opposed to vaccination, it's a small group. It's an important group and difficult to reach group, but it's also small.
The larger group is what we call “vaccine hesitancy.” People who have some concerns, they don't want to be first in line and vaccination is not their top priority. Those folks are reachable.
Guy Kawasaki:
Why do you say that the anti-vaxxer one percent is still important?
Gretchen Chapman:
Primarily because of the way that they are geographically and socially clustered. So people with similar political attitudes, or attitudes about lots of other things, tend to be connected with each other in social media and they tend to live in the same neighborhoods.
So if there is a neighborhood of people where a lot of parents are opposed to vaccination and none of the kids in those families have been vaccinated against measles and then some international traveler comes through and unknowingly spreads measles to the community, it's going to spread like wildfire there whereas if that same one percent of the population, which is evenly spread throughout the country, they would be protected through herd immunity because so many people around them would be vaccinated.
So if we end up with that same kind of clustering effect with the COVID vaccine, so far, we know Republicans are more hesitant than Democrats. We know that African-Americans have lower trust of the vaccine than whites and Asians and even Latinx respondents in surveys and people tend to be geographically clustered in where they live according to politics and according to race and many other features. So we may end up with geographical areas where there's more hesitancy towards the vaccine than others and that could end up making those areas more susceptible to continue to spread.
Guy Kawasaki:
What do you do for the most hardcore anti-vaxxer?
Gretchen Chapman:
We don't have any empirically backed interventions in the literature that are effective at changing the minds of people who feel very strongly against vaccination. In fact, when people have very strong beliefs about anything, it doesn't have to be vaccination - it's not trivial to change their mind around - a technique that people who were opposed to vaccination use, quite effectively, is the power of stories and anecdotes.
They don't hit their readers with boring scientific facts and tables and graphs. They tell heart-wrenching stories about a kid who was developing, normally got the measles vaccine and then, within days, started to show the first signs of autism, and those kinds of stories rip your heart out.
You want to look for a cause, and the obvious cause, in terms of the story, is the vaccination that occurred shortly beforehand so you may start to believe that connection. People who are in favor of vaccination and base their beliefs on the scientific data about vaccination, they tend to use a lot of charts and figures and graphs and yet psychology shows that anecdotes can be much more psychologically effective and influential than the charts.
I'm not saying that telling the right stories is going to turn around some person who has a lifelong opposition to vaccination, but I do think that we can broaden the sort of techniques that we use in trying to communicate our message that vaccines are safe and effective.
Guy Kawasaki:
Do you tell the positive story of, “I got a vaccination; now I can live free; I can visit my family; I can see my grandchildren,” or you tell the negative story of someone didn't get vaccinated, died or infected, his or her family. So what's more powerful? The positive or the negative?
Gretchen Chapman:
The positive story is usually really boring. “My kid got vaccinated and nothing happened - the end.”
During COVID, I think that we may be able to turn that positive story into something a little bit more engaging. “My kid hadn't seen his grandparents in a year, but finally it was our turn in line to get vaccinated and we did, and the grandparents had been vaccinated and we were able to go visit, and it was wonderful.”
The negative story, though, I agree with you, is more heart-wrenching. About a hundred young children - I think the figure might be 100 children under the age of five die from the flu on average each year - and the CDC has this very heart-wrenching video about families who have lost a child to influenza. So that's the negative story and it's very emotionally effecting to hear that.
The message is clear: Don't let this happen to your child. Make sure that you and your kid gets vaccinated.
I have one other thought to pitch to you because this is a two-dose vaccine. Well, the two vaccines that have been approved so far are two-dose vaccines - there are some one-dose vaccines in the pipeline - get recalled, getting people back for the second dose is important, and we know from the Gardasil HPV vaccine, that can be challenging. So I think this is an opportunity to think about some creative ways to do reminders. Reminders are kind of boring, but they work like the literature indicates that giving people reminders in the right time does get them in for vaccinations.
So I have a colleague, Alison Buttenheim, at the University of Pennsylvania, and she and I were brainstorming the other day of how could we have a really effective reminder and what we came up with is a bracelet like a silicon wristband - think Lance Armstrong-type wrist band - and it would be in two parts that clip together.
So you get the first part after your first dose, if you could still wear it, but it's only the first part, and that's your reminder that you're due for the second dose. Then when you come back for the second dose, you get the second part, which sort of like snaps in and completes the bracelet to be this very fashionable accessory that you're now wearing, where you can publicly signal that you have completed your course of vaccination.
Guy Kawasaki:
Our next remarkable expert is Phil Zimbardo. He is professor Emeritus of Psychology at Stanford University. He has also been on the faculty at Yale, New York University and Columbia University.
His Stanford prison experiment is a classic demonstration of the power of situations to shape human behavior. He is the recipient of the American Psychological Association Division One Hilgert award for his lifetime contributions to theory and research in general psychology
He is the author of The Lucifer Effect: Understanding How Good People Turn Evil, The Time Paradox: The Psychology of Time That Will Change Your Life, and five other books.
Last but not least, he taught me psychology when I attended Stanford in the previous century.
Phil Zimbardo:
This is a place for applied psychology to encourage and promote people's willingness to get vaccinated against COVID-19. I can think of three separate social, psychological tactics. We will first identify with social role models by the followers, and the social world models are going to advocate taking behavioral action, voluntarily getting vaccinated.
So we're going to focus first on celebrities, high-visibility people was a cohort of likes. So I would start with TV celebrities like Dr. Phil, Judge Judy, Oprah Winfrey, Dolly Parton for those over sixty-five. Curiously high-visibility people like world's basketball star, Steph Curry, and maybe with his whole family, Michelle Obama, of course, Taylor Swift for the younger generation.
Then we have to also focus on ethnic racial identities with dealing with the Asian, Hispanic, black population. I just thought Carlos Santana, certainly for Hispanic. I just did a master class with him yesterday, talking about how to play the guitar and how to understand music.
The other thing I was thinking in relation to this identification is a TV program - Unmasking the Masked Singer - and we could turn this into Unmasking the Mysterious Coronavirus. So that would be another theme that we could elaborate on, and then secondly, we need a visible symbol of shared identity, and nothing is better than the V sign - victory in war. It's the vaccine's victory over our most deadly enemy, the pandemic virus. Again, seeing people on social media, making the V sign, which we did at the end of wars
Then, I think, the third thing I would suggest is social inclusion, meaning: “You join our team. We now have the ammunition to win this deadly war, and it's vaccination for all men, women, and children to triumph over this ferocious enemy who has been attacking our basic human freedoms of life, liberty, and their pursuit of happiness.” Again, obviously, the use of vivid metaphors help.
So those are several different applied psychology ideas to encourage people to get vaccinated. One of our problems so far is a recent survey showed that about thirty percent of Americans are afraid of vaccination. There's always been a fear of vaccination among many populations that it's not clear what they're putting into your body could be something that's going to control your body, control your mind, so that's why we need people, celebrities that they can identify with to say, “You need to get vaccinated.” You have to see them getting injected.
Again, I think in many of the small towns, we need the mayor or the head of a hospital or chief of police, see they have been vaccinated. The problem is we have to show them getting the injection, not just talking about it. So I think these are just a bunch of ideas that you could package into building up a nationwide program for everyone to be vaccinated.
The other issue is it's a vaccination, not only for yourself, but for others. That is to the extent that you are vaccinated, you no longer become a carrier. You no longer communicate the virus to other people, in your friends, in your family, in your team.
Guy Kawasaki:
Is there anything that you think absolutely will not work that you would warn people off of?
Phil Zimbardo:
I think anything which says you are obligated to do this, that it's your duty as a citizen to do this. I think anything which is saying, “You obey the rule; the law of a good health.” So essentially the point is: it's voluntary. So you don't want to say, “You must do it.” Essentially, I'm saying all of these ways of saying “Join our team. People you care for, people who you trust are doing it,” it's joining the bandwagon rather than be left behind. Be the only one not vaccinated.
Guy Kawasaki:
What if a law were passed that it is a requirement? Do you think that's a mistake?
Phil Zimbardo:
Yeah, I think it would be a mistake because, again, unlike seatbelts and other things, you are private, you are in your home, so nobody knows whether or not you got the vaccination. So that requiring it leads to some percentage of people who are rebellious, who rebel against authority, who rebel against being forced to do it. So that's why I think it's playing up their freedom, that is the freedom to take this action which will save your life and the life of your family.
One of the terrible things about COVID is people's family losing their mother or father or children. So I think we want to play up “It's the freedom of choice, but it's a choice for the greater good.”
Guy Kawasaki:
David Aaker is next. What Bob Cialdini is to influence, David Aaker is to branding, that is, he's basically the godfather of branding. He is Professor Emeritus at the Haas School of Business at UC Berkeley and the Vice-Chairman of Prophet, a marketing consultancy co-founded by Scott Galloway.
In 2015, David was inducted into the American Marketing Association Hall of Fame for his lifetime achievements. His books include Creating Signature Stories, Strategic Messaging That Energizes, Persuades and Inspires, Managing Brand Equity and Building Strong Brands, plus ten other books. Oh yeah, he is also the father of Jennifer Aaker, a remarkable professor at the Stanford Graduate School of Business.
David Aaker:
I think there's two types of people. One are those that are just hesitant and they're really concerned about really the safety of it, and I think for those people, if you have an authoritative spokesman, Fauci or Biden, and they're telling you it's safe, and they're taking the vaccine themselves, I think that will push them over the edge. I think there's evidence that's already happening.
The problem is with the hardcore, committed anti-vaxxers that have been living with this commitment for a long time, I think that's a different story, and my take on responding to that comes from two books, really. One book is George Lakoff's Don't Think of an Elephant! where he, really brilliantly, makes the case that you don't win an argument with logic and facts and so forth, or science. The winner is the one that frames the argument the right way.
So if you're wondering whether it should be infrastructure investment or tax relief, then the person that frames the discussion right will win, and no matter of facts or logic will change that. So if we're talking about tax relief, good or bad, then that argument is really over. I think this kind of conceptualization of the importance of framing the argument really applies here.
Guy Kawasaki:
So how would you frame the question?
David Aaker:
I think that the framing of the question is whether the vaccine is safe is not a frame that allows you to win because then you start talking about facts and science and logic, but if you frame the argument about the experience of having this virus, how horrible it is to die alone, how horrible it is to have these lingering side effects that destroys your life, and you do that in a vivid way, then the other side is left with framing that, "Well, dying alone isn't so bad. Living with long-term side effects is not so bad,” and you've really won the day.
So you've got to focus on that element of the thing. I think that arguing about the safety of vaccine will not help you because it's a wrong frame with this group of people.
Guy Kawasaki:
They're framing it as a loss of individual freedom. So how would you fight that frame?
David Aaker:
Basically, you ignore their frame. You have to consistently use words and symbols and stories to get the conversation onto your frame. If you argue against this concept of personal freedom, then you're accepting their frame. It means their frame has won, and so, really, you make things worse.
What you have to do is replace that frame with another firm, and that's very hard to do. There's no question about it. You don't want to be labeled as anti-tax relief or pro-abortion. If they get you in that box, then you're done.
Guy Kawasaki:
How about this? If people frame it in terms of individual freedom, wouldn't a good response be, “We believe in personal freedom also, personal freedom to go to football games, personal freedom to see your grandchildren, personal freedom to party, personal freedom to go to bars? So by taking the vaccine and wearing a mask, we're increasing your freedom, we're not decreasing your freedom.” Would that work?
David Aaker:
I don't think so. I think, in fact, that will just validate their frame, and that will mean that that's the discussion we're having. I don't think it's possible to win that argument in the context of that frame. I think you have to change the frame, and that leads to the second book because that's related to how you would change the frame, and that's the book Creating Signature Stories.
The idea there is that we know, from literally hundreds of studies, that if you're in an argument with somebody who is committed to a different position, no matter of facts or logic or science will change their mind, they will either ignore you or they'll distort what you say or there'll be very skeptical and they'll counter-argue. That will be the result.
What gets through to people like that are stories because you don't argue against the story, it's just a story. So if you can have a story that has emotion or humor or so interesting that they will actually read it or hear it, they will actually talk about it to others, and the idea of counter-arguing just won't really occur to them.
So I think that what I would do is to create some vivid stories around the frame involving the experience of “This virus is horrible.” I would have vivid stories of people that have died or family members that have seen somebody die and they weren't able to be with them and how horrible that was, how sad the next Thanksgiving is going to be without them, how lonely their children are going to be. I would have a vivid story about somebody with these long-term side effects. Their life is ruined. They have uncertainty if they're ever going to be able to get up in the morning with energy and to stop doing ongoing testing to see if there is one of the organs is failing or if their heart is still working.
We've been there before, we've done this, and it's worked, and that was the tobacco situation. There was data in the early fifties that showed that smoking caused lung cancer by a factor of sixteen. You were sixteen times more likely to get lung cancer and that was proved in the early mid-fifties.
So in the mid-sixties, people are still arguing about whether that's that big a deal so what people did is started showing these very vivid stories of people with late-term lung cancer that had been smokers. They themselves told the story and we have data that made a huge difference. People stopped smoking. Teens stopped started smoking, and so it works, and that's an attack I would take.
Guy Kawasaki:
What if you are trying to get people to get vaccinated and stories are used against you. So right now there's a story that a nurse got vaccinated, eight days later, she was infected. So you could tell that story to "prove" that the vaccine is not effective. How do you combat a story if you're on the other side?
David Aaker:
I had a student that came to my office a long time ago, and I said, "What do you want to do as a thesis?" Most entering students have no idea, and he said, "I want to study metaphors,” he says, "Because I believe the last metaphor wins." If somebody says, "This is just like, dah, dah, dah." And then you say, "Oh no, it's just like this other da, da, da.," there's a recent factor that's very powerful. What's the last metaphor that's in your mind? What's the one that is most prominent?
I think that one tactic - and believe me, the Republicans have learned their sin and done it very well - and that is you, just by sheer repetition, by sheer discipline, you don't go there. You just say, "Yeah, but what about this person that died because of this? We got so many of those and so on." I really have been taken with this student's research who did go on and study metaphors and he could demonstrate the last metaphor wins.
So what we have to do is to make sure our story is more visible and more consistently told than the other guy. Again, if you go and counter that story about the nurse, you run the risk of giving that visibility, allowing that to be the last metaphor or story heard and make it more visible. It's not an easy situation, and it's frustrating and it's very tempting, so let's argue back. I think that Lakoff would say that's a mistake.
Somebody that believed in stories would say, "We've got to make our story better than your story. We got to have more of our stories than you have of your story. We have to tell it more often and more frequently and be in your face. We must never walk away from the discipline of using our frame as a basis for discussion."
Guy Kawasaki:
Next up is Jonah Berger. Jonah is an Associate Professor of Marketing at a Wharton. He received a BA from Stanford University in human judgment and decision-making and a PhD from Stanford in marketing. He is the author of three books, Contagious: Why Things Catch On, Invisible Influence: The Hidden Forces That Shape Behavior, and The Catalyst: How to Change Anyone's Mind.
Jonah Berger:
I think the quick answer is to stop telling them what to do, because when we tell people what to do, they push back. They counter-argue. They come up with reasons they don't want to do it. They think about all the reasons why what we're suggesting is often a bad idea.
Rather than telling them, we need to ask them. We need to ask rather than tell them simple things like asking them a question, right? So rather than saying, "Hey, you should get vaccinated," you can ask them something like, "Think about your elderly parents or maybe your grandparents or think about your kids if you have kids. Would you want them to be vaccinated? Would you want the people around them to be vaccinated? If so, if you feel like, ‘yes,’ then shouldn't you get vaccinated also?" Right? Encouraging them to make the decision themselves, giving them the freedom and autonomy to make the choice but using the right questions to guide that choice. Asking rather than telling and guiding them on the path to a better decision.
Guy Kawasaki:
Do you believe in the power of influencers, whether it's governors, mayors, media stars, the athletes? Is that an effective way?
Jonah Berger:
There's certainly a benefit of folks that have a large audience, right? They're not necessarily influencers always, you might think of them as reachers. They're just like a television show with more people watching it has a bigger audience. It reaches a larger set of people with the message. Someone who has a bigger following online certainly reaches more people with that message. So it can be evaluated as disseminate the message.
In addition to reach, all of us who think about marketing communications think about impact. Not only will that message reach people, but given it reaches people, will it have the right impact? And to me that's less about who that person is or how many people follow them, but what the message itself is. So the right messages can have a really big impact, whether delivered by a person that has a big reach or one that has a much smaller one.
Guy Kawasaki:
Where do facts lie in this equation in the sense of, “It's a 9-11 every day and we're the worst country in the world?”
Jonah Berger:
What do you mean “facts”? There are things called “facts”? I think we're in a post-fact society, right? Nothing is a fact anymore. I make a joke, but I think that's part of the problem.
Part of the problem now – and, by the way, the confirmation bias has been around forever; the confirmation bias isn't new - we have a tendency to look for information and believe information that supports our existing views and ignore information and not look for information that opposes those views. The challenge is one person's fact is another person's fake news.
You may say, "Okay, well, great way to get someone to change is to list all these facts or all these reasons why they should do something,” but as anyone who's ever tried to convince a spouse of anything knows that person's not just sitting there listening, they're sitting there thinking, "Well, why should I believe you? Let me poke holes in your argument. Let me figure out why what you're suggesting won't work."
I think the problem with facts is they encourage people to push back, right? They encourage people. People basically have an ingrained anti-persuasion radar and that sort of alarm system, a spidey sense, a defense mechanism that goes off when they feel like someone's trying to persuade them. Facts set off that system; questions don't set off that system as much.
If you ask someone, "Would you want your kids to be vaccinated? Would you want your elderly grandparents or the people around them to be vaccinated?" they're sitting there, they're not sitting there thinking about what you're suggesting is wrong, they're sitting there thinking about what their opinion is. We love being asked our opinion. So they're focused on what they think, which makes them much more likely to come around in the end.
Guy Kawasaki:
Let's take anti-vaccination prior to the pandemic. You could make the case that's some visible people presented what they said was a fact, which is, you take MMR, your kids are autistic. So how come it worked then?
Jonah Berger:
There's a set of people that are interested in that idea to begin with. That's already something they are open to believing, so just telling them that that's wrong isn't necessarily going to do it. One thing I talk about in my recent book, The Catalyst, is we need to change minds not by pushing people but by identifying the barriers to change and mitigating them.
I think too often we think the thing we need to do to change people is provide more information. If we just provide more facts, more figures, more reasons, more information, they'll change, right? Just like if there's a chair in a room, we think if we push that chair, that chair will go in the right direction. The problem is people aren't chairs. When we push chairs, they go, when we push people, they dig in their heels, and so we need to stop saying, "Well, hey, what could I do to get this person to change?" and instead say, "Why hasn't this person changed already?"
Sometimes the problem is information, right? If someone doesn't have access to the right information, if someone is open-minded but hasn't been given information, then information can be really effective. But if people already have a lot of information that disagrees with what you're suggesting, information is not going to solve the problem. You have to figure out what the barriers to change are and get rid of them.
Guy Kawasaki:
Next, coming to us from Boston, Sinan Aral. He is the David Austin Professor of Management at MIT. He co-leads MIT's initiative on the digital economy. Sinan is a Phi Beta Kappa graduate of Northwestern University, holds master's degrees from the London School of Economics and Harvard University, and he received his PhD from MIT. He is also the author of The Hype Machine. He's truly an expert about the impact of social media on society.
Sinan Aral:
The first thing is we absolutely have to control and reduce the spread of misinformation about the vaccine and we have to increase the communication of the science and the facts transparently. What we saw in our COVID survey was that, as phase three data about the Pfizer and Moderna vaccines came in, people changed their confidence in taking a vaccine dramatically. We saw a huge increase in the United States about the numbers of people that said that they would probably or definitely take a vaccine as the ninety, ninety-five percent effectiveness numbers started to come out and become more commonly known.
At the same time, we've seen decreases in likelihoods of taking vaccines associated with the spread of misinformation or faulty information, or uncertain information about the vaccine. Number one, we've got to reduce and snuff out the misinformation and increase the transparent communication of science and facts. That's paramount.
Guy Kawasaki:
I know how you increase the science and facts, how do you decrease the misinformation?
Sinan Aral:
Well, a lot of the way we handle misinformation, obviously, I talk a lot about in my book, which is we have to rely on the news media to report fairly and in a factual way, but we have to think about the social media platforms and the spread of misinformation over those platforms.
Obviously, they took a lot - Facebook, Twitter - they took a lot of effort around the election to tamp down misinformation around the election. There were brand new policies. I just talked with Nick Clegg from Facebook about their election policies to tamp out misinformation.
They reduced retweeting without "tweeting". Twitter asked you to read the article before you retweeted it. Facebook took down a lot of misinformation, that works. Facebook banned QAnon and started cleaning them out. Facebook said that you couldn't declare victory early. Facebook started labeling, Twitter started labeling.
We need the same concerted effort around vaccine misinformation as we had around election misinformation, and we need that consistently applied with as much importance and pressure, if not more, as was applied for the election itself. Reducing misinformation, increasing transparent communication of science and facts is number one.
The second thing I would say is, and one thing we're researching very specifically, is using social proof. In other words, around elections, there's a number of different things that Facebook does. We all get these stickers that say “I voted,” and we wear these stickers just to indicate the voting and to try and encourage people around us to vote as well. So the notion of your friends and neighbors having been vaccinated might give you confidence, and seeing celebrities and public officials getting vaccinated might have an effect.
I want to be careful about this because there's actually two competing theories about this as it relates to vaccines. One is conformity. As I see other people do it, I'm more likely to do it. But the other is free-riding, which is very different in a vaccine context because as more people get vaccinated, I'm actually safer. I might have a counterbalancing debate in my head about, "Well, what are the personal risks to me of getting an adverse reaction to this vaccine. If lots of people around me are getting vaccinated, maybe the potential negative side effects will outweigh the conformity behavior that I might exhibit."
That's not true for voting. That's not true for product adoption. In fact, it might work in the opposite direction for product adoption. I want to get on a new product that everybody seems to be enjoying. When it comes to vaccines, there's this personal risk and then there's free-riding that could come with other people getting vaccinated and me knowing that. So what we're actually doing - that's where our study comes in - which is, we're going to randomize telling people, “Here is the fraction of people in your zip code that say they're going to get a vaccine,” and we're looking at what does knowing that do to change your answer in whether or not you will get a vaccine. We still don't have definitive results, but we will within the next three weeks or so, and we plan on writing and publishing a paper about it very fast so that we can know whether that kind of social proof is actually good or bad. Is it free-riding or is it conformity? That's a really important question.
I think that it's great to have theories, and I love it when Richard Thaler and other people have ideas about how to nudge this behavior. What we try to do is to actually go out there and do a large-scale randomized experiment to find out what the true behavioral impacts of something like social proof or celebrity endorsement are on the likelihood of a vaccine, given that there are competing theories around conformity and free-riding.
Guy Kawasaki:
Let's say you are hardcore Republican, MAGA kind of guy or gal, and then you see Lindsey Graham and Marco Rubio get vaccinated, how do I interpret that?
Sinan Aral:
As with any of these kinds of questions, you're going to have variation. Some people are going to say, "Oh, they sold out. They gave in to those liberal Democrats." Some people are going to say, "They finally came around,” and some people are going to say, "I used to think I shouldn't get one. Now I think I will because I trust these politicians." The question is: in what proportions will those three things happen? The next question is: how will those behaviors be distributed geographically across the United States or other parts? In the South will it be one way, in the North will it be another? In rural areas will it be one way, in cities will it be another?
We have data down to the zip code level, and we can actually answer some of those questions. I'm hoping that all of these theories around conformity, celebrity endorsements being positive, seeing that your friends and family are doing it make you more comfortable in that, "Oh, they've assessed the risks, and they've decided that it's worth getting vaccinated," rather than the free-riding explanation. I'm hoping that more of those will be the norm.
Guy Kawasaki:
So it's a good thing that Marco Rubio and Lindsey Graham do it?
Sinan Aral:
My gut intuition is that conformity will win the day over free-riding, that the more people we see of our friends and neighbors and family getting vaccinated, that the more likely we'll be to get vaccinated ourselves. My intuition is that as public health officials and celebrities and politicians get vaccinated that that should nudge people to get vaccinated but I'm not sure. That's why we're doing the research, because there is a chance that it will go the other way and we want to know that.
Guy Kawasaki:
Is there any special data or indications or theories about black people?
Sinan Aral:
I think that, certainly, there are data that show that black citizens in the United States have less trust of institutions and government proclamations, so having leaders of the black community endorse and encourage vaccinations is essential, because there's a lot more trust there, than there is in generic governmental institutions or politicians that don't represent that community or minority communities in general, because there's a lot of distrust that's been built up, in large part, justifiably in some senses, over the years.
Guy Kawasaki:
And any other key ideas?
Sinan Aral:
I would like to see some gamification. I was looking at some data the other day that showed that, somehow, when you look at app revenue - I was teaching a class, and I was looking at the distribution of app revenue over different types of apps, and gaming apps earn more than double the revenue of any other kind of apps in the App Store, and what I took away from that is that the gaming industry - gaming as in video games or different kinds of games you play on your apps - that the video game industry has really understood gamification and rewards, what the right rewards are for certain types of behaviors.
Maybe there's room for some sort of giveaway or win a prize or be enrolled in a lottery or a raffle to win a big monetary reward. There's been research that shows that disproportionately creates more behavior change than the cost of the reward, and that that might be worth it. That's why you give away the lotteries, rather than paying everyone a small percentage of the lottery ticket and giving it to everyone. I think that's an avenue that might be something that we could look into.
I also think that the media has a really important role to play here, because media - as well as social media - is and can be sensationalist. In other words, “Dog Bites Man” is not a story that reporters report, but “Man Bites Dog” is a story that reporters report, because it's “Wow, that never happens!”
The problem is that the media really needs to proportionally cover the risks and the benefits. So the adverse reactions are going to be a very small fraction of the positive benefits of vaccinations, but someone having a dramatic adverse reaction is news. I fear that the media will jump on those kinds of stories and will report them disproportionately to their prevalence in society.
Part of the problem is that getting sick or having an allergic reaction is something negative that happens upon getting a vaccine but the positive benefits of getting a vaccine are not proactive. It's just that you don't get sick. So there's almost nothing to report, because nothing happened.
Guy Kawasaki:
“Your grandparents didn't die.”
Sinan Aral:
Exactly! it's a tricky reporting situation, because, of course, the media will convince themselves, or will maybe even perhaps rightly argue the public has a right to know about adverse reactions, and they do, b but imagine that the media coverage is proportional to the adverse reactions compared to the positive benefits. It should be less than one percent of the reporting, but it won't be. It's going to be way more than that, because it's sensational.
That's something that's important for the media to think about. We also know, obviously, that on social media, that kind of sensational information spreads farther, faster, deeper, more broadly than the mundane.
Guy Kawasaki:
How do you fix that? I understand the problem. Are you going to tell Fox not to sensationalize allergic reaction to vaccination? This I got to see.
Sinan Aral:
I just did.
Guy Kawasaki:
Okay. That's going to work well.
Sinan Aral:
Indeed, that's an uphill battle, but I hope they listen because they have a public policy role to play in this specific set of reporting. The information flow during a public health crisis is essential. There are a number of vectors of flow of information during a public health crisis - you've got your institutions. You've got the media. You've got social media. You've got word of mouth, and everybody is part of that information flow.
We're part of the information flow as we talk to our friends and family over the holidays. The media is part of that. Social media and their policies around misinformation are part of that. Government organizations, public pronouncements are part of that. None of us can abdicate our responsibility in communicating appropriately about this.
Guy Kawasaki:
You're about the seventh person I've interviewed for this, and let's just say that the predominance of people have said, "It's not going to be statistics and data. It's going to be stories,” which you conflicted. Is it a nuance or is it…?
Sinan Aral:
Well, no, I think that's part of my point about the reactions. Those are stories and the stories of, "Oh, I got a vaccine in my arm. I had a little bit of arm soreness, and I was a little tired and then the next day, I was fine." Those aren't stories that are going to be told, because they're not sensational. So we definitely have to be careful about the stories that we tell, and then they have to be proportional to the data, because otherwise, we could get completely the wrong impression of, for instance, the prevalence of adverse reactions. That's a story issue. And certainly, the friends and family, neighbors, word of mouth, as well as the celebrity stories, the public health professionals getting vaccines in public, those are all narrative stories that are incredibly likely to be influential. And so, all of that is really important. But, look, at the end of the day, when I think about whether or not I want to get a vaccine or I want to vaccinate my kid or my mom, I am interested in the risks and benefits. And I want to know what my chances are of this outcome or that outcome. So I think that statistics has a role to play, and we need to tell those statistical stories in a way that is understandable, in plain English, and so that people can make smart decisions over the next several months.
Guy Kawasaki:
I don't think the day is going to come where 3,000 people die per day from vaccination.
Sinan Aral:
That's exactly my point. We may be more likely to report those that die from the vaccination, than those that die from COVID, simply because it's sensational. That's a real challenge.
Guy Kawasaki:
The next guest is Neil Anthony Lewis Jr. He is an Assistant Professor of Communications and Social Behavior at Cornell University, with graduate faculty appointments in Communications in Psychology. He also holds a joint appointment in the Weill Cornell Medical College Division of General Internal Medicine as an Assistant Professor of Communication Research in Medicine.
Lewis received his BA in Economics and Psychology from Cornell University and his MS and PhD in Social Psychology from the University of Michigan. He won the Rising Star Early Career Award in 2019 from the Association for Psychological Science.
Neil Anthony Lewis Jr:
I think there are two main things that we need to think about and work on to increase vaccine uptake. First, we need to do as much as we can to remove the logistical hurdles that people are facing, right? So people need paid time off, first of all, to be able to go in and get the vaccine, and probably, at least a day or so to be able to stay at home after they get the vaccine so they can get over some of the mild side-effects.
Side-effects will happen with the vaccine. Now, we've seen that, that's a normal part of the process. People need some time for that too. So if we don't give people time and take care of those other logistical hurdles, then we're sort of dead in the water. People aren't going to go take it. So we need to deal with that logistical hurdle first.
The second thing is we need to work on clear messaging that explains to people what's happening with the vaccine. So the data I've seen on vaccine hesitancy, so far, suggests that the biggest reason people are hesitant is uncertainty, so people are worried about the vaccine because it's new, and frankly, we've also had some mixed messaging.
So at the beginning of the pandemic, we told people, "It takes years to make a safe vaccine." Now we turned around and said, "Oh, by the way, we've made one in a few months." It's understandable, I think, why people are concerned and so we need to explain those differences, that normally, the way vaccine production works is that each company goes off on its own and they work on their vaccine without helping each other out and so the discovery and development process can take some time. It'll take a long time.
For this vaccine, things were different. It was all hands-on deck. We had scientists from all over the world, working together nonstop for months to get it done, and they did get it done. That's a remarkable feat that we have - at least two so far - remarkably effective vaccines for every group of people that we tested it with, but we need to explain that process to people and show them why these vaccines are trustworthy rather than just telling them to trust us. So those are my two big overarching things.
Guy Kawasaki:
Would you say that Operation Warp Speed has been effective and good?
Neil Anthony Lewis Jr:
I would say… yeah, putting these resources together to get people to work together on the vaccine was good. I think the name Operation Warp Speed is terrible and the reason for that is it does suggest to the general public's mind that the vaccine was rushed and that's part of why people are afraid of it. Putting the resources together, to get scientists to work together, to have the resources to develop a vaccine, I think was a really good thing. The naming, probably, was not the best choice.
Guy Kawasaki:
Why is the naming bad?
Neil Anthony Lewis Jr:
When you're signaling to people that we are rushing to get something done, that you're rushing to develop this thing that, "Oh, by the way, we're going to inject into your body," people are a little bit worried about that rush to get it done. People want to know that these vaccines and other medicines that we're taking, a lot of care went into the development process, and the name "warp speed" does not imply slow and steady careful development.
Guy Kawasaki:
Like in Silicon Valley, we say, "It's okay to fail fast."
Neil Anthony Lewis Jr:
Yeah, but there's the word in that, “fail fast,” or, I know the other one I've heard at Silicon Valley was the "Move fast and break things." So that's the signal we have in our mind that, "Oh, when you're moving fast, things aren't going to go well,” so that's why I thought the name was probably not the best.
Guy Kawasaki:
Part of your expertise is decision-making and influencing and persuading people who are members of specific groups so can you address some of the specific groups we're dealing with? How's that for a smooth segue, huh?
Neil Anthony Lewis Jr:
Yeah. So there's a lot of concern about racial disparities with vaccine uptake that, especially given that we've had really stark racial disparities and infections and deaths so far. So there's some concern about, particularly black, Latino, indigenous communities, being concerned about the vaccine and I have done a lot of research, setting messaging within these groups, and I think an important thing to keep in mind here is that, when you're talking about historically marginalized communities in this country, trust-building is even more essential.
These are communities that, frankly, the field of medicine, science more broadly, has had a terrible track record with, right? There's a long history of mistreatment, including in this very pandemic. I don't know if you saw the news stories recently about how Dr. Susan Moore was treated or mistreated when she got COVID, but there's a long history here, and contemporary trend of mistreatment with these communities. Again, we have to do our work to show people, these communities, not just tell them, but show them, why these communities should be trusted at this time, and that's taken the time to address the concerns that they have.
Guy Kawasaki:
Maybe you can give us some historical examples of why people would be hesitant to believe the government this time.
Neil Anthony Lewis Jr:
One of the more famous cases of mistreatment was the Tuskegee-Syphilis Experiment, that lots of African-American men who are recruited to enroll in the study to study the effects of treatments on syphilis. Even when we figured out what effective treatments work, that treatment was held back from black participants in the study. This is one of those early cases that we still talk about in medicine, that there's some recent studies by some economists, in fact, showing that even knowledge about this historical case still has this lingering effect on distrust in the medical community that lead people to believe that, "This is not a community. Medicine does not necessarily have my group's interest at heart. They don't really care about us."
So yeah, cases like this just are things that we have to keep in mind, that not all groups are going to assume that the medical establishment really has their interests at heart, and so we have to deal with that history in our messaging and constantly show that we're doing better this time and are here to make improvements.
Guy Kawasaki:
So now, I think people understand the historical context, and your recommendation is basically to show that, "This time it's safe. It's good. You can believe us." But, how exactly do you recommend showing it?
Neil Anthony Lewis Jr:
There are ideas about celebrity endorsements that can be helpful. The other piece is, I think also explaining the data. So one thing for me was when the FDA documents came out, I walked through that very carefully to look at what are the effectiveness rates by group. It was nice to see that, “Yeah, this vaccine is just as effective for every group we looked at.”
It's my job to look at data like this all the time, being able to walk through and show people that, "Look, we actually did take the time to recruit a really diverse study sample, and we checked to see if it is effective for every category that we have. Here's the data. Here's how we know that it's safe and why you can trust it." I think that can help.
So yeah, the celebrity endorsements can help, but also showing people how you know that you can trust this and how we know that it is safe for each of these groups can be helpful.
Guy Kawasaki:
Next, Sam Wineburg. Sam is the Margaret Jacks Professor of Education and a professor of History and American Studies at Stanford University. He attended Brown and UC Berkeley. He holds a doctorate in Psychological Studies and Education from Stanford. If you want to learn the history of history and how not to be misinformed by the internet - that's a double negative, but I can't think of a better way to say it - Sam is your man.
Sam Wineburg:
So I think the first thing that we need to do is to understand that people's opposition to vaccinations is not monolithic. There are a lot of different communities and a lot of different reasons that people are resistant.
So for instance, there are members of the black community that have some very legitimate reasons for being suspicious of government-sponsored vaccinations. Those people are different from people who advocate a natural or a pure lifestyle that don't want any kind of substance in their bodies. Those people are different from people who see this as an issue of personal Liberty, and then there's a group of people that are fence-sitters, who are simply confused, who are susceptible to the kind of misinformation and disinformation that is flowing over the web and those people are really in a different category entirely. They are swayed by information that's not authoritative, and frankly, they're confused.
I think the first thing that we need to do is not to disparage people as if they are all of one type, to understand where they're coming from, to show empathy, and to try to understand that people's resistance is based on fear. The way that you can make fear more entrenched is to demean people, to call them deplorables, to belittle them. So the first thing is to show some empathy and to be curious.
What is actually behind someone's resistance to taking the vaccine? That's number one. The kind of question that I worry about is the question of people who go to the internet and go to their social media feed, and try to figure out, "Is this something that I should do? Should I get vaccinated? Am I safe? Is this something that will hurt my health?" And I think that I can give you a particular example of how disinformation runs rampant on the web.
So one of the things that I've seen across my feed, and I've seen in the news media, is the claim that with the vaccine, you will be injected with a microchip. Now this particular claim is…it's effective as disinformation. First of all, let's be very clear: there will be no injecting of microchips. But why does this particular claim have wings? It's because it has an element of truth in it.
So the company that has a technology for tracking vaccines has talked about and made an option to the government, which the government has not exercised at this point, this is all theoretical, but a company - API Jack I believe it's called - had obtained $138 million loan from the government in order to make sure that they have a technology of putting vaccines in plastic vials, like an eye dropper way of delivering the vaccine rather than a vial and a syringe.
It’s still theoretical; it's not yet in production, but one of the options they've made available is to have a microchip that is on the syringe so that the dosage can be tracked for, making sure that it's not expired, and that it's not fraudulent, and so there is an element of a microchip there and the way that you see disinformation spreading on the web, is turning the element of truth of a microchip, into the idea that you will be injected with a microchip and it's very...
Disinformation, obviously, there's many types of it, and some of it quite sophisticated with deep fakes. But this is what I call a “cheap fake.” So a woman who has propagated this particular canard has created a Facebook video based on an interview with a man named Jay Walker of this company in the Christian broadcasting network - and you can look at the full five-minute interview on YouTube - she's taken the interview, and she's imported it, probably, into some type of program like iMovie, and then with print rollover, where the actual video is silenced, she puts over "The government will track your..." There's an actual quote that she uses of, "There will be microchips implanted that will be able to follow you."
This is not something that was said. This is something that's - she puts this print that is flashed on the screen and this is a video that's been seen close to 10,000 times on Facebook. She maintains a website called activistmommy.com, and this is the way these things spread.
So what can people do? I would recommend two things. One I know will warm your heart because I know that you are a big supporter of Wikipedia, but Wikipedia has a page called Misinformation Related to COVID, and it is deeply sourced. I checked it this morning. As of this morning, there were 645 references. So if someone's confused, let me recommend to them, go to Wikipedia. It's updated frequently.
This particular page is a protected page. It means that I, for instance, do not have the verification rights as a Wikipedian to go and change that page. This page can only be changed by people who have a high level of Wikipedia clearance, and if you don't trust the Wikipedia entry itself, then look at the references and see if there's venues that you do trust. That's number one.
Number two, it's the simplest thing in the world, it's a tool that's at our disposal, on a variety of devices that are either sitting on our desk or in our pockets, and that's going to Google. Google, as the philosopher Michael Lynch in Connecticut says, is the world's greatest fact-checker and the world's greatest biased confirmer.
So let's take this example at the same time. We decide which one it wants to be, and often, when we make a mistake, it's because we don't know how to use the tool effectively. So we come across a feed by this woman, Elizabeth Johnston, activistmommy.com, saying that there will be a microchip implanted. All we need to do is a little bit of what we call “lateral reading.” Go to our Google browser, put in "COVID vaccine microchip". There are a variety of keywords that will work, and let me recommend to users, use one of the five or six most common Google filters.
Go to Google News first. I tried this just to see if I could help our listeners along and when you go to Google News and you have as keywords, "microchip COVID injection", then you get, immediately, a very excellent source, Reuters article that overthrows this canard. You have something from ABC News. There are a variety of legitimate sources, a wide swath of them that you can choose from to see that there really is no basis to this particular claim.
Guy Kawasaki:
Just for clarity, when you say, “Go to Google news,” can you explain that? Because that's different than going to the Google search bar, right?
Sam Wineburg:
Right. So many people will just enter it into their search bar, but the next time that if somebody is confused about what I'm talking about, the next time you look at what the search produces, you will see a series of filters across the top of the page. I think the first one is everything, then it's Google News. Then it's images. Then it's videos, and just press on “news.” Why press on news? Because the way that Google aggregates stories that are current, they put it under Google News.
If something is fast-breaking or quickly disputed or something that enters what's called a “data void” on Google, which is for a search that people bad actors will come up with a particular term, so people that search it in a “data void” and they'll come to a website that is purveying misinformation or disinformation, Google News will be the fastest way along with Wikipedia.
Wikipedia is incredibly quick in this way. Also Reddit, but Reddit is a little bit more complicated to use and a little bit more difficult to ascertain whether it's true or false.
With the general public who's confused, and gosh, my heart goes out to them because I spent a great deal of my time being confused, I would recommend to those among us who are confused to go with that Wikipedia page that I recommended: “Misinformation related to COVID.” Bookmark it in your browser, and go to Google and go look up at the top at Google News and there you will see aggregated stories that are much more current.
Guy Kawasaki:
Anything else you want to add?
Sam Wineburg:
I think anything else would complicate something. The more complicated a solution is, the less likely people are going to follow it, that's why I want to restrict myself to two pieces of advice, Wikipedia and Google properly used. It doesn't mean it's foolproof, but it means that you will be much more thoughtful and much more informed than just by relying on what that uncle or your cousin or your godmother has decided to post on Facebook.
Guy Kawasaki:
Do you have any specific advice for encouraging black people to get vaccinated?
Sam Wineburg:
I, as a graduate student in psychology at Stanford, I took a seminar with Albert Bandura who was an incredible scientist, an incredible psychologist who did groundbreaking work on people freeing themselves, for instance, of phobias. One of the things that I learned to sit at the heels of Bandura is that there are two different types of models that when we look at them as role models, one is more convincing than the other.
If we are scared and feeling a lack of efficacy, then to see a mastery model, say for instance, we're phobic about snakes and we're so scared. We're agoraphobic as well. We are scared to go outside because a snake might bite us. To see someone who is a professional snake handler does not help us.
What helps us is what Bandura called a “coping model,” someone who is like us, and so I think that those people and activists in the black community that are worried and rightfully concerned about unequal healthcare in this country, they can take charge by taking prominent members of the community and demonstrating and talking openly, perhaps about their own fears and reluctance and how they overcame them, how they have been vaccinated, how they have not suffered any adverse side effects.
These coping models that we perceive as similar to ourselves are much more influential and persuasive on changing our own minds and overcoming our resistance than someone who's very different or somebody who's a master who has none of the worries that dog us at night.
Guy Kawasaki:
Our final remarkable guest is Katy Milkman. She is a Professor of Operations, Information and Decisions at Wharton. She also holds a secondary appointment at Penn's Perelman School of Medicine. She received her undergraduate degree from Princeton University in operations research and financial engineering and her PhD from Harvard University's joint program in computer science and business. Her upcoming book is, How to Change: The Science of Getting from Where You Are to Where You Want to Be. None other than Angela Duckworth wrote the forward for this book, and when I asked Angela to participate in this episode, she told me that since Katie was in it, I didn't need both of them. You can't get higher praise than that.
Katy Milkman:
There's two parts to the problem that we need to solve, in my opinion. One is the persuasion challenge, and that's ensuring that enough people decide they want to get the vaccine, and I'll talk about that more in a second. But actually the second part that I think we can't underestimate is the follow-through challenge.
So it turns out that even if we persuade everyone, "Yeah, okay, I'm willing to do this. It's the right thing. I want to. It feels safe. This is the right choice for me." A lot of people still won't follow through. They'll mean to. Life gets in the way or they get a little nervous or it seems like a big hassle. So there are all sorts of reasons we don't follow through.
About thirty to seventy percent of the things we intend to do related to our health, or even something like voting, we end up not following through on. So we need to focus on both of those issues.
Guy Kawasaki:
When you say follow through, do you mean getting the first shot or the second shot?
Katy Milkman:
Great question. Yeah. So when I say follow through, actually I'm just talking about getting either shot would be a good follow through problem. Even getting the first shot to get people to follow through on that is a challenge but it's made worse by the fact that now not only do we have to get people to follow through on their intentions once, which is hard enough for things like voting and getting a flu vaccine, now we have to do it twice, three weeks apart, and that is going to make the challenge of follow through even more monstrous.
So I think we need to be focusing attention not only on persuasion, that's important, but also on this follow through challenge, both because one, it's always a challenge and two, this particular vaccine coming in two doses, three weeks apart makes it even more of a monster. Let's start with part one.
Okay, so persuasion - it's an area I teach and I read. Literally every year at Wharton, I teach a class where we read Bob Cialdini, who I know you are also having as a guest on your show, and he has written the rule book for this and we should be following it.
So one of the key things his research points to is how important it is to make sure that if we're unsure whether something is really the right thing to do, it's really visible that lots of other people are doing it. That's going to make us feel much more comfortable and more like, “It makes sense to do this thing because I'm not sure. It sounds safe. The scientists are saying it's safe. But my friends and neighbors and my colleagues, are they doing it? Are people like me doing it? Are people I relate to making that choice?”
If we see them flocking to do it, all of a sudden that visibility makes us feel much more comfortable. “Oh, this is the normal thing to do. It probably is a reasonable thing to do.” I think it's really critical that we tap into that and make it very visible when people are getting their vaccines that we're giving away stickers that say, "I got my COVID-19 shot."
I just saw that the CDC has come out with plans to do something like this. That we make it visible on social media. There's been studies showing for instance, if Facebook makes it visible to you, who in your social network has voted and particularly highlights friends who voted, you're more likely to go to the polls. We should be using that same platform and other platforms too, to make it visible to people. Especially at this time of social distancing, we're going to need technology to help increase that visibility of all the folks doing it.
I think it's great that several former presidents have come out and said they're going to get vaccinated on live TV. The more role models and authority figures we have, both getting vaccinated and talking about it, the more comfortable everyone's going to feel. So that's really important to persuasion, building that social norm.
There are lots of other smart things we could do too, write transparency about the process to make sure people understand how well vetted this is and how rigorous our testing process is for the safety of a vaccine like this in this country. That's going to be really important. Making sure we have a diverse set of people who were highlighting getting the vaccine and talking about it safety, so it doesn't feel like it's a message coming from a single demographic group or a single type of person and that's critical because we trust authority figures, but we also trust authority figures who represent our identity group, particularly.
Another thing on persuasion that's going to be important is making sure false information and misinformation isn't spreading rapidly and that's challenging, but there's a lot that social media companies can do to chip in there and they've been doing a lot more around politics, recently, slapping labels on things that are known to be misinformation, making it harder for people to share misinformation by asking, "Hey, have you read this article?", and so on.
There's also some suggesting that if we ask people, "Is this valid? Is it information that you can trust? Do you think this is true?", before they share things, that may be helpful because people actually can filter. They're just normally not in the mindset of doing that. That's research by Dave Rand and Gordon Pennycook that's shown that can be really valuable.
If social media could get on the case and also try to down rank information from untrusted sources, those are things that could really help because misinformation is going to be part of the problem unquestionably as well, that's persuasion.
Guy Kawasaki:
Basically, you're saying we need the herd mentality for herd immunity.
Katy Milkman:
Absolutely. Yes. We need a lot of herding going on in the year ahead. Lots of herds would be good for us.
Guy Kawasaki:
I wrote to a doctor at the CDC who I saw mentioned in some article about getting people to get vaccinated. What I suggested was that on social media, it's highly desirable and even a status symbol to be verified. So if you look at my social media, probably yours, there's a little check mark. So I think that what Facebook and Twitter and social media could do is also have a verified mark and then-
Katy Milkman:
If you've been verified as vaccinated?
Guy Kawasaki:
But see, here's an interesting thing. You tell me if I'm right or wrong. So when I told this idea to some people, they immediately said, "Well, how does Facebook verify that you've been vaccinated? You could just claim to be vaccinated and not be vaccinated," to which my response was, "I don't think it matters because if you say you're vaccinated and you're not vaccinated, but people see that you are vaccinated and they get vaccinated, what's the problem?"
Katy Milkman:
I'm a hundred percent with you. I don't think we want social media companies downloading our medical records, and I agree, if people are falsely claiming they're vaccinated when they are, there's no downside on social media. I can see how there's a downside if you're an employer or an airline or something and you're trying to vet whether or not it's safe to bring this employee back to work, but that's a whole other sphere. As long as we're not going to use Facebook's validation method to make those kinds of decisions, I think you're a hundred percent.
I don't care if people lie. I hope they don't, and, by the way, it's fascinating that people sometimes are dishonest and there's lots of great research on that, but more often than not, they're honest. So I would feel okay about it.
Guy Kawasaki:
Now talk to me about the follow through part.
Katy Milkman:
Yes, great. Now follow through is a topic that's near and dear to my heart. It's something that I'm working on that I've studied a lot and I think we know a lot about this. Another thing that's nice about it is you can't really argue with it, right? You might feel uncomfortable about persuading people to do something if they don't feel great about it. I'm okay with persuading because I trust the scientists, I trust the science and I think we're getting it right.
Now we need to make people see that and be comfortable with it. Follow through is just, I mean, to do it and all I'm trying to do is help you accomplish your intention. There's a lot we know that helps with follow through and some of it is common sense and some of it's more interesting. So let me start with a little more interesting point.
It turns out that if someone just gives you an appointment, say your employer or your doctor's office, they say, "Hey, we've scheduled an appointment for you to get your vaccine." You're more likely to follow through, about thirty-six percent more likely than if they call you and say, "Hey, you can schedule an appointment."
Now this is really interesting. This was a study done by Gretchen Chapman at Rutgers University where they were having free flu shot clinics and they either told people, "You can come in and get one anytime," or they said, "Here's your appointment, but you can change it and come in at any time." Everything was identical procedurally for the people - it was just a free flu shot clinic and you had an "appointment". You just showed up and got vaccinated like everyone else, but it feels like there's a slot reserved for you.
Someone's thought about you. You don't have to think about the follow through challenge. Now you know when to put it on your calendar and you expect someone's waiting for you with it. So I think if we can do smart things like that, that's one thing that helps.
If we can't give people appointments, I actually have some research showing if you just send people a mailing, encouraging them to come get a free flu shot at an onsite clinic and ask them to write down the date and time when they intend to do it, it's not an appointment. You're not mailing it back, but you're getting them to think concretely about the when, “When is this going on my calendar?” And maybe it goes on your calendar with a little invite like you sent me to schedule this conversation. All of a sudden, I'm much less likely to forget, which by the way, is a huge barrier to follow through.
Here's another really simple, inanely simple, but so important point, which is reminders. It turns out reminders matter a ton. There was this great study done of tuberculosis patients by Dave Rand and Erez Yoeli and collaborators - you actually mentioned him earlier. These are great scientists - and they did this study where people who had tuberculosis aren't always compliant with their treatment recommendations and so people started getting a text message. "Hey, did you do your treatment? Did you comply today?" And if they didn't write back and say, "Yes," a couple hours later, they got another one and then another one and then they got a phone call. And guess what? The treatment outcomes were ten percent better for the group that was in this nag condition than in the regular group. So it might sound boring, but people actually do benefit, especially when it's something important, from nagging. It can save lives.
So I think we should also be making sure that if we schedule appointments for people or get them to make plans, we're really following up and this is going to be particularly critical for that second appointment. No one should leave their first shot without it scheduled to get a second shot and a series of reminders cued up so there's no way they can miss it because they forgot.
The one other point I want to make is there's a lot of research showing one of the reasons we don't follow through on things is because it sounds it won't be fun and we sort of want to put it off. “This is going to be unpleasant. I'm going to get a prick. Oh, I'm going to maybe feel a little crummy,” and one thing we can do to try to alleviate that is can we balance that displeasure with something that we actually might look forward to.
So Nobel Laureate, Richard Thaler at the University of Chicago suggested one thing that might help would be: what if we give everybody who comes in a lottery ticket? Something to look forward to? Something that sort of makes this more of a treat? You could imagine other ways of making it a treat or festive. You could get silly.
I wrote in The Economist about what if we had everybody get vaccinated at a roving ice cream truck, and then they got a free cone. I mean, it's ridiculous, but can we think about ways to make this something that isn't so dreary?
Maybe you pick up some chocolates as a gift from your employer on your way out and everyone knows that there are delightful chocolates waiting for them. What is it that we could do that makes us something that has a little perk at the end of it
I'm anxious about the idea of paying people, though I think it should be tested but I'm anxious about it because if we pay people a lot to get vaccinated, they may infer a signal like we're paying you because it's so risky, but that's another way you could potentially sweeten the deal. So we need to think about that as well. How do we make it so it's not aversive and not something people are dreading?
Guy Kawasaki:
And like seat belts and smoking and vaccination prior to entering school, what if we made it, you had to do it by law?
Katy Milkman:
Yeah. Mandatory is a great thought, and honestly, I would say if there were the political will, and again, given the safety data is looking good and if it were vetted thoroughly by lots of people we trusted, I don't see why we shouldn't do that. Given how many lives are at stake here, it seems really reasonable.
I suspect it will eventually be mandatory, at least in some hospitals, which is the case with the flu vaccine. It may be mandatory in a lot of workplaces. It may be mandatory in school districts. So I think there will be mandates. It seems hard to imagine that it will be mandated, say by the federal government or at the state level, that everyone get it, but I think it's worth having a conversation about that, given the importance of this.
Guy Kawasaki:
There are a lot of things mandated in Australia that are not mandated here that works so, like voting.
Katy Milkman:
I think one way to think about it that might be a little bit more digestible or people might find more acceptable is really, if, instead of mandating it, “You have to have this or else you'll be fined,” or “Something bad will happen to you,” it seems like denying access to things is probably a safer way to go, meaning you can't fly if you don't get it. You can't send your kid to school if they haven't had it and you haven't had it, things like that.
So then I think people find that a little bit more tolerable. There's still some sense that you have a choice, but there's so many things you lose out on that you make that cost benefit decision and end up choosing that this is better, but it doesn't feel as imposed.
Guy Kawasaki:
Yeah. Taylor Swift could say, "Okay, I'm going to have a concert at this hundred thousand seat stadium and you have to prove that you're vaccinated to get in."
Katy Milkman:
Exactly, right. Once it's the ticket to the things that we value, I think a lot of people make the decision that will make us all healthier and better off. I suspect that there may be ways to get to herd immunity or nearly a hundred percent vaccination rate that don't require mandates across the board and we may end up there.
Guy Kawasaki:
May I remind you of what I consider a brilliant Cialdini-esque idea that I think you came up with, which is to call people up and say, "There's a vial with your name on it.”?
Katy Milkman:
Actually, I cannot accept credit for that. It's something I am working on, but it is actually due to two other brilliant scientists, Gretchen Chapman at Carnegie Mellon University and Alison Buttenheim at the University of Pennsylvania are part of a big study we are running, literally right now. We're running it both with Wal-Mart and also with Penn Medicine and Geisinger Health, two large local health systems, to test different messages we can send that will encourage people to get a flu vaccine, and we're thinking of that as sort of a proxy, things that work to nudge flu vaccination are likely to work to nudge COVID-19 vaccination.
One of my favorite ideas, it was a tournament that we ran. We're testing dozens of ideas. One of my favorite ideas was just pointing to a flu vaccine and saying, "Hey, this has your name on it." We send people a text message with a picture of a vial and say, "This is literally yours. It is set aside for you. Come and get it at your upcoming doctor's appointment. Be sure to ask for it when you're there. We've got this reserved for you." So I think that's brilliant too. It's like having an appointment.
Gretchen did the work on the power of scheduling an appointment for you. This is taking it to another level, “Hey, you have your appointment, but also literally the vial with your name on it is set aside for you.” So we will test and see if that works and we should have data back actually from those trials in a couple of weeks, which is really exciting because we hope it'll inform the messaging that's used around COVID-19 vaccinations.
Guy Kawasaki:
Prior to all of us getting vaccinated, or eighty-five percent of us getting vaccinated twice, we still have to social distance, wash our hands and wear masks. What do you think if there was pressure on social media people or social media members that everybody changed your avatar to an avatar where you are wearing a mask? Do you think that would have a positive impact?
Katy Milkman:
That's interesting. Some of my friends have changed their profile pictures to do just that. I do think visible signs of support are one way we can convey again, the norm, everyone's doing it. I don't know that everyone physically wearing a mask on social media is the thing that's most critical or is going to be most visible.
I think, honestly, it's more important that when we're out walking around, we're all wearing it so everyone sees this as happening, that if we post photos outside, that's the norm rather than necessarily the avatar being the symbol. But I do think that this is the same point as vaccination.
Social norms, as Bob Cialdini has proven, are a powerful motivator. They shape our decisions in ways that we can't even fully appreciate, and particularly by the way, there's some really interesting work he's been involved in showing not only if I see most people are doing it, but if I see an upward trend, that's an even more powerful way to convey, "Hey, not only is this the norm, but it is growing more and more common."
Guy Kawasaki:
I'm Guy Kawasaki and this is Remarkable People. I hope you found this special episode enlightening, inspiring and above all, actionable. If you know people who can use this information, please ask them to give it a listen. It's literally a matter of life or death.
My thanks to the nine remarkable people who participated. They gave unselfishly of their time and expertise. My thanks to Peg Fitzpatrick and Jeff Seih, who helped me take many moving parts and put them all together. Everyone, that is all eleven people, did this during the holiday season. My thanks also to the people at reMarkable Tablet. ReMarkable Tablet is a sponsor of the Remarkable People podcast.
If you need a tool that does one thing very well, take notes, get a reMarkable Tablet. I use it for almost every episode of the Remarkable People podcast. The great news is that vaccines are here and more are coming, but they will do limited good if we don't take them. It looks like the end is in sight, but we must continue the good fight. Remember to social distance, wash your hands and wear a mask. After all, it's one big ohana and we are all in this together.

This is Remarkable People.