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Penn Nursing Professor Offers Congressional Testimony on COVID Vaccine Hesitancy

Testifying before the U.S. House Committee on Science, Space and Technology about the grim challenge of COVID vaccine hesitancy, Penn Nursing’s Alison Buttenheim, PhD, MBA, the Patricia Bleznak Silverstein and Howard A. Silverstein Term Endowed Professorship in Global Women’s Health, called on Committee members to recognize and exploit the power of “fun and delight” in public service ad campaigns designed to change hesitators’ vaccine perceptions.

Quoting Cass Sunstein, Harvard Professor and author of Nudge, a landmark book on behavioral science, Buttenheim cited “a deep human need to smile and laugh,” and said “we can leverage that need through evidence-based messaging that exceeds people’s expectations about getting vaccinated.” As an example, she pointed to the recently released “Sleeves Up, NOLA” New Orleans public service TV ad campaign using local personalities, Carnival dance culture, and joyous humor to promote vaccination.

Five-part strategy
The seemingly lighthearted “fun and delight” point was part of her deadly serious emphasis on the need for sustained and effective national public messaging as part of a larger five-part strategy to break through the public’s misconceptions, fears and hesitancy about COVID inoculations.

Buttenheim, is a Penn Nursing Associate Professor, Senior Fellow at the Leonard Davis Institute of Health Economics (LDI), and Scientific Director at the Center for Health Incentives and Behavioral Economics (CHIBE). She is a behavioral scientist who studies vaccine acceptance and hesitancy. Last July, she was appointed to the National Academies of Science, Engineering, and Medicine’s new Committee on Equitable Allocation of Vaccine for the Novel Coronavirus that produced the 273-page Framework document of the same name.

She is also co-author of “Strategies for Building Confidence in the COVID-19 Vaccines,” a February 2021 rapid expert consultation report produced through National Academies’ Societal Experts Action Network (SEAN), sponsored by the National Science Foundation. Much of her Congressional testimony was informed by this scientific initiative’s insights.

One of four experts
Buttenheim was one of four experts called before the February 19 House Science Committee virtual hearing entitled “The Science of COVID-19 Vaccines and Encouraging Vaccine Uptake.” The three other witnesses were Kathleen Neuzil, MD, MPH, Director of the Center for Vaccine Development at the University of Maryland School of Medicine; Philip Huang, MD, MPH, Director of the Dallas County Department of Health and Human Services; and Keith Reed, MPH, CPH, Deputy Commissioner of the Oklahoma State Department of Health.

The Committee members acknowledged that vaccine hesitancy was “not so much about virology as it is about psychology” in a country where tens of millions of people decline to be inoculated against COVID for reasons ranging from an unfounded fear of autism, bizarre conspiracy theories, an overarching mistrust of the medical system, or concerns about the fundamental safety of a vaccine developed and tested in such a brief period of time.

The urgency of the situation was underscored by Committee members’ sense of shock that such large numbers of health care workers themselves are declining to be vaccinated against the deadly disease that directly threatens them daily.

‘Last mile challenge’
In her main presentation, Buttenheim detailed the five most important science-based solutions she urged Congress to endorse, fund, and promote as the country “tackles the last-mile challenge of getting shots into arms:”

  1. “Embrace the dual goal of vaccinating efficiently and equitably. This recently has been framed as sort of a false choice or an either/or with people saying that we can either be fast or be fair with vaccine rollout. We have the science to do both, but we have to be deliberate, intentional, and innovative in our approach to both tracking and achieving those complementary goals.”
  2. “Fix the easy stuff. Hassle factors can be a major barrier to vaccination. Even people who are motivated and excited about the vaccine can be deterred by the smallest amount of friction in the system. Whether that’s complex logistics, inconvenience or confusing instructions, making and keeping a vaccination appointment should be easy and hassle free. And frankly, fixing those hassle factors is often easier than changing someone’s mind.”
  3. “Keep doing the hard stuff even if it doesn’t scale. There are many people with very legitimate concerns about the speed of vaccine development, diversity of trial participants, or trust in the medical research establishment. What’s emerging as the most effective way to help those folks is sustained, repeated one-on-one conversations with trusted peers or vaccine validators. Now, you can’t bake that kind of engagement in a chat bot or a website FAQ or a message on the side of a bus or even a Tik Tok video. We have to stand up and support those time-intensive interventions and get them to the people who need them, even if they don’t scale.”
  4. Use fun and delight. “The “Sleeves Up, NOLA” public service announcement is a truly fantastic example of the idea of leveraging fun and delight in an effective messaging campaign.”
  5. “Fail fast, learn fast. Behavioral science advances in much the same way lab science does. We generate hypotheses about an effective intervention and then test those hypotheses via experiments. We need to bring the same speed and rigor to vaccine acceptance research that we brought to vaccine development research so we can get it right in real time and also learn for next time.”

This is an excerpt of an article that was first posted on the LDI web site. It was written by Hoag Levins. Please click here to read the full version.