The vaccines against SARS-CoV-2, the organism that causes COVID-19, are a slam-dunk, whether in terms of their economic impact, a humanistic perspective, or an observed reduction in morbidity and mortality. And the United States as a whole is doing reasonably well in getting people vaccinated (although Sedgwick County is a little behind the national average). As of the writing of this blog post, more than half of US adults have received full vaccination, and a large additional fraction has received at least partial vaccination. And while I’m not particularly interested in the pursuit of a theoretical threshold like “herd immunity,” most everyone agrees that the more people we can get vaccinated before this fall, the better. After all, the virus is still spreading among the unvaccinated population as quickly as it was at its peak.

Some universities are mandating vaccination. I can understand why. But my instincts always trend more toward influencing decisions rather than mandating behaviors. So it was helpful (and, I’ll admit, a little discouraging) to see that the Equal Employment Opportunity Commission (EEOC) recently ruled on using incentives to get employees vaccinated. In short, and to steal from our frequent collaborator Al Lewis:

“If employers set up a system in which they administer the vaccine themselves on a voluntary basis, businesses can also offer employees incentives — be they perks or penalties — so long as they are “not so substantial as to be coercive.”

If the process of setting up vaccine distribution yourself sounds tricky, you’re right. The new mRNA-based vaccines, in particular, while scientific marvels, are pretty delicate and require special handling. So we anticipate most of our members will utilize more traditional routes to vaccination, like clinics and health departments. How can we get our employees to take that leap?

In thinking out loud about this question, I’m cross-tabulating two sources. Source one is the new edition of Influence by Robert Cialdini, a seminal text in the science of persuasion. Source two is a summary by German Lopez, based mainly on Kaiser Family Foundation survey data, on the six overarching reasons some Americans are slow to be vaccinated: lack of access, lack of fear of COVID-19, fear of side effects, lack of trust in vaccines, lack of confidence in institutions, and conspiracy theories.

Let’s discuss how Cialdini’s Seven Keys to Influence might address those six big reasons for slow vaccination and how we can apply them to get more people immunized:

1. Reciprocity. Pharmaceutical representatives don’t give out medication samples, tchotchkes, and meals to doctors’ offices out of charity or even advertising. They do it to cause a feeling of indebtedness on the part of the clinical staff. Doctors who receive these gifts are far more likely to prescribe medications represented by salespeople than are doctors who don’t receive the gifts. The same goes for people who’ve received free address labels from a charity. We can copy this strategy in our employee populations by pointing out the generosity of our leave policies around COVID-19 infections or exposures. The company is doing this for you. All we ask in return is that you do your part by reducing everyone’s risk by getting vaccinated. And we’ll even help give you time off and help you get to the vaccination distribution center!

2. Commitment. When a company asks you to sign up for their newsletter, “club,” or punchcard, they’re trying to get a commitment from you, however small it may be. Consider asking your employees to sign up for a newsletter from your wellness department or vendor, and make sure vaccines are mentioned in nearly every edition.

3. Social proof. Colleges and universities once tried to discourage binge drinking by pointing out how many students were injured or killed by binge drinking behavior. It didn’t work. When those same colleges and universities pivoted to a strategy of showing how many students did not binge drink, they saw results. People do what they see others doing. So once you have an idea that a big chunk of your employees has already been vaccinated, point this out in a campaign and emphasize how proud the company is of its employees’ contribution to safety. Even an employee who doesn’t particularly fear infection may want to be part of a positive culture.

4. Authority. People trust authority figures. In the vaccine world, people trust their personal physicians most of all. So if you feel your vaccine push is falling short, encourage employees to see their doctor to talk about the minimal risks and potentially huge benefits of vaccination.

5. Liking. People prefer to be seen positively by their peers. This desire can often override other emotions or beliefs like a lack of trust. If we can make vaccination the norm in our workplace and point out the positive effect of people who’ve received the vaccine, a certain number of people will experience a change of heart.

6. Scarcity. When Amazon alerts you, “Only two remaining in stock,” they’re taking advantage of our attraction to scarce resources. Gold and platinum would not be expensive and desired if you could dig them out of your backyard with a shovel. So this summer, as we anticipate another rise in COVID-19 cases in the fall, we should point out the scarcity of time to take advantage of vaccination. Only three months left!

7. Unity. This principle takes advantage of our natural tribal instinct toward “Us versus Them.” When the anti-smoking Truth Initiative debuted, it used this exact trick by casting Big Tobacco as an opponent to be defeated by a unified, righteous group of young nonsmokers. The effect on the youth smoking rate, pre-vaping, was astonishing. By one estimate, it prevented 300,000 kids per year from smoking. The Truth Initiative essentially turned the Big Tobacco companies into conspirators and encouraged kids to rebel. And it worked.

Our goal shouldn’t be to trick anyone into doing something they don’t want to do. But in working to get the largest possible fraction of the population vaccinated, we should use the best, most scientifically sound arguments and strategies we can.

As the Medical Director of the Kansas Business Group on Health, I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.