Persuading the vaccine-reluctant: Meet people where they are

One year after vaccines to combat COVID-19 began to be administered in America, there is both good and bad news to report. The good news is that, according to Our World in Data, 201 million Americans have been fully vaccinated against the disease. The bad news is that this represents only 60.9 percent of the population, the lowest vaccination rate among the world’s wealthiest democracies.  

The seemingly irreducible percentage of vaccine-skeptical Americans has frustrated the Biden administration, prompting President Biden to issue vaccine mandates for federal workers and private employers with more than 100 employees. Although I believe that the president should have the authority during a pandemic to issue such an order, it is unclear under current law that the order will be upheld, and there is no question that the short-term effect has been to stiffen resistance to the vaccine.

While the courts deliberate the legality of the president’s vaccine mandate, it’s worth taking a deeper look at the sources of vaccine hesitancy and reconsidering whether we have reached the limits of persuasion. Walmart, for example, which operates in many areas of the country in which vaccine hesitancy is common, has mounted an intensely local effort at persuasion, meeting the vaccine hesitant on their own terms.  

In Jackson, Miss., Walmart worked closely with the Jackson County Housing Authority to provide on-site vaccination for low-income seniors. Volunteers went door-to-door with iPads to facilitate appointments. In Nevada, Walmart partnered with La Casa del Inmigrante, a trusted local nonprofit, to establish an accessible offsite vaccination center to reach the region’s underserved Hispanic population.  

In Montgomery, Ala., Walmart partnered with nonprofit Humana, which “made proactive outbound telephone calls to schedule vaccination appointments for members at high risk in the underserved communities, prioritizing those communities with the highest Social Vulnerability Index. Humana and Walmart took steps to support these vulnerable members.”   

As Aaron Bernstein, senior director of analytics for Walmart, has explained, Walmart’s strategy has been “to reach underserved and rural communities by partnering with community leaders, elected officials, faith-based leaders, nonprofits and community organizations.” The goal is to “meet people where they are” and “engage in more productive dialogue,” in order to persuade the vaccine-reluctant population.   

Walmart’s effort to “meet people where they are” has entailed different approaches in different counties; the common thread has been to partner with trusted local leaders who support vaccination in order to allay the concerns of people who are reluctant to be vaccinated. The approach recognizes that the sources of reluctance might be different in, say, the African American community than in the evangelical community. Those sources must be identified and addressed in partnership with trusted local voices.    

It seems to be working. Walmart shared its vaccine distribution data with the Network Contagion Research Institute (NCRI) in Princeton, N.J. Researchers correlated that data with Centers for Disease Control and Prevention (CDC), social media and Google search data, and developed a “large-scale climate model of vaccine reluctance with specific underlying indicators down to the county level, which revealed factors that quantitatively forecast reluctance to COVID vaccinations on the county level.” These included factors ranging from searches on Google indicating concerns about side effects, to partisan voter profiles, to relative wealth, to ethnic composition, to percentage of health-challenged individuals, to tweets about COVID-related conspiracies.   

This predictive map can be a useful tool for public health officials and the private sector in identifying not just vaccine reluctance but its potential sources in individual counties. Once those potential sources are identified, messaging that targets concerns can be developed with the appropriate local influencers.

As researchers analyzed the data, they came across a fascinating anomaly: The very communities that were generally reluctant for vaccines showed stronger vaccination rates for doses administered by Walmart, an indication that Walmart’s community-based outreach efforts were bearing fruit. “An unexpected key finding in the research,” according to the NCRI, “is that Walmart appears to be over-performing with communities that are high in vaccine reluctance. The research demonstrated that the presence of hard-to-reach communities such as African Americans and [Donald] Trump voters was a significant predictor of success for Walmart’s vaccine distribution compared to general distribution. These findings follow on programmatic outreach by Walmart to target hard to reach communities.”   

There is nothing new to Walmart’s approach, which has been favored by prominent groups such as NOCOVID. But now there is empirical validation that progress can be made when the hard work of persuasion is undertaken in earnest by people and organizations willing to “meet people where they are.” That strategy should be adopted in public-private partnerships throughout the country, particularly as the new omicron variant of the coronavirus spreads.    

Persuasion is never easy, particularly in an information environment in which sowing distrust in American institutions motivates extremists of the right and the left and authoritarian adversaries.  But these data demonstrate that open and candid discussions that meet people where they are will never be a waste of time.  

John Farmer Jr. is director of the Eagleton Institute of Politics at Rutgers University. He is a former assistant U.S. attorney, counsel to the governor of New Jersey, New Jersey attorney general, senior counsel to the 9/11 Commission, dean of Rutgers Law School, and executive vice president and general counsel of Rutgers University.