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Image: Tina Tiller
Image: Tina Tiller

PoliticsSeptember 20, 2021

If we want to reach 90% vaccination, we need to change up our strategy

Image: Tina Tiller
Image: Tina Tiller

Stuart Nash has staked a case of wine on 90% of New Zealanders being vaccinated by the end of the year. Communications specialist Samson Samasoni explains why the minister won’t be winning this bet any time soon. 

In July 1988, Andy Mochan was shaken awake by explosions and alarms on an oil-drilling platform in the North Sea, off the coast of Scotland.

Mochan, a supervisor, rushed from his quarters to find the platform ablaze, the structure melting in the inferno. He had moments to make a critical decision: face certain death by staying on board or possible death by leaping 15 storeys into the icy waters. In his own words, it was either jump or fry.

The Piper Alpha tragedy killed 167 people, including those who waited to be rescued. Mochan survived, along with 60 others. The disaster led to major health and safety reforms, altered the way insurers manage risk and gave change managers a metaphor for effecting swift change. The burning platform – a device our government has used to good effect during the Covid pandemic response.

Any change process, whether gradual or hastened, must instil confidence and certainty that the end gain will justify any short-term pain. A burning platform helps build urgency and an understanding of the penalty for not getting with the programme – jump or fry.

With each Covid outbreak and lockdown, the go hard, go early mantra has driven restrictions on our freedoms usually reserved for wartime or natural disasters. We’ve complied. The current lockdown was supported by four out of five of us, but future endorsement of constraints on our liberties is starting to fray.

In contrast, the vaccination programme has been measured – some unkindly say the approach has been go slow, go late. The downside of an unrushed process, unless extremely well executed, is that it allows time for doubt to be sown and hesitancy to seed. Every border breach, vaccination mishap and administrative misstep is amplified to cast doubt over the entire enterprise.

The delta outbreak is the vaccination campaign’s burning platform, propelling a surge, with record-breaking results. But its utility will be short-lived; the data shows it’s already peaked. And it’s a lost opportunity for a proposal the government aren’t keen to proffer in any case.

Government minister Stuart Nash has staked a case of Craggy Range wine with opposition MP Mark Mitchell and broadcaster Mike Hosking on 90% of eligible New Zealanders being fully vaccinated – without incentives, other than the fear of dying – by the end of the year.

The prime minister is more ambitious. To avoid even one preventable death, she implores everyone eligible to get vaccinated, but unlike Nash, doesn’t nominate a deadline. When culturally more compliant societies than ours are failing to achieve 100% vaccination, it’s hard to fathom how her plea will be realised.

At the time of writing, we appear on track to reach  78% – 37% are fully vaccinated, 35% ready for their second dose and 6% have made appointments. With more than three months to go, there’s a fighting chance Nash will prevail.

But change communications theory, lessons from overseas and, quite frankly, logic suggest that without incentives and penalties we’ll struggle to reach even 80% by Christmas. And Nash won’t be imbibing any wine winnings for his New Year’s celebration.

Vaccine supply and health infrastructure aside, the obstacles will be the digitally excluded and under-informed, the capricious 18-30 age group, those who won’t follow through on their second dose, the Māori population, and the really hard to convince.

When there’s no research to inform a change process, communicators often start with the hypothesis that 20% of the target group will willingly adopt the desired behaviour. At the other end of the spectrum, 20% will be highly resistant and half of that (10%) will be vehemently opposed.

So, the initial task is motivating the 60% in the middle – who need varying degrees of information, persuasion, or incentives – towards the compliant end. The resistant 20% may need penalties and enforcement.

When research becomes available it’s about validating and fine-tuning that initial proposition, understanding the attitudinal or physical barriers to achieving the target, and audience segmentation.

The Ministry of Health diligently publishes monthly vaccine research insights. The latest from July (pre-delta) says 79% of us are likely to get vaccinated (up from 67% in March), 14% are unlikely and 7% unsure.

Where the ministry data potentially falls short is in understanding the hard to reach, and possibly least informed, because the research is conducted entirely online.

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In March, Victoria University’s chair in digital government reported that although government agencies were heavily reliant on digital channels during the earlier major Covid outbreaks, officials were conscious that 20% of the population don’t or can’t engage via digital channels.

It’s estimated up to 30% of Pasifika and 25% of Māori are living in the digital divide. Seniors, the disabled and other ethnic minorities also feature highly as digitally excluded and will require resource-intensive support to conform.

Lack of digital access won’t be an excuse for many of the 18 to 30 age group. But they will be challenging for the same reasons they have low turnout rates for elections, plus their youthful sense of invincibility. Creative solutions that fit their lifestyle, their emotional drivers and channels of communication will be key.

Encouraging group bookings so they can vaccinate with friends, use of drive-ins, creating a vibe at centres so they’re less clinical, using texts or messaging to communicate rather than email, could be useful tactics. Maybe even rigging up a mock parliamentary press conference media wall, with a life-size cardboard cut-out of Dr Ashley Bloomfield, so they can pretend to run a presser during the after-jab rest period. The photos they share on their social platforms will resonate far more than any advertising. The point is, it’s time to get creative.

And then there’s the inconvenient need to get them back for their second jab.

Health ministry research indicates 99% of New Zealanders who get one dose will get their second. But overseas experience suggests about 8% will not follow through because they’re too busy, had a poor experience getting the first dose, feel it’s not needed, had a reaction the first time, or can’t be bothered.

Targeted advertising and promotions to encourage second doses must start now. The whole publicity campaign needs to pivot. We’re beyond the “call to unite” and “join the journey” messaging. We need to directly tackle the key reasons given for being hesitant, including the persistent “fear of unknown or long-term side effects” and who to trust.

For myriad reasons, the Māori community currently have the lowest vaccination levels of any ethnic grouping. The government is providing more resources. One of the challenges will be effectively engaging with younger audiences, given their youthful age profile – the median age for Māori is 25, compared to Pākehā at 41.

For Pasifika, the median age is 23 but we’re highly concentrated in only a few parts of the country, so the issues are very different.

Then there’s the really hard to convince. In a recent Toronto study, an unvaccinated group were asked what would motivate them, and about one-third said if it was required for travel, mandated for work or a $100 cash sweetener would do the trick. However, 14% are vaccine hesitant – 8% unsure and 6% definitely won’t. Canada kicked off its programme in December. Nine months later, 75% have had their first dose.

Our July research is not helpful on the hard to persuade because it predates the delta outbreak. Alarmingly, the 21% of our population aged 16 and older who are unlikely or unsure about getting vaccinated equates to 848,100 New Zealanders. The data suggests that those “unlikely” are more likely to be female, have no formal school qualification, in a household with children, and live in a rural area.

Looking at countries that have achieved 90% vaccination would be instructive for Stuart Nash. But there are none, even though many started their vaccination campaigns much earlier than us.

The United Arab Emirates has achieved over 90% for the first dose. Portugal, Qatar, Spain, Singapore and Denmark and are not far behind.

Having lived and spent time in Qatar and the UAE, it’s no surprise that their compliant communities are leading. Qatar has another driver in the Fifa World Cup it’s hosting late 2022. Significant national and social investment has been made into planning a superior event, where the unvaccinated won’t be welcome.

Aotearoa doesn’t have an international occasion to galvanise us. And our government has preferred not to articulate what change managers call a “future state” to keep us on course towards a shared vision. They’ve opted instead for a road map.

The government says the road map needs a reset because delta is a game-changer. Others say we need better touch points for the whole journey. Change managers would argue that part of the game plan is forecasting and modelling for every potential scenario and risk; the “reset” should already be known.

Spain, which recently came to our rescue with five days’ worth of vaccine doses, has fully vaccinated 76% of its population. Perhaps it’s because the 1918 Spanish flu pandemic is unreasonably named after them – there are two main origin theories, but neither begins in Spain – that Spaniards have high trust in their health system and consequently high confidence in vaccines.

Studies suggest we’re generally satisfied and have confidence in our health system, even if one third report having unmet health needs. However, the preschool immunisation programme may offer some helpful insights.

At 4½ years of age, the average rate of immunisations across all ethnic groups is 72% but jumps to 86% when children reach five. This is when parents are required to supply vaccination certificates for primary school, whether their children are immunised or not. The combination of custodial oversight and some official impetus to drive behaviour is compelling.

As the country cascades to levels two and one, the urgency created by the delta variant will wane. The South Island is getting frustrated, more people are testing the limits of what they can get away with at higher lockdown levels and the business community has had a gutsful.

If we’re serious about achieving the 90% target, incentives and penalties can’t be avoided.

Some Australian states now require vaccination passports to enter pubs and major events. We should do the same and include churches, gyms, sports clubs, and any venue where groups gather.

The US has mandated all federal workers be vaccinated. Businesses with more than 100 workers must vaccinate or be tested weekly. We should do the same with public servants, tertiary students, large workplaces, even beneficiaries and pensioners. Students aged 12 and over should be required to file their vaccination passports with their schools.

The government should have used the delta outbreak to warn us that a more restrictive vaccination regime could be on the cards if we don’t get rates to a certain level by a certain time. But we know that’s not how they roll.

In the meantime, we’ll need to employ resource-intensive tactics and creative solutions to mobilise the remaining groups. Public health communicators may need to borrow more from the creativity of Burning Man than rely on the urgency of another burning platform, if Nash (and the country) are to end 2021 on a winning note.

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