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Vaccine insights

After PM gets 1st COVID shot, a psychologist’s 10 tips to get nation to follow

Unlike US, Israel has no strong anti-vax movement, so the right campaign will go far in winning hearts and minds, says Prof Golan Shahar, an expert on vaccinations and human psyche

Nathan Jeffay

Nathan Jeffay is The Times of Israel's health and science correspondent

Prime Minister Benjamin Netanyahu smiles before receiving a coronavirus vaccine at Sheba Medical Center in Ramat Gan from his personal physician, Dr. Tzvi Berkovitz. Netanyahu, 71, followed by Health Minister Yuli Edelstein, became the first Israelis to get the vaccine. (AMIR COHEN / POOL / AFP)
Prime Minister Benjamin Netanyahu smiles before receiving a coronavirus vaccine at Sheba Medical Center in Ramat Gan from his personal physician, Dr. Tzvi Berkovitz. Netanyahu, 71, followed by Health Minister Yuli Edelstein, became the first Israelis to get the vaccine. (AMIR COHEN / POOL / AFP)

Prime Minister Benjamin Netanyahu received Israel’s first COVID-19 shot on Saturday night, kicking off the country’s vaccination project and a high-stakes public campaign to convince citizens to take the long-awaited coronavirus protection.

The premier said he wanted to be the first Israeli to roll up his sleeves so as to encourage others to follow his lead. President Reuven Rivlin, who is due to receive his shot Sunday, has cited similar motivation. If there is any truth in recent polls, that encouragement is much needed.

A survey published early last week in the Israel Hayom daily suggested that 37 percent of Israelis wouldn’t take a shot, while only 44% said they planned to get inoculated.

Midweek figures caused even more consternation. A Haifa University poll published Tuesday suggested that less than a fifth of the population were willing to get inoculated immediately, with many preferring to let others take the plunge first and see how it goes.

An Israeli nurse seen during a simulated vaccination against the coronavirus, at Sheba Medical Center in Ramat Gan. (Miriam Alster/Flash90)

But leading psychologist Prof. Golan Shahar is more optimistic. He believes that people get nervous about committing when put on the spot by pollsters, and that once the vaccination process gets going there will be a “snowball” effect that generates confidence.

Shahar, a professor at Ben Gurion University and the author of several studies on vaccination psychology, views the Haifa University poll as particularly problematic and “way too pessimistic.”

Psychologist Prof. Golan Shahar (courtesy of Ben Gurion University)

The survey, he argued, provoked negative responses by creating an intimidating and unrealistic scenario under which people would need to be the nation’s first, without time to get used to the idea.

And he believes that whatever the nation’s view of the vaccine is now, it can be significantly improved by the right campaign. Netanyahu’s very public vaccination was the opening act in the state’s campaign, which will include encouragement by scientists, doctors and celebrities lauding the vaccine and leading by example.

It will involve cross-media advertising and a 10-person task force identifying fake vaccine news. A steering committee for the campaign is being formed and is expected to include representatives from Google and Facebook.

Israel is starting its vaccine campaign in a far better position than the US, Shahar said, as it doesn’t have a strong anti-vax lobby. Nevertheless, he believes the challenge is great, as it involves overpowering an “irrational” trait in many people which makes them worry about a health intervention that will protect them.

“Vaccine hesitancy is actually an illustration of how the human brain and mind doesn’t operate rationally, and getting the right messaging is so important,” he said.

Shahar said the following key points can help bring about higher vaccination rates.

1. A personal example disarms ‘irrational forces’

Prime Minister Benjamin Netanyahu wears a face mask to help prevent the spread of the coronavirus as he chairs the weekly cabinet meeting, at the Foreign Ministry, in Jerusalem, July 5, 2020. (Gali Tibbon/Pool via AP)

Is Netanyahu’s insistence on taking the first shot driven by a hunger for the limelight? Shahar thinks that, in part, it is, but said this doesn’t matter. The main thing is that the premier wanted to lead by personal example, and this is powerful, he believes.

“It’s good leadership,” Shahar said. “Because there are irrational forces against compliance, it’s good to have emotional forces promoting compliance, and personal example is one of these.” He said now that the country has seen the prime minister get vaccinated, it needs to see pictures and videos of public figures from all fields doing the same.

2. A vaccine is like a bomb shelter

Lots of Israelis say they will get vaccinated only when large numbers of other people have gone first. This threatens to delay the vaccination program, but Shahar says it is easy to call people on this mindset by reminding them that in other areas of life they don’t wait to protect themselves until others do the same.

“There’s a human urge to protect our lives that needs to be appealed to,” he said. “When rockets hit Sderot, you don’t see people there saying they’ll let others go into bomb shelters but won’t go themselves. They want protection for themselves.”

A successful campaign will use familiar terms like the language of Israel’s security challenges to highlight the power of a vaccine to protect the health of every person who receives it and their families, Shahar said.

Tel Aviv municipality worker opens the door of a bomb shelter in Tel Aviv on March 25, 2019. (Roy Alima/Flash90)

3. Ignore the anti-vax lobby

“Israel isn’t like America, where the anti-vax movement is strong and where it aligns with a certain political outlook,” observed Shahar, adding that in his research into Israeli polio protection drives, anti-vaxxer claims had hardly any impact on general public willingness to vaccinate.

Therefore, he thinks that while there is a temptation to counter the claims of vaccine opponents, this would only give oxygen to an issue that, in Israel, is a fringe phenomenon. The anti-vax movement shouldn’t be referenced in any vaccination campaign, he said.

4. Find each community’s sweet spot, and deploy its leaders

The state needs to prepare its diverse populations for vaccination differently, Shahar believes. For example, it must deploy influential rabbis to encourage the ultra-Orthodox community to vaccinate. The fact that parts of the community have failed to heed coronavirus regulations and are reluctant to interrupt prayer and study routines can actually be turned to the advantage of a vaccination drive, he said.

Police officers clash with Haredi men during a protest against the enforcement of coronavirus restrictions in the Jerusalem neighborhood of Mea Shearim, October 4, 2020. (Nati Shohat/Flash90)

“The argument can be that vaccination will prevent the state from needing future measures, like lockdown, which as we have seen can interfere with Torah study,” Shahar said, voicing confidence that rabbis will come on board over the coming weeks, even if initial attempts to sway them aren’t succeeding.

He added that an equivalent argument in Arab communities, where some mass weddings have been held in contravention of rules, is that widespread vaccination will prevent further interruption to such celebrations, which are a central aspect of communal life.

5. Stress that the science is sound

On Wednesday, Albert Bourla, CEO of Pfizer, the company providing Israel’s first vaccines, lit the Hanukkah candles at a virtual ceremony organized by the Israeli embassy in Washington. He spoke of the “determination it took to create the COVID-19 vaccine and how these efforts made the impossible — developing a vaccine so quickly — possible.”

Shahar considers the swift development an achievement of epic proportions, but notes that the speed with which it happened generates some nervousness about its quality, particularly as the messenger RNA technology that Pfizer and some other companies are using, is new. He said leaders need to address this directly.

“A campaign needs to say that the vaccine was not developed irresponsibly, it was developed responsibly, and there were large-scale experiments with safe methodology,” he said.

“It also needs to be stated that messenger RNA vaccines, while new, have been developed based on sound science that was being researched for decades. It’s just that a virus that threatened the global economy pushed them to be concluded quickly. Development was responsible.”

Pfizer CEO Albert Bourla lights the Hanukkah candles at a virtual ceremony organized by the Israeli embassy in Washington, on December 16, 2020. (Screen capture/Israeli Embassy in DC)

6. After ‘erratic’ pandemic decision-making, it’s time to build trust

Shahar’s research on polio prevention drives in Israel found that trust in the Health Ministry was a key factor that determined whether or not people vaccinated.

He said some of the government’s decision-making during the pandemics, including ever-changing COVID restrictions, left the public unsettled and confused.

“As long as Israel drives the public crazy with decisions that are seen as erratic and fluctuating, trust in the ministry, and by extension in mass vaccination, will be eroded,” he commented

7. Caring and driven leadership changes minds, ‘hysterical’ leadership doesn’t

There is a race against time as many people are already deciding their position on the vaccine, and opinions quickly become entrenched. “My research has shown that after [individuals’] early decision making, the agency conducting vaccination — in Israel’s case the Health Ministry — can influence people,” said Shahar. “And the more it is perceived as caring, the more there is compliance with its requests.

“A key finding in my research has been that early decision making [has a significant impact]. So hit hard now, but do it in a way that increases the emotional bond to the Health Ministry, and do it in a way that stirs positive emotions,” he said.

Shahar warned that appeals to the public that are seen as “hysterical” are a turn-off and liable to backfire, adding: “Negative pressure, threats and stirring guilt are usually not effective.”

8. A hybrid of traditional advertising and social media influence

Instagram app icon on the screen of a mobile device in New York. (AP Photo/Jenny Kane)

Shahar believes the campaign needs to span traditional media including radio, television and billboards, in the various different languages used in Israel.

But enthusiasm for vaccines needs to go viral on social media as well. Celebrities and influencers will play a part, but regular Israelis will impact the thinking of their friends and colleagues and need to be galvanized, he said.

9. Remove politics, but deploy politicians

Israel’s crumbling so-called unity government, established to steer the country through the pandemic, has proved to be anything but. New elections are likely, and opposition figures are bitterly criticizing government policy. Avigdor Liberman, leader of the opposition Yisrael Beytenu party, even urged Israelis in September not to comply with the government’s “illegal” health regulations, which he said were purely political and not in citizens’ best interest.

Yisrael Beytenu leader MK Avigdor Liberman, on September 6, 2020. (Sraya Diamant/FLASH90)

Shahar says there is no room for such political arguments as the country prepares to vaccinate. The nation’s ability to immunize depends, in large part, on the ability of politicians to put aside their differences and unite around the importance of taking shots, he said.

“Liberman needs to get his act together, and like all other politicians, signal unity of message and responsible behavior, and when people see this, they’ll follow suit,” Shahar said.

10. No sitting on the fence

To many, failing to take the vaccine seems like an easier option than committing to it. They won’t think of it as taking an anti-vaccine stance, but simply as failing to respond to invitations to take a shot.

But Shahar thinks the state needs to challenge this mindset to a point where there’s no middle ground on vaccination — one is either for or against.

Shahar thinks the state needs to stress that while everybody has the right to decline the offer of a vaccine, opting out is an active decision with ramifications for their health and the health of others.

“The message should be that if you don’t want to vaccinate that’s fine, but that’s a specific decision you’re making, and it could have ramifications,” he said.

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