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You can’t just blow the bloody doors off: why the NHS vaccine ad misses the mark

Can Michael Caine and Elton John encourage Covid-19 vaccine uptake? Tom Laranjo, managing director at behavioral planning agency Total Media says no. For him, the most recent star-studded public health campaign misses the mark when it comes to addressing the concerns of the Black, Asian, minority ethnic (BAME) community. It also fails to acknowledge the highly complex and individual issues many vaccine hesitant have.

Last week, Sir Elton John and Michael Caine joined forces in an ad to promote vaccination uptake in the kind of celebrity mash-up that only a worthwhile cause could inspire.

Sadly, it seems unlikely to achieve its stated objective of encouraging greater vaccination uptake among the highest-priority groups.

Global healthcare expert, Professor Lord Darzi has praised the video for showing how quick and easy it is to get vaccinated, but are speed and ease really the only barriers to people not taking the jab when offered?

As Nadhim Zahawi said on Sky News, overall Covid-19 vaccination acceptance is currently very high, with 85% of those offered taking up the jab. So, it appears the vast majority of people find it easy enough.

Cultural reflections

The challenge in low vaccination rates comes from two, sometimes overlapping, areas: diverse communities and the vaccine-hesitant.

A recent study by the Royal College of General Practitioners (RCGP) revealed that people of Black ethnicity were 50% less likely than people of white ethnicity to get vaccinated, and people of Asian ethnicity were just 33% as likely as their white counterparts to accept vaccination. A further study showed that even amongst NHS staff these discrepancies hold true.

So, if vaccination uptake in the UK is predominantly a challenge among the vaccine-hesitant, diverse communities then why won’t Elton John and Michael Caine be able to work their magic?

One issue lies in the fact that as older, white men, Elton and Caine are not representative of diverse communities, and evidence from behavioural science shows that we are all more likely to listen and respond to people who reflect our own culture.

The Hertfordshire Behaviour Change Unit report finds that residents are more likely to have the Covid-19 vaccination if they see examples of other people in their community having the vaccination – particularly key members.

But there's a misinformation gap to address too. Greater reluctance among people from ethnic minority communities has been ascribed to various factors including poorer engagement with the health service historically, lack of trust, and exploitation of religious concerns through claims the vaccine contains pork or alcohol, is not halal or alters DNA.

Tonight, broadcasters, including Channel 4 and Sky, will unite in a message to the BAME community to debunk these falsehoods.

The video – which also features actors Sanjeev Bhaskar, Asim Chaudhry and Nina Wadia, presenter Konnie Huq, the mayor of London, Sadiq Khan, and the former Tory party chair Sayeeda Warsi – will reach 10 million people, and could go some way to solving this challenge.

Not every problem requires a hammer

A further issue when addressing vaccine-hesitant people across the board, is that those reluctant to take the jab often have personal, specific and understandable concerns that cannot be addressed in a broad ad campaign. They require more patient and personalised solutions.

One such solution is motivational interviewing (MI) - a process where physicians identify and address personal issues around vaccination – which has shown real promise in early studies on vaccination uptake for new-born babies.

This sort of technique is not a broadcast solution to the problem, but as Abraham Maslow said “it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”

In supporting the drive for vaccination uptake amongst all communities the government cannot overly rely on big, set-piece messages, but must deploy a variety of tactics.

Closing the intention-action gap

As the roll-out of the vaccine expands beyond the current tiers, the challenges are likely to magnify to match.

The government will not only have to persuade people who are hesitant, but will also have to encourage people who say they will take the vaccine - but fail to follow-through.

This is a potentially substantive problem because, as Professor Kathy Milkman says, “anywhere from a third to two-thirds of people who say they’ll do something, such as get a medical check-up or exercise, fail to act on their intention”.

Closing this intention-action gap is something that the ad campaign, with its message of ease and speed, can help to close.

However, other tactics need to be utilised alongside it to nudge people to completion. These include on-the-day text messaging, clear messaging around local uptake and even - as is being tested by Professor Katy Milkman - indicating that 'your vaccine is reserved and waiting for you' - suggesting it will be wasted if you are a no-show.

If the government objective from this campaign is to encourage 'everyone in the high priority groups' to take up the vaccine, then the campaign misses the mark as it neither appeals to the communities where uptake is at its lowest nor does it address the highly complex and individual issues many vaccine-hesitant have.

As sincere and heartfelt as this campaign undoubtedly is, its failing is in addressing the wrong issue, to the wrong audience, with the wrong message.

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