Did rationing priorities induce vaccine hesitancy?

A story of messaging and first impressions.

Back in early February, Dr. Scott Gottlieb — a former FDA Commissioner — offered an observation that stuck in my mind.

In a WSJ op-ed, Gottlieb wrote:

One reason for the hesitancy may be that it was necessary to ration scarce doses at the start, causing many Americans to internalize the idea that some people may be more likely to benefit or more deserving than others.

Let’s unpack Gottlieb’s observation…

Initially, scarce vaccine supplies were aimed at the elderly in  long-term-care facilities (where the vast majority of covid deaths were accumulating) … and to covid-patient-facing healthcare professionals (especially those in direct contact with confirmed covid patients).

Made sense: Protect the most vulnerable and the most exposed.


But, what about people further down the priority pyramid?

For example, youngsters were initially told (by no less than chief political-scientist, Dr. Fauci) their covid risk was miniscule, so they should go to the end of the line.

English translation: Party on!

Now, people scratch their heads wondering why twenty-somethings are ambivalent about the vaccine.


Early on, vulnerable old-timers (like me) were getting bumped by an expanding list of mostly unionized “essential employees”.

The vast majority of these government-coined “essentials” were under 60 (i.e. low consequential covid vulnerability).

And, after the frontline healthcare workers, many of them were of questionable essentiality (e.g. virtual teachers who had made no near-term commitment to in person teaching).

See What do lawyers, prisoners and ‘the media” have in common?

The message to the rest: You’re not essential (and really not that vulnerable) so so don’t clog the system.

The new message: The fate of the nation depends on you getting vaccinated.

The predictable reaction: Why wasn’t I important before?


More generally, people down the pyramid were  getting pounded with a clear message:

You’re not at risk … and, by the way, you’re not essential … so, there’s no pressing need to get you vaccinated.

Now, it’s their turn, and these people aren’t rushing the gates to their shots.


A couple of takeaways…

> First impressions “anchor” peoples perceptions … “adjusting” those perceptions is always a challenge … especially if they’ve been given time to harden.

> Solidifying perceptions requires strong, clear, consistent messaging … don’t signal people one thing on one day and another thing on another day.

> None of should be surprising… it’s straightforward behavioral economics.

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