Viewing Vaccination as a Change Management Challenge

Sensemaking, a useful view at the anti-vax individuals

Anti Vax as a Change Management Problem

Steven Schatz
Learn | Change Consultants
www.PowerStart.com
Schatz@powerstart.com

Vaccination rates have fallen precipitously. A significant percentage of the population has not and seemingly will not respond to efforts to encourage vaccination. It is useful to look at this situation as a particularly difficult change management issue.

If current efforts are not working to change people’s minds about vaccination, why? What methods might work?

I find guidance in the writing of Karl Weick, who studies how people in organizations behave. He talks about Sensemaking. To approach this anti-vax issue in terms of sensemaking, an underlying belief is that people are behaving rationally based on how they view the world. Their approach may seem wrong, ludicrous, or irrational to others, but to those who are either anit-vax or hesitant, they are behaving rationally within their view of the world.

If we want to create change (no matter what the situation), we must understand the sense those resistant to change are making of the world. This is key. I believe there are two very important distinctions between the vaxers and the anti-vaxers.

1. The first distinction is how they gather and share information and what they look at as proof. Weick distinguishes between argumentative vs narrative approaches. Someone who thinks argumentatively makes a series of points, often backed by data. A narrative thinker communicates concepts through storytelling. To illustrate this let me tell a story (note the power of storytelling to communicate an idea). Xerox copiers are very complex. When something goes wrong that defies a simple fix, an argumentative thinker would turn to the manual. In a study of Xerox repairmen, a researcher named Orr found that when one hit a problem they couldn’t fix, they would talk to other repairmen, who would tell stories of similar issues they had run into and what they had tried and what worked.

They communicated their most important, trusted information, not through the manual, which presented data, step-by-step procedures, and “arguments”. Instead, they told stories, which included feelings and sensory data (there was a burning smell…there was a click before the paper wrinkled).

This method of seeking proof is clearly different between the two camps. Through personal recountings and social media, anti-vaxers trade stories. Stories include those who had bad reactions to vaccines, plots to use vaccines for unsavory purposes, stories of those who had minor cases of the disease (including the former President) and recovered, origin of the disease questions, stories to cast doubt upon those creating, making, distributing, and profiting from vaccines. These stories are much more compelling than a chart or graph. An action/adventure movie is bound to be more interesting (to narrative thinkers) than a scientific lecture.

Trying to create change with a group that relies primarily on stories/narratives by presenting arguments/data is wasted effort. There are stories (again the power of storytelling) of people dying of Covid who did not believe they had the disease.

2. This brings me to the second distinction – belief or trust. Foundational beliefs of the world are hard to create, harder to change, and very personal. These beliefs can be used to create new beliefs, as long as the new belief reinforces the original belief. And whatever your belief is, we make decisions and take actions based on that belief. I believe that the scientists working on the vaccines have come up with a relatively safe and effective drug. My core belief is that I trust that the government and the “powers that be” are working to make sure things are safe. I hold to this belief with very little evidence for and some evidence against. I also trust my food is safe without evidence. I take drugs, trusting they will do what I am told they will do.

However, if my basic belief is that there are conspiracies of powers that be, then trying to prove me wrong by giving me data and examples provided by the government and/or the medical establishment, is a fool’s errand. It does not make sense to disprove a core belief with evidence from a source that is, in the person’s mind, corrupt.

The Q conspiracy fed into core beliefs that there were powers out there controlling a confusing world. When the predictions of that belief didn’t happen, the core belief didn’t change. The individuals looked for other ideas that supported their core beliefs and stopped thinking and talking about Q.

Remember, this fear of big pharma, big government, powers that be, does not come from idiotic ramblings. There have been plenty of examples that can encourage doubt. Polio still is active in Pakistan because during the search for Ben Laden, the CIA ran false vaccination clinics. There is a still great distrust about vaccination clinics in that area. During the Tuskegee experiments, the US Department of Health lied to African American. This lasted until 1972. Thalidomide was approved for use by pregnant women in the 50s and 60s for nausea. The list goes on. A belief in big, powerful entities that control lives and a mistrust of government is not an irrational basis for making sense.

One more academic example and then I’ll get to how I think we can implement change. Watzlawick ran an experiment. Two people are shown slides with a sick cell and a healthy cell. The viewer has to decide if the cell is sick or healthy. Right after their guess, they are told if they are correct. Their task is to infer rules that can divide sick cells from healthy cells. Makes sense so far. So, with the feedback, they should both be able to develop rules and probably get better dividing sick from healthy. Oh, but that tricky experimenter messed with them. Subject A was given correct feedback. If they guessed correctly, they were told they were correct. If they guessed wrong, they were told they were wrong.

But Subject B was told they are right if A’s guess is right and wrong if A was wrong (no matter what Subject B guessed). The result?

A’s rules were simple, straightforward, and concrete. B’s were complex. B had to make sense of wrong data. So, they came up with very convoluted, subtle, and complex rules.

However, the A’s, instead of thinking the B’s are too complex, were impressed with the subtlety of their thinking. And the more complicated the explanations were, the more impressed A’s were.

So what?

There is an inherent attraction to sensemaking that is more intricate and complex. There is an attraction to believing that the virus was created so that Gates could inject the world with magnets and microchips to control the world. This type of argument feeds into the belief that there are powers out there that are controlling a world that has become too confusing and is changing too quickly.

And again, trying to bring about change by directly challenging with data, or worse, dismissing these core beliefs will reinforce the beliefs, not lead to change.

Pointing out logical (argumentative) problems using untrusted sources simply will put people in a defensive posture where any input that attempts to encourage change will be blocked. This is particularly the case when information sources – online, in the media, and acquaintances – are continuing to muddy the water with a variety of claims. Some are obvious grifters, selling product or seeking financial support. Many are true believers. Together, they provide a nearly impenetrable wall that holds to the behavior we wish to change.

So, what to do? What to do? Is it possible to implement change in this instance? Is it possible to encourage vaccination and maybe even mask wearing? I believe so. Here are some approaches that should work.

  1. Stories not data. If anti-vaxers communicate by narrative, information needs to be presented by narrative. Positive stories of those who were vaccinated, were exposed, yet did not get sick are important. Equally so are the stories now coming out about people who got sick who wished they had gotten the vaccine. Stories of people who did not get the vaccine and infected loved ones are important. People who were hesitant, got the vaccine and did not suffer consequences are also needed. These stories could be made more effective by including people talking about their concerns prior and what helped them to make up their minds.

    The more compelling the story, the better.
  2. Trusted sources. Do NOT have stories from doctors or people from the medical or political establishment. Even well known anti-vaxxers will not carry so much weight. When dealing with people who doubt authorities, the thought will be “they got to them”. While pundits and anti-vax proponents can do continued harm, they can’t do much positive. Their power comes from their voice as a challenge to the “system”, as an alternative. Once they voice support for vaccines, they have “joined the other side”. This offers an explanation as to why anti-vaxers do not change their message in the face of clear proof. Their power lies in their difference. Giving that up, while it may saves lives, will compromise their standing. There will no longer be reports on what “that lunatic” said this time, if they stop making outrageous statements.

    This points to a crucial step in change management which created real problems for this particular change implementation. If at all possible, involve those who will be affected by the change in designing the change.

    In this case, the change – getting vaccinated – had clear us and them sides already established. It might not have been possible to bring doubters into the design of the change in this case. Indeed, in this case, even the need for change was being questioned by many leaders (who were denying the seriousness and in some cases, the existence of the problem).

    However, this does illustrate how much harder it is to implement change when input is not sought and realistically considered during the design process. When something is decided from on high, by some unknown them there will be more resistance simply because people do not like to be told what to do.
  3. Sticks and an occasional carrot. There comes a time in every change implementation when it is apparent that some people, for whatever reason, are going to oppose the change.

    Try carrots first. This has been tried with vaccines. Financial inducements, prizes, and more have been offered. They have moved the needle some (pun intended). However, in my experience with other change initiatives, I have found that the size of the reward doesn’t make a lot of difference. Most people who won’t embrace or at least accept change for $50 will not change their minds for a chance at a bigger prize.

    For those adamantly against change or completely indifferent (I’m too young to catch it, so I won’t get vaccinated), a stick is necessary. In the case of vaccines, loss of privileges (admission to group settings, including restaurants and schools, is one of the most obvious; refusing health care or insurance coverage is more controversial), loss of employment because lack of vaccination puts others at risk, or enforced isolation or quarantine (the leper colonies or plague cities in the past – and yes, I know that there is no way these are going to happen) are options. In change implementations, it is important to lay this out beforehand with the client. Decide what happens when push comes to shove. Is there the willingness to “pull rank”? When dealing with an unruly child who doesn’t want to take a bath, it is good to start with explanation, perhaps offer a bribe, but there comes a time when you have to decide if you going to pick up the kid and put ‘em in the bath and wash ‘em, over their screams and objections or are you going to put up with dirty sheets and a smelly child. This was the approach used for increasing seat belt usage. First was positive reinforcement and encouragement. Then a bit of pain – seat belt warning buzzers within cars. Then, concentrated enforcement with greater cost – tickets, points against driving record, and increased insurance rates. Enough points against the driving record and the privilege of driving was taken away. Core to this enforcement was the message that driving is a privilege. In the case of anti-vax, we may not be able to force vaccination, but the privilege of going out to places where one may spread the disease – schools, concerts, restaurants, etc. – can be taken away.

    Note that with the Delta variant and the increases in deaths, vaccinations are again increasing. As those from populations not originally considered at risk succomb, more younger adults are getting vaccinated. Death is a pretty useful stick. It is harder to not “believe” in Covid or vaccinations when the stories of those getting sick and dying outnumber the stories of vaccination reactions or speedy recoveries from “just another flu”.
  4. Time

    One difference between covid and, one hopes, a change initiative is the amount of time available. There is a natural resistance to change. However, over time, that resistance fades as the change becomes the new normal. There are new changes to be upset about. Change initiatives for seat belts and smoking were measured in decades. Covid change had to be measured in months. The only reason the change implementation has been as successful as it has been is it has become increasingly obvious that refusing or even delaying change means risking death. As the body count increases, the resistance to change fades. Please note that I am NOT recommending this as a feature of your next change initiative. But the stories of those who suffer badly and/or die are outnumbering the stories of reactions to vaccines. The new narrative is winning. I recently saw an anti-vax post and the writers stated, “Trust me. They don’t work and they are dangerous.” A couple of months ago, that might have held some weight. Now when data comes in and even though it is from “the powers that be” and even though it is data not stories, when the data shows that over 99% of deaths from covid are unvaccinated people … well, that unknown poster’s “trust me” doesn’t hold a lot of water for more and more people.

Steve Schatz is the principal at Learn | Change Consulting and has helped individuals and organizations understand, set, and achieve goals for over 25 years. He may be reached at Schatz@powerstart.com