Summary.    One of the biggest obstacles to bringing the pandemic to an end is the hesitancy of a large portion of the population to get vaccinated. Key to overcoming their reluctance is providing a superlative experience before, during, and after...

In addition to the logistics challenges that have slowed the rollout of the highly effective Pfizer-BioNTech and Moderna Covid-19 vaccines, there is another obstacle that needs to be overcome: the large numbers of people — up to 40% of the U.S. population — who say they won’t get vaccinated.

Experts believe that herd immunity, which is contingent on 70% or more of the population being immune to the virus, is necessary to end this epidemic. Crossing the chasm to get to these numbers will require addressing concerns about getting vaccinated. It entails providing people with a superlative experience before, during, and after vaccination. Here’s a framework for doing just that.

Creating trust. Much of the hesitation to get a Covid-19 vaccine stems from the lack of trust in the health care system, the pharmaceutical companies that brought the vaccines to market in record time, in some vaccination advocates, and in our government that is regulating and promoting it. In addition to strategies to combat misinformation, we must wage an all-out effort to build public trust.

One way we can do so is to harness the power of data. For example, those who receive the vaccine are currently encouraged to sign up for the Centers for Disease Control and Prevention’s (CDC’s) V-safe, a proactive reporting system for adverse events that collects symptoms data from recipients via mobile phone. The aggregated data from V-safe could be made public and understandable in a visually compelling way so that the public could see how few people are experiencing adverse effects and how many people have gotten the vaccines so far. Simple visualization techniques by social media companies could show how big the “herd” is and which people in individuals’ networks have gotten it, reinforcing the notion that vaccination is a common, almost mundane matter.

In addition, because inequities erode trust, we must help people who are marginalized believe the vaccine is the right choice for them. People of color, other minority groups, and vulnerable populations, such as pregnant women and those over age 75, were underrepresented in the clinical trials of the two approved vaccines. To compensate for this, national and state public health authorities and vaccine administration sites could provide real-world safety data to help people of various ethnicities and conditions see how the vaccine is faring in groups that most closely represent them.

Getting the word out. Ultimately, for certain communities, we may need to employ scalable ways for people to get personalized health information about the vaccine. This is especially important for marginalized populations who have less access to doctors. Possible approaches range from a simple text messaging system modeled on Text4Baby, a free system that lets expectant mothers text “BABY” or “BEBE” in Spanish to receive educational messages timed to their stage of pregnancy, to WeMUNIZE, a GPS-enabled software as a service successfully rolled out in Nigeria that uses robocalls featuring voice recordings of influential community leaders to encourage immunization. Availability in multiple languages will be essential.

Making it simple to sign up. Often the sheer complexity of the health care system prevents people from getting the right care. Once there is interest in getting the vaccine, people need to know when and where to get it. Because the vaccine is being rolled out in waves to different populations, “calculators” like the one in The New York Times can help people understand when it is their turn.

When that time arrives, we should make it easy to find a place to get vaccinated and make an appointment. To that end, we should make vaccination sites searchable on major search engines and third-party applications and provide an Open Table-like scheduling system for people to seamlessly schedule themselves for the shot — similar to what is already being done in health systems for frontline health workers. For certain groups like older adults and those with digital literacy barriers, the simplest and best system may be for them to simply call and talk to a person who can help them schedule an appointment. It could be similar to the service provided by Accolade, a personalized advocacy company for employers where one of us (Shantanu) works. Accolade employs health assistants to help employees and dependents schedule doctor appointments.

Acing the vaccination. Getting a shot isn’t pleasant, but there is plenty we can do to make it a good experience. We have the potential to help people feel as comfortable as possible and to be proud of their contribution to keeping us all safe.

We should set up vaccination sites to offer easy access, minimize waiting times, and provide more time and attention to those who need it. When it comes to access, convenience is key. Thankfully, we can leverage the innovation and infrastructure built for Covid-19 testing. For example, drive-through testing sites that allow people to stay in their car could add a vaccination service that follows the CDC’s guidelines on drive-through vaccination. Vaccination sites could designate certain time slots for anyone who wants or needs a higher-touch experience, such as children, the elderly, those with physical challenges, and those who fear needles.

To help people feel good about getting the vaccine and contributing to a social good, we could instruct vaccinators to give recipients a simple “congrats!” or elbow bump, send them a V-safe text message that welcomes them to the herd, or create an iPhone message special effect that shows fireworks when a user texts a friend that he or she got the vaccine, much like it does today when users text “Happy New Year” to friends and family.

Supporting the recovery. The hardest part of the vaccination process is actually the one to three days after someone has received the shot when a significant proportion of people experience side effects, which range from pain at the injection site to headaches to low-grade fevers. Managing expectations about these side effects is essential. If people expect no side effects but feel terrible, they will have a bad experience; conversely, if they feel less discomfort than anticipated, they will have a better experience.

An opportune time to set expectations is during the 15-minute waiting time that is currently required immediately after the vaccination to monitor for adverse effects. This could also be a moment to convey some important educational information. Places offering vaccines, such as CVS or Walgreens, could create a quiz or interactive video in their app to test the user’s knowledge of Covid-19, immunity, and post-vaccination behaviors and offer a coupon based on the user’s score. Vaccine recipients could also receive personalized educational messages in the days following their shot such as “Day 1 after vaccination: If you are feeling sore in your arm or a little under the weather, you’re not alone, and that just means the vaccine is working!”

Some people will also need a simple way to get in touch with a health care provider if they are concerned about their side effects or are coming down with Covid-19. Currently, tools such as V-safe are simply for reporting side effects to public health authorities. A more user-centered approach would give vaccine recipients with more serious concerns a simple way to message or talk to a health care professional at the facility where they received the vaccine. These clinicians could help them triage their symptoms and gauge whether medical attention is needed or provide empathy and reassurance that what they are experiencing is normal and the symptoms will subside on their own.

Maintaining engagement. Unfortunately, getting the shot doesn’t mean people can immediately go back to their pre-2020 ways of living. Immunity to the vaccine takes days to build, a second dose of the vaccine is vital, and we still need to wear masks after getting vaccinated. Herd immunity depends on people understanding this.

In the days that follow a person’s first vaccination, the CDC (via the V-safe app), a health care provider, or a pharmacist could send daily automated messages to help him or her know where on the immunity curve they are as a way to encourage people to remain cautious as their immunity builds and encourage them to get the second dose a month after their first. Recipients of the message could see their immunity ticking up from 20% to 50% in the days that follow and then stay stuck at 50% until they get their second dose.After their second dose, they could see how their protection is increasing until it exceeds 90%. This could be much more powerful than simply sending people a reminder that they are due for their second dose.

Creating viral effects. Diffusion of innovation is ultimately a social process. As more and more people take the vaccine, getting the last cohort of people who are most resistant to taking the vaccine, the “laggards,” will be a challenge. In addition to the tactics mentioned above to build trust and celebrate people who get the shot, we can borrow from efforts used to get Americans to vote: e.g., “I voted” Facebook picture frames, the use of celebrity influencers, and direct outreach by nonprofit organizations. For example, social media platforms could add a function that makes it easy for people to notify the members of their networks that they have scheduled or received the first shot and then the second.

Ultimately, designing a successful vaccination experience will require local adaptation. What works in a largely professional, urban community will differ from what is effective in a working-class, rural one. It will also require rapid testing and iteration. A key tactic may be measuring the Net Promoter Score (NPS) of how people feel about having gotten vaccinated. The NPS is based on the responses to a simple question: “On a scale of 0 to 10, how likely are you to recommend this company’s product or service to a friend or a colleague?” Asking those who received the shot whether they would recommend it could help us better understand whether a particular vaccination process and improvements made to it are working or not.

By thinking of the vaccine as a consumer product, vaccination as a service, and a high NPS as a goal, we can better design the end-to-end vaccination process and bring this pandemic to a close as quickly as possible.