Table 3

Adaptation exemplars for high variance strategies

Identity segmentation

GermanyTarget sport-minded young adults with team affiliation (eg, ‘Top Shots’ campaigns for football fans; ‘Bundesliga has the highest average attendance on any football league in the world; we get our shot and we get back to it.’)
BrazilTarget indigenous tribes with in-group identity (eg, ‘Outsiders like miners are bringing COVID-19; this medicine will keep your village safe from other peoples’ diseases; ‘You must act to protect your village by getting these shots; the miners don’t care if you get sick.’)
ChinaTarget taxi drivers and transportation workers with professional pride (eg, taxi campaign fronted by Han Han, famous racecar driver; ‘You keep our city moving. Protect yourself and our city by moving fast to get your vaccine.’)
Common enemy
JamaicaEconomic distress as common enemy (eg, campaign ‘Poverty is our Enemy. Vaccination=Visitors’ by emphasising cruise company selections of ports of call will depend on island vaccination rates.)
Saudi ArabiaHealth of religious community as common goal (eg, communicate ‘Our duty is to the health of the Islamic Nation; we must act in unity to stop COVID-19 now.’)
Leverage scarcity

ChileFrame vaccine as precious and describe scarcity globally (ie, Chile is doing better than other countries at getting vaccines, so don’t waste them.)
SwitzerlandFrame vaccine as precious and emphasise natural scarcity (ie, slow ramping up of production and distribution is to be expected) to avoid blaming of government for inability to procure vaccines.
AustraliaFrame vaccine as precious and emphasise limited opportunities to gain mobility or go to certain places (ie, travel freely or with ease).
Mali, NigerFrame vaccine as precious and offer first to traditional leaders (eg, chiefs, kings, and emirs) or religious leaders.
UgandaFrame vaccine as precious and emphasise it is above corruption and therefore will be distributed equitably to all as it is available.
Prompt anticipated regret
SwedenUse less emotional language and non-health situations (eg, ‘Take a little care now to avoid missing out on something special later’ with images of weddings, graduations, travel)
NepalUse emotional appeal to get shot to avoid bringing disease to the family, especially elders and schoolchildren.
Compromise effect

IndiaDo not use compromise effect by offering a range of choices of getting the vaccine but rather by emphasising how most other people who were unsure thought it safest to go ahead and get the vaccine when available (ie, the modal response). Frame non-vaccination as a very extreme choice.
CanadaUse compromise effect by approaching hesitant populations with choice of vaccinate now, sign up for next month, or don’t sign up now.
IsraelWait to use compromise effect until there are choices among available vaccines so that a middle option could be a one-dose shot or a (future) nasal spray.
Uniqueness neglect

EcuadorAllow the wealthy to access vaccines through their doctors rather than mass clinics even if that means they must pay for the vaccine.
GreeceIn online registration let people enter personal health notes they feel are important to be known (eg, pregnant, allergies, chronic conditions); entering them in will give reassurance that the vaccine is ok for them specifically.
South AfricaAvoid public communication of uniqueness neglect sentiments as perceived consistency is critical to trust; special accommodations for health conditions should be handled privately.
  • Suggestions provided by Delphi panel members for local adaptation during second round of expert input. The strategies in this table represent those with high levels of variance between global regions and thus require the most local adaptation for effective use.