Table 3

Adaptation exemplars for high variance strategies

Strategy
Identity segmentation	Germany	Target 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.’)
	Brazil	Target 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.’)
	China	Target 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	Jamaica	Economic 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.)
Common enemy	Saudi Arabia	Health 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	Chile	Frame vaccine as precious and describe scarcity globally (ie, Chile is doing better than other countries at getting vaccines, so don’t waste them.)
	Switzerland	Frame 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.
	Australia	Frame vaccine as precious and emphasise limited opportunities to gain mobility or go to certain places (ie, travel freely or with ease).
	Mali, Niger	Frame vaccine as precious and offer first to traditional leaders (eg, chiefs, kings, and emirs) or religious leaders.
	Uganda	Frame vaccine as precious and emphasise it is above corruption and therefore will be distributed equitably to all as it is available.
Prompt anticipated regret	Sweden	Use 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)
Prompt anticipated regret	Nepal	Use emotional appeal to get shot to avoid bringing disease to the family, especially elders and schoolchildren.
Compromise effect	India	Do 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.
	Canada	Use compromise effect by approaching hesitant populations with choice of vaccinate now, sign up for next month, or don’t sign up now.
	Israel	Wait 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	Ecuador	Allow the wealthy to access vaccines through their doctors rather than mass clinics even if that means they must pay for the vaccine.
	Greece	In 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 Africa	Avoid 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.