Behavioral nudges have been shown to help people to make healthier choices. Essentially, “nudging” someone is prompting them to make a choice by changing the way their choices are presented to make the one that’s good for them stand out as more attractive.

Behavioral nudges can help improve vaccine uptake, but there have been limited studies on this in low- and middle-income countries, especially in Africa. To support the ongoing efforts of the National Department of Health and partners in accelerating the uptake of COVID-19 vaccines, Project Last Mile collaborated with Ipsos to undertake the first nationally representative study in South Africa. The study aimed to understand and explore the feasibility of incentive programs and behavioral nudges to improve COVID-19 vaccination rates.

The report captures the final results of research undertaken for the South African National Department of Health by Project Last Mile and Ipsos, and supported by the United States Agency for International Development (USAID), to accelerate the uptake of COVID-19 vaccines.

Between March and May 2022, Ipsos conducted a telephone survey with 5000 people across South Africa. The final sample profile broadly represented the national population profile on key demographics, including employment status, home language, and religion.

The survey questionnaire asked people to respond to questions ranging from vaccine related attitudes, beliefs, and behaviors to standard demographic questions for population-based surveys in South Africa. It then tested six behavioral nudges to assess the most effective intervention. The nudges ranged from issuing out vaccine passports, employer mandated vaccines, and financial / time compensation, to increasing convenience and accessibility of vaccines, reserving a vaccine and having the vaccine as part of a routine doctor’s visit.

Of the six nudges tested, the most effective by a fair margin was addressing the issue of time and effort required to be vaccinated. Respondents said they were more likely to choose to be vaccinated if they were offered the option of a mobile vaccine clinic with free, speedy vaccination, close to home.

The next most effective nudge was employer-mandated vaccination.

However, different nudges appealed more strongly to people based on their beliefs about vaccines, their attitudes towards them, and even their location in South Africa.

This initiative is funded and supported by USAID. The content and information provided on this website are the responsibility of Project Last Mile and are not official United States government information and do not necessarily represent the views or positions of USAID or the United States Government.