APRIL 4, 2022

Using Trump’s vaccine endorsement to move the needle on COVID-19 vaccines

A team of economists and political scientists that included Stanford’s Brad Larsen ran a large-scale advertising experiment in thousands of U.S. counties showing a video compilation of former President Donald Trump’s Fox News interview recommending the COVID-19 vaccine, leading to a significant increase in vaccinations.

BY MELISSA DE WITTE

People still skeptical of the COVID-19 vaccine can be persuaded to get vaccinated after watching a public service-style announcement featuring former President Donald Trump and his family encouraging voters to get the shot, according to a new study that included researchers from Stanford University, the University of North Carolina at Chapel Hill, North Carolina State University and the University of California, Berkeley.

A large-scale advertising experiment that showed a video compilation of former President Donald Trump’s Fox News interview recommending the COVID-19 vaccine, led to a significant increase in vaccinations. (Image credit: Getty Images)

The researchers created an advertisement that included an interview between Trump and Fox News anchor Maria Bartiromo where Trump urged his supporters to get vaccinated. The video, which also included a Fox 13 News Utah broadcaster sharing Trump and First Lady Melania Trump’s vaccination status, was placed on more than 100,000 YouTube channels – including Fox News’ own YouTube channel, where it ran before segments with some of the network’s most prominent personalities like Laura Ingraham, Tucker Carlson, Sean Hannity and others.

The team found that the ad had a significant impact on vaccine uptake: the 1,000 low-vaccinated counties across the U.S. where they showed the ad had an average of 103 more recorded vaccinations compared to a group of similar counties where the researchers withheld the ad, totaling to an increase of 104,036 vaccinations overall. The findings were released April 4 as a working paper of the National Bureau of Economic Research.

Persuading vaccine-averse Trump supporters to get vaccinated

Vaccination uptick has faced a political divide, with Republicans lagging Democrats. Data from the Kaiser Family Foundation found that among the 27% of American adults who remained unvaccinated, 60% identify as Republicans, compared to only 17% as Democrats.

“While a majority of both parties are vaccinated, those who remain unvaccinated are largely Republicans, despite messaging from the CDC and medical experts about the efficacy of the COVID-19 vaccine,” said Brad Larsen, an assistant professor of economics at Stanford’s School of Humanities and Sciences and a faculty fellow at Stanford Institute for Economic Policy Research (SIEPR) and one of the study’s authors. “We felt like there should be a better way to send a message that would resonate with people on the right.”

Inspired by social science research that has shown partisans follow cues from party leaders, the researchers wondered whether vaccine-hesitant Trump supporters could be swayed to get vaccinated if exposed to a potent message that Donald Trump had received and endorsed the vaccine, a fact the former president has touted on several occasions.

The research team put the question to the test in a large, randomized controlled trial at the county level.

The researchers, who also include political science professors from the University of North Carolina Tim Ryan, Marc Hetherington, and Rahsaan Maxwell, Steve Greene from North Carolina State University and economics Professor Steve Tadelis from UC Berkeley – worked with a professional video editor to create a short, 27-second video that opens with a Fox 13 News Utah broadcaster saying “Donald Trump is urging all Americans to get the COVID-19 vaccine.” It quickly transitions to a phone interview between President Trump and national Fox News anchor Maria Bartiromo where Trump says, “I would recommend it, and I would recommend it to a lot of people that don’t want to get it, and a lot of those people voted for me, frankly.” Bartiromo is shown nodding in agreement.

Next, the ad shows footage of Trump with First Lady Melania Trump where the Fox 13 News anchor tells viewers that the Trumps had both received their vaccines privately in January 2021 at the White House.

Then, a photo Ivanka Trump had shared over her own social media channels of receiving the vaccine herself was shown, with her own endorsement: “Today I got the shot. I hope you do too.”

Today, I got the shot!!! I hope that you do too!
Thank you Nurse Torres!!! 💙 pic.twitter.com/gPL1Mecv1G

— Ivanka Trump (@IvankaTrump) April 14, 2021

The ad closes with a brief statement: “Your vaccine is waiting for you.”

Finally, the ad links to the original Fox News broadcast to show viewers that the video clips were not taken out of context.

The researchers then rolled out a targeted campaign over YouTube’s advertising platform, Google Ads, where they were able to home in on counties with low vaccination rates – areas where the ads could be most effective, Larsen explained.

Between Oct. 14-31, 2021, the team assigned 1,083 counties across the country to receive the ad. The experiment also included a control group made up of 1,085 similar counties where the ad was not shown.

In total, the campaign resulted in 11.6 million impressions with 6 million unique viewers.

The researchers had no control over which channels the advertisement would be featured on YouTube. The fact that it appeared the most on Fox News’ YouTube channel – a network that has contributed to much of the partisan rhetoric towards the vaccine and other public health measures related to the pandemic – was driven by Google Ads’ algorithms. The ad also appeared on thousands of other YouTube channels, such as Forbes, NBC, MSNBC, Glenn Beck and even Saturday Night Live.

To analyze the effect of the ad campaign, the researchers linked their experiment counties with data from the Centers for Disease Control and Prevention (CDC) on the number of vaccines administered in each county up through each date from Sept. 15 through Nov. 30, 2021 – one month before and after their advertising campaign.

In sum, they found that:

• Vaccinations in the average targeted county increased by about 103, totaling 104,036 across all counties.
• It cost on average about $1 or less in advertising to lead one more person to choose to receive the vaccine (about $99,000 was spent on advertising).
• More ads lead to more jabs: researchers found 1,000 additional ads resulted in 8.6 additional vaccines.
• Counties that received more ads per capita, or where viewers engaged with the ad more by watching more of it or clicking on the Fox News link, had larger vaccine increases.
• The counties that were the most responsive were those with a strong but not overly strong Trump base – counties with up to a 70% vote share for Trump. Those with the highest Trump vote shares were more obstinate and unmoved by the campaign.

Beating politics with more politics

The study reveals that, even among the most vaccine-hesitant crowd, the right message and messenger can change attitudes.

In an effort to understand what might sway this large group of skeptics, sociologist Robb Willer, a professor of organizational behavior at Stanford Graduate School of Business, conducted an experiment with help from colleagues at Stanford, Northwestern University, and MIT to see how vaccine-hesitant Republicans would respond to pro-vaccination messages from partisan sources. The results were revealing: In a preprint paper, Willer and his coauthors found that Republicans are amenable to persuasion by former President Donald Trump and other prominent GOP politicians — but that pro-vax messages from Biden and other Democrats fail to move them.

You run Stanford’s Polarization and Social Change Lab, which focuses on reducing the harms of political polarization and developing effective strategies for social activism. So why a study on how messaging from political leaders affects Republican attitudes towards vaccination?

Since the earliest days of the pandemic, my lab has worked on finding the most effective way to communicate public health guidelines. One of the first things we figured out was that the content of the message doesn’t matter as much as the source of the message. So we shifted to finding ways of recruiting the right sources: People who would be trusted within subcultures and communities that are not naturally receptive to COVID public health guidelines.

We were also attuned to the idea that polarization was going to be a big problem, and that it was going to become critical to reach Republicans effectively. Sure enough, vaccination has become incredibly polarized despite very few Republican elites having been anti-vaccination.

In the study, you randomly assigned 1,480 self-identified Republicans to one of three “conditions.” One group watched a video featuring pro-vaccination statements by former president Donald Trump and read an essay that included endorsements from other Republican leaders while touting the GOP’s contributions to vaccine development; one group received a similar video-and-essay package featuring President Biden and other Democratic leaders; and a control group got a video and essay about neckties.

We didn’t make anything up. We worked entirely with existing endorsements.

Unvaccinated Republicans who were exposed to the Republican endorsement package were 7% more likely to increase their intention to vaccinate than those exposed to the Democratic one. What aspect of the messaging drove that response?

We found more evidence that it was driven by the sense that Republican elites wanted people to get vaccinated, and less about wanting to be part of something Republicans would get credit for.

We also found that hearing a pro-vaccination message from Republican elites like Donald Trump led Republicans to become more likely to encourage others to vaccinate. That’s an underrated effect: Getting people to encourage others is a way to get into this community and help promote vaccine confidence.

On the flip side, the Democratic endorsement package actually drove down Republicans’ willingness to encourage family and friends to get vaccinated.

I was a little bit surprised by that.

A cavalier response to this study might be: Why is it so important to persuade Republicans to get vaccinated? Who cares if a bunch of anti-vaxxers refuse to protect themselves?

First, I think everybody’s life is valuable. That’s just basic public health logic. Whether or not people understand that the measles vaccine can help their child, it will; and their life matters, so we should try to work with them to help them understand the science.

Second, Republicans are the biggest barrier to containing the virus in the U.S., and that’s bad for everybody. Republicans are 32% of the population, and 44% of themopen in new window are now saying no to vaccination. That means that an ideological group representing 14% of the American population doesn’t want to get vaccinated. Having a sizable subpopulation of unvaccinated people who disproportionally interact with one another can serve as a breeding ground for variants that could in time evade our vaccines and pose a threat even to the vaccinated population.

How can your findings be applied in the real world?

The most significant takeaway to my mind is that Republican leaders could really do a lot in this space if they were so inclined. A pro-vaccination campaign led by Republicans would be terrific. But you could also intervene directly using existing content. Groups like the Ad Council could make public service announcements that include Republicans endorsing vaccinations.

If I could wave a magic wand, I would build both a top-down and a bottom-up program for reaching people through their most trusted leaders. I would create PSAs featuring nationally famous figures with appeal among Republicans, but also reach people through respected political and religious leaders in their local communities. There is very good reason to think that faith leaders could be particularly influential with religious Americans. We are testing that now.

And maybe don’t show Republicans pro-vaccination messages from Democrats?

Absolutely. If you are segmenting the population to target people with persuasive messages that fit their concerns and identities — which you should do whenever you can — present Democrats with Democrats, and Republicans with Republicans.

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