What Voting and Flu Shots Have in Common

Voting is a hallmark of representative democracies worldwide. It is among the most important forms of civic engagement and decides the future of a country. The flu shot is an important preventative health measure that reduces the chances of catching and spreading the flu. Totally different behaviors, right? Not so much. From a behavioral perspective, the two are pretty similar. And taking a closer look at how they’re similar is a useful way to find new intervention strategies.

Most of us agree that both actions are good and important. But despite thinking they’re good, most of us don’t do them. Last year’s flu season was the worst in recent memory, but only 37 percent of Americans got vaccinated. Voting in a midterm election is pretty similar, with roughly 40 percent of people turning out to vote.

Even though getting a flu shot and voting are both things we generally think are useful, they’re hard to follow through on.

Last year’s flu season was the worst in recent memory, but only 37 percent of Americans got vaccinated. Voting in a midterm election is pretty similar, with roughly 40 percent of people turning out to vote.

In both cases, society as a whole benefits more than the individual who takes the action. It can be hard for the individual who takes the action to see the direct impact of that action. If you’re a healthy adult, getting a flu shot will have a relatively small direct benefit to your health, because your chances of catching the flu are already fairly low. But by getting vaccinated, you stop the disease from spreading to other people, potentially preventing those with weaker immune systems from getting sick. And if the whole population were vaccinated, we’d develop herd immunity, meaning the disease would find it nearly impossible to spread.

Voting is similar. In isolation, it’s almost irrational for any individual to vote, because elections are rarely close enough for one vote to change the outcome. It can also be hard to see the ways that one election will change daily life in the future. But across a population, if everyone voted, we would have a government that was more representative than our current one, presumably leading to policies that are better for more citizens.

Both actions are a classic setup for present bias. The benefits of voting and vaccination are uncertain, abstract, and in the future, while the demands on our time right now are concrete and certain. All of this disinclines us from taking action.

Even if we are motivated to get a flu shot or vote, there’s a lot of friction that makes it logistically challenging and generally unpleasant to follow through on these behaviors. Getting a flu shot requires that you know the right time, where to go, and the cost of getting the vaccine. Then when you finally show up to get vaccinated, you probably have to fill out paperwork and wait in line. Your reward for this? A painful shot and lingering soreness in your arm.

Registering to vote requires paperwork, then you have to figure out where your polling station is, when it’s open, and when you can go. Some states have made this a bit easier with early voting, but in other states this is made harder by requiring specific identification. Once you show up to vote, there’s more official paperwork and often a line you have to wait in, followed by the annoying process of filling in bubbles on a sheet that goes into a machine that looks like an industrial shredder. At least at the end of it you’re rewarded with a sticker.

Not only do hassles make it harder to follow through on our intentions, it makes these experiences more unpleasant.

Not only do hassles like these make it harder to follow through on our intentions, it makes these experiences more unpleasant. And we just don’t like to repeat experiences that are unpleasant.

Finally, social norms and behavior-promotion strategies might work against us when it comes to voting and the flu shot, even when they come from the most well-intentioned designers or researchers. Both behaviors are private—we don’t necessarily know who among us voted or was vaccinated (unless we ask or go out of our way to check). It’s hard to build a strong norm around these actions when they’re not easily visible to everyone. And when we don’t have strong norms for a behavior, there’s less external incentive to take action.

But all is not lost—behavioral science has made progress toward increasing both voting and flu shots, and there are lessons people working on these problems can learn from each other.

What can the vaccinators learn from the GOTVers?

Making a specific and concrete plan for future actions, or using implementation intentions, is effective for increasing both flu shots and voting. But the GOTVers (people who work to Get Out The Vote) on the ground have done a really good job of implementing en masse the findings from David Nickerson and Todd Rogers’s now classic study about making a voting plan. Insurers, pharmacies, and doctors could be doing the same thing.

GOTVers have learned that emphasizing a voter’s identity (“I am a voter”) is better than emphasizing the behavior alone (“I voted”). If you want the behavior to stick, it’s better to associate a behavior with who you are as a person. This election season, being a voter even shows up as an option on the dating app Bumble as a way to signal whether you’re doing your civic duty. Maybe if we allowed people to self-identify as “vaccinators” we could create a similar identity around flu shots. We feel good when we do things that are consistent with our personal identities, so identifying in this way could help people who are able to get vaccinated follow through each year, while communicating the value to others.

Adding public accountability by reminding people that their voting file is public is a great way to encourage people do the right thing, even if we’d prefer people voted for other reasons (like fulfilling their civic duty). This is harder to implement with a flu vaccine, where health privacy laws protect the sharing of personal information. But organizations that already have this information could create a feeling of public accountability without actually making private information public. For example, imagine if your insurance company called you on the phone to tell you they noticed you hadn’t gotten a flu shot yet.

What can the GOTVers learn from the vaccinators?

Most obviously, we know from the research on vaccination (and other domains) that mandates are an effective strategy for increasing vaccination. When the flu shot is a mandate, people manage to get vaccinated. Mandating voting is probably the best strategy we could take for increasing turnout. Unfortunately this strategy is politically challenging to implement—but not impossible. Australia managed to do this. Each country is unique, but Australia’s success suggests others could mandate voting, too.

In the absence of a mandate, a strong default can be the next best thing. The vaccination research shows that presumptive recommendations and standing orders successfully increase vaccination. When doctors discuss vaccination with their patients as though it’s a given that they will get vaccinated, patients are much more likely to follow through. Instead of asking people, “Do you plan to vote?” we could be asking them, “When are you planning to vote?”

Flu vaccinators have done a good job of removing the friction of getting vaccines for some populations by bringing the flu vaccine to where people are. Bringing mobile vaccine clinics to offices is a great example of this. On-site vaccinations also make it more public, making it easy to see who does and who does not get vaccinated. GOTVers could encourage collective voting efforts, where work teams or groups of friends vote together at the same time (assuming people can go to the same polling station and still have privacy around who they vote for). This would also make voting much more fun.

How to create more vaccinators and voters in the future

Thinking about voting and flu shots together can generate new strategies to increase socially important behaviors. Often we get too focused on the specific constraints on the behavior we care about and forget the underlying elements that may have been addressed elsewhere.

But these novel solutions are of more than mere academic interest; they get to the heart of what it means to participate in a society. Stepping back to think about these underlying elements is good practice for designing novel intervention strategies, helping more of us act to strengthen our collective health and democracy.