Puerto Rico is taming Covid-19 by using force and reducing friction
Photo by Ricardo Arduengo, AFP via Getty Images
AFP via Getty Images
In the global race to end the Covid-19 pandemic, the USA not only struggles to keep up with other countries, but also fails to learn from its successes.
US officials and health authorities lagged behind Japan’s gradual testing efforts early on. As the disease spread in the summer of 2020, Americans resisted lockdowns and quarantine measures, quickly falling behind countries like New Zealand with their effective “Go Hard, Go Early” program. The US then lost pace on tracing contacts with South Korea and was quickly overtaken by Canada on air security measures. Compared to other high-income Western nations, the United States comes last in vaccinating the public while leading the world on two unfortunate metrics: total cases and deaths.
If global-minded Americans hadn’t already been embarrassed by the country’s poor pandemic performance, an announcement by the White House’s Bureau of Intergovernmental Affairs in late October made our continental Covid-19 failure clear. The OIA reported that the Commonwealth of Puerto Rico, the US island area 1,000 miles south of Florida, is vaccinating all 50 states.
Coronavirus pandemic (COVID-19) research data courtesy of Hannah Ritchie, Edouard Mathieu, Lucas … [+]
Open access data published online on OurWorldInData.org.
Even the Democratic states of New England, which pride themselves on their well-funded health systems and progressive policies, are several percentage points behind Puerto Rico. Latest figures show that the island has administered more than 155,000 doses per 100,000 residents. In addition, 90% of eligible Puerto Rican teenagers are fully vaccinated, compared to just 50% of mainland US teenagers. What’s even more impressive is that Puerto Rico is the world leader in preventing new cases. The positive fall rate is around 2%, second only to New Zealand.
Do like the Puerto Ricans
To achieve the 74% full vacation rate, island leaders and public health officials (1) used force where necessary and where effective, and (2) made it incredibly easy for citizens to get vaccinated.
With Americans in mainland America sitting on a massive excess of vaccine doses – and the death toll now surpassing 760,000 – there are important lessons to be learned from Puerto Rico’s two-pronged approach. For starters, US executives should buy a second tine.
Embedded in the American ethos is the belief that most problems can be solved by violence. And when that doesn’t work, the instinct is to use more force and forget that there is another option. Instead of trying to beat Covid-19 by force (and only by force), Americans on the mainland should act like Puerto Ricans and look for ways to reduce friction.
Through force and friction theory
In a recent episode of the Hidden Brian podcast, Loran Nordgren, professor at Northwestern University, brought this friction reduction theory to life with the story of a furniture chain in Chicago.
As reported by Nordgren, the company makes fully customizable sofas and chairs. And buyers have been known to spend hours in the showroom or online designing their perfect seating arrangements. But they almost never bought it. Initially, the retailer assumed that customers need more incitement: lower prices, louder advertisements, or more intrusive salespeople. But Nordgren’s colleague at the Kellogg School of Management, David Schonthal, quickly discovered the real problem. People didn’t buy these new sofas because they didn’t know what to do with their old ones. And with that in mind, the company launched a sofa pick-up program that drove sales skyrocketing.
The moral of the story: it works to push harder sometimes, but for best results it helps to find out (and address) what is holding people back.
Frictional losses to promote vaccinations
For months, Puerto Rico has been pushing its citizens hard and enforcing some of the toughest pandemic restrictions in the US. Government measures included non-essential shop closings, stay-at-home orders, strict mask requirements, and an airtight curfew that lasted over a year.
But in addition to using force, Puerto Rican leaders have also taken gentler steps to increase vaccination rates. Here are two approaches that have worked well. If the entire United States emulates these efforts, we could increase vaccination rates and finally get ahead of the pandemic:
1. Facilitate vaccinations
Puerto Rico’s vaccination efforts were fraught with logistical difficulties from the start. The island’s hospitals continue to experience frequent power outages four years after Hurricane Maria, while citizens struggle with an island-wide poverty rate of 43.5% (almost four times the mainland average of 11.8%). Additionally, as is the case in most states, it has not been easy for Puerto Ricans, with a population of 3.2 million covering an area of 3,515 square miles, to travel to large, centralized vaccination centers.
Instead of forcing residents to travel long distances or taking time off work because of syringes, José J. Reyes, commanding officer of the National Guard of Puerto Rico, has made it his mission to bring people vaccine doses.
Working with nonprofits and local leaders, Reyes made Covid-19 recordings available in bars and beaches, at airports and nursing homes, in churches and schools, and even brought cans door-to-door. There are a total of 975 vaccination providers on the island and soon 300 locations only for children. Combining mandates and a clear mission to make vaccination easier for people, Puerto Rico outperforms mainland America in almost all vaccination metrics and without massive protests or threats of violence.
With many local pharmacies and doctor’s offices across the continent, there is no shortage of doses available. However, getting to these websites is not always convenient for busy parents or people who have multiple jobs. New York has tried to address this problem by reducing friction. After FDA approved vaccinations for children ages 5-11, NYC schools started hosting pop-up vaccine pages last week. And so that parents don’t have to worry about missing work, Mayor Bill de Blasio grants every city worker and contractor four hours of paid vacation per child per dose.
Polls show that Americans are more open to the vaccine than ever. Hence, we need to make it as convenient and easy as possible for those on the fence. Bringing vaccines to schools, churches and recreational facilities would be a positive start. Support from teachers, religious leaders, and local influencers would be an effective complement to reducing psychological friction for people who are considering vaccination but who find it difficult to do so.
2. Depoliticize the pandemic
Across the country, political affiliation is the # 1 indicator of a person’s vaccination status, often spurred on by malicious posts on social media and incessant shouting on TV news. Vaccines themselves have become a symbol of their own political ideology: give me freedom (R) or give me public security (D).
This is not the case in Puerto Rico. The island is not divided between Republicans and Democrats, which has enabled all major political leaders – along with most local officials, community organizers, health care providers and scientific experts – to stand together in their efforts to contain the pandemic.
Although mainland America may never be able to reproduce Puerto Rico’s impartiality, one possible avenue to consensus can be found in psychological research.
Several studies show that advocating matches rather than waiting for points of contention makes people more receptive to new ideas, which reduces friction. So instead of identifying and reinforcing what makes Democrats and Republicans different, we should better ask, “What can we all agree on?”
If we put theory into practice, we could begin by asking a seasoned newscaster to moderate a nationwide conversation on Covid-19 that featured respected, moderate leaders from both parties. The goal: to find the lowest common denominator. Thus, instead of hardening their perspectives in the echo chambers of partisan media, our nation would have the opportunity to watch passionate leaders with different opinions doing something we never see on television: agreeing to one another.
While the two sides may not agree on government-enforced vaccine mandates, clinical trials may help them agree that vaccines reduce the likelihood and severity of disease. Perhaps both sides can acknowledge that a small percentage of vaccine recipients have had complications while also recognizing that infection by the virus is far more dangerous than any known vaccine side effect.
Highlighting points of alignment helped Puerto Rican leaders come together and send a clearer message about the importance of vaccination. Prior to the issuing of mandates across the island, the mayors of all 78 parishes and leaders from over a dozen religious denominations participated in the spread of vaccinations.
In the 50 states, the widespread and intense polarization is the result of two social mistakes: not feeling closely connected to others (especially those with whom we disagree) and not feeling respected by those with different views. If there is any hope of herd immunity through vaccination (an achievement that would require vaccination of 90% of the population), we must find ways to ease our nation’s political and interpersonal tensions.
Puerto Rico’s success shows that an effective pandemic response is possible. But executives need to know when to push and when to lubricate the wheels. Vaccine requirements worked on the island, but so did efforts to make vaccines more accessible and the fact-based information more credible.
More than a third of eligible Americans remain unvaccinated. If half of the vaccine holdouts could be persuaded to roll up their sleeves, the number of Americans who will die of Covid-19 in the next year would drop by a similar fraction.
The theory of friction tells us that we humans will never win by denigrating them, by questioning their intelligence, or by using force alone. We on the mainland have the opportunity to follow Puerto Rico’s guide and reach the finish line more safely and quickly. It takes a little more force and a lot less friction to get there.