Christy Ruffell, manager of clinical nursing standards at UCHealth Medical Center in Fort Collins, Colorado, gives a COVID-19 vaccine shot to certified nursing assistant Luis Perez in December. Getting all Americans vaccinated against the virus will require effective messaging from public health experts.
Photo by Helen H. Richardson, courtesy MediaNews Group/The Denver Post/Getty Images
With COVID-19 cases surging to new highs and hundreds of millions of vaccine doses on the way, the pressure is on to persuade Americans to get immunized. Public health messengers are working to meet that goal, but are facing steep challenges.
Willingness to get a COVID-19 vaccine has steadily gone up among U.S. adults, but skepticism remains a serious obstacle to achieving herd immunity — and doing so in an equitable way. A December survey from Kaiser Family Foundation found 71% of adults would get a COVID-19 vaccine that was determined safe by scientists and available for free, up from 63% in September. But more than a quarter were still hesitant, saying they probably or definitely would not get vaccinated.
In another survey from public health groups, including the National Association of County and City Health Officials, only half of survey respondents said they would definitely or probably get vaccinated, and a full 39% were undecided, preferring to wait and see how well immunizations proceed. Mistrust of vaccine safety and efficacy is especially high among Blacks and Hispanics, who also face higher rates of death and hospitalization from COVID-19 than whites.
A syringe is filled with COVID-19 vaccine at Berks Community Health Center in Reading, Pennsylvania, in January.
Photo by Ben Hasty, courtesy MediaNewsGroup/Reading Eagle/Getty Images
While much could change in coming months, especially under a new presidential administration, the numbers paint an uphill battle for health communicators and underscore just how critical community engagement will be to realizing the full potential of the vaccines and stopping the pandemic.
“Yes, we need a vaccine, but more than that, we need people to get vaccinated,” said Michael Mackert, PhD, MA, director of the Center for Health Communication at the University of Texas-Austin.
Work on what is effective to boost confidence in the new vaccines is underway. In November, for example, the Ad Council partnered with the COVID Collaborative, a national group of experts in health, education and the economy — including APHA — to create a $50 million COVID-19 vaccine education campaign. It is expected to be one of the largest public education campaigns in U.S. history, with reaching minority communities a priority.
Better communication on COVID-19 vaccination is sorely needed in the face of rampant misinformation spread by some elected officials, including the former U.S. president. The rapid speed at which the vaccines were produced and new mRNA technology used for some of them has also led some people to show hesitancy.
The COVID Collaborative and the Ad Council partnered to develop a Mask Up America toolkit with resources to help governors communicate on COVID-19 safety. The partners are also working on communication tools to help increase Americans’ confidence about COVID-19 vaccination.
Image courtesy Ad Council
“It’s a whole new game,” Brian Castrucci, DrPH, MA, president and CEO of the de Beaumont Foundation, told The Nation’s Health. “It’s a novel vaccine for a novel virus, so even people who have always taken vaccines willingly are maybe now more skeptical and we urgently need to effectively communicate with them.”
In December, de Beaumont, in partnership with APHA and other groups, released results from a nationwide poll of 1,400 registered voters, including an oversample of Black and Hispanic people, on messaging language that resonates. According to the poll, groups least likely to be “absolutely certain” about rolling up their sleeves for a COVID-19 vaccine were rural and farm communities as well as Republicans, Blacks and women ages 18 to 49. One-third of respondents said their top concern was vaccine side effects.
Keeping family safe was the most powerful motivator for vaccine acceptance, the poll found, with significantly more respondents saying they would get vaccinated for their family, rather than for the country, economy, community or friends. Among the most convincing reasons for taking a COVID-19 vaccine was high efficacy and ending the pandemic.
Scott Ratzan, MD, MPA, MA, a distinguished lecturer at the City University of New York Graduate School of Public Health and Health Policy, said understanding and reaching the wait-and-see group — which surveys say is more than a third of the population — is a major hurdle to reaching herd immunity.
Juana Duran, a resident at the New Jewish Home in Manhattan, receives a COVID-19 vaccination in December from a Walgreens pharmacist. As of December, 71% of Americans said they would be willing to get the vaccine, a rate public health communicators and educators are working to increase.
Photo by Spencer Platt, courtesy Getty Images
Ratzan is co-founder of Convince USA, launched in December as part of a global project to increase understanding of why some people are less willing to get a COVID-19 vaccine. The project plans to release resources to help public health workers build vaccine literacy and acceptance in their communities.
“We need to find the right messages and the right messengers and convince people to become (vaccine) ambassadors among their friends and community,” said Ratzan, who is editor-in-chief of the Journal of Health Communication: International Perspectives.
A December Morning Consult poll found that a majority of U.S. adults turn to their families for vaccine guidance.
Amelie Ramirez, DrPH, director of Salud America at UT Health in San Antonio, Texas, said using a role-modeling strategy featuring messengers who look like and share familiar cultural experiences and values with their audiences will be key to engaging diverse Hispanic communities, where adult immunization rates are already much lower than among whites. Bilingual messaging attuned to people’s health literacy levels will also be key, she said.
“I think we can certainly lean on what we already know (about vaccine communication) and act quickly, especially since COVID-19 is hitting our communities so disproportionately,” Ramirez told The Nation’s Health. “But more research is needed...We have a very hard job ahead of us.”
Mistrust is also high among Black Americans, a result of historical and ongoing racism and mistreatment within the health care system. In a fall 2020 survey conducted on behalf of the COVID Collaborative, NAACP and UnidosUS, just 18% of Black respondents trusted that a COVID-19 vaccine would be effective, and only 14% trusted it would be safe.
Camara Phyllis Jones, MD, MPH, PhD, an epidemiologist, family physician and anti-racism activist, said central to engaging with Black communities is acknowledging the legitimacy of mistrust and being fully transparent in answering questions.
But even then, it may not be enough. To build trust, strong protective actions are needed on other fronts, such as enforcing safer workplaces and ensuring that front-line and essential workers have adequate protective equipment, Jones said. That would help send a message to people of color, who bear disproportionate health and economic impacts from COVID-19, that their lives matter on their own and not merely to build herd immunity.
“Messaging on vaccines needs to be paired with real action that protects people,” Jones, a former APHA president, told The Nation’s Health. “We need messaging with words and messaging with resources.”
In Nevada, work is underway to share vaccine messaging via community health workers who deliver flu shots in settings such as barber shops and churches. The effort, a partnership between Immunize Nevada and the Southern Nevada Health District to reach underserved communities of color, had administered about 3,000 flu shots by early January, said Carol Luna, program director at Immunize Nevada. The hope is to leverage the trust built up through the flu program into future COVID-19 vaccination programs in the communities.
“Engaging community health workers was key for us, because we knew we’d need it going into COVID-19 vaccine distribution,” said Heidi Parker, MA, executive director of Immunize Nevada.
In many places, vaccine education experts are overwhelmed responding to a surge of COVID-19 infections and managing unprecedented vaccine distribution logistics, leaving little capacity for much else, said Lilly Kan, MPH, senior director of infectious disease and informatics at NACCHO. Fortunately, local health departments can lean on longtime community connections to crowd out misinformation, she said.
“Leveraging trust where it already exists will be critical,” Kan told The Nation’s Health. “It has to be an all-hands-on-deck approach.”
For more on COVID-19 vaccine education, visit www.debeaumont.org and www.naccho.org. For additional COVID-19 information from trusted sources, see APHA’s www.covidguidance.org.
- Copyright The Nation’s Health, American Public Health Association
