But for these vaccines to bring the pandemic to an end, enough people need to be willing to take them. That’s not a given.
Various polls have told a story this year about a rising tide of hesitancy. Polls in September showed a slim majority of Americans – 51 percent in one survey – are willing to take COVID-19 vaccines. More recent surveys show a slight uptick in confidence.
About 65 to 70 percent of people will need to either survive COVID-19 infections or get vaccinated in order for us to achieve herd immunity, according to the World Health Organization. In the U.S., that’s 182 million adults. (Based on 70 percent of 260 million US adults, according to US Census Bureau.)
While vaccines for infectious diseases such as measles, polio, tetanus and smallpox are widely regarded as the greatest public health interventions in history after clean drinking water, global vaccination rates have been flattening or declining in many parts of the world for the past two decades.
Vaccine hesitancy is a complex phenomenon. It is rooted in social and cultural issues like parental authority, historical experiences, religious views and confidence in various information sources. Anyone can be vaccine hesitant — there’s not a clear correlation between levels of education, wealth or access to information and vaccine hesitancy.
The traditional public health communications response in the face of these trends has been to speak louder and more emphatically about the importance of vaccination and to highlight the risks of vaccine refusal on communities. It hasn’t worked.
That’s because the conversation about vaccines isn’t really about vaccines. Writing about cases where communities have refused vaccination, Heidi J. Larson, Ph.D., director of the Vaccine Confidence Project in London and author of Stuck: How Vaccine Rumors Start—and Why They Don’t Go Away says:
“Vaccine revolts unleash underlying sentiments about personal and collective histories, relationships with government, big business and international bodies.”
Vaccine hesitancy, it seems, is about power, fear and trust. Overlay these trends on our pandemic moment – with declining trust in our public health institutions, rising misinformation, a polarized media and social media environment –and it’s a recipe for resistance.
So how do we respond? I’ve seen people ask who this generation’s Elvis Presley is, suggesting that a well-lit photo of the right celebrity will turn the tide of public opinion. There’s certainly a role for celebrity influencers, but if vaccine hesitancy is rooted in issues of power and control, something more will be needed. COVID-19 presents an opportunity to do something dramatically different in vaccine communications, an approach that abandons a paternalistic tone in favor of a shared decision-making model and potentially reframes the problem of vaccine hesitancy.
There are some efforts like this underway. In July, an interdisciplinary working group convened by the Johns Hopkins Center for Health Security produced a report urging the groups involved in vaccine development to take a ‘design thinking’ approach that put the public at the center of the effort. The recommendations emphasized the need to understand public expectations, earn public confidence in the fairness and even-handedness of vaccine allotment and availability, make vaccines available in familiar settings and communicate in meaningful, relevant and personal terms.
We can do this. But it means rethinking how we talk about vaccines and how we engage people around them. From a positioning standpoint, vaccination messaging has to be grounded in the science, but it has to focus on things that are more personal and meaningful than efficacy and safety information. Think about common everyday concerns — jobs, schools, restaurant dining, travel — that will be enabled by a successful vaccination program.
It also requires a dynamic set of outreach and communications strategies that will be rooted not in selling but in education and engagement.
Here are a few examples of things various stakeholders should consider doing:
- Vaccine manufacturers should produce robust analyses of their data in peer-reviewed publications and ensure wide distribution of their findings to key opinion leaders (KOLs), relevant medical societies, allied health professionals and patients, the latter using patient-accessible language
- The federal government should lead a strong vaccine distribution effort, prioritizing the geographies and communities where the vaccine can be most effective in mitigating the spread of COVID-19 and protecting frontline workers and vulnerable populations
- State and local governments, in coordination with federal authorities, should create awareness campaigns that position vaccines broadly as an offer, not a mandate, but that emphasize their value in ending the pandemic
- Insurers and policymakers should set minimal copayments or waive cost-sharing provisions for vaccines to ensure broad access, particularly for the most vulnerable people
- Healthcare professionals should counsel people with patience, recognizing that in many cases the concerns people express in rational terms may often reflect emotional issues such as fear, vulnerability and powerlessness
- Advocacy groups should create tailored communications for their audiences, particularly patients with health conditions that put them at higher risk for severe COVID-19
- Employers, who have found themselves in the unaccustomed position of communicating about health-related topics to employees and customers, should embrace an appropriate role in vaccine communications, educating leadership teams on vaccine data and recommending vaccination to employees, particularly those in roles that place them at risk of infection
- Nonprofits that serve at-risk communities should redouble outreach efforts to reach those whom the pandemic has shown are so clearly disproportionately impacted by COVID-19
- Vaccine experts, public health experts and epidemiologists in academia and government should serve as trusted sources to media outlets and other communities (including social media) to address misinformation and disinformation in clear but compassionate terms
- Media outlets should write extensively about vaccine issues — the good and if necessary, the bad — and aspire to provide a fully accurate picture of the risks and benefits, knowing that in past vaccine experience there has been an overemphasis on stories that lacked a scientific basis in fact
- Government should make an effort to engage and solicit involvement from influencers, even non-scientific ones, who have a strong following in key communities and on social media. In so doing, there should be an effort to provide them with access to trusted, scientific sources and resources that can help them shape their comments in accurate ways
- Social media platforms should monitor and flag factually inaccurate posts and point participants in the direction of accurate information
- Celebrities who appeal to different age, gender and demographic groups should join the cause, reinforcing trust in trustworthy sources and encouraging people to ask the right questions and take appropriate actions
In short, it will take a team effort. A big one. One that is less reliant on authority and more invested in transparency, authenticity and two-way communications. An effort that treats people like they’re smart, have agency and can make their own decisions. Which, after all, is true.
We all have a stake in ending this pandemic. We appear to have worked out crucial aspects of the science. That, in turn, gives us the opportunity to talk about the science in transparent, accessible ways, and engage people in the decision about getting a vaccine with dignity. In so doing, we can achieve the goal of herd immunity that would end the pandemic.
Over the long term, this new model for communication about COVID-19 vaccines could set the stage for more successful vaccination campaigns. That’s worth our valuable time and energy.
Mike Kuczkowski is the founder and CEO of Orangefiery, a consulting and communications firm that serves biotech, pharmaceutical and nonprofit clients in healthcare. With more than 25 years of experience in consulting, communications, politics and journalism, he and his team help organizations navigate complex issues of public interest and create growth and change through a combination of insights, messaging, engagement and organizational learning. He is a trustee of the Institute for Public Relations.