Four Steps To Help Achieve COVID-19 Vaccine Adoption: How Health Professionals Can Embrace Their Role As Messengers – Health Affairs

Recently, the Centers for Disease Control and Prevention (CDC) announced updates about reactions to COVID-19 vaccines. They reported that—as of December 18, 2020—3,150 of the 112,807 (2.8 percent) people receiving a first dose reported “health impact events” requiring missing work or seeing a doctor. These numbers may appear frightening, but data from clinical trials are reassuring that Pfizer and Moderna COVID-19 vaccine side effects are generally mild. The country needs to ensure Americans understand that rising absolute numbers of side effects need not imply a higher rate of reactions—nor that the risk-benefit profiles have changed.

Stepping back, this announcement is a reminder that COVID-19 vaccine distribution introduces daily exercises in health communication—and that health care workers are ideally positioned to help with this role. Health professionals remain the most trusted source of vaccine information. How nurses, physicians, interpreters, pharmacists, and others speak about vaccines matters for two reasons: Patients seek their advice for personal decisions, and health workers are social endorsers by virtue of getting vaccinated first. While large-scale messaging and public health campaigns may often be the domain of public health institutions, health professionals can leverage their credibility to amplify messages, whether through their offices and communities, or by engaging with social media and local outlets as many have already during the pandemic. Yet, given vaccines are being distributed amid the pandemic’s broader uncertainty, some providers may find themselves underprepared for this job.

And this task could not be more critical. Despite the CDC announcing that 10 million doses have been distributed, curbing the pandemic requires achieving durable immunity in approximately 60–70 percent of the US population—197 to 230 million people—primarily through vaccines. While confidence in COVID-19 vaccines has increased, more than a quarter of the population reports still being hesitant, indicating that they “probably or definitely would not get a COVID-19 vaccine even if it were available for free and deemed safe by scientists.”

To optimally leverage their position as vaccine messengers, health professionals can use four strategies.

Recognize Hesitancy Is Not Monolithic

It is simplistic to consider reluctance to accepting COVID-19 vaccines monolithic. A better taxonomy for vaccine hesitancy might subdivide individuals into groups with historical mistrust of the health care system, particularly communities of color; individuals concerned about insufficient data on long-term vaccine side effects; and people convinced by misinformation.

To be sure, these descriptions are likely still too simplistic. Consider recent polling data from the Henry J. Kaiser Family Foundation (KFF), which further characterizes participants into four levels of vaccine enthusiasm: “as soon as possible” (34 percent), “wait and see” (39 percent), “only if required” (9 percent), and “definitely not” (15 percent). The same poll finds White adults are spread across these groups; for example, about one-third prefer to “wait and see,” while 15 percent say “definitely not.” And reasons underlying these attitudes vary; among White adults who are hesitant, 56 percent are worried about side effects, 49 percent believe risks of COVID-19 are being exaggerated, and 36 percent do not trust vaccines in general.

Not only are these attitudes nuanced, but they are also shifting as the pandemic timeline advances. The KFF poll found 12 percent greater vaccine enthusiasm among Black adults compared to a September one.

Conflating the distinct reasons influencing a patient’s views may threaten a patient’s trust, just as other one-size-fits-all approaches previously have in public health. Instead, a clinician with this awareness, combined with the curiosity to understand a patient’s specific concerns and motivations, can facilitate personalized conversations. For many people, a health professional who makes space to listen to them, acknowledges the drivers of their hesitancy, and offers tailored information may help promote vaccine adoption.

Learn From Disinformation Campaigns

The stickiness of misinformation holds lessons for public health campaigns. The “Plandemic” conspiracy theory, for example, incorrectly convinced millions that COVID-19 was intentionally planned and gained more attention than the most popular 2020 online events. Experts from FirstDraft, a nonprofit addressing misleading information, have identified two features that make many disinformation campaigns compelling: They are usually visual and participatory.

A recent investigation of COVID-19 vaccine narratives—which examined 14,394,320 posts on Twitter, Instagram, Facebook Pages, and public Facebook Groups—found that “photos and videos accounted for 51 percent of all content.” While clinical agencies regularly issue fact sheets or lengthy PDF booklets about COVID-19, misinformation campaigns often stem from an emotionally appealing visual, such as this meme.

In addition to using visuals, disinformation communities regularly involve participation from individuals. FirstDraft describes how conspiracy groups such as QAnon are “democratized” and have been compared to a “massive multiplayer online game.” To help people feel empowered in this way, clinicians can partner with their clinic or health system, local organizations, and public health institutions to deliver community-based messages and visual narratives. Creative visuals, such as NYC Health + Hospitals’ graphics with the Statue of Liberty receiving a COVID-19 vaccine, can be displayed to patients in waiting rooms and offices. Clinicians could convene clinic COVID-19 vaccine information task forces, involving participation from patient volunteers, to define messaging approaches and organize vaccine campaign events.

Avoid Offering False Reassurance

Health workers must be careful not to overstate the current science or offer false reassurance, which research demonstrates can backfire and betray trust. Instead, messages can focus on the process and what is understood.

For example, a clinician might acknowledge that the COVID-19 vaccines are new and developed quickly but explain each one was trialed on thousands of people in a scientifically legitimate fashion. When faced with questions about side effects, one can acknowledge the magnitude of people experiencing severe reactions but convey the base rates of these events as the appropriate anchor (for example, how many people in the absence of a vaccine experience anaphylaxis or a heart attack in a given day). They can emphasize that with about 95 percent effectiveness, the two approved vaccines are among the most effective vaccines ever created. They can also point to infrastructure that often escapes public attention, such as the CDC’s unprecedented post-marketing vaccine safety surveillance system.

An approach that acknowledges worries while responding with only fact and evidence will prove most effective in the long term.

Shift Traditional Public Health Messages To Community-Based, Hopeful Ones

Public health messaging has historically taken the form of one-way communication. A senior figure—perhaps an elected official or an institution—might issue a public service announcement on television or an agency website heavy with text. The tone is often doom and gloom or negative, instructing people what they should not do. But addressing concerns about a COVID-19 vaccine necessitates creative approaches.

After months of quarantine and economic depression, people may resonate less with pessimistic messages than with hopeful ones. Vivek Murthy, MD, 19th Surgeon General of the US and nominee to be the 21st, recently summarized, “We’re always telling people, ‘No, no, no.’ Don’t eat that slice of pizza. Don’t drink that beer. Don’t smoke that cigarette…. Instead, [we have] to create guidance that helps people get to ‘yes.’” A hopeful visual message might, for instance, depict how a COVID-19 vaccine will help restore love and community through herd immunity.

As important to the content is how the message is delivered. Clinicians can engage people where they are: YouTube, TikTok, Instagram. The process of spreading accurate information about vaccines can move from a monologue to a conversation. On these media, people can participate, such as by asking a question in an Instagram Live or sharing a photo of a vaccine button analogous to the “I Voted” US election sticker.

Taken Together: Positive Social Momentum Around Getting A COVID-19 Vaccine

Health professionals have an opportunity to be the conduit for accurate, hopeful information about COVID-19 vaccines. Their messages may gain the most traction if they understand the nuances of hesitancy, use visual and participatory narratives, convey facts over blanket assurances, and center around hope. Taken together, these tactics can build positive social momentum around getting a COVID-19 vaccine when the chance arrives.

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