Now that the Pfizer-BioNTech and Moderna Covid-19 vaccines have been granted Emergency Use Authorizations, the U.S. could start to move toward a pre-pandemic normal over the next year. But that is dependent on enough people taking the vaccine.
Various polls have pegged the proportion of Americans willing to get the Covid-19 vaccine at around 50%. Though polling shows willingness to receive the vaccine has ticked up, a sizeable portion of the population remains either hesitant or unwilling to receive a vaccine for Covid-19, skeptical that vaccines made so fast are safe.
“I think hesitancy is to be expected,” said Wen-Ying Sylvia Chou, program director of Health Communication and Informatics Research Branch at the National Cancer Institute’s Behavioral Research Program. “The acceptance of vaccines has been a public health concern.”
The healthcare field has spent the better part of a year trying to treat and prevent the spread of Covid-19. Now they’re also tasked with addressing Covid-19 vaccine misinformation and showing the public the value and safety of vaccination. Vaccines save up to three million lives each year, but for a variety of reasons, some still have reservations about their necessity or safety. Past vaccination campaigns have revealed ways to communicate the benefits of vaccines, and now that Covid-19 vaccines are in use, healthcare professionals are drawing on those experiences.
Hesitancy to receive vaccines, not just the Covid-19 vaccine, is an old phenomenon. People may not seek out or may refuse vaccines because they don’t perceive that they’re at risk for disease or because they lack confidence in the vaccine. It might be inconvenient for someone to make and attend a vaccination appointment. But the Covid-19 vaccine introduces new concerns.
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“Covid vaccination behavior is very different, very different than some other vaccination behaviors,” said Chou. One reason for this is speed. “There’s never been such a rapid development of a brand new vaccine or a set of vaccines…this is faster than anything we’ve seen.” Previously, the mumps vaccine held the record as the fastest vaccine ever developed, at four years, while multiple Covid-19 vaccines have been made in less than one year.
“That’s different from how we’ve done it before, layered on top of what looks like it might have been a very politicized approval process,” said Alison Buttenheim, an associate professor in nursing and health policy at the University of Pennsylvania, and scientific director of the Center for Health Incentives and Behavioral Economics. A YouGov survey found that half of about six thousand U.S. adults surveyed believed the speedy vaccine development was motivated by political interests more than public health concerns.
In a report from the National Institutes of Health on Covid-19 vaccination communication, Chou and her coauthors stress that identifying and addressing the concerns of different communities will be critical elements of Covid-19 vaccine campaigns.
“There are a few tools we have in the toolbox that we know are really effective,” said Buttenheim. One strategy supported by behavioral science is having trusted figures or celebrities publicly receive the vaccine.
“I think about the example of Elvis Presley taking the polio vaccine,” said Chou. In 1956, he received the vaccine on live, primetime television, backstage at the Ed Sullivan Show. “This is a guy that has such popularity, so I think that is a message that promotes unity.”
In this strategy, which psychologists call “credibility enhancing displays,” a trusted figure like a celebrity or community leader engages in a behavior, like receiving a vaccine, to encourage others to do so. It shows that the figure believes in their actions or, in this case, trusts a vaccine.
When vaccines are urgently needed but in limited supply, celebrity endorsements might have negative effects. Even if people want to wait and see how others respond to the vaccine before getting it themselves, “they also want to feel like people aren’t jumping the queue,” said Buttenheim. “In addition to the safety profiling process being transparent, we also really want the allocation process, who gets vaccines, to be transparent and feel fair to people.”
Working with community leaders, not just celebrities, to craft messages promoting vaccines has proven effective at inspiring trust in the past. But it’s important that these leaders have shared experiences with others in their community.
“Sometimes you need a spokesperson who is of the same racial or ethnic background, but that’s not enough,” said Chou. Watching a celebrity — who has access to high-quality medical care — of a certain racial or cultural background publicly receive a vaccine may not be enough to persuade people of that same background, without that same access to care, that a vaccine is safe. “We need to think about relatable experiences and the messengers need to come from those communities,” said Chou.
These messengers might also know which vaccine concerns affect their communities. “We don’t want to dismiss people’s concerns,” said Chou. “There are vaccine-hesitant parents very worried about a child who is immunocompromised or pregnant women not sure if this vaccine is safe for them. And these are very legitimate and valid concerns.” Any vaccine-related messages, she added, need to respect those concerns.
Buttenheim stressed that transparency about the vaccine and safety data is also key to earning trust. To make the safety profiling process more transparent, the FDA’s Vaccines and Related Biological Products Advisory Committee meetings to discuss Emergency Use Authorization of the Pfizer-BioNTech and Moderna vaccines were live-streamed to the public. Full recordings of the eight- to nine-hour meetings were posted to the FDA website. These discussions, Buttenheim said, have been “quite transparent, we know what data they’re looking at.”
Part of transparency is also being clear about what the vaccine can and can’t do. In the NIH report, Chou and her co-authors write that messages about the vaccine should acknowledge the unknowns while pointing out that as the science progresses, knowledge about the vaccines could change. They write that messages should also be clear that the vaccine won’t solve the pandemic overnight, or even in a month; 75-90% of people need to be vaccinated for everyone to resume normal social and working lives.
For the time being, states are focused on distributing the limited doses they have to frontline healthcare workers. Buttenheim, who serves on Philadelphia’s Covid-19 Vaccine Advisory Committee, estimates that her region is still a few months away from launching efforts to engage the general population with vaccine promotion campaigns.
“There are lots of discussions about what we need to do now, should we be surveying people, should we be identifying opinion leaders,” said Buttenheim. “All those gears are just starting to engage and chug away, but it’ll take a few months.”
But the virus is still spreading now, underscoring the urgency of vaccination. “We are not protected right now. If we’re afflicted by this virus, a lot of things can go wrong and there are no cures,” said Chou. “We need to make sure that people understand [vaccination] is not a political decision.”