Public health education is the best way to get COVID shots in arms

As we crossed another grim milestone — 500,000 American lives claimed by COVID-19 — accelerating vaccine distribution efforts provide a promising light at the end of the tunnel. But one issue threatens to prolong the pandemic: a sizable percentage of the U.S. population is not ready to roll up their sleeves and get vaccinated.

While the number of U.S. adults who intend to get vaccinated appears to have increased in late 2020, many still have concerns and do not plan to get vaccinated, taking a wait and see approach.  This could prolong the pandemic. One survey found that approximately 40 percent of the public is hesitant to get vaccinated, including some healthcare providers and groups disproportionately affected by the virus. A handful of other surveys have generated similar findings and Centers for Disease Control and Prevention’s data show that Black and Hispanic communities are less likely to get vaccinated than whites. And one-third of military members have refused vaccination, especially young, enlisted members as compared to officers. 

To tackle vaccine hesitancy, we need a national public health education campaign like no other we have seen in this country. 

Recently, the Ad Council and the COVID Collaborative unveiled the “It’s Up to You” advertising campaign to encourage Americans to get the vaccine. Images and messages from the campaign are now appearing across TV and digital video, social media and audio platforms nationwide, which feature focused messages to reach skeptics, including those in Black and Hispanic communities. However, different areas of the country may have different information needs and face different vaccine implementation challenges.

Here is what should be front of mind.  

The campaign must emphasize that while the vaccines were developed more quickly than in the past, pharmaceutical companies and their partners did not cut corners with safety. Messaging this to the public will mean explaining key terms and concepts, including those used by regulatory agencies like the Food and Drug Administration. For instance, how does an “emergency use authorization” differ from typical FDA approval? It also will require illuminating terms used in the clinical trials and gaps in public understanding of COVID-19. What is a “serious adverse event,” how does it differ from a common event, like a sore arm and who is collecting this information? 

While people in the medical and pharmaceutical communities understand these nuances, most people do not. We cannot address vaccine hesitancy without first breaking through the jargon.

The campaign should explain the potential benefits of the vaccine, steps being taken to address potential risks, including side effects, and communicating about what is unknown. Scientists are still learning how well vaccines prevent people from spreading the virus that causes COVID-19 to others, even if a vaccinated person does not get sick.  This is one reason why mask wearing is still recommended along with other COVID-19 safety measures.   

The campaign should also address misinformation, demonstrate empathy and try to assuage concerns about privacy. Trust in pharmaceutical companies is universally low, and mistrust of government and medical institutions is higher among Blacks than whites. This mistrust could lead people to worry about personal information they are asked to share to get vaccinated and how their information will be used by third parties.

The kinds of personal information required for vaccination may vary depending on whether people are vaccinated through their employer, their primary care provider, a mass vaccination clinic or another setting. The public needs to be told how the information will be used, how it will be protected and how their confidentiality will be maintained. 

Once these messages are tested and refined, they need to be disseminated through print and online platforms.

Interpersonal communication is also a key component of addressing vaccine hesitancy. Although healthcare providers are trusted sources of information about vaccines, it can be challenging for providers to find the time for in-depth vaccine-related discussions with their patients. Not having an insurance billing code specifically for vaccine counseling may also serve as a barrier to sufficient patient-provider communication.

Numerous reports indicate that some healthcare workers are abstaining from vaccination. A large-scale survey sponsored by the American Nurses Association found that 66 percent of respondents were very comfortable speaking with patients about other vaccines, but only 18 percent were very comfortable discussing COVID-19 vaccines. Healthcare providers need tools and resources to build their confidence and skills in counseling patients about COVID-19 vaccine safety and efficacy. 

It is not enough to have authorized vaccines. We must also educate, motivate and facilitate the public getting vaccinated at their earliest opportunity. Because of the lack of a national public health education campaign about COVID-19 , the media has stepped in to fill the information vacuum to date. Campaigns should evolve over time based on information needs and as the science evolves. It is also important to  evaluate the impact of the campaigns to learn from them and plan for the future.  

At the heart of the Biden administration’s national COVID-19 vaccination agenda is addressing vaccine hesitancy and promoting uptake of the vaccine. The “It’s Up to You” campaign may be a strong start. Until we provide the information the public needs through focused, rigorously tested messages, a substantial proportion of people may not be comfortable rolling up their sleeves.

Let’s not give COVID-19 a chance to overstay its welcome.

Jennifer E. Gerber, PhD, MSc, is an epidemiologist at RTI International with a background in vaccine science and policy (@je_gerber). Lauren McCormack, PhD, MSPH, is vice president of RTI International’s Translational Health Sciences Division and an adjunct associate professor, University of North Carolina Gillings School of Global Public Health(@Lmac7).