With all Americans 16 and over now eligible to receive a coronavirus vaccine, health-care workers and public health officials are turning their attention to the approximately one-third of Americans who say that they are on the fence or that they do not want to get vaccinated.
No single message will persuade everyone, but experts say a combination of strategies is already convincing reluctant people that getting vaccinated is for them.
Here are some of those strategies, from the broadest to the most personal.
Make vaccination visible
For any strategy to work, people first have to perceive vaccination as a normal part of life.
That is why public health officials, nonprofit groups and major brands are collaborating on nationwide public service campaigns and partnering with celebrities to make vaccination more visible.
The model for the celebrity shot dates to 1956, when few teenagers were getting the year-old polio vaccine. Two critical things happened that fall to reverse the trend.
First, 21-year-old Elvis Presley got the shot in front of cameras before “The Ed Sullivan Show.” Second, the March of Dimes launched a wildly successful peer-to-peer campaign among teen social groups. In short, it leveraged the cool kids, but it may not have gotten the cool kids without the King.
The wide range of celebs touting coronavirus vaccines includes musicians and actors (such as Elton John, Britney Spears and Lin-Manuel Miranda), sports personalities (Patrick Mahomes, Richard Petty, Kareem Abdul-Jabbar), WWE stars and Fox News personalities. “Don’t be such a chicken-squat,” chided country music icon Dolly Parton in a video as she got an injection of the Moderna vaccine, which she helped finance. “Afterwards, I felt like superwoman,” Oprah Winfrey wrote.
Broad public service announcements, however, inevitably turn some people off. One person may find Google’s “Get back to what you love” message poignant, while another finds it manipulative.
“No national ad campaign is ever going to be as effective … as people who look like you and come from your community saying: ‘This is important. It’s the right thing for us,’” said Kelly Moore of the vaccine education group Immunization Action Coalition.
It’s why the polio campaign needed both Elvis and the teens next door.
Have nationally trusted messengers recommend it
The opinions of our leaders matter, whether that is the president or a prominent public health official such as Anthony S. Fauci, the nation’s top infectious-disease expert.
“When the people in the front of the room — political leaders and so on, people in charge of vaccination — speak up in favor of vaccination, confidence rises and stays high,” said University of North Carolina researcher Noel Brewer, who studies the intersection of public health and human behavior. “When the government and the folks in charge of vaccination do not speak in favor of it, confidence falls.”
Both of those scenarios have played out since the first vaccine became available in December.
Although President Donald Trump led the initiative that sped vaccines to the market, he was vaccinated privately in January before leaving office and did not disclose it or encourage his supporters to get a shot until March. (Vice President Mike Pence and his wife were vaccinated on television in December.)
It was a puzzling missed opportunity to celebrate a big achievement, Brewer said, “and we see the remnants of that in today’s society.” According to an Economist-YouGov poll released this week, 30 percent of Republicans said they would not get vaccinated, compared with 22 percent of adults overall.
While politicians’ cheerleading can be useful for some, it won’t convince everyone. A focus group of vaccine-hesitant Trump voters last month said pitches from politicians — Trump included — were not persuasive.
It is the medical professionals who can best convey the possible risks of both the vaccines and the disease to a jittery public, Moore said.
This is why many are still listening to Fauci.
“He established trust by saying things people didn’t want to hear when they needed to be said, then also saying encouraging things,” Moore said. “There is nothing more easily lost in this process and nothing more precious in the process than that real trust.”
But not everyone likes what he has to say, either. This week in a different focus group, vaccine-hesitant Trump voters said they do not want to hear from Fauci.
Make vaccination come with privileges
Of the many strategies Brewer and his colleagues explored in a 2017 study on the psychology of vaccine uptake, one of the most effective was simply requiring it.
For some people, being allowed to travel to see the grandkids, to take a cruise or to return to the office or school is enough of an incentive to persuade them to get vaccinated. According to a Kaiser Family Foundation poll conducted in late March, 7 percent of respondents said that they would get a vaccine “only if required.”
However, that step cannot occur before people believe vaccinations are safe.
“If there’s not some community-wide level of confidence in the vaccine,” Brewer said, “policymakers cannot implement all of these super-effective approaches without receiving a great deal of blowback from the general public.”
In the Economist-YouGov poll, 61 percent of respondents thought the Moderna vaccine was very safe or somewhat safe, compared with 59 percent for the Pfizer-BioNTech vaccine and 42 percent for the Johnson & Johnson vaccine.
Pushback against “vaccine passports” has already begun in the United States, even though the Biden administration has said it does not plan to create them. But private businesses such as cruise lines, sports teams and others are already beginning to require proof of vaccinations.
“Being confident in the vaccine and deciding to get vaccinated — those need to be voluntary, personal decisions,” said Elisabeth Wilhelm, a vaccine confidence strategist with the Centers for Disease Control and Prevention. “We ask people to think very, very carefully when they talk about incentives, whether it’s a bag of rice for your kid getting vaccinated in Nigeria or getting a coronavirus vaccine in your workplace in the United States. It is a lever that can be used — it just should not be the first that you pull on.”
Tailor the message to the audience
Traditionally, public health messages — from smoking cessation to seat-belt campaigns — have been broadcast widely, on billboards, in public service announcements and on popular TV shows. That one-size-fits-all approach doesn’t work well for vaccines, experts say, because pregnant women, for example, probably have concerns very different from those of Republican men or Latino immigrants.
“When it comes to vaccine hesitancy, it is more like personalized medicine,” said Christopher Graves, founder of the Ogilvy Center for Behavioral Science at Ogilvy Consulting, “more customized to specific worldviews and cultural filters.”
And unlike conventional vaccine messaging, which aims to persuade parents to get children vaccinated, the coronavirus messages are aimed at persuading adults to get their shots.
“Respecting their autonomy is important,” Moore said.
As is adapting the message to the recipient.
People who say they prize individual choice are more likely to be convinced by messages emphasizing that getting vaccinated increases your freedom to get together with friends and colleagues, experts say.
Gabriel Salguero, founder of the National Latino Evangelical Coalition, said he is using biblical references in his sermons to quell the fears of some Christians who falsely believe the vaccines contain microchips or fetal tissue or are an ominous sign of the End Times.
Successful messaging isn’t only about finding the right words. Olajide Williams, a Columbia University neurologist, uses music and art in the Hip Hop Public Health program to reach communities of color.
And for those who are skeptical of the science, data can make a real difference: 95 percent of doctors who have been offered a vaccine have taken it — a figure that helped turn around 19 vaccine-hesitant Trump voters who took part in a two-hour virtual focus group.
“The one group everyone trusts is doctors,” said Claire Hannan, executive director of the Association of Immunization Managers, a nonprofit that coordinates with states to control vaccine-preventable diseases.
Have friendly faces in familiar places
While many people are eager to sign up for mass vaccination sites, others are unable or unwilling to take a place in line, for reasons such as a lack of transportation or worries about showing up at sites where staffers are often dressed in uniform.
When it comes to relieving those worries, nothing beats a friendly face in a familiar place, say experts who have documented the value of enlisting primary-care physicians, community leaders and pastors. It’s better still if the shot can be given right there, in their office or sanctuary.
“It’s one thing for a pastor to say it, another to have a pop-up vaccination site in the church,” Wilhelm said.
In Maryland, the Health Advocates In-Reach and Research Initiative (HAIR) is using barbershops and beauty salons to debunk misinformation within the Black community.
Ideally — and particularly if an easily stored, single-shot vaccine were widely available — doctors could offer shots during regular appointments, just as they do the flu shot.
“It is done as a matter of routine, rather than a big issue,” said former CDC director Tom Frieden, who has advocated for primary-care physicians to play a bigger role.
Messengers need to be honest about risks, communicating how they compare with the benefits, said Moore, who advocates for transparency with issues such as the rare but worrisome clotting associated with the AstraZeneca and Johnson & Johnson vaccines. Federal officials paused the use of the Johnson & Johnson vaccine last week.
“If you hedge, you can undermine the entire vaccination campaign in a moment if you appear to be covering up,” Moore said.
And trusted spaces exist on social media, where small groups can engage in Q&A sessions or Facebook live streams.
Meeting people where they are could even involve going door-to-door, as in a political campaign or with the census.
The key to getting more people vaccinated, said UNC’s Brewer, is “to make it easier.”
Make vaccination routine in peer groups and social networks
Seeing Elvis or Fauci getting vaccinated is helpful. But most people who are considering getting the shot want the answer to a straightforward question.
“Are people like me taking this vaccine, and how are they doing?” said Bruce Gellin, president of global immunization at the Sabin Vaccine Institute.
You are more likely to roll up your sleeve, Gellin and other experts say, if you’ve talked to your neighbor, co-worker, cousin or golf buddy about having done so.
That’s why the Philadelphia Department of Health began building connections with vaccine role models people may spot in their neighborhoods rather than on TV or at the ballpark, looking to block captains, pastors and barbers to lead the way.
“They are people where someone will say: ‘I know this guy. I’ve seen them on the block,’” said James Garrow, the department’s communications director.
Vaccine experts leverage the peer pressure with other tools, giving out “I’m vaccinated” stickers and buttons, offering selfie opportunities at mass vaccination sites and encouraging people to post their just-vaxxed pictures online to create a sense of solidarity. “Vaxxies” have become one of the defining social media images of 2021.
It’s all about creating links with people where they are — online or in person.
“Don’t mute your crazy uncle,” said the CDC’s Wilhelm. Instead, she said, share your experience with family and friends and talk to them about the advantages of getting a shot — such as new opportunities to get together safely.
The bottom line, Wilhelm said, is that vaccination is contagious.
Scott Clement contributed to this report.