Studies suggest that many Americans will not accept this new vaccine — at least not right away. In a recent Pew Research Center survey, only 51 percent of U.S. adults indicated their willingness to take a coronavirus vaccine. Distrust is even higher among communities of color. This hesitancy may impede herd immunity even once a safe vaccine is available in wide supply. A lot of this mistrust is likely to be a result of recent attempts, especially by President Trump and his aides, to interfere in the scientific and regulatory review process. In the Pew survey, only 19 percent had a high level of confidence that the vaccine development process will yield a safe and effective product.
Building trust in a new vaccine starts with ensuring a transparent, science-based regulatory process. Despite political pressure by the Trump White House, career professionals at the Food and Drug Administration, backed by a few political appointees, have taken steps to ensure evidence-based review of candidate vaccines in recent weeks.
These steps are essential for restoring vaccine confidence, but they are not sufficient. A large enough number of people won’t take the vaccine without a national communication and education campaign. Such a campaign was recommended by the National Academies of Science, Engineering and Medicine. Unfortunately, there has been minimal investment in such a campaign and other efforts to increase confidence in a vaccine. While the Centers for Disease Control and Prevention received $200 million for vaccine preparedness from the Cares Act, this money is supposed to cover all activities, including distribution and administration, not just communication and education. This money is not enough for vaccine distribution, let alone for communication and education.
The United States has never immunized its population in the numbers needed to establish herd immunity against SARS-CoV-2. That means we’ll be embarking on an immunization program of unprecedented scale — which requires a communication campaign to match. Fortunately, there is money already authorized for communications about covid-19, about $250 million. Unfortunately, the Trump administration originally earmarked it for a Department of Health and Human Services advertising campaign to counteract “covid despair,” which has since been canceled. But that money could be reallocated for informing people about the vaccine, either now or after the Biden administration takes over in January.
A national vaccine communication and education campaign needs to fulfill three goals: It must restore trust in vaccines, be national in scope and — at the same time — engage local communities, particularly communities of color. Here are a few strategies that could help accomplish these goals.
First, leverage trusted vaccine endorsers. In a survey experiment, my colleagues and I found that a coronavirus vaccine endorsed by Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, increased acceptance of the vaccine as well as willingness to take it among Democrats, Republicans and independents. We found that a bipartisan endorsement of a vaccine by Trump and House Speaker Nancy Pelosi (D-Calif.) had about one-third to one-half as large an impact as an endorsement by Fauci. A joint endorsement by prominent Republicans and Democrats as well as prominent scientific leaders would go a long way. This is not a pipe dream, either: There has been bipartisan support for vaccines in Congress. For example, prominent congressional Democrats and Republicans — including Senate Majority Leader Mitch McConnell (R-Ky.), a polio survivor — have a history of supporting vaccines.
Ethnic and racial minority groups in the United States have been disproportionately harmed by the pandemic: African Americans had a covid-19 mortality rate twice that of Whites. Higher mistrust of a vaccine in communities of color is grounded in the ugly history of public health and medical exploitation of people of color.
This distrust will not be easy to overcome. But the glaring racial and ethnic disparities in the impact of the pandemic will only get worse if authorities don’t address mistrust of vaccines among those disproportionately harmed, which will compound this tragedy.
Getting communities engaged with the vaccine will be easier with a scalable template. One approach involves pairing a community validator (e.g. a Black church leader) with an expert (e.g. a Black physician with roots in the same community) and replicating this model across the country. Organizations with deep roots in communities of color (such as historically Black colleges and universities), the National Medical Association and the National Hispanic Medical Association will be essential partners in such an effort.
I have researched vaccine acceptance in many populations and countries. Reasons for vaccine refusal can vary from place to place, but one thing is constant: Health-care providers are the most trusted source of vaccine information — even among those who end up refusing vaccines. This makes them an indispensable resource for ensuring high uptake of a vaccine. But, because of a lack of training in vaccine communication, health-care providers are ill-equipped for communicating with their patients using evidence-based techniques, such as presumptive communication (which presents vaccination as the default choice to nudge patients into accepting a vaccine) and informed declination (in which the patient has to be counseled about the consequences of vaccine refusal).
Medical organizations such as the Infectious Diseases Society of America could work with the CDC and HHS to develop online training to prepare health-care providers for a once-in-a-generation immunization program. Similar efforts were undertaken by the American College of Obstetricians and Gynecologists during the 2009-2010 H1N1 influenza pandemic, in which pregnant women were a high-priority group.
Most important, the communication and education campaign must be evidence-based. A tragic feature of the U.S. response to the pandemic so far has been a disregard for evidence-based public health interventions. It would be ironic if a vaccine promotion campaign does not utilize the best of communication and public health promotion science. This is no amateur hour.
Vaccinating almost the whole country in a short period of time — while the pandemic rages on — will be a daunting task. A communication strategy will be essential for the success of this program. The time to prepare for a communication and education campaign is now, not after a vaccine is introduced. You build your playbook before the game, not after kickoff.