This year can’t end soon enough! 2020 will be remembered for years as a time of great upheaval and uncertainty. We are experiencing an unprecedented wave of illness and resultant economic hardship. Complicating the Federal government’s response to the Coronavirus pandemic is extraordinary political gamesmanship at a time when the country should be singularly united to fight the spread of the disease. We are intractably divided by politics, misinformation and a lack of trust. Falsehoods regarding the virus, often based along political lines, are seriously undermining our ability to reduce cases, hospitalizations, and deaths. The COVID-19 pandemic will claim an estimated 500,000 lives in the United States by April 1, 2021.
Fortunately, there is some good news. Pfizer’s COVID-19 vaccine has received the Food and Drug Administration’s emergency authorization for immediate use. News that the Pfizer and Moderna coronavirus vaccine candidates show approximately 95 percent efficacy is very encouraging. Health care workers and nursing home residents could begin receiving the first shots by mid-December. The vaccine rollout can’t come soon enough, although the speed of the vaccine rollout continues to be undefined. The slow transition occurring between the Trump and Biden administrations, complicated by the unknown availability of vaccine doses, makes most everyone wonder when life will be normal again.
Last month, I discussed “cultural cognition”, the tendency of individuals to conform their beliefs about disputed matters of fact to values that define their cultural identities. For many of our patients, COVID-19 is so entwined with their political identification that any information that suggests the disease is real and deadly threatens their core beliefs. Many of those who believe that COVID-19 is “fake news” are also likely to distrust communications regarding the efficacy of the COVID-19 vaccine. In a recent Pew Research Center survey, only 51 percent of U.S. adults indicated their willingness to take a coronavirus vaccine. Among communities of color, distrust is even higher. Herd immunity requires that 55% to 70% of the population become vaccinated.
Currently, healthcare communicators continue to convince their audience of the real risk posed by the disease, dispel falsehoods, laud first responders, promote wearing masks / social distancing / frequent handwashing, and apprise the community of shortages regarding beds, staff and supplies. All this should be supplemented by profiles of the ill and dead to humanize this tragedy.
With the vaccine on the horizon, a new armament of messaging must be utilized to supplement those mentioned above. Communications strategies must now include the following:
- Do market research. It is important to understand the reasoning behind people’s decisions to act a certain way. Surveys or focus groups can help you to understand what people in different populations think, know, or want to know about COVID-19 and vaccines. Interpret their feedback and test differing messages to find the ones most likely to move behavior in the favored direction. Start with their beliefs about vaccines, not yours.
- Provide both effective and realistic advice, and the means to follow that advice. COVID-19 is disproportionately affecting Black and Latino populations. There may be virological factors that aren’t yet understood, and because of past transgressions in the name of “science”, these groups may be skeptical regarding vaccines. Also, social determinants of health play a role. For example, Blacks and Latinos are more likely to work in jobs that can’t be done remotely, live in crowded conditions, rely on public transportation, and have inadequate access to health care. Messages regarding vaccine efficacy, convenient availability and the valued social impact the vaccine has for their community must be thoughtfully crafted.
- Build public trust around the vaccines. Emphasize that FDA guidelines for testing and approving a vaccine are scientifically sound and do not compromise safety and efficacy. Remind your audience that the FDA and the CDC have robust long-term vaccine safety and monitoring systems. A small percentage of those who received it experienced symptoms such as body aches and headaches, similar to what people might experience after a flu shot; a sign the vaccine is creating an immune defense. coronavirus.
- Address misconceptions and outright falsehoods. Efficacy for the vaccine is not yet known. Remind patients that vaccines have various efficacy rates — a full round of polio vaccines is 99% to 100% effective; full vaccination against diphtheria, tetanus and pertussis is 80% to 90% effective; and efficacy of flu vaccine varies from year to year. Vaccines are not made using human embryos. The Pfizer and Moderna vaccines use genetic code rather than any part of the virus itself, with a technique called messenger RNA, or mRNA. The genetic recipe directs cells to make pieces of the spikes that sit atop the coronavirus. Once injected, the body’s immune system makes antibodies that recognize these spikes when later exposed to the virus.
- Leverage trusted vaccine endorsers. A recent survey found that a coronavirus vaccine endorsed by Dr. Anthony Fauci increased acceptance of the vaccine as well as willingness to take it among Democrats, Republicans and independents. On a community level, a successful 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). Reach out to local organizations with deep roots in communities of color, especially those already engaged in public health issues, and partner with them in vaccine-related messaging.
- Encourage providers to have COVID-19 vaccine conversations with patients. For most patients, their primary care physicians are trusted endorsers. Providers should set expectations about vaccine availability, discuss its appropriateness for the patient and address whether any concerns. Specifically, providers should inform patients that limited COVID-19 vaccine doses may be available in 2020; vaccine supply will increase substantially in 2021; and the goal is for everyone to get a vaccine as soon as possible, but, not everyone will be able to get vaccinated right away. Encourage providers to tell patients they will gladly be innoculated when the vaccine is made available to them.
- Remind providers to start from a place of empathy and understanding. The first step is to acknowledge the disruption COVID-19 has caused in all our lives, providing an opportunity to recognize common concerns that can be addressed by a vaccine. Providers should also encourage patients to continue taking steps to protect themselves from COVID-19 and remind them that vaccines protect their health, as well as the health of those around them.
Now is the time to begin strategic communications regarding the COVID-19 vaccine. A strategic communications plan that leverages the already trusted guidance you’ve offered will help to convince your patients that a return to normal is not that far off, provided we all do our part in getting vaccinated. Rely on the value that trusted endorsers provide, including your providers, for getting your critical messages out. Do your best to dispel falsehoods, convey accurate information, craft messaging that is culturally relevant and as always, show that you care.
We are all in this together.
James Shulkin, Senior Vice President – Healthcare Brands at NOISE, Inc., has been a member of WHPRMS since 1999