As the public awaits their turn to get the COVID-19 vaccine, demand for it appears high. Although acceptance of the vaccine is growing, a recent poll suggests that 30 percent of Americans are not open to getting inoculated. This makes it unlikely that once the vaccine is widely available, we will quickly reach the vaccination rates we need for herd immunity and a return to pre-pandemic life.
There are several reasons for vaccine hesitancy including concerns about safety, a lack of urgency and distrust in the government and pharmaceutical companies. To combat this, the U.S. Department of Health & Human Services (HHS) has launched the COVID-19 and Flu Public Education Campaign to educate the public about the vaccine’s safety and effectiveness. CVS Pharmacy is involved in a separate effort to educate underserved communities of color about the vaccine. While these initiatives have the potential to reach individuals who are skeptical about a COVID-19 vaccine, we must not assume that potential reach translates to effectiveness.
To persuade the most hesitant communities to get a vaccine, we must engage the local people to lead the development and dissemination of COVID-19 vaccination education messages.
As a public health researcher, I’ve had the chance to work directly with vaccine hesitant communities — from Latinx families to older African Americans. Through this work, I’ve partnered with community members to design health interventions, often allowing the community to take the lead. I typically see the community come up with better health intervention ideas.
Allowing local people to lead education messaging will enable these messages to be tailored. This type of tailoring has been important with other vaccines. For example, in 2006, the human papillomavirus (HPV) vaccine — like the COVID-19 vaccine — was found to be highly effective, safe and it also requires multiple injections. However, initial vaccination rates were low — partially due to the unfounded belief that the HPV vaccine may promote sexual activity, resulting in stigma and vaccine hesitancy.
To push the HPV vaccine, Colorado-based public health professionals engaged parents and youth from urban Denver and from semi-rural Mesa County to develop unique HPV messages tailored to community-specific hesitations. The Denver campaign focused on dispelling HPV misconceptions while the Mesa County campaign focused on HPV vaccination as a form of cancer prevention. If applied to the COVID-19 vaccines, this type of tailored, community-led design would enable the most persuasive local message to be developed and address hesitations.
Community-led education messages would also enable a sense of ownership, which would allow trusted, local people to encourage members of their communities who might be reluctant to take the vaccines. In King County, Wash., students across 10 high schools led peer education outreach to bolster the HPV vaccine in their schools. Schools where campaigns to push for the HPV vaccine enjoyed uptake rates that were 19 percent higher than in schools without campaigns.
The tangible results in vaccine uptake would not likely have come from even the best government or industry-led education campaign.
Finally, vaccine hesitancy is complex and involves attitudes that will not likely change with education alone. The public health sciences have shown that changing behavioral intention requires hearing a message more than once, contemplation and an eventual readiness to act. Community-based education that trusted, local messengers own and embed into the community discourse is more likely to result in repeated, relevant vaccine messages and this will be necessary to change attitudes among the most vaccine hesitant.
Many people see the current demand for the COVID-19 vaccine and assume that once the vaccine is widely available, hesitant people will be more open to it. However, many experts believe that reaching herd immunity is still an uphill battle.
Daniel Schober is an assistant professor in the Master of Public Health Program at DePaul University, and is a Public Voices fellow through The OpEd Project.