To convince the public to accept COVID-19 vaccines, the federal government’s communications campaign will have to be flexible, non-partisan and definitely not boring, say healthcare comms experts.

And given this week’s news on the status of COVID-19 vaccines, that campaign may need to start soon. In a Wednesday press conference about vaccine distribution, Health and Human Services Secretary Alex Azar said he expects there to be 40 million doses of the first two vaccines — those that could soon gain Food and Drug Administration approval — ready for distribution as soon as the end of December. Pfizer is planning to submit its coronavirus vaccine to the FDA on Friday.

At the press conference, Azar and other officials outlined plans to deliver the first of the vaccines, but most government comms efforts have focused on educating the public generally about the science and approval process, not logistics.

Even the HHS’s $250 million COVID-19 comms campaign, recently given the go ahead by Azar, will not address specific on-the-ground information like who will get vaccinated first and how the vaccinations will be distributed.

“Logistics? No,” says HHS deputy assistant secretary for public affairs and human services Mark Weber. “We are working in support of CDC and others across the department to move folks who are hesitant [about] acceptance when the vaccine is available by building trust, supporting healthcare providers and engaging communities and individuals.”

Weber was noncommittal when asked if there might be a separate campaign planned for vaccine distribution, though he did say HHS would share resources with the Centers for Disease Control and Prevention and other government health agencies for any initiatives.

An education campaign will most likely be needed, communications experts say, given the number of vaccines in development, the government approval process and other questions about COVID-19 vaccines in general.

“One of the challenges is that the first two vaccines will likely be made available to some people under an emergency use authorization. That’s never happened with vaccines in terms of making them available to a non-military population,” says Glen Nowak, director of the Center for Health and Risk Communication and a professor at Grady College of Journalism and Mass Communication at the University of Georgia.

The only other time a similar process was used was when the Department of Defense needed an anthrax vaccine approved, says Nowak, a former media and communications adviser for the CDC. He says the communications challenges will only become more complex once the vaccines are approved.

“It’s not clear which people would be eligible to receive a vaccine under the emergency use authorization,” Nowak says. “Conceivably a few months down the road, there will be more doses of vaccine available and the number of people who would be eligible would be broadened. So right now, it’s really important for the communications efforts to really communicate to people what is actually happening with these vaccines.”

Another stumbling block, Nowak says, will be defining terms and setting expectations.

“There’s also not been a lot of communications or information about how those initial doses will be administered,” he says. “There has been speculation that the first doses will likely be available to healthcare workers on the front lines, but again, that’s not a really well-defined group. I assume it would be more than just doctors, nurses and staff in hospitals. And who’s going to administer that vaccine? So there are a lot of things that need to be communicated about right now.”

Given all the moving parts — several vaccines, some with multiple doses and many different audiences — Nowak says the comms campaign will need to be large and multilayered.

“I don’t think it’s one generic campaign that appears everywhere with the same message,” Nowak adds. “There may be some part of it that does that, but there’s going to be a lot of customization tailoring to the concerns of different groups and the needs of different groups.”

Because of that level of specificity and because a distribution education campaign needs to address vaccine skeptics, the effort will need to be flexible and draw on successes as they happen.

“Assuming the experiences of the first millions of people that get vaccinated are good, you think they would come back and they say, ‘Well, you know, that was easy to do. I didn’t have significant reactions after vaccination and I haven’t gotten sick from COVID-19 and now I’m free to go back to my life before the pandemic,’” Nowak predicts. “Those experiences are going to carry far more weight than experts saying, ‘Trust us, this vaccine is safe and effective.’ You still need [expert messaging]. Absolutely. But it has to be reinforced by people’s firsthand experiences.”

The campaign will also have to be more imaginative than a traditional health campaign, given the tribalism in the country, says MacKay Jimeson, president of Ember Global Advisors and past senior director of corporate affairs at Pfizer.

“A boring government campaign is not going to get the job done,” he says. “I would like to see credible, scientific NGOs, like the Robert Wood Johnson Foundation and CDC Foundation, for example, to form a joint effort to lead the COVID-19 recovery initiative.”

“We made similar efforts for the Hurricane Katrina recovery effort and also for the Haiti earthquake recovery,” Jimeson adds. “Both were very nonpartisan. It should involve joining credible sources along with securing the backing of the business community in a very strong digital and grassroots effort. It should be a less traditional effort but one designed to motivate, using experts, celebrities and religious leaders to build trust around the science but also excitement around the vaccine.”

Jimeson isn’t the only one who worries that a traditional government health campaign may miss the mark.

“I think a lesson that all of us who have been in government and also in the communications field outside of government recognizes that PSA campaigns really don’t get the job done,” says Peter Pitts, a visiting professor at the Université Paris Descartes Medical School.

Pitts, a former FDA associate commissioner and current president of the Center for Medicine in the Public Interest, says traditional channels like PSAs or even President-elect Joe Biden’s bully pulpit will be helpful, but they won’t be enough.

Any campaign spokespeople and the campaign itself, Pitts says, should directly address anti-vaccine sentiments and populations and should confront audiences about their skepticism on the media platforms those audiences frequent.

“I’ll give you an example. The other day, I did an interview on the Christian Broadcasting Network, and I said, among other things, that this is a teaching moment about the value of vaccines,” Pitt says. “I know that this is an audience that doesn’t necessarily like hearing that, but it reaches millions, tens of millions of people. What was interesting was that on the CBN website, there were about 500 really nasty comments about me personally, and about the vaccine. If that wakes people up, I’m glad to be part of the debate.”

Confronting opponents directly, Pitt contends, is a three-for-one tactic. The controversy draws attention to the issue, reinforces positive behavior for those who are considering getting vaccinated and increases the chance the message will change someone’s mind.

“I believe that we absolutely should play into the controversy because the alternative is preaching to the converted,” he adds. “Which feels good, but it doesn’t accomplish anything. I would rather see efforts made against conservative media outlets, and parts of the country that voted for Donald Trump, who might considerably be more anti-vaccine than others, rather than saying let’s get vaccinated to the people who are elbowing to be the first in line.”

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