It all started with a donut.
On March 22, right after the first day of spring, Krispy Kreme offered a free glazed donut to customers who showed their COVID-19 vaccination card. Since then, the chain has given away more than 1.5 million donuts. On Friday, National Donut Day, all customers can get a free donut. If you’re vaccinated, you can have two.
As the first day of summer approaches, vaccination incentives have become a growth industry. They include everything from million-dollar state lottery giveaways to full-ride, four-year scholarships at public universities, from hunting and fishing licenses and state park passes to sweepstakes offering Super Bowl tickets, tropical cruises, a year of free groceries or airplane tickets for two to anywhere you can go in the friendly skies. The latest: a grand prize of $5 million in New Mexico’s Vax 2 to the Max sweepstakes. As James M. Berklan notes in McKnight’s Long-Term Care News, you can cue the calliope music.
The incentives appear to be helping. In Ohio, the COVID-19 vaccination rate went up 45% after Gov. Mike DeWine announced the Vax-a-Million giveaway on May 12. The vaccination rate nearly doubled among 16- and 17-year-olds – who, along with younger adolescents, are in the running for college scholarships. In a good optic for the younger generations, a 22-year-old Shaker Heights woman won the first of five $1 million prizes a week ago. The second drawing takes place this evening.
The U.S. Treasury Department says it’s acceptable to use coronavirus relief funds to provide cash and other incentives for vaccination if they are “reasonably expected” to increase immunizations and the costs are “reasonably proportional” to the expected public health benefit.
In MM+M, Marc Iskowitz ponders the implications of turning state governors into game show hosts and examines the behavioral theories at work in the latest barrage of incentives. The new tactics are coming at a time when the pace of vaccination has notably slowed, when mega-sites across the country are shutting down and the focus is shifting to the streets and neighborhoods of America. Long lines of cars at baseball stadiums are giving way to pop-up clinics and mobile vaccination vans, even a vaccination clinic in a black-owned barbershop in Maryland. Community advocates are making phone calls, knocking on doors and offering rides to nearby vaccination sites or giving shots to people in their homes.
Most of this activity is taking place quietly, away from the headlines and the fanfare. One-on-one conversations are centering on a basic message, a simple incentive without ruffles and flourishes or bells and whistles but a value beyond measure: Getting vaccinated will protect your health and the health of those you love. The odds of winning that lottery are very good indeed.
Of course, folks on the front lines of the vaccination effort are still trying to win hearts, minds and arms the old-fashioned way. As Alicia Lasek and Danielle Brown report in McKnight’s Long-Term Care News, researchers have identified the “key element that will get the most nursing home workers vaccinated.” That element, not surprisingly, is trust.
Nursing home employees, you may recall, were included in the first wave of vaccination last December, part of group 1a along with other front-line healthcare workers. Yet six months into the vaccination effort, immunization rates among nursing home staff remain well below those of nursing home residents, who were also in that top priority group. The reasons are many and varied, and they are explored in a newly released, federally funded guideline, “Invest in Trust: A Guide for Building COVID-19 Vaccine Trust and Increasing Vaccination Rates Among CNAs.”
CNAs are certified nursing assistants, often described as “the backbone of the nursing home workforce.” Researchers found that “the CNAs with the greatest levels of vaccine hesitancy had the lowest levels of trust in their employers.” Notably, CNAs also had low levels of trust in other sources of pandemic information, including the media, government agencies and the pharmaceutical industry.
The guideline – no slim-jim brochure but a 50-page document – offers tips and techniques for building, cultivating and nurturing trust. There’s nothing terribly earth-shattering in the guidance; it’s not so much rocket science as empathetic human behavioral science. As John O’Connor writes in McKnight’s, “We need to take a more compassionate and understanding view of why the mistrust exists.”
“Invest in Trust” suggests this: “Make time to listen and create lots of opportunities for CNAs to get their questions answered by trusted local experts. One-on-one conversations between managers and staff who have already gotten vaccinated and those who are still deciding are one of the most effective tools we have.”
The guideline includes a toolkit with suggested language for such conversations and cautions strongly against tactics using guilt and shame. Employers are encouraged to provide a dedicated email address and phone number for workers to share their questions in confidence.
Another pearl: “Celebrate vaccination success as a community but address fears at the individual level.” A survey among long-term care workers by the Robert Wood Johnson Foundation uncovered a variety of fears: That vaccine side effects could be as deadly as the virus itself; that the vaccine could harm their pregnancy or their potential to become pregnant; that vaccine side effects would cause them to miss work; or that being prioritized for the vaccine suggested they were being used as guinea pigs.
“Take time to understand their real fears – and recognize that uncertainty may be one of them,” the report advises. “For people already skeptical of large organizations like pharmaceutical companies and government, a new vaccine is a greater unknown than the disease they’ve been fighting on the point of care for more than a year. They see COVID-19 every day, but the vaccine is new. For many people, uncertainty is more frightening than anything else.”
In a way, the CNAs are a kind of bellwether, a canary in the coal mine of vaccine hesitancy, which we have learned is often about access as well as attitude. The principles and practices set forth in the guidelines—including the use of motivational interviewing as a way to encourage self-propelled behavioral change—can be applied in any number of real-world settings.
Trust is the river running through this pandemic. In the Biden administration’s National Strategy for the COVID-19 Response and Pandemic Preparedness, presented right after Inauguration Day, goal number one was “restore trust with the American people.” Goal number two was to mount a safe, effective and comprehensive vaccination campaign. The Ad Council and Covid Collaborative have repeatedly emphasized the pivotal role of trusted local messengers in that campaign. The vaccination clinic in the Maryland barbershop could be the first of up to 1,000 across the country, as a 10-year-old program training barbers and hair stylists as public health partners and advocates is finding a new wave of expression–and a nationwide push from the White House.
Trust in science, trust in government and trust in the media are all being tested now, as is our trust in each other in a partially vaccinated, partially masked world.
The rollout and the challenges
· Why are people deciding to get vaccinated now? A Time/Harris poll fielded May 21-23 asked U.S. adults who had been vaccinated within the past seven days. More than one third (37%) said they were influenced by the CDC’s announcement that the fully vaccinated can go maskless in most public situations – which represents a bit of reassuring news for an agency that has taken heat for the timing as well as the content of its masking recommendations. Nearly half (48%) of the recently vaccinated were concerned that people will stop wearing masks even if not fully vaccinated. The majority (53%) cited a desire to protect themselves from disease, but an equal number said they wanted to protect people around them who can’t get vaccinated.
· The Kaiser Family Foundation reports that 32% of unvaccinated adults would be more inclined to roll up their sleeves if the COVID-19 vaccines had full FDA approval rather than emergency use authorization. And 21% of unvaccinated adults who are employed would be more willing to receive the vaccine if their bosses offered paid time off to get vaccinated and recover from any side effects.
· The League of United Latin American Citizens is partnering with Hornitos Tequila on a vaccine awareness and education campaign for the Latino community. The Vacunate Hoy (Vaccinate Today) project is designed to counter misinformation and disinformation specifically directed at this population, Sabrina Sanchez reports in Campaign. Latinos get sick, are hospitalized and die from COVID-19 at higher rates than whites and are less likely to be vaccinated.
· Legal challenges are being mounted to COVID-19 vaccine mandates issued by nursing homes, hospitals and colleges. At Houston Methodist, with a workforce of 26,000, 117 employees are going to court to fight mandatory COVID-19 vaccination. Houston Methodist says 99% of its workforce has already had their shots and believes it is on legal terra firma. June 7 is the deadline for compliance.
· About 10% of U.S. long-term care providers have mandated COVID-19 vaccination for current employees or new hires, Kathleen Steele Galvin and James Berklan report for McKnight’s. Among facilities not currently mandating, 12% of those surveyed by specialty investment bank Ziegler said it is highly likely and 37% said it is somewhat likely they will do so.
· The U.S. Equal Employment Opportunity Commission has issued a technical assistance document stating that “Federal EEO laws do not prevent an employer from requiring all employees physically entering the workplace to be vaccinated for COVID-19, so long as employers comply with the reasonable accommodation provisions of the ADA and Title VII of the Civil Rights Act of 1964 and other EEO considerations.” The EEOC also describes the types of incentives businesses can offer to employees who get vaccinated, cautioning that employers must keep vaccination information confidential.
· In California’s Santa Clara County, employers must determine the COVID-19 vaccination status of their employees. The county includes headquarters offices of Google in Mountain View and Apple in Cupertino as well as the campus of Stanford University and the city of San Jose. The county’s vaccination rates are among the nation’s highest; more than 75% of residents age 16 and older have received at least one dose.
· The return to the office will not be like flipping a switch but more like navigating a 12-to-18-month learning process, according to a People Management survey of 556 HR professionals and business leaders in the U.K. While the vast majority (83%) say the workforce is broadly optimistic about returning, 53% say staff are worried about contracting COVID-19 at work and 43% are concerned about disease transmission on public transportation. Other issues to address: mental health support, flexible working hours, and balancing work with family care responsibilities.
The vaccination dashboard
· 41% of the total American population is fully vaccinated, as are 48.5% of those age 12 and older, 52% of adults and 75% of seniors.
· We have one month to go before the July 4 target date of getting at least one shot into the arms of 70% of adults; right now we’re at 62.8%.
· The percentage of positive SARS-CoV-2 tests is less than 3% nationally, one of the lowest rates since large-scale testing began.
· On the Friday before Memorial Day, the Transportation Security Administration counted nearly 2 million people going through U.S. airports on their way to somewhere else. That’s slightly below the 2.5 million of 2019 but six times the number passing through in 2020.
· Moderna has applied to the FDA for full licensure of its COVID-19 vaccination in people 18 and older. Pfizer and BioNTech filed a similar application last month for their vaccine in folks 16 and up. Both vaccines are currently available under an emergency use authorization.
Over Memorial Day weekend, we saw our East Coast and West Coast daughters and their significant others for the first time in 6 months and 17 months, respectively. We joyfully depleted our E-Z Pass account as we sailed down the New Jersey Turnpike and I-95 to Alexandria, Virginia, and artfully dodged the cicadas to complete those long-lost hugs. Good things come to those who wait. And vaccinate.
…and some songs
Many thanks for joining us. See you back here next week with a spanking new edition of the Vaccine Project Newsletter. Be well and hug when you can.