Communications is a public health strategy

Last week, I had the pleasure of speaking at the National Adult and Influenza Immunization 2022 Summit with the brilliant Jon Dewitt with Artemis Strategy Group. I’m sharing a slightly revised (although still long!) version of what I shared in case it’s helpful to others. It highlights concrete actions states and the CDC can take now.

Prior to my remarks, Jon shared 6 factors that impacted vaccine uptake nationally.

1. Fear about pandemic
2. Skepticism about efficacy
3. Anti-science campaign
4. Anti-government campaign
5. Tribal badges
6. Media attention

I used my experience in North Carolina to share how we managed those factors during COVID and what they might mean for moving forward.

As context, I think it’s fair to say that North Carolina outperformed expectations with the primary vaccine series. We did our first round of research in November 2020 and a follow up four months later. In that time, we moved the intent to vaccinate from a 59% to 79% - and remember that this was during the Johnson and Johnson issues among other challenges.

Most importantly, we then moved most people to act on their intent. For the primary series 73% of adults were fully vaccinated including 97% of North Carolinians 65 and older. This means that fear about the pandemic overcame factors like tribal badges and anti-science sentiments for older North Carolinians.

There was no gap between Hispanic and non-Hispanic North Carolinians and a 2% gap between Black and White.??Of course, we would have liked to hit a 100% vaccination rate. That said, I think our results were a success.?

There are lots of ways we can think about communications and its role that success. For today, I am going to use four M’s - message, messenger, method, and measurement.?

Message

We had a straightforward goal -?We wanted North Carolinians to trust the information that they received from NCDHHS about COVID-19 vaccinations. Here we were starting from a place of strength.???

Jon’s research affirmed that the work we did prior to the vaccine campaign had generated meaningful trust. After more than 150 media briefings, countless media interviews, and authentic engagement with communities, the Department and the Secretary were among the top sources of trusted COVID information.?

Our strategy was to flood the zone with accurate information. I can’t say this enough. We did not repeat misinformation. Everyone loves a myth/fact sheet. They don’t work. They make it worse. Research shows that people only remember the myth.??

Instead do the media interviews. Publish content on your media channels. Provide tools for your partners to share accurate information. These are actions that states can be doing now to build trust.??

When it came to how to talk about vaccines, our research showed that while reasons for hesitancy may differ, effective messages are similar. The lynchpin is the messenger. This was counterintuitive to many who had very passionate perspectives on this subject. Being able to point to the research – and having Jon and his team share the findings and answer questions – kept us from diverting much needed resources like time and money to multiple campaigns.?

Research is a place where the CDC can help by conducting the research for states and oversampling for key demographic groups and regions of the country. Do it as early as possible and let states know that you’re doing it. That won’t be enough though. You need to share the findings with state communications people. Let people ask questions so they have confidence in the findings. Provide a deck and tools that states can use to build buy-in for the findings with their teams and partners.??

Messenger

Our research showed that our two strongest communications tools to drive vaccine uptake were messengers and relationships. We were fortunate that our Secretary was a trusted source of information, and we used her voice a lot. Doctors and other public health officials were trusted voices and eventually people were turning to friends and family.?

In a big state finding who those trusted doctors and others were, is hard to do, and we couldn’t be everywhere doing everything. That’s why community relationships are vital. It was people on the ground who could identify the most influential voices.

It’s not always who you think it is. In one town, it was the funeral director. But more than that, they were often the trusted source of information. They knew how to reach people in their community and could share resources.?

The truth is that government agencies aren’t built for community engagement and need to build that muscle. ?

Identify who those groups are and start building authentic relationships now. Meet with them regularly, listen and learn from them, and show them that their voices are heard with meaningful actions. These can’t be transactional relationships. Start conversations now.

Method

How we did the work was also a difference maker. Paid media was important to keep vaccine messaging prominent, but it has little impact on people actually getting shots. The research told us that we had to:?

• Increase knowledge about vaccines and boosters?
• Increase understanding of safety and proven protection against severe COVID-19 related illness and hospitalization, and long-term symptoms.?
• Clarify and answer questions about eligibility and accessibility as determined by the FDA and CDC.?

First, make it as easy as possible for your local health departments. They needed to know what we knew, and they needed us to make it as easy as possible for them to share information in their communities. Make sure you to talk to the people responsible for communications and outreach. We learned that a lot of the information was going to the Health Director, but it didn’t always make its way to the communications team. We launched regular Teams meetings with the communications staff in the local departments.

Frankly, it’s embarrassing that we weren’t doing this long before a pandemic. It gave us a chance to share what we knew and the resources we had for them, answer their questions, and learn from them what was working and what was needed. We also developed toolkits in Canva that they could brand.?

So here’s another ask for the CDC team. Start hosting monthly calls between your communications staff and the communications leads in each state. Be sure you have someone from the Department communications staff, not just public health.

Let your partners be your messengers and make it as easy as possible. We trained more than 125 people to present Vaccine 101 presentations. Presentations engaged YMCA groups, education leaders, church groups, business professionals, and so many others. They gave hundreds of presentations.??

?We created ways for everyone to be involved. In 2021, our Bring Back Summer campaign in engaged 350 partners, including businesses, event centers, retail stores, pharmacies, sports leagues, libraries, health care providers, and so many others to help people get vaccinated.??

We also made it easy for people to get answers to their questions. To date, North Carolina has hosted 10 livestreamed, telephone town halls in English and 8 in Spanish with more than 372k participants combined with roughly half calling in and half viewing via social media. These townhalls covered different topics and featured North Carolina medical experts and people who had been impacted by COVID. People can ask questions by phone or by typing in social media.??

The lesson here is don’t rely on paid media to do the work for you. And don’t do it all yourself. Create the tools and vehicles that make it easy for all kinds of entities to help.??

Measurement

We had three powerful tools to track progress.??

First, we did at least quarterly benchmarks of Jon’s research so we could see how the changing environment was impacting intent, trust, risks, and reward.?

Second, we leveraged the robust data states had about vaccinations to know where we needed to devote communications resources.?

Third, to get at the true impact of the campaign in terms of the number of additional vaccinations, the team created reports based on regression analysis. This analysis showed a statistically significant effect on vaccinations as a result of community outreach efforts. ?

Build the tools now so that you engage people where they are with good information from people they trust and you know what it working so that you can refine your efforts.?

Now let’s step back.

We need to be real that COVID vaccines were resourced at a level that was unprecedented. I’d be remiss if I didn’t mention that and the implications for adult vaccine uptake.??

Very little money is typically spent on public health communications. Let’s take the flu. North Carolina is the 9th most populous state, and I believe it gets around $330,000 for this work. There were millions of dollars available for COVID vaccines and almost all was reimbursed from FEMA. If it’s not funded, it can’t happen. That seems unlikely to change, and it’s a reality that we operate in. This is where the CDC could help more by providing tools that allow for co-branding and editing.??

The next is data. States have little to no demographic data about who gets adult vaccines. For COVID, states have robust detailed data about who is getting COVID and who is getting vaccinated, allowing communications resources to focus on who and where they are most needed. States need to be thinking about how they are building data systems.??

And lastly operations. Adult vaccines largely operate independent of government and through private pay. With COVID vaccines, communications was fully integrated into the operation process. The state had the ability to ensure vaccinations were where people could access them. And they are free. Communications cannot make up for lack of easy access. Be sure that your communications team is part of your larger adult vaccine team from the beginning.?

In short, because we had money and data and were part of operations, we could identify which populations in which communities were being hardest hit, partner with community organizations and trusted messengers to get reliable information to people through activities like robo calls, canvassing, presentations, direct mail, social media ads featuring local people, and local townhalls, and we could coordinate with operations to ensure that shots would be available in easily accessible places to deliver on our promise.??

That’s a lot! To get started, ask yourselves three questions???

• Is communications fully integrated into your operations as equal partners???
• Are you meeting people where they are or making them come to you???
• Are you doing the ongoing work of transparency, simplicity and frequent communications 365 days per year???

?Bottom Line: Communications is a public health strategy.??