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COVID-19
February 9, 2021

Experts Offer Advice to Shore Up Confidence in COVID-19 Vaccines

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum and JAMA
JAMA Health Forum. 2021;2(2):e210158. doi:10.1001/jamahealthforum.2021.0158

With the rollout of coronavirus disease 2019 (COVID-19) vaccines underway, experts convened by the National Academies of Sciences, Engineering, and Medicine are offering guidance on strategies to address COVID-19 vaccine hesitancy and skepticism that threaten to undermine the goal of achieving herd immunity to the coronavirus.

The National Academies’ rapid expert consultation describes a variety of strategies for public engagement and communication to build trust and confidence in the COVID-19 vaccines, including highlighting public support for vaccination, leveraging endorsements by trusted celebrities and local leaders, and focusing such efforts on people who are hesitant or skeptical about being vaccinated, rather than on those who are adamantly opposed to the vaccines.

In addition, special efforts “to reach the most vulnerable, namely Black, Latino, and Native American communities that have experienced far higher COVID-19 mortality rates, are critical,” the National Academies said in a news release. Such community engagement “is key to overcoming mistrust and building confidence through actions like using many channels of communication, engaging trusted messengers with roots in the community, and working toward racial equity.”

Public opinion surveys conducted by researchers at the Kaiser Family Foundation indicate that attitudes about COVID-19 vaccination are shifting over time. In a survey conducted in January, the researchers found that 47% of the public said they wanted to get the vaccine as soon as possible (or were already vaccinated)—a significantly higher proportion than the 34% of the public in the “as soon as possible” category in December.

An additional 31% said they wanted to “wait until it has been available for a while to see how it is working for others” before getting it themselves. However, 7% said they would only get the vaccine “if required to do so for work, school or other activities,” and 13% said they would “definitely not” get it.

This means that the number of US residents embracing COVID-19 vaccination falls short of an immunity level of 70% to 90% that researchers suggest is needed to halt the spread of COVID-19.

The committee that developed the National Academies’ rapid expert consultation wrote that the specific concerns among people who are hesitant about being vaccinated for COVID-19 vary widely. They noted that communities of color in particular are justifiably distrustful of government-sponsored medical research and that their vaccination hesitancy stems from “a painful legacy of health care discrimination, medical research exploitation, and unconsented experimentation” on communities that have experienced racism.

To address vaccine acceptance at the national, state, and local levels, the National Academies committee described a variety of strategies for public engagement and communication. For example, they advise local governments to form partnerships with organizations—such as faith-based networks, existing community health worker programs, or local activism groups—with strong existing community relationships. Ideally, those community groups already have trusted leaders and know how to tailor information to their audiences.

Research has highlighted the potential effectiveness of dialogue-based interventions, including social mobilization and engagement with community leaders and trusted community representatives, as well as the importance of community involvement in creating, adjusting, and implementing these solutions to ensure adequate buy-in and trust,” the report noted. It added that social media or advertising campaigns encouraging community members to share why they choose to get vaccinated “can be persuasive.”

The expert guidance also highlighted evidence-based communications tactics for promoting COVID-19 vaccine acceptance. This includes stressing support for vaccinations—such as by offering “I got vaccinated stickers” to encourage vaccine acceptance—and using empathy to reach out to people who are hesitant or skeptical rather than directing efforts toward the small minority of the population that is strongly opposed to vaccination.

“Research on COVID-19 vaccination, and routine vaccination more broadly, emphasizes the importance of empathy as key to interacting with those who may be vaccine hesitant or skeptical, including through such techniques as motivational interviewing between providers and patients,” the committee wrote.

Leveraging “relatable, trusted, and credible” celebrities or other famous figures—such as basketball star Stephen Curry, who recorded a video interview with National Institute of Allergy and Infectious Diseases Director Anthony Fauci, MD, “to talk about the vaccine, how we know it’s safe, how it was developed so quickly, and how it will be distributed”—offers another avenue to encourage vaccine acceptance. On a local level, in Baltimore, public health experts and researchers worked with faith leaders in the Black community to reach out to and educate resident about COVID-19 and influenza.

Other recommended communications strategies include emphasizing facts and avoiding repeating false claims, because efforts to correct misinformation can have the effect of reinforcing false beliefs; shaping communications to reflect the target audience’s specific concerns, motivations, and who they trust; and adapting messaging to changing circumstances.

“What influences someone’s vaccine decision now is likely to change as distribution, knowledge about the virus, infection rates, and media coverage change,” the report notes.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Stephenson J. JAMA Health Forum.

Corresponding Author: Joan Stephenson, PhD, Consulting Editor, JAMA Health Forum (Joan.Stephenson@jamanetwork.org).

Conflict of Interest Disclosures: None reported.

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