The political environment has strongly influenced the development, distribution and eventual uptake of the COVID-19 vaccine. This challenge requires ongoing direct and substantive communication with groups and prominent individuals associated with people who indicate they will not be vaccinated, such as conservative groups. This area is one that many vaccine experts and scientists might find uncomfortable, but it can become critical to success. The US now has a sharp geopolitical divide over vaccine uptake, as southern and mountainous states lag significantly behind the northeast or west coasts. These areas are at high risk of continued transmission of COVID-19. The geopolitical divide over vaccines is widened by systematic weaponized health communications from both dedicated anti-vaccine groups with tens of millions of followers on social media, and state actors such as the Russian government.
Another aspect of constructive public health policy is recognizing the importance of human behavior in changing the course of the COVID-19 pandemic in the US. However, existing approaches provide guidelines for examining the specifics of health behaviors surrounding vaccination, and specifically COVID-19 vaccines. Applying state-of-the-art behavioral science to vaccination offers opportunities to address issues surrounding vaccine uptake.
To address the gaps outlined in this report, the Commission makes some recommendations to state, state and local governments, as well as other public and private entities.
First, pre-marketing and post-marketing vaccine surveillance should be clearly and continuously communicated to the public, the press, community organizations and leaders (particularly for populations who are socially and economically disadvantaged), and health care providers dealing with suspicious or hesitant patients. . Communications need to be adapted to emerging situations, such as the extent of community dissemination, safety events, the level and durability of protective immunity, the availability of new vaccines, the requirements for boosting and the need for targeted campaigns based on the best evidence in behavioral science. Messaging and framing are also essential: experts communicating on local and national platforms should have relevant expertise in infectious diseases, epidemiology, vaccinology, immunology, social and behavioral sciences and public health.
Second, scientific communication and knowledge translation and collaborative efforts should work with local and national press and journalism organizations to train journalists, news editors and production staff and social media workers to communicate accurate and non-sensational vaccine messages; and provide technical advice (for example, on topics, problem definition and graphics or visualization) to news outlets and social media platforms to produce news content and public service announcements. This content should be designed to effectively educate and reassure a broad, diverse audience on important vaccine-related topics. Ideally, these media efforts to build public confidence in vaccines should be formulated and implemented as soon as possible.
Third, the most effective way to increase COVID-19 vaccine uptake is to make it simple to act on existing vaccine intentions. We recommend behavioral interventions with evidence of improvement in vaccine uptake for other immunizations, including reminders, strong recommendations from clinicians and local clinics.
Fourth, once they receive clear evidence that ethnic minorities are disproportionately affected by the COVID-19 pandemic, community leaders should work with local organizations to increase access to COVID-19 vaccines by implementing additional community vaccination sites with health professionals who are culturally competent (ie who integrate knowledge about individuals and groups of people into practices used in appropriate cultural settings to enhance the quality of care). In addition, this engagement can support accurate vaccine messages that are culturally based and target such communities and other populations that are socially disadvantaged. Special attention, interventions and response efforts to ensure equal access and adoption must be a priority.
Fifth, reaching out to politically conservative groups around the urgency of vaccinating all US residents, including involving conservative leaders who want to serve as COVID-19 vaccine champions, should be promoted.
Finally, interdepartmental government task forces should be established to explore options for countering coordinated disinformation from both national anti-vaccination activist groups and state actors. Aside from health and human services, such as the CDC, all government agencies must recognize the impact of anti-vaccination activities on homeland security, commerce, and justice and consider representation from these branches of the federal government. The State Department should also make efforts to address the weaponized health communications surrounding COVID-19 vaccines.