COVID-19 Vaccination Communication: Applying Behavioral and Social Science to Address Vaccine Hesitancy and Foster Vaccine Confidence

"Drawing on behavioral and social science research, in addition to establishing collaborative partnerships with trusted community organizations, can increase the likelihood that COVID-19 vaccine communication endeavors will be successful."

Public health entities charged with communicating about COVID-19 vaccines face challenges such as a compressed timeline for educating the public and the need to address misinformation and vaccine hesitancy ahead of rollout. Data from an Associated Press-NORC Center for Public Affairs Research survey of 1,117 United States (US) adults conducted December 3-7 2020 revealed that only about half of Americans plan to get a coronavirus vaccine, one-quarter are unsure, and one-quarter (40% of Blacks) indicate they will not get vaccinated. In this context, this report: summarises evidence from behavioural and social science to inform COVID-19 vaccine communication efforts, outlines foundational considerations, and delves into more specific evidence-informed communication strategies for enhancing confidence in COVID-19 vaccination.

The National Institutes of Health (NIH) Behavioral and Social Sciences Research Coordinating Committee formed a COVID-19 vaccine communication working group in September 2020 and convened an expert panel on November 5 2020. The panel, which comprised 15 experts in public health and social sciences (e.g., communication, psychology, behavioural economics, health disparities, anthropology), identified evidence-informed communication approaches that could guide government entities in communicating COVID-19 vaccine-related information to a variety of constituents. The panel also made recommendations about how these communication strategies could be optimised, tailored, targeted, and delivered to address the unique needs and perspectives of diverse populations. The panel discussion formed the basis of this report.

Foundational best practices that underlie COVID-19 vaccine communication recommendations discussed in the report include:

• Ensure coordinated communication and consistent messaging: Although a national strategy is important, most communication ultimately must be locally implemented and coordinated. Message framing may differ depending on the specific community of focus, but it is important to minimise conflicting or distracting messages.
• Foster transparency and build trust through partnerships: Presenting clear and accurate information that does not exaggerate or minimise the benefits or potential risks is vital. Leveraging trusted sources to disseminate the messages can be accomplished through sustainable partnerships between federal agencies and trusted entities or individuals who reflect the diversity and views of the intended audience.
• Consider the range of health literacy: Plain language and visual representations should be used where possible. Communication strategies should be developed to accommodate different levels of health literacy, digital literacy, and science literacy. It is important that translations into other languages be done in a culturally sensitive way so that the information is conveyed in an accurate, nuanced, and accessible manner.
• Prioritise equity: Communicators should make efforts to engage with and address the needs of vulnerable, underserved, and traditionally marginalised populations to avoid exacerbating disparities. Communication efforts should be sensitive to the fact that people may have to balance competing priorities.

Three intersecting considerations for communication efforts outlined in the report include:

1. What is being communicated: Define the goals of vaccination communication; establish top-line messages; consider and address in an empathic way the underlying reasons for vaccine hesitancy to instill trust; monitor the spread of both general and COVID-19-specific vaccine misinformation, taking steps to mitigate its impact; and ensure the goals of communication efforts continue to evolve in response to emerging pandemic- and vaccine-related information and shifts in public sentiment to sustainably reinforce vaccine confidence.
2. Who is the intended recipient of the message: Consider the perspectives of the intended audience - including concerns, motivations, values, and information needs - with special attention to communities already experiencing health and social disadvantages by virtue of their race, ethnicity, health status, age, access to health care, occupation, living conditions (e.g., congregate settings), and socioeconomic conditions.
3. How is the message communicated: Tailor communication to the community's values and priorities by co-developing and co-disseminating COVID-19 vaccination messages through meaningful partnerships with trusted information sources; frame COVID-19 vaccination as a social norm that is collectively beneficial and acceptable (e.g., through "I got the shot" stickers); modify the choice architecture in ways that make vaccination the easy and convenient action; ensure that all messages are accurate, transparent, and truthful, avoiding overactivation of fear and overly directive message framing; aim to promote unity and apolitical decisionmaking regarding vaccination; and use personal narratives (e.g., from celebrity spokespeople) and short videos (e.g., "edutainment") to convey key messages in an accessible way.

In light of the panel's assertion that evidence-informed communication is critical, it is noted here that communication strategies would "benefit from ongoing evaluation so that they can efficiently adapt to real-time changes in COVID-19 vaccine research, as well as the evolving public health communication context. No single communication approach or message can address all COVID-19 information needs, perspectives, and concerns over time, but careful consideration and continuous reevaluation of communication efforts will help reduce vaccine hesitancy, enhance vaccine confidence, and bolster uptake."

Click here for a 1-page fact sheet outlining vaccine communication do's and dont's.