As with most things in this ever-changing year, our collective knowledge of how consumers view the COVID-19 vaccine is evolving rapidly. Here are our current answers to key questions related to planning consumer-facing communications about the COVID-19 vaccine, to aid health systems with their planning.
Answers to this question vary depending on the source. We turn primarily to Dr. Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases. In a recent Facebook livestream, Dr. Fauci said that the “overwhelming majority” of people will need to receive the vaccine, and further specified that about 75% to 85% of people will need to be vaccinated for the U.S. to reach “herd immunity” and stop the spread of the virus, WebMD reported. “You’re not going to see (herd immunity) unless the overwhelming majority of people get vaccinated,” he said. “If they want to wait a month or two, that’s OK...but I don’t want them to wait six to eight to nine months.” McKinsey & Company reported a broader range of potential scenarios, ranging from 58% to 94% of the population needing to be vaccinated to achieve herd immunity.
The percentage of U.S. adults who indicated that they would agree to be vaccinated — if an FDA-approved vaccine to prevent COVID-19 was available right now at no cost — has fluctuated, from a July high of two thirds (66%) to a September low of half (50%) to nearly two thirds (63%) as of early December, according to Gallup. Pew Research Center has had similar findings, reporting that intent to get the vaccine (probably or definitely) was 60% in a November survey. It will, without a doubt, require some very smart, strategic, persuasive communications from all of us in our local communities, and, of course, at the federal level, to persuade enough consumers to get the vaccine to achieve herd immunity.
Age is a factor, as one would expect. Most older adults, a full three fourths (75%) of those 65+, are likely to agree to the vaccination, compared to 55% of those under 30, per Pew research. Likewise, those with higher household incomes are more likely than those with middle or lower incomes to say they would get immunized.
For communications planning, it’s extremely important to understand that Black Americans are far less inclined to get the COVID-19 vaccine compared to other racial and ethnic groups, in spite of the fact that Black communities have been disproportionately affected by the pandemic. Pew research found that 42% of Black Americans would vaccinate, versus 63% of Hispanic and 61% of Caucasian adults. English-speaking Asian Americans are even more likely to get the COVID-19 vaccine (83%).
The very understandable hesitance of Black Americans has been widely documented. As summarized in the Washington Post:
Many Black people say they do not trust the medical establishment because of glaring inequities in modern-day care and historical examples of mistreatment. The spread of misinformation about the vaccine development process hasn’t helped either. This deep seated skepticism has led to a burst of confidence-building efforts across the country, some led by the nation’s top Black doctors and scientists and funded by the U.S. government. So far, the response has been mixed at best, with many Black Americans...saying they want more information or cannot count on the federal government to work in their best interests.
There is also, unfortunately, a divide between Republicans and Democrats, even on this. As of November, Pew found that 69% of Democrats would definitely or probably get the COVID-19 vaccine, as compared to just 50% of Republicans. It’s going to take more than Vice President Pence rolling up his sleeve to bridge that gap.
The best, most in-depth study that we’ve found on consumers and the vaccine is McKinsey & Company’s report, “COVID-19 Vaccine: Are US Consumers Ready?” It provides a more nuanced and very useful segmentation with regard to COVID-19 vaccination attitudes and intentions, identifying three segments: Interested Adopters, Cautious Adopters and Unlikely Adopters.
Our recommendation is to focus primarily on the Cautious Adopter audience segment, initially. They are more persuadable than Unlikely Adopters and will be essential to reaching critical mass. The federal Department of Health and Human Services “Vaccinate with Confidence” campaign is, similarly, focusing on the “Movable Middle.”
According to McKinsey, Cautious Adopters want to wait until the vaccine has been on the market 3-12 months, or until they feel confident in it. They are quite focused on the health implications of the vaccine, specifically, the side effects, ingredients and speed of the development process. They want to know that it’s safe — and want to see that others are safe after receiving the vaccine. Clear, strategic communications can encourage many of them to get vaccinated sooner.
Recent NRC Health research found, similarly, that half of adults surveyed worry that the vaccine has been rushed (52%) and nearly half worry about the side effects (46%). These are clear, consistent barriers that we all must work together to overcome.
While the national research has been consistent and clear, it must be said that attitudes in individual healthcare markets may vary. Conducting local research in your market to assess its specific challenges is always a strategic consideration.
Early adopters of the COVID-19 vaccine, or Interested Adopters in McKinsey parlance, will be key to crossing the chasm (to co-opt a tech marketing term) and achieving a vaccinated majority. We consider them a crucial influencer audience, as living proof that the vaccine is safe and side effects are usually moderate.
According to the aforementioned McKinsey research, Interested Adopters have generally been affected by COVID-19; many have tested positive for or been hospitalized for the virus. They also tend to be quite engaged in their health, with one or more chronic conditions and a primary care provider. Attitudinally, they: are motivated by the personal health protection the vaccine provides (57%); believe getting vaccinated is the right and responsible thing to do (54%); and don’t want to risk getting COVID-19 (50%). The importance of this group — and stories of their experiences and motivations — is high.
In addition, as discussed previously, Black communities will require different communication efforts than the general Cautious Adopter audience. Black Americans are 1.6 times more likely to be in the Unlikely Adopter segment as Caucasian Americans. This challenge is more likely to be effectively met at the local level, by health organizations working closely with local leaders and communities of color in a more grass roots manner. Health systems can partner with them and provide them with information and tools.
Rural communities are also more likely to be Unlikely Adopters, according to McKinsey, and may also benefit from unique communication approaches.
We would not suggest the most vaccine-hesitant consumers as an immediate primary audience; however, influencing some consumers in this group may ultimately be needed to develop herd immunity, depending on how many in the Cautious Adopter group convert and how the pandemic continues to evolve.
Unlikely Adopters have unique concerns that make them more difficult to influence. Some of their hesitancy drivers overlap with those over Cautious Adopters, including concerns about the ingredients in the vaccine and that it was rushed. In addition, though, many in this group do not believe a vaccine would protect them (21%); would rather risk getting COVID-19 (16%); and don’t like people telling them what to do (15%). Clearly, this is a tougher “sell.” Addressing this segment would require specific strategies, including influence by their physicians and other leading members of their communities. This is covered further below.
Health systems’ natural inclination is to communicate the science behind the vaccine and fill information gaps. This is necessary — and not all there is to it. We recommend planning a multi-level messaging architecture that can encompass both scientific messages, simply stated, and the corresponding practical and emotional benefits for consumers.
Certainly, messages that convey and prove safety and efficacy are a good place to start. Side effects were cited by consumers across all segments as the single most important driver of being unlikely to get the vaccine, so pay special attention to this topic right now.
Beyond that, it’s extremely important for people to see that many people, including people like them, are being safely vaccinated. A wonderful recent article in The New York Times Magazine summarized a considerable body of behavioral research conducted in recent decades that documents how prosocial behavior is effectively driven by the perception that many others are doing it. (If you are in any way a research nerd, you’re going to want to read that article. It made my Sunday morning, surprisingly tucked between stories about the top entertainers of the year, like a box of fresh Paleo chocolates found buried in a messy home office desk drawer.)
Ultimately, in addition to safety, there are a few other key emotional drivers that we can lean into to positively influence vaccine behavior: choice, control, empowerment, hope, pride and love. An excellent Guide to COVID-19 Vaccine Communications from the Center for Public Interest Communications at the University of Florida discusses the relevant emotional drivers in detail, along with many other relevant recommendations. According to that source:
"It’s tempting to activate emotions like fear or shame to get people to take a vaccine. But fear immobilizes us, and shame is likely to achieve the opposite reaction (to what) we’re hoping for. Look to more constructive emotions like pride, hope and parental love to get people to act."
Another disclaimer, of sorts: messaging will, of course, vary by market and by brand. We recommend that health systems align vaccine messaging with their brand strategies.
Also, keep your messaging, as consistent as possible. This is difficult when things are moving so quickly and the situation remains extremely “fluid.” However, too much inconsistency can undermine trust. Repeat your key message points time and time again, via a range of messengers.
The McKinsey research cited above verified that physicians are a highly trusted source of vaccine information. Cautious adopters want to receive information from healthcare leaders including physicians and government health authorities. Even among those who previously said they would not get a vaccine, 19% said their doctor’s recommendation would make a major impact on their willingness. As such, it is absolutely crucial that health systems’ physicians are informed about and supportive of the vaccine and have the messaging and tools to share that support with patients. Saad Omer, director of the Yale Institute for Global Health, wisely recommends in the Washington Post that physicians receive training in presumptive communication — presenting vaccination as the default choice to “nudge” patients into acceptance — and informed declination.
McKinsey also found that although physicians are the most trusted information source, local news and social media tend to be the most frequent sources of vaccine information. This gap is rather problematic, give the fact that information gleaned from local news and social media is more likely to result in consumers being less likely to receive a vaccine. This underscores that absolute top priority that must be placed on arming physicians as key influencers.
Additionally, it’s highly effective for a message to come from trusted messengers in the same “in group.” According to Applied Behavioral Economist, David Fetherstonhaugh, in the University of Florida report mentioned above:
“I couldn’t stress enough the importance of a message coming from within an in-group — someone that’s automatically on the inside. It’s almost like such messages even bypass deliberate cognition because they are coming from a trusted source. They’re my family, or it’s my pastor, or it’s my party leader.”
Right now, if you can plan to do just a few things in addition to your crucial employee vaccination effort, these are some strategies that we would recommend for this first phase in your consumer-facing vaccination work.
I will admit, no one really asks this question. And if you take away just one thing from this article, I hope it will be this:
Our collective task is more than merely filling an information gap. We’re actually trying to create a new social norm.
If you have any questions, or would like to consult on your COVID-19 vaccine communications strategies, please feel free to email me: firstname.lastname@example.org. Fill out the form below to get a complimentary slide deck to share with your team.