New Approaches to Vaccine Communications

"New Approaches to Vaccine Communications," hosted on August 26, 2024 by the Public Health Communications Collaborative.

1. New Approaches to Vaccine Communications MONDAY, AUGUST 26 2:30 – 4:00pm ET / 11:30am - 1:00pm PT This event will be recorded. The recording and slides will be available on publichealthcollaborative.org later this week. All attendees are automatically muted upon entry.

2. Closed Captioning and ASL Interpretation If you’d like to use closed captions or ASL interpretation: Hover over the “More” button or the “Interpretation” button on the bottom of your Zoom screen. Live closed captioning is being provided by AI Media. ASL interpretation is being provided by Keystone Interpreting Solutions.

3. Meet Today’s Experts Dana Howe Communications Director Vaccinate Your Family Mike Perry Partner PerryUndem Jessica Malaty Rivera Senior Science Communication Advisor de Beaumont Foundation Angie Robertson Campaigns and Rollouts Team Lead Immunization Services Division’s (ISD) Office of Communications at CDC

4. Testing Messages about Vaccines Insights from Focus Groups Prepared for the Public Health Communications Collaborative August 26, 2024

5. The Public Health Communications Collaborative (PHCC) sponsored four focus groups to develop and test messages aimed at hesitant adults/parents to build confidence and support for vaccines. PerryUndem, a non-partisan research firm, conducted the focus groups and analyzed the results. Background.

6. 6 The four focus groups were held online on April 24 th and May 1 st 2024 using Zoom. Each focus group consisted of 6-8 participants and included individuals of different genders, races, ages, income, education and regions of the country. Three groups were held among vaccine hesitant adults. We defined these individuals as not always getting seasonal vaccines (e.g.. flu) and not being fully up to date with the COVID boosters. One group was held among vaccine supportive adults. These are individuals who are more likely to get seasonal vaccines and many are up to date date with the COVID boosters. A few participants in every focus group were parents of children under age 18 to allow us to learn their views about childhood vaccination. Methods.

7. General Feelings about Vaccines. DETAILED INSIGHTS.

8. The COVID vaccine experience casts a large shadow over this discussion. COVID comes up often, unpromoted. It is their new touchstone on any conversation about vaccines and will likely stay that way for the foreseeable future. Feelings are still negative. These (mostly) vaccine hesitant adults cite it as an example of a vaccine that was rushed and untested. Some assert the vaccine had unforeseen side effects or simply didn’t work. A few talk about regretting getting the vaccine (“I get more sick now than before the vaccine”). Some said they only did so because they were forced to by employers. Misinformation continues to swirl and has not been corrected.   It undercuts “newer” vaccines . More on this later, but the experience with the COVID vaccine seems to particularly fuel doubts about “newer” vaccines like HPV, the flu, RSV, Shingles, etc.  

9. Many trust themselves more than experts. They feel confident in their ability to sift through information they hear or read and make good decisions about vaccines. This is likely a byproduct of their COVID experience. Some feel they were lied to and believe information was held back. They don’t know who or what to trust – so they rely on themselves.   There is an unwavering belief in their own research. These participants claim to do their own reading about vaccines – mainly news articles or online stories but also sources like the CDC and their doctors. They talk to friends and family too and this informs their decisions.   They lean on personal experience. Some talk about getting a vaccine and feeling serious side effects. Others talk about regretting getting a certain vaccine (i.e., COVID). A few talk about getting a vaccine and still becoming sick with the disease (i.e., the flu). Some mention getting childhood vaccines (i.e., MMR) and feeling protected. These experiences with vaccines – good or bad – shape their feelings in an outsized way.

10. Most want to hear from their providers but there is tension too. Doctors play an important role. Many say they turn to their primary care providers for information about vaccines. Those with children generally trust their pediatricians. They say that providers frequently bring up vaccines during appointments and urge them to get them for themselves/their children. Many say they get seasonal reminders about vaccines from providers too and also their pharmacies. For most, providers are an important resource who help inform their thinking. But many admit they often ignore their providers’ advice. Even though their doctors encourage them to get the flu vaccine each year, for example, many say they don’t get it. COVID boosters are another example where doctor advice is ignored. A few also mention the HPV vaccine as another their pediatrician/doctor encourages for their children but they skip.   And a few feel their providers are too pushy. These participants complain their doctors are too forceful in pushing vaccines on them (particularly COVID, flu) and not respectful enough of their own hesitancy and concerns. One or two question the motives of their providers – “are they pushing these vaccines because they are paid to?” This frustrates them and causes tension in the doctor-patient relationship.

11. They sort vaccines into “old” and “new.” Vaccines that are perceived to be older – MMR, polio, chickenpox – are generally trusted. They feel there has been enough data and experience to determine these vaccines are safe and effective. These participants, with a few exceptions, think these vaccines have a proven track record. And parents in the focus groups generally feel comfortable giving these vaccines to their children.   “Newer” vaccines raise questions. Participants have less comfort with and knowledge about vaccines that feel newer to them – Shingles, RSV, HPV, Flu, COVID. In some cases, they know less about the diseases they protect against (Shingles, RSV, HPV). They are unsure about potential complications or side effects – and know fewer people who have received these vaccines. There are big information gaps to fill in around these vaccines.   It is not always consistent what makes something “new” but this language comes up repeatedly. The discussions don’t always make clear what the dividing line is between old and new. For some, it seems as simple as vaccines that they received when they were children versus ones that appeared in their adulthood. For others, a vaccine being on the market for at least 20 or 30 years is a marker of “old.” But this dividing line is important and shapes how they think about these issues.

12. The HPV vaccine taps into biases, misinformation. Many are unsure of the need to get the HPV vaccine (including many parents) and most think it is only for girls / women. They have questions about the age when young people are supposed to get it. Many don’t seem to know what HPV is or what serious illnesses it can lead to. Some parents mentioned their providers wanted their children to get the vaccine but they held off because it felt “too new,” or they simply didn’t feel comfortable with it.   Some express worries about “promiscuity” or its connection to sex. A few participants, especially dads, talk about raising their girls to be “safe and smart” about sex. They feel they have brought them up the “right way” and question why their daughters need to get the HPV vaccine. For others, there seems to be an underlying feeling that having their daughter vaccinated will make her more reckless / promiscuous. And their sons are generally missing from the conversation – again, they think this vaccine is only for girls.   There is low awareness of the cancer connection. Most participants seem unaware that HPV is the leading cause of cervical cancer. It is new information to them. For many, this is compelling to hear and makes the vaccine feel more important / urgent.

13. Feelings are generally positive about the flu vaccine though many don’t get it. Most believe the flu vaccine is safe and important for some people. Some talk about the need to get the flu vaccine to protect themselves / their families. A few mention that it is especially important to protect older and sick adults in their lives.   But some don’t think it is effective. They mention instances where they received the vaccine but still got the flu. Others talk about friends or family who were sick after getting vaccinated. It makes them question whether it is worth getting each year. Some acknowledge they trust the vaccine, but don’t think they always need it. What is missing is an appreciation that the vaccine lessens the severity of the flu – participants rarely mention this.   A few say their own experience with the vaccine makes them unlikely to get it again. Participants mention having bad side effects / serious flu-like symptoms from the vaccine. This has put them off getting the flu vaccine in the future.

14. The MMR and chickenpox vaccines are respected. The MMR vaccine is largely seen as safe and effective. These participants have received this vaccine. They feel it works – and they don’t have worries about potential side effects. There are a couple participants who said they wanted to space out this vaccine for their children because of autism concerns. But, this is the exception and even these participants still had their children vaccinated.   Participants use the lack of these diseases as a proofpoint that it works. They mention that the MMR vaccine has been around for a while. More importantly, they feel people do not get these diseases anymore. This makes them feel confident in their effectiveness. And, they are also reassured that it’s been used for decades without notable long-term consequences. They seem to ignore recent outbreaks of the mumps, for example, or what that could mean for the future due to growing vaccine hesitancy.   While the chickenpox vaccine is more recent, it is also broadly trusted. Most participants do not raise concerns with the chickenpox vaccine. It is seen as an “older” vaccine in their minds and generally viewed as safe and effective. Some participants mention how chickenpox was widespread when they were growing up. But, children are now vaccinated and don’t get it. As with MMR, participants feel this shows the vaccine is working as intended.

15. Shingles and RSV are new and less familiar. Participants have low information about the Shingles and RSV vaccines. They are seen as newer, unproven vaccines. Most haven’t heard much about either one. A few have had providers who mentioned they should consider getting them. Others have heard from friends / family about how painful shingles can be. Parents or those with friends with young children have heard about the dangers of RSV. But, most in these focus groups have not received either vaccine for themselves or a family member.   Some feel they are intended only for certain age groups. A few older participants have had providers mention the shingles vaccines to them. Others have heard that the RSV vaccine is for older adults or young children. Many feel these vaccines are “not for me” – and so they haven’t tried to learn much about either one. It isn’t a priority because they don’t fall within the at-risk populations for these diseases.   Still, most seem open to getting these vaccines in the future…but they want more information first. These vaccines don’t have the built in trust of “older” vaccines. Most participants don’t have major red flags, but they acknowledge not knowing much about them. So, they want to do more research, as well as talk to their providers. There are opportunities for ongoing education about both vaccines.

16. Messaging Insights + Ideas.

17. The communications environment is oversaturated and deeply impacted by COVID. Many of our messages are familiar. These vaccine hesitant individuals have been absorbing messages about vaccines for a while now – particularly around COVID and the flu. This means they had heard our messages before. Generally, our messages are well-received – but the bar is high . Many agreed with the various themes of our messages but they want more from messaging. They only found one or two of the messages to be actually compelling – causing them to think and be curious. Their overconfidence is hard to shake . They are jaded and believe they know a lot of this information already. Changing minds should probably not be the goal of messages right now. Our communications goal should be “openness.” Our best responses to the messages were usually “this makes me curious” or ”that grabbed my attention” or “I think I will look into this.” This is particularly needed around newer vaccines, where suspicions run deep. You can’t avoid COVID – but you don’t need to be boxed in by it . When they bring up their negative experiences with COVID, it may be best to respond briefly then pivot to more affirmative messages about vaccines.

18. Some general messaging insights…. Access isn’t the problem. These individuals don’t face many barriers to getting vaccines – they believe them to be accessible, affordable, and convenient. Doing it for others isn’t compelling. They have already heard this message, internalized it, and know it be true. It is not new and misses the point in terms of their personal decision-making. Combatting m isinformation is not a message for them. They know it is a problem but don’t think it impacts them. They trust their own knowledge, research, and decisions. This message is for others. What they want – just to feel comfortable with vaccines. This is the only thing they are focused on – and messaging should go straight at it. This is why messages about the rigor of the vaccine development process or that evoke the successful history of vaccines seem to work better. Should we also try to shake their confidence? Our message explaining the seriousness of diseases – e.g.,, HPV is a leading cause of cervical cancel – jarred some participants. That may not be a bad thing. While it probably should not be a lead message, using this as a talking point might help and cause people to go back and do more research.

19. STRONGEST MESSAGES PROS CONS “ Vaccines are developed over years through a rigorous scientific process.  Before being made available to the public, vaccines are tested in clinical trials to assess safety and efficacy. Vaccines that are developed in response to emergencies, often draw on years of available research with the added benefit of more resources and funding.” Goes directly at their concerns about the development process and vaccines being rushed / not enough data about long-term outcomes. Makes some think about COVID; it underscores the rushed development process for COVID vs other vaccines. “Vaccines have a proven track record of reducing disease. Our parents and grandparents were vaccinated against polio – with great success. Today we can vaccinate our children against chickenpox to reduce the chance of shingles and HPV to reduce the chance of cancer. No matter how long a vaccine has been available they each play an important role in saving lives, reducing disease, and creating a healthy community.” A good reminder of vaccines’ historical effectiveness at reducing illness and eradicating diseases like polio and measles. Plays into some fears about “old vs new” vaccines. They don’t think there is the same historical track record with newer vaccines. “These illnesses can be more serious than you think . Measles can cause blindness. HPV can cause cancer. Chickenpox can cause Pneumonia. Mumps can cause deafness. Tens of thousands of people can die from the flu in a year. Vaccines can stop these diseases in their tracks or minimize their worst effects.” Many are unaware or have forgotten about the seriousness of these diseases and this message grabs their attention (more than the others). Can seem like a scare tactic by focusing on just the most serious illnesses or threats.

20. WEAKER MESSAGES PROS CONS “Getting vaccinated is about caring for yourself, your family, and everyone else too. Vaccines are proven to lessen the spread of illness in schools, in offices, and in communities.” They understand that vaccines are helpful at reducing community spread of diseases. Does not do enough to alleviate their own personal worries about vaccine safety / effectiveness “Being healthy is so much better than being sick. Vaccines are a safe way to prevent or minimize illnesses and to feel well.” They agree that vaccines are helpful at preventing sickness. Again, does not address their personal concerns about vaccine safety / effectiveness. “Most of us can’t afford to be sick right now. Missing work, paying for medicine, going to an urgent care center or ER… these can lead to big medical bills and loss of income. Vaccines protect your health, save lives, and help you avoid medical bills.” Many are worried about medical debt, the high costs of care. Large bills and cost from these diseases is not a top concern when it comes to vaccines. “Cost should not stop you from getting a vaccine. Most vaccines are covered by insurance and are free or very low cost to you.“ Plays into concerns about high health care costs right now that so many Americans struggle with. Participants do not see cost as a barrier to getting vaccines. “Don’t let misinformation get in the way of your family’s health. When it comes to vaccines, make sure you are going to trusted and accurate sources like your doctor or pediatrician, nurses, or your local health department, to get the facts.” They are aware that misinformation about vaccines is a problem. They do not see themselves as susceptible to misinformation – they have lots of confidence in their own research and experiences.

21. Vaccine Promotion During Respiratory Season Learnings from past and present digital campaigns Dana Howe, Communication Director

22. Vaccinate Your Family protects people of all ages from vaccine-preventable diseases.

23. VYF is at the Center of the Vaccine Ecosystem Communication Policy Community Partners ACTIVATE EMPOWER INFORM Vaccinate Your Family is at the Center of the Vaccine Ecosystem © Vaccinate Your Family, 2024

24. 2023-24 Campaign: # NotJustFlu Perceived risk and susceptibility to flu is generally low, and is often cited as one of the reasons for forgoing vaccination. ”Not JUST flu” “Flu season” is now respiratory disease season, with seasonal spikes in flu, COVID-19, RSV, and cold infections as the weather gets colder and people spend more time inside.  “Not just FLU”

25. Focus on high-risk groups Promote flu vaccination in the context of respiratory disease season (COVID, RSV, general ”winter wellness”) Leverage powerful personal stories & advocates # NotJustFlu framing allowed us to …

26. Our #1 Lesson: The power of partnerships & trusted messengers.

27. 2024-25 Campaign Development “Viral Mythbusting ” Goal: provide trusted messengers with handy (evidence-based) rebuttals to the most common myths that circulate alongside viruses each year. Identify most common myths/misinformation Use evidence-based strategies to push back Create a useful toolkit of shareables for community partners

28. Viral Mythbusting Example Myth: “Flu vaccines can give you the flu.” Lead with the fact   Flu vaccines can’t get you the flu.   Warn about the myth   Has anyone ever told you they got sick with the flu because they got a flu vaccine? It’s a common myth, but there is no truth to it.   Explain how the myth misleads   When you get a flu vaccine, it is possible that you may experience some symptoms like a low-grade fever for up to a day, muscle aches, or soreness in the arm where you got the injection. This is your immune system responding to the vaccine and creating antibodies, and it is nothing compared to the serious symptoms of a flu virus infection, which often include fever for days on end, extreme fatigue, cough, sore throat, headaches, and more serious complications.   Finish with fact   You can’t get the flu from a flu shot – it just isn’t possible. You CAN get sick with flu after a flu shot, but your risk of doing so is lower than if you hadn’t gotten it. Get vaccinated.   For example…

29. More myths: “We don’t know if COVID vaccines are safe because they’re too new.” “Flu vaccines don’t work.” “Flu isn’t very serious so I don’t need to be worried about it.” “COVID is just a mild illness now.” “Natural immunity is better than getting vaccinated.” … and be sure to leave room to address what pops up in real time! (5G? Autism? There will be the misinformation-of-the-moment during respiratory season)

30. What are the pros and cons of a unique flu campaign vs. respiratory season campaign? How will we deliver messages to priority audiences (highest risk for serious illness or less likely to get vaccinated)? How do we keep the campaign fresh and messages relevant over the course of respiratory season? How will we know what worked? Campaign Development Considerations

31. Thank you & be in touch! Dana Howe [email protected] @ vaccinateyourfamily on Instagram, Facebook, LinkedIn @ vaxyourfam on X

32. “Keeps It That Way” Childhood Vaccination Communication Effort Angie Robertson, MA Campaigns and Rollouts Team Lead Immunization Services Division Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases

33. Formative research via 14 virtual focus groups among parents of young children, including general population and parents living in rural areas Concept testing via 12 virtual focus groups among parents of young children, including general population and parents living in rural areas Research Conducted

34. Research-backed Insight Implication Many parents lack knowledge around the individual diseases and associated health risks posed by vaccine-preventable diseases. Communications should educate around disease risk , opening the door for parents to learn more about the diseases themselves and the protection routine vaccines can provide. Generally, parents are  motivated to protect their children  from harm, and most parents focus on health-promoting activities such as eating well, staying active, and practicing good hygiene to help children stay healthy. Vaccination is rarely mentioned as related activity. Communications should elevate routine vaccines as a key priority in protecting their child’s health . Parents cite their family pediatrician as a trusted source of information. They also conduct their own research. We will encourage parents and healthcare providers  to have this important conversation, together.  Parents identify several settings/circumstances when protecting their child against illness is a top-of-mind health concern, such as daycare and school, where germs spread quickly and easily . There is an opportunity to leverage school and daycare partners and relevant hooks (e.g., summer camp, back to school season) to reinforce the relevance and necessity of routine vaccines. Parental decision-making is both fact-based and emotional . Creative should address both aspects by providing relatable, yet fact-driven and clear information .  While most parents say their child has received at least some routine vaccines, parents living in rural areas are more likely than general population parents to express hesitancy or disclose their intention to forego one or more vaccines.   Communications tailored to parents living in rural areas should include links to supporting evidence and/or CDC resources and should encourage conversations with trusted providers to allay concerns. Research Findings

35. Routine childhood vaccination in the United States has been so successful as a public health intervention that serious diseases such as diphtheria, mumps, and rubella, once common at young ages, are now practically unheard of . Let's keep it that way. Through the innocence of childhood, “Keeps It That Way” will creatively showcase the vaccine-preventable diseases and will: Educate parents about diseases and combat misperceptions; Reinforce the importance of childhood vaccinations as a tried-and-true measure to protect children’s health; and Encourage healthcare provider conversations through unique and engaging content.  Creative Approach: “Keeps It That Way

36. Strategy Digital Paid Media Traditional Media Organic Social Media Partners and Jurisdictions Meta (Facebook and Instagram) ​ Out of Home displays​ Digital display ads ​ Focus limited resources on reaching parents in 17 jurisdictions Arizona, Colorado, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Kansas, Minnesota, Montana, Ohio, Oklahoma, Oregon, Utah, West Virginia, Wisconsin, Wyoming Mat releases/sponsored articles Radio media tour Podcasts and publications focused on parenting Incorporate messages into key data releases Organic social content and graphics on CDC flagship handles (X/Twitter, Facebook, Instagram, LinkedIn) Connections with federal programs that serve children and clinical, public health, educational organizations Connections with jurisdictional immunization programs for input Adaptable, unbranded content

37. May – July Measles Activation July – September Back to School/Summer Activation Diphtheria, Mumps, Rubella, Pertussis/Whooping Cough, Polio Onward 2024 - 2025 Evaluation, Refinement, and Additional Products and Paid Media Additional diseases, plain language fact sheets in multiple languages Materials are available to jurisdictions and partners.  If you are interested in learning more and collaborating, please contact [email protected] .  Timeline

38. International Travel Evergreen Measles Creative

39. Overlay Copy: Frame 1: He thinks “Measles” is a cartoon character. But... Frame 2: Measles is a very contagious and serious virus that can cause complications like pneumonia (infection of the lungs) and encephalitis (swelling of the brain). Make sure your child is up to date on all vaccinations Frame 3: Measles symptoms include: High fever, rash, cough, red watery eyes, runny nose. Frame 4: He thinks “Measles” is a cartoon character. Childhood vaccinations keep it that way Status Copy: Measles might sound cute, but it's actually a very contagious virus that can be serious for children. Keeping your child up to date with vaccines helps keep them protected. Measles Social Media

40. Diphtheria, Polio, Rubella, Mumps, and Pertussis Creative

41. Overlay Copy: Frame 1: She thinks “Mumps” are mega jumps. But... Frame 2: Mumps is a very contagious virus that can cause many complications, including: Meningitis (swelling of brain & spinal cord tissue), Deafness. Frame 3: Mumps symptoms include: Swollen cheeks and jaw, Fever, Headache. Frame 4: Mumps symptoms include: Tiredness, Muscle aches, Loss of appetite. Frame 5: She thinks “Mumps” are mega jumps. Childhood vaccinations keep it that way Frame 6: Talk to your child’s healthcare provider about recommended vaccines. Status Copy: Mumps is a very contagious viral infection, not a jump rope move. Learn more at the link in bio. #CDC #PublicHealth #VaccinesWork Mumps Social Media

42. The “Keeps It That Way” website provides: A recommendation for parents to make sure their child is up to date on all recommended childhood vaccinations. Information about 18 vaccine-preventable diseases. Links to resources for parents including easy-to-read vaccine schedules. Assets for partners https://www.cdc.gov/vaccines/keepitthatway.html Website

43. Alison Albert Ati Chamanzad Shauntrelle Chappell-Ige Janine Cory Sara Dodge Ramey Nicole Dowling Amanda Dudley Mimi Eckert Sally Ezra Allison Fisher Veronica Gilliard Erin Glotzer Rosa Herrera Kathleen Holmes Tara Jatlaoui Molly Kellum Dayle Kern Haley McCalla Meg McCarron Jamie Mells Isabel Mendez Sarah Meyer Jill Moses Georgina Peacock Laura Randall Ethan Riley Maria Rivera Shannon Stokley Angela Tripp CDC’s Immunization Services Division Applied Research, Implementation Science and Evaluation Branch Field Services Branch Health Education and Communication Branch Immunization Operations and Services Branch Informatics and Data Analytics Branch Partnership and Health Equity Branch Surveillance and Epidemiology Branch Vaccine Supply and Assurance Branch CDC-funded 61 Jurisdictional Immunization Programs and CDC Project Officers American Academy of Family Physicians American Academy of Pediatrics HRSA’s Maternal and Child Health Bureau and Bureau of Primary Care KRC Research Weber Shandwick Acknowledgements

44. Thank You This presentation contains links to non-United States Government websites. We are providing these links because they contain additional information relevant to the topic(s) discussed in this document or that otherwise may be useful to the reader. We cannot attest to the accuracy of information provided on the cited third-party websites or any other linked third-party site. We are providing these links for reference only; linking to a non-United States Government website does not constitute an endorsement by CDC, HHS, or any of their employees. Want to connect? Email [email protected] .

45. Download Our New Resources Just Released! Communicating More Effectively About Vaccines is available to download today Updated 2024-25 Flu and COVID-19 Messages are also on publichealthcollaborative.org/resources

46. Thank You More Resources www.publichealthcollaborative.org Contact [email protected] Follow PHCC X: @PH_Comms LinkedIn: Public Health Communications Collaborative