Troubleshooting for COVID-19 Vaccine Communications

Likely challenges and the suggested actions to help you quickly educate your communities, combat misinformation and encourage everyone to get vaccinated

Communication challenges need to be promptly addressed during each phase of COVID-19 vaccine roll out to strengthen public confidence and uptake. Advance communications planning is crucial to ensure rapid response to challenges as they arise. Below are potential scenarios and suggested responses to mitigate negative impact on vaccine confidence and uptake. The World Health Organization (WHO) has also prepared a comprehensive set of scenarios and suggested responses focused on vaccine safety (see pages 25-29).

Phase 0:

Pre-authorization planning

Key communication principle: Start early with communication about COVID-19 vaccine safety, including the vaccine development process and steps taken to ensure the safety and effectiveness of vaccines. Be proactive and update the media and public regularly.

Scenario 0.1:

Influencers, including scientists or health care workers, publicly express skepticism.

Throughout the process of vaccine introduction, influencers with large social media followings may share uncertainties about COVID-19 vaccines related to how quickly they were developed.

Suggested actions:

  • Get out in front of issues. Use proactive communication about safety measures used during COVID-19 vaccine development.  (e.g. infographics from Public Health Communication Collaborative)
  • Respond promptly with basic details about vaccine safety and efficacy, without dismissing concerns
  • Emphasize that no shortcuts were taken in development — all phases of clinical trials were completed. (e.g. share real-time vaccine trackers that describe each phase of development)
  • Use empathy combined with scientific information to build trust and make a stronger case.
  • Avoid repeating misinformation.
  • Include a variety of messengers, from health care workers to faith leaders to community-based organizations. The right influencers, especially content creators such as YouTube creators or bloggers who are well-known nationally or locally, can contribute to making vaccination a social norm – sometimes for free. Learn more here, including tips for selecting influencers to leverage throughout all phases of the rollout.
  • Be on the lookout for a nationwide campaign from the Biden administration, being developed by the CDC to highlight the stories and experiences of people who have received the vaccine and are working in their communities to encourage others to do the same. One goal is to provide consistent nationwide messaging that can be used by your messengers.

Scenario 0.2:

Misinformation about the vaccine is spreading through online forums, and an influential figure urges against taking the vaccine.

Rumors can spread quickly on social media. Misinformation from influential messengers, such as celebrities or community leaders, could prevent members of the public from taking the vaccine. Sometimes, mainstream media organizations pick up on the story.

Suggested actions:

  • Reinforce vaccine safety and efficacy to foster transparency and trust that may make the public less inclined to believe misinformation. (e.g. Video from the COVID-19 Prevention Network)
  • Prepare or adopt evidence-based fact sheets, FAQs and talking points to respond to efforts to spread conspiracy theories or misinformation.  (e.g. CDC, JHU, and WHO fact sheets)
  • Help local media partners identify misinformation.
  • If the rumor isn’t gaining traction, ignoring it may be the best response.
  • If a misinformation campaign starts to take hold, identify trusted messengers (e.g., faith leaders, celebrities, parents, caregivers and policymakers) to present counter-messages about vaccine safety and effectiveness, without repeating misinformation. Community-based organizations and advocacy groups also can help stop the spread of misinformation. Provide messengers with the evidence-based materials you’ve prepared.
  • Don’t engage in online debates and avoid repeating rumors, especially in a format that could be shared out of context. Stick to facts on the safety of COVID-19 vaccines.
  • Block and delete comments from social media users who post offensive or inaccurate information on relevant forums. Do not respond to them.  Do respond promptly and with compassion to sincere questions or concerns.
  • Make sure all spokespeople understand how to combat misinformation. One excellent resource is the Media Manipulation Casebook created by the Shorenstein Center at Harvard.

Phase 1:

Targeting prioritized groups

Key communication principle: Continue providing evidence-based information about available vaccines. Evaluate local knowledge, attitudes and concerns to gauge and respond to the information needs of the public and health care workers. Prepare for questions about who will get the vaccine and when.

Scenario 1.1:

A small number of people who have been vaccinated experience similar adverse events after immunization (AEFI)

With many people being vaccinated, it is likely that some people might experience AEFI, which may generate public concern. It is important for health authorities to take time to investigate, and then communicate to the public whether the illness or health event is related to the vaccine or not.

Suggested actions:

  • Promote  CDC factsheets describing what people can expect when vaccinated to manage concerns and expectations. Push out proactive messages that prepare people for minor reactions, similar to those from the flu shot.
  • Make sure people know health experts are monitoring for side effects or AEFI, and investigating the causes. Explain how safety monitoring systems work. (based on guidance from CDC)
  • Be clear about the possible AEFI of the vaccine, which will help build trust. Give journalists all the facts about vaccine side effects in advance, especially more common ones.
  • Communicate with the public that side effects may be more pronounced after receiving the second dose of vaccine, and emphasize that this is a normal sign of the body building immunity.
  • Acknowledge public concern and keep the public updated on the status of the investigation.
  •  If AEFI become major news, communicate quickly and transparently. Brief journalists, interact with members of the public on social media, and provide health care workers with materials to address people’s concerns.
  • Involve local health care workers in reassuring the public about the vaccine’s safety. Nurses are consistently ranked among the most-trusted professionals. Respected community leaders also may be good messengers. (share personal vaccination stories of these community leaders)
  • Monitor public sentiment to adjust messaging accordingly.

Scenario 1.2:

Essential workers and some health workers don’t know if they qualify for the vaccine or where to get it.

Health care and essential workers will be among the first groups to receive the vaccine, but  exact sequencing will vary by location. This is likely to result in confusion and frustration about eligibility, particularly while vaccine supply is limited.

Suggested actions:

  • Clearly communicate national recommendations for allocation drawing on direct language from CDC/ACIP guidance.
  • Let people know that vaccines will be given in priority order: first to health care workers and people in long-term care facilities or other group residential care facilities, then to frontline essential workers, like first responders and teachers as well as people 75 years and older, then to people aged 65-74 years, those with high-risk medical conditions and other categories of essential workers.  Allocation will be expanded to additional groups as soon as there is enough supply.
  • Explain and widely disseminate who is classified as an essential worker, using state-specified guidance (e.g. North Carolina Dept. of Health guidance).
  • Use briefings and campaigns to explain reasoning behind state prioritization and decision-making. Include timelines for when and where vaccine will be available for prioritized groups.

Scenario 1.3:

Members of the public are angry that incarcerated people are prioritized for vaccination during phase 1 in some states.

Large outbreaks have occurred in correctional facilities, putting incarcerated persons at higher risk.

Suggested actions:

  • Explain goal to provide vaccines first to the people who are at the most risk, including people who are older, have underlying conditions, or live in crowded or congregate settings, including prisons and jails, as outlined by CDC.
  • Remind people that the state has a duty to protect the health of people in its care, and to slow the spread of COVID-19 in places where it can spread the fastest. Incarcerated people have experienced a higher rate of COVID-19 cases and deaths than the general population.
  • Remind people that incarcerated people do not have the ability to socially distance or take other precautionary measures to protect themselves from the virus.
  • Remind people that jails and prisons are part of the local community, the average jail stay in many states is a matter of days and someone can be booked, exposed to COVID-19, and released even on the same day.
  • Explain that outbreaks in correctional facilities impact the local community, including the number of patients who need to be treated in local hospitals.

Scenario 1.4:

With eligibility in phase 1 quickly increasing, but with varying criteria across jurisdictions, members of the public are eager to get the vaccine, wondering when exactly it will be “their turn” and how to access vaccine.

Explaining the prioritization rationale and distribution process is crucial so that the public understands why they may have to wait and how to find out when and how the vaccine will be available to them.

Suggested actions:

  • Explain that it will take time to vaccinate everyone. A  phased approach is needed because initial vaccine supply is limited and that manufacturers are working to increase production. As a result, jurisdiction allocations will increase and allowing additional people to be to vaccinated.
  • Make it clear that this approach will help to protect the most vulnerable people, those at greatest risk of exposure, severe disease or death, first.
  • In case of other methods of population sub-prioritization, for example by age, communicate the increased vulnerability of these populations and how more straight forward criteria may streamline roll-out.
  • Try to set expectations as vaccine supply begins to increase. Provide anticipated dates for when specific target groups may start to make appointments and how and where they will be able to register and access vaccine. (People can use this tool to find their place in the vaccination queue.)

Phase 2:

Engaging general public

Key communication principle: As new vaccines are introduced and more members of the public are vaccinated, prepare to incorporate additional information about vaccine safety and effectiveness as it becomes available. Anticipate reports of AEFI, which may or may not be related to COVID-19 vaccines.

Scenario 2.1:

As allocation expands, health care workers feel they do not have time or expertise to educate patients about COVID-19 vaccines.

There are resources available to help with patient conversation and counseling.

Suggested actions:

  • Acknowledge how busy health care workers are and express gratitude for their work on the front lines.
  • Provide health care workers with materials to help educate patients on vaccines and vaccine safety (e.g., CDC resources for patient education).
  • Encourage health care workers to ask their employers to facilitate dissemination of fact-based materials about vaccines to patients.

Scenario 2.2:

Public perceptions favor one specific COVID-19 vaccine because it is perceived to have fewer side effects compared to other available vaccines. The favored vaccine is not widely available, causing delays in uptake.

Suggested actions:

  • Listen to questions and concerns from the community and respond accordingly.
  • Reinforce messaging around the safety and efficacy of all authorized COVID-19 vaccines.
  • Explain differences between available COVID-19 vaccines. Be honest about side effects and reinforce the benefits of vaccination. Keep the information brief and easy to understand by a lay audience. (See CDC fact sheet about different COVID-19 vaccines.)
  • If appropriate, explain that certain vaccines may be recommended for specific population groups.

Scenario 2.3:

There’s a rumor that a COVID-19 vaccine has caused an increase in cases of a specific autoimmune disorder.

In this scenario, even though investigators have proven the link isn’t possible and no issues have been detected in AEFI monitoring, some health care workers and a well-known immunologist are supporting the rumor — in fact, some health care workers are refusing to be vaccinated, saying they’re concerned about “reactions.”

Suggested actions:

  • Have a vaccine safety communication plan, with pre-tested messages, ready in advance.
  • Engage a vaccine expert, opinion leaders and other health influencers to make a statement reinforcing the safety of the vaccines and the danger of rumors: Not getting vaccinated puts people at risk for COVID-19.
  • Choose trusted messengers, such as health care providers who have already taken the vaccine, as per CDC Vaccinate with Confidence guidance.
  • Without repeating the rumor, develop messages that explain the vaccine’s safety for that population and push back against misinformation with facts. If time permits, messages should be pre-tested.
  • Learn why people are opposed to being vaccinated, let them ask questions and have their concerns answered. Persuasive tactics, such expressing empathy and compassion, can help break through resistance. (See research on vaccine hesitancy in America from Hart Research Associates.)

Scenario 2.4:

Even with vaccination underway for a couple months, there is a sense that some people still have a ‘wait and see’ approach and want to wait longer before being vaccinated.

Suggested actions:

  • Have messages around the safety of vaccines ready and share data on how many people have already been vaccinated in the jurisdiction.
  • Describe how to access and interpret information from vaccine safety monitoring systems like the Vaccine Adverse Event Reporting System (VAERS).
  • Work with vaccination roll-out team to ensure that access barriers are reduced and vaccine distribution points are as convenient as possible for pockets of the community that remain unvaccinated. Convenience of vaccination very often trumps hesitation.
  • Be transparent about the occurrence of severe anaphylactic reactions but also share data on how rare these reactions have been, how soon after vaccination they tend to occur and the mechanisms that vaccine providers have in place to monitor vaccine recipients post administration.

Phase 3:

Ensuring high coverage

Key communication principle: Once the vaccine is widely available, continue reinforcing the safety and effectiveness of the vaccine. The primary goal at this phase is to use uptake data to target communications and tailor programmatic activities to help ensure everyone gets vaccinated. There will still be hesitance in some groups that will need to be addressed with transparency and expert messengers.

Scenario 3.1:

Members of the public are hesitant to be vaccinated because of concerns about cost and personal information collected by the government, and/or are not sure where to go to get vaccinated or whether they should get the vaccine.

Cost and privacy may be particularly important concerns for vulnerable people. Media stories about states having to sign data agreements with CDC might raise privacy concerns.

Suggested actions:

  • Make clear that the vaccine is free for everyone, including for people who not have health insurance.
  • Provide up to date information about who can get the vaccine, and where people can go to be vaccinated for free.
  • Clearly communicate that the vaccine helps to prevent COVID-19, so you do not need to be sick to get vaccinated; rather it will help to keep people from getting sick. (See CDC fact sheet that debunks this and other common misconceptions.)
  • Let people know what protections are in place to keep their personal information confidential. Be transparent about what types of personal information will be recorded and why it is needed (e.g., to send reminders about the second dose).
  • Explain that individuals will not be asked about their immigration status.
  • Ensure all communication materials, are available in languages other than English. (View resources in Spanish and French here.)

Scenario 3.2:

Certain groups remain hesitant to receive the vaccine due to historical mistrust.

People in Black and Brown communities have historically been left out of or even exploited by medical studies, raising concerns that the effects of the vaccine on them may not be known.

Suggested actions:

  • Acknowledge communities’ concerns as legitimate.
  • Ask existing community advisory groups for input on messaging, communication channels and help building an inclusive communication plan. (See recommendations from NAACP and Langer Research Associates.)
  • Provide regular updates to community leaders about vaccine planning and roll out, communication efforts and messages to share with their communities about safety, effectiveness, and access — including in non-English formats.
  • Build trust by following guidance of groups led by Black and Brown community leaders such as the Black Coalition Against COVID-19 and the Latinx COVID-19 Task Force of the American Public Health Association.
  • Build trust with youth through trusted institutions like HBCUs and social media influencers.
Scenario 3.3: People no longer think they need to follow public safety protocols such as wearing a mask.

Until enough people are vaccinated that the U.S. reaches herd immunity, everyone needs to continue practicing the 3 W’s, including after being vaccinated.

Suggested actions:

  • Explain that it’s going to take time to vaccinate the entire U.S. population.
  • Reinforce that for everyone to stay safe, people must continue to follow the 3 W’s: wear a mask, watch your distance (stay six feet apart, especially indoors) and wash your hands frequently. (See “Waiting For Vaccine” video and other tools from Public Health Communication Collaborative.)
  • Have respected experts explain the concept of herd immunity and that public health officials will determine when additional safety protocols can be relaxed.
  • Communicate clearly that even after being vaccinated, people should continue to practice the 3 W’s, as explained by the CDC.