Yes, we’ve undersold the vaccine. Marketing can fix that

(Credit: Getty Images)
(Credit: Getty Images)

“It’s up to you,” goes the tagline. Not to get vaccinated, but to get informed.

“As the COVID-19 vaccines become available, you may be asking yourself, ‘Should I get it? And if I do, will I be able to go about life without putting my family at risk?’” 

So intones the voiceover in a recent ad, part of a public service campaign launched last week. Aimed at the 40% of Americans who have yet to make up their minds, the pro bono effort pulls at heartstrings through images of normal life that we sorely miss – holding hands, hugging and hanging out at family gatherings.

“It’s up to you,” goes the tagline. Not to get vaccinated, but to get informed. 

This campaign is blanketing airwaves at a time when the national discourse is, in many ways, 180 degrees removed from hugging and hand-holding. The warnings started shortly after the vaccine rollout began, with many media outlets and health officials cautioning that protection doesn’t start right away, vaccinated people can still transmit the virus and masks and social distancing are required long after vaccination. Unmasked hugging? Frowned upon without a personal risk-benefit analysis involving hugger, huggee and their inoculation status. 

These exhortations about the continued need for vigilance stem from some uncomfortable truths. A small fraction of people could still get sick after vaccination – the available shots are phenomenally effective but don’t offer perfect protection – and we don’t know the extent to which vaccinated people can spread the virus. 

Moreover, since we haven’t reached herd immunity, we most certainly shouldn’t let down our guard on any of the aforementioned behaviors. Nevertheless, experts believe rhetoric that harps on downsides is, to the typical listener, contradictory to the vaccine push.

“Obviously caution is the most conservative approach, but it’s inappropriate to say that everyone should get a vaccine and simultaneously say it makes no difference,” said Uma Karmarkar, a neuroeconomist at the University of California, San Diego. “There has to be a more nuanced middle ground.” 

To be fair, these pundits, providers and policymakers are often acting out of “an abundance of appropriate caution,” Karmarkar noted, “because in the past they’ve seen what insufficient messaging or overly strong promises can do.”

Still, Dr. Aaron Richterman, a fellow in the Division of Infectious Diseases at Penn Medicine in Philadelphia, believes the public health advisers may have gone too far.

“It’s a good thing for scientists and officials to acknowledge areas of uncertainty, but in this case I think relatively small unknowns were overemphasized, particularly early during the vaccine approval process and rollout,” he explained in response to emailed questions. “The reality is that a person who has been fully vaccinated with any of the vaccines tested thus far has an extraordinarily low risk of having a bad outcome, and this fantastic feature of the vaccines was getting lost for many people.”

As to exactly how much the vaccines will reduce transmission, available evidence suggests that it is likely to be a large reduction. Nonetheless, Richterman added, “The uncertainty in the amount that transmission was reduced was translated into an uncertainty about whether transmission would be reduced at all, which I think was confusing to people.”

The reality is that the three shots currently going into arms – from Pfizer/BioNTech, Moderna and Johnson & Johnson, and even the pre-registration jab from AstraZeneca and Oxford – effectively eliminate the possibilities of hospitalization and death from COVID-19. J&J’s single-dose shot is 66% effective overall, but 85% effective in preventing severe infection. So far, they’ve proven remarkably effective against all three of the variants first identified in the U.K., Brazil and South Africa, though studies are ongoing. 

For those in the  communications business, priority number one should be selling Americans on that “extraordinarily low” threat of severe disease incidence and death, rather than the comparatively lower chance of mild infection and the unknowns of asymptomatic spread. Consumers, especially those at highest risk of dying from the pandemic, need to hear that the vaccine is worth it, so that more shots get into arms. The messages must be heard clearly and consistently.

Marketers should consider this their chief objective, as opposed to overengaging in conversations around ill-advised hugging, the need for human contact and low-risk changes in behavior. Stern warnings about doing things differently, even in one’s own home, are not only an overly cautious read of the science. They create the misimpression that vaccines offer little benefit or that they offer a false sense of security, and could be used as a pretext by some to justify not getting the vaccine for themselves or their loved ones. 

The COVID-19 vaccines already face an uphill climb, due to their newness, expedited approval and the current state of rampant misinformation. That said, people getting vaccinated should be fully informed that, while the risk has been dramatically reduced, no risk is nil, and they and their families need to consider specifics on a case-by-case basis. So how should we talk about this?

“Nothing in medicine is ever 100%, but we have good reason to believe that there will be a large and meaningful reduction in transmission with the vaccines and that, because of this, vaccines are really our ticket out of the pandemic,” Richterman explained. “A simple way to think about this is that the vaccine will make every activity massively safer both for the person getting the vaccine and for those around him/her.”

Previous approaches to risk communication have involved some level of transparency about risk and an acknowledgement of the complexity, Karmarkar recalled. But balancing that with opportunities for increasing the range of activities in which people can participate in a safe and appropriate manner has been a struggle. 

“That’s one of the debates that’s ongoing right now in the academic social sciences, as well as in many institutions: How to explain what you can do without minimizing that the risks still exist,” she observed. “But as long as we are stuck with messaging that treats it as binary – either you’re fine or you’re not, we’re either in normal times or coronavirus times – we’re limited in the amount of nuanced messaging we’re capable of.”

Fortunately, the messaging is starting to become more refined, shifting from dour communications that breed frustration to ones that strike a more helpful tone while not minimizing current risks. There’s the aforementioned “It’s Up to You” campaign, coordinated by the Ad Council, as well as a social-media effort recently launched in the E.U., in which health officials stress that vaccination will help people get their lives back. 

As supply ramps up and communication around the vaccine shifts from distribution to demand generation, such marketing efforts serve to remind us that sound public health, like sound medicine, is not just about saying “no.”

“We have to remember that we are dealing with human beings and should focus on the recommendations that are really going to make a difference,” said Richterman. “Almost all COVID transmission is going to occur without vaccination and in the context of indoor, poorly ventilated, unmasked, face-to-face contact, and this would be where I would focus my public-health messaging energy.”

And let’s not forget that Americans have had to deal with a lot of ambiguity and conflicting voices this past year. Managing it all has been very frustrating.

“People would love to have some clear direction,” said Karmarkar. “We want people to feel like they’re on the same team, like they’re getting good information and making these choices. The messaging that the vaccine will fix things – but also that the vaccine is not good enough – is in seeming conflict when you’re trying to figure out if it’s okay for your children to go back to school.”

Nor should health marketers forget that there are many potential reasons why someone might want to get the vaccine, including to engage in close contact with loved ones who have also been vaccinated. All such motivations should be supported.

Whether the Centers for Disease Control and Prevention will issue relaxed guidance in coming days for fully vaccinated people, as some have speculated it will do, remains to be seen. “Fortunately, it looks like the CDC is planning to make recommendations in line with the reality that it is safe for vaccinated people to gather indoors for a meal,” Richterman said.

Meanwhile, in terms of phraseology, Karmarkar suggests avoiding words like “getting back to normal.” Such language, she explained, connotes “doing things without any consideration of the conditions that lead to increases or decreases in the virus. And until we reach some kind of consistent steady state, that’s less helpful for most people.”

Instead, Karmarkar recommended expressions like “moving forward,” which helps us “make space for these more complex, dynamic points of view, as opposed to assuming that everything will be the same, like going to parties and spending time with friends.” 

Richterman agrees, adding, “‘Don’t let your guard down’ is absolutely the best overall message, since the vast majority of society is not yet vaccinated, and the goal of this message is to protect the unvaccinated. But focusing on what activities people who have been vaccinated should do will have little effect on this protection.”

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