The campaign we need to beat the coronavirus anti-vaxxers

We need to get 80 per cent of the population vaccinated. But in a recent poll only 45 per cent of the population say they are certain to get the vaccination (just 35 per cent of those aged 35–44) with 18 per cent saying they definitely or probably would not.

Much has been written about anti-vaccination propaganda. But far less about how to combat the seep of vaccine hesitancy into everyday life. UK vaccination campaigns have long been underpowered, and seemingly divorced from the communications best practice of other fields.

So with the wonderful prospect of a working vaccine for coronavirus within reach, it’s time to think about what we need to do to get the UK vaccinated.

The first blog in this series was about designing an inclusive programme to drive vaccination.

This blog will set out the nature of the world-class communications and marketing campaign we need to push vaccine uptake.

Let’s start with information.

Usually, when you are explaining, you are losing. But this campaign is different: the vaccine is new — the arguments as yet unrehearsed — and that offers an opening to misperceptions. Our opponents will seek chinks in the information and evidence about the safety, effectiveness and side effects of the vaccine. If you spend any time in online discussion threads about any contentious topic, you cannot miss the injunction to “do your own research”. We have to ensure that the conscientious worried, in the course of doing their own research, easily find the correct information, backed by the evidence.

So a critical resource before we even begin to campaign is a central repository of information and expertise — a comprehensive central NHS coronavirus vaccination site, built for an age of mistrust and designed to motivate as well as inform.

Many will come to the site needing light-touch information and reassurance. They must find it. But those seeking deeper and more detailed information must also find that clearly signposted. The site must be authoritative and constantly updated. It must be upfront about the three key issues: safety, effectiveness, side effects. It must being transparent about when knowledge is evolving. The site must pre-empt questions and concerns, presenting information simply and upfront. And it must avoid counterproductive tactics, such as mythbusting and FAQs.

It must offer the most tailored information available, specifically supporting vaccination demand amongst people with health conditions, people from ethnic and cultural backgrounds where vaccine uptake is lower, pregnant women, children and babies, those in high-risk occupations and older people.

And everyone with an interest in vaccine promotion needs to understand: we link to that single site, nowhere else, to make our case. The pro-vaccination campaign needs to secure the pre-eminent position of the NHS coronavirus vaccination site as the primary source of information and gateway to expertise in England. The proliferation of sources of information, most well-intentioned, some accidentally inaccurate or outdated, some actively misleading, offers space for confusion and misperceptions to spread — and be exploited.

The government starts this campaign disadvantaged by low trust from its handling of the pandemic. So it must understand its responsibility to design a programme that is resistant to conspiracy theories from the outset. That means transparency and openness about the safety certification process, manufacturing, procurement and supply. It means no loose threads that opponents can exploit, playing on distrust. It means opening up the thinking behind contentious issues — such as which groups will qualify for the vaccine and when, and how vaccination interacts with resuming personal freedom.

On this note: ministers and those involved at a senior level in the programme must be ready to confidently answer the question “Will you get vaccinated?” with the answer “Yes, when it is my turn”. Equivocation will be seized upon and magnified.

But information is not a campaign, though it is necessary scaffolding. A campaign is persuasion, built on evidence. And let’s hope the NHS is commissioning the biggest audience research project ever, to understand where people are, and what insights that drive their behaviour. We need to know what people think, who influences them, and how to reach them.

For example, all of these groups would need different approaches:

• People who are persuadable — maybe they have some nebulous safety concerns or are not sure about the practical steps to take to get vaccinated
• People for whom getting vaccinated is not a priority, perhaps because they think they are at low risk
• People whose personal circumstances (eg social exclusion, poverty) mean public health messages and public services struggle to engage with them
• People who are actively resistant to getting vaccinated, for personal, religious or cultural reasons

Suggesting messaging and approaches in the absence of sitting in the focus groups and reading the polling is a fool’s errand. What follows are some untested hunches

“Not vaccinated? Wave goodbye to your foreign holiday this summer”. Are the potential losses of not getting vaccinated, such as poor health, or the positives, such as the additional personal freedoms, more motivating? What role can the government play in positioning the loosening of restrictions on individuals as benefits of vaccination? Conversely, how motivating are the prospect of continuing limitations on personal freedom, as an explicit consequence of remaining unvaccinated? The evidence seems to suggest potential losses are more motivating.

“Getting vaccinated is quick, easy and supports a healthy lifestyle”. Messaging that positions getting vaccinated as part of a general healthy approach to life or looking after your immune system seem to work. And it is definitely worth testing messages that emphasise the ease and convenience of getting vaccinated.

“Show your love for your family and friends. Get vaccinated.” Messaging shouldn’t induce fear, but must at the same time be clear about the seriousness and dangers of the disease. Without taking a mythbusting approach, communications should test how to address the widespread perception that it is not worth getting vaccinated as Covid-19 is a “manageable” illness, perhaps by pointing to other people for whom it is likely to be more serious. Tied to this, it would be worth testing a more general callout to the benefits to one’s family and community from getting vaccinated as well as to individuals. Testimonials setting out a “typical” story, with a balance of losses and impacts, might be worth testing — worst case testimonials seem not to work, and in some cases, a reminder about risks to a child from disease have led reduced uptake as that is also seen as a risk.

“Talk to your family about getting vaccinated”. It seems to be the case that discussing vaccination with friends and family helps decide people in favour — so the campaign should test encouraging such prior discussions.

“People like me get vaccinated.” Building the social norm of vaccination is critical. Campaigners must test ways to secure the positioning of vaccination as “something people like me do”. It would be worth testing the effectiveness of advocacy from generic health care professionals, high-profile individuals, influencers, celebrities and community leaders. The most powerful message will be the public decision to share vaccination status, so high-profile individuals should be invited to get vaccinated early, and helped to publicise their decision. Religious and cultural leaders have a specific role to play, as they can help disseminate specific information that will discourage particular manifestations of misinformation. Institutions — from national and local businesses to football clubs and churches — should encourage vaccine uptake among their staff, customers, supporters, congregations and communities.

“People like me get vaccinated” #2 Providing tailored information related to people’s own characteristics can help support vaccine uptake — but too much information or a gap in information for a specific group (perhaps because research has yet to be done) can discourage. When building specific communications to particular communities, the campaign must test which levels of information are most appropriate (whilst, as described above, taking a maximum transparency approach for those who want deeper information).

“I’m your GP, and I recommend you get vaccinated”. It would be worth testing the impact of a known healthcare provider (such as a GP, practice nurse, midwife, pharmacist or health visitor) confidently recommending vaccination. It would be worth creating the expectation that healthcare professionals should be ready to support vaccination, provide basic information about the programme and signpost to the central NHS coronavirus site.

We know some things probably don’t work: dire warnings, shocking images, inducing fear, tragic testimonials. And there is no point to testing the provision of corrective information as a direct counter to misperceptions (ie mythbusting/fact-checking approaches) as this does not lead to changed behaviour.

Messaging is nothing without delivery. So the government needs to assemble a crack team of communicators and campaigners who can deploy the tested messaging at scale across every channel they need to reach the relevant audiences, both paid and earned, nationally, regionally and locally. Frequency and visibility of reminders and the generation of a steady (even overwhelming) stream of positive content will help motivate action. The push to get vaccinated must become unavoidable for targeted groups.

The fragmentation of the NHS means there is real danger that tested messaging and proven techniques get diluted in the proliferation of local or specific campaigns. We have all seen our local health services using counterproductive mythbusting tactics to promote flu jabs. To combat this, there will need to be strong central comms leadership and accountability.

Critical to the success of the campaign will be aggressively denying airspace to anti-vaccination propagandists to share their message. With the science and the health recommendation settled, the campaign needs to work with journalists and editors to develop a shared understanding of “balance” in news and broadcast, and the implications of giving airspace to anti-vaccination viewpoints.

And the danger is real: on 12 November, BBC Today decided to use the discredited approach of listing myths and getting an expert to rebut them — rather than a responsible approach of just inviting the expert, giving them the opportunity to answer questions on the core issues of vaccine safety, effectiveness and side effects without sharing myths, and discussing real issues of contention, such as pace of rollout and who gets it first. It might be worth considering the approaches adopted by other campaigns — such as about mental health and suicide — for pointers in how to broker a conversation with journalists about responsible reporting that supports public health.

Alongside this, we need a tough approach to disinformation on social media. Social media companies have begun to voluntarily take action on anti-vaccination propaganda, but the government should go further and mandate significant penalties if they fail to take it down, as Jonathan Ashworth has demanded.

Campaigners also need to think through the nature of influence in a social media age: administrators of major discussion boards and big social media groups have huge reach. We need to bring them into a conversation about what is acceptable doubt in good faith from an average poster, and what is committed anti-vaccination propaganda, and how to deal with these.

This is hard: I personally tried to engage with the Due In network of doulas who run hundreds of big Facebook groups for pregnant women and new mums, and found their commitment to what they saw as “neutrality” on childhood vaccination unshakeable, which allows doubt and misinformation to grow invisible to the wider health promotion community. And yet leadership from admins of similar groups is possible — compare the widespread exclusion of propaganda for multi-level marketing jobs in parenting groups. Fostering leadership and responsibility and helping admins spot and respond to the signs of disinformation is the right approach to take.

All of this assumes an effective government and NHS with the right skills and investment to run the world-class campaign this country needs to get to 80 per cent vaccine take-up. The responsibility is government’s — but citizens can help. And that is the subject of my final blog in this series.

I’m neither a scientist, a medic nor a health promotion professional. What I am is a campaigner who desperately wants the potential of a coronavirus vaccine to be realised. I make no claims to expertise — and would love to read others’ thoughts on how we get this done.

Part 1 — the programme we need

Part 3 — what individuals can do