Despite the high degree of confidence in the efficacy of the three COVID-19 vaccines (Pfizer, Moderna and Johnson & Johnson) approved by the Food and Drug Administration (FDA) for Emergency Use Authorization expressed by public health officials, some people remain reluctant to get vaccinated. Understanding the different reasons underlying vaccine concerns may be key to increasing confidence and getting the majority of the adult population vaccinated.
We know COVID-19 has hit marginalized and under-resourced populations the hardest, but we should not assume that members of these communities will stand ready to get vaccinated as soon as vaccines become available. Members of these communities tend to seek out various outlets to inform their opinions on whether to pursue getting vaccinated. These may include religious and/or other community leaders and news outlets catering to specific demographics, as well as friends, family, and other loved ones. There is no “one size fits all” approach to building vaccine confidence and addressing concerns people may have about being vaccinated, which is why communication must be based on a culturally proficient framework.
Why are some people so wary of the COVID-19 vaccines? Part of the answer may lie in ”attitude roots,” a term defined as underlying fears, ideologies and worldviews that lead to the rejection of scientific facts.1 Attitude roots stem from a person’s lived experiences and ingrained values. In turn, they can have important implications for how effective communication campaigns are in conveying their intended message.
For example, using empirical evidence on COVID-19 vaccines’ efficacy in employee communications will have a limited impact on individuals who do not fully understand or value such insights as “proof” that the vaccines are safe. These employees might respond better to testimonials, town halls and other forums that foster open dialogue and conversation. It is also important not to ostracize employees who do not respond to traditional public health messaging. Much has been made of the understandable distrust some communities have for the health care system, but we must also ensure that efforts to engage these groups do not inadvertently alienate them by making light of their reasons for being so.
In designing communications about the vaccines, employers should acknowledge the range of employee concerns while clearly and transparently providing fact-based information to build trust and ultimately enthusiasm for COVID-19 vaccines. Employers have a responsibility to help mitigate vaccine reluctance by taking a culturally conscious approach to their messaging.
Here are some strategies to consider:
- 1 | Shift public health communications from vaccine alarmism to vaccine certainty: When messaging about vaccines focuses on their potential negative consequences and the importance of maintaining the current status quo (e.g., mask wearing and physical distancing), it inadvertently implies that the vaccines themselves are ineffectual and will not result in meaningful change. To combat the inertia among those who may not see the value in getting vaccinated, especially when confronted with reminders of the science’s limitations (e.g., “the vaccine is not 100% effective at preventing COVID-19 infection”; “the vaccines’ impacts on COVID-19 variants are unknown,” etc.), employers should deploy communications highlighting what we do know about their safety, efficacy and overall benefits to both the individual and society. This information will provide needed context for these uncertainties.
- 2 | Survey employees to determine their attitudes on COVID-19 vaccines: Employee surveys play an important role in gauging the degree to which employees may be reluctant to get vaccinated. Early evidence suggests that although some racial/ethnic groups are more likely to express vaccine hesitancy, their reasons vary widely. Some common myths that have emerged about the COVID-19 vaccines range from adverse effects on women’s fertility to mistrust in their safety and efficacy due to the speed in which they were developed.2 To combat the spread of inaccurate information, employers should turn to their vendor partners (e.g., fertility benefit providers, chronic condition management programs, etc.) to assuage these concerns through webinars, email campaigns or other targeted communications.
- 3 | Engage community members and advocates: Leveraging community, religious and grassroots leaders who can be trusted mediums of information for Black, Indigenous, and People of Color (BIPOC) communities is a necessary step to build trust in public health systems and vaccine effectiveness. For example, promotores de salud (community health workers) are excellent resources for connecting with the Latinx population. These community health workers can provide linguistically appropriate and culturally conscious information.3 By working closely with community-based organizations and leaders, employers validate the diversity in ideologies and worldviews of their employee populations.
- 4 | Encourage open and transparent conversations on COVID-19 vaccines: It is important to create opportunities for employees with vaccine questions to connect with reputable experts. To the extent possible, hosting virtual town halls with chief medical officers or other clinical personnel with diverse backgrounds may help move bridge the gap between those presently unwilling to get vaccinated to becoming open to doing so. Consider recording these sessions and working with employee resource groups (ERGs) to disseminate them to relevant employee subpopulations.
- 5 | Provide multilingual communications: Employers must account for the different linguistic needs of their population to effectively deliver information about vaccine efficacy. Providing translated materials and interpreter services is crucial to increasing overall health literacy. An example is Johns Hopkins University Bloomberg School of Public Health’s video explaining how mRNA vaccines work for Spanish speakers. Employers must also be conscious of employees who are deaf or hard of hearing by providing American Sign Language communications as well.
Building vaccine confidence must be done through a lens of cultural consciousness and humility that validates individuals’ attitude roots while dispelling myths based on inaccurate information. As the COVID-19 vaccine supply continues to increase and meet the demand of those who want to get vaccinated, employer communications can help the effort by focusing on building trust among those who remain reluctant in ways that resonate most effectively with them.
- 1 | Hornsey MJ, Fielding KS. Attitude roots and Jiu Jitsu persuasion: Understanding and overcoming the motivated rejection of science. 2017. American Psychologist, 72(5), 459-473. http://dx.doi.org/10.1037/a0040437. Accessed March 2, 2021.
- 2 | Kelen GD, Maragakis LL. COVID-19 vaccines: Myth versus fact. Johns Hopkins Medicine. January 13, 2021. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-19-vaccines-myth-versus-fact. Accessed March 2, 2021.
- 3 | Zamudio MI. How promotoras de salud are fighting vaccine conspiracies In Chicago’s Latino communities. Borderless Magazine. January 26, 2021. https://borderlessmag.org/2021/01/26/how-promotoras-de-salud-are-fighting-vaccine-conspiracies-in-chicagos-latino-communities/. Accessed March 2, 2021.