At the time of writing, more than 250 million people have been vaccinated against COVID-19, and we’ve passed the milestone where the number of vaccinations exceeds the number of reported global cases.

While some countries have had teething problems with their vaccine rollouts, most would agree things are generally heading in the right direction. The important charts are trending up and to the right. At this point, it’d be easy to assume that success is guaranteed.

But momentum is building because vaccinations are being administered to people that want them. 

We could still end up in a situation where takeup falls below the required level, due to too many being cautious about taking the vaccine. Not to mention that the emergence of new mutations is likely to raise the threshold required for herd immunity. 

There have been signs of this even in Israel, which has led the charge in distributing vaccines to its citizens. A recent slowdown in its vaccination campaign has been attributed to vaccine hesitancy, and it should remind us of the potential threat. 

In December, we found that rates of both vaccine hesitancy and refusal were high enough to warrant concerns. Now that hundreds of millions have received first doses, we’ve conducted another wave of research to find out: 

  • Has vaccine hesitancy decreased following the initial rollouts?
  • Do communication strategies need to change as vaccines become normalized?
  • Are people becoming complacent about the need for vaccination?
  • Are ethnic communities being underserved by vaccination messaging, and if so, how do we fix it?

Vaccine hesitancy is down – but still too high for comfort.

Compared to December, the headline figures are promising.

Back then, just over a third of UK/U.S. internet users planned to get a vaccine as soon as it was available to them. This has now risen to over half. At the same time, hesitancy to the vaccine (answering “not sure yet”) has almost halved, going from 12% to 7%. 

In many ways, the most difficult stage of the rollout has been completed. The biggest possible setback would have been reports of deaths or injuries wrongly attributed to the vaccine before most people had received their shot. Fortunately, this doesn’t look like happening. 

But refusal is still stubbornly high at 14%.

Combine the figures for refusal and hesitancy, and that’s 1 in 5 who are at risk of not taking the vaccine. 

It underlines just how important it is to continue the right messaging, in the right places, to ensure enough people get vaccinated.

For the purposes of this blog, we’ll create a single audience made up of those who, when asked about their plans to get a vaccine, answer either “no” or “not sure yet” – what we call the “vaccine skeptical” and the “vaccine hesitant” respectively. 

We’ll then look at their biggest concerns and motivating factors around the vaccine, which, when combined with other information about their online and offline lives, can suggest the best angles for pro-vaccine messaging. 

Supplement trial safety data with real-world successes.

Some concerns have become effectively obsolete after the early months of vaccination campaigns. Just 1 in 20 are now worried about the expense of the vaccine, for example.

The biggest reason why people are currently hesitant about vaccines, as it was in December, is concern about potential side effects, followed by feeling the vaccines weren’t tested enough, or were developed too quickly. 

So how can we move the dial here? 

More could be done to point to the first recipients’ experience of side-effects, and to studies that show just how effective the vaccines are in the field. A good example is a recent study in Scotland, which confirmed a drastic fall in hospital admissions following doses of the Pfizer and AstraZeneca vaccines. 

This has become especially important because of how vaccine politics has developed over the last couple of months. Some countries have been reluctant to recommend the AstraZeneca vaccine to their over-65 population, citing a lack of data. 

While they’re entitled to make that decision, the issue is that any misalignment between countries, or skepticism voiced by politicians, is an invitation for misinformation to thrive. And that misinformation can convince the vaccine hesitant to refuse the jab. 

This is why reporting real-world data as rollouts continue is so important.

It bolsters findings from clinical trials and provides more assurances about safety. 

But we should sound a note of caution – as we first outlined in December, the vaccine hesitant and skeptical aren’t always the most confident in science.

Just 40% have a university degree, and they’re 27% more likely to seek out alternative medicines/therapies. They’re also much less likely to be interested in science or technology. It’s very important to make sure that using real-world examples and successes doesn’t make people feel like guinea pigs, or like the rollout is really just an extended trial of some unproven product.

Vaccine complacency could be sneaking upwards.

A really encouraging sign is that the number of vaccine hesitants saying they have no concerns with the vaccine has doubled. As receiving the vaccine becomes normalized and demonstrably safe, some concerns should naturally fade away. 

More worrying, though, is the 50% increase in those thinking the vaccine isn’t necessary.

In December, we highlighted the threat of vaccine complacency, whereby early successes of the vaccines, reducing the number of hospitalizations and deaths, might convince people they don’t need to get protected. If someone is undecided about whether to get their shot, they may think they don’t need to take it, as other people effectively have on their behalf. 

The February data suggests that while the overall number of vaccine hesitants and vaccine refusers has got smaller, their sense of complacency may be creeping upwards. Whereas hesitancy in December was more specifically around safety and side-effects, complacency now plays a bigger part. It’s a sentiment that should be monitored closely. 

We have to anticipate the upcoming months and how the public mood may change. If we take the UK as an example:

  • The weather will improve. 
  • Some lockdown restrictions will ease.
  • Vaccines will have more of a tangible effect. 

People may feel their vaccination is less of a priority at that point than they did when hospitals were under severe strain, and there was less idea of how normal life might resume. During the spring and early summer it’s important that communications remind people that vaccination is still necessary, even if the situation may seem much rosier at that point in time. 

Public figures have done their job – time to boost word-of-mouth.

Now we move onto the practicalities – if 1 in 5 are still hesitant or skeptical about taking the vaccine, what can be done to persuade them? And has anything happened since December that would require a change in approach?

The thing that will most persuade the vaccine hesitant is the same it was late last year; seeing more research into the vaccine and its side effects. As we mentioned before, this can be addressed by reporting how successful the jab has been in the real world, albeit being careful not to make people feel like the rollout is a kind of extended experiment.

There has been one interesting development since December, and it’s something that public health messaging has been slow to catch up with. In December, seeing public figures receive the vaccine was more persuasive than seeing friends and family take it (15% vs. 7%). Come February, and these have swapped; people are now more persuaded by what they hear from friends and family than celebrities. It’s actually the only motivating factor that’s grown since December at all. 

Applying some classical marketing principles can be very instructive here. Take the model of technology adoption, also called Rogers’ bell curve. It describes how new technologies and products go through a five-stage process, beginning with innovators and early adopters, before finally reaching the laggards. A vaccination campaign is different, not least because its earliest adopters tend to be much older than normal. But it’s a good way of understanding which groups command the biggest influence at certain points in time. 

In the UK and U.S., we have gone past the innovator stage for vaccinations. 

Many have now had their parents and grandparents tell them about their first dose. At the earliest stages, public figures, particularly politicians and older celebrities, were useful to achieve buy-in. But in reaching the mass market, influence has to come from word-of-mouth and ordinary people’s experiences. For vaccine rollouts, this means boosting those voices. 

The UK government has shown some initiative, introducing virtual stickers that can be put on Facebook and Instagram posts. Social platforms could, in turn, do more to amplify this. And they have the tools already tailor-made for it.  

In the past few years, social media has encouraged voter turnout for elections; millions registered that way for last year’s presidential race in the U.S. The same principles could be applied to the COVID-19 vaccination drive, pointing users to where they can sign up for a shot, and encouraging them to share their experiences. “I voted” can become “I got vaccinated”. 

Ditto for the power of stickers, hashtags, and all-round shared experiences. Social media will be awash with post-shot selfies in the coming months, and they could be a great asset in spreading the message to the vaccine hesitant. 

Empathize, don’t stigmatize.

Even as rollouts continue apace, opposition to vaccines is hardening in some quarters. The number of the vaccine hesitant and skeptical saying that nothing would convince them to take the shot has increased by 22%, and the number who cite general suspicion of vaccines as a concern has increased by 19%. There could be a few reasons behind this, but one may be a growing mentality of “us vs. them”. 

There’s a risk that all the hard work in nudging vaccine hesitancy and administering jabs leads to a counter-reaction. 

It may encourage some to define themselves in opposition to the mainstream. If, for instance, people are encouraged to declare they’ve been vaccinated on social media, some may use that as an opportunity to declare that they’re not part of the bigger group. 

By definition, this will be difficult to manage. But we can offer a couple of suggestions.

First of all, ensure that messaging at no point stigmatizes its target audience. The Ad Council, which is behind the “It’s Up To You” campaign in the U.S., has a useful way of thinking about this. They refer to the vaccine hesitant as “people who have questions”. Just as a way of describing the group, it shows empathy and treats them with respect.

As we pointed out in December, the radical anti-vaccine wing is a very small part of COVID-19 vaccine hesitancy. Most of it stems from the specifics of COVID-19 vaccines, produced more quickly than any other in human history. 

Some have pointed to North American campaigns for diphtheria vaccination in the 1930s as a model, citing the power of evoking guilt and shame. But we believe this would be a dangerous tactic. Partly because it overlooks the difference between how the two vaccines were developed, and partly because it overlooks how social media can allow opposition to mobilize against this kind of messaging much more quickly. 

There’s also a lesson here for social platforms, who have to ensure groups don’t emerge in opposition to vaccination campaigns, turning vaccine hesitants into vaccine refusers. 

Minorities are underserved by pro-vaccine messaging.

Since COVID-19 vaccines went into production, it’s been thought that vaccine hesitancy could be higher among ethnic minority groups. As has been covered in multiple studies, they’ve been ill-served by medicine and medical research in the past. 

But minority groups have been disproportionately impacted by the pandemic, and reduced vaccine uptake will only exacerbate that. This makes reaching them all the more important.

As the UK is more accepting of vaccines generally, hesitancy is lower for its BAME community, compared to Black Americans. But the same pattern applies in both countries – minority groups are less likely to get vaccinated than the white audience. 

Black Americans and the British BAME community share some things in common, and offer lessons that can be applied to targeting in both the U.S. and the UK.

In both countries, minorities are more likely to say that standing out in a crowd is important to them, and they tend to have a strong sense of self-image. 

So messaging has to respect them as individuals. This is again something the Ad Council in the U.S. has tapped into smartly with the “It’s Up To You” campaign. The slogan and creative makes the viewer feel empowered; you’re left understanding you have a vital role to play.  

That interest in self-image also suggests the media that may be most effective in reaching them. Ethnic minorities in both markets tend to be interested in fashion and like to follow lifestyle bloggers, particularly for fitness and beauty. Healthcare company Kaiser Permanente has used influencers effectively to promote annual flu jabs (with a specific focus on minority groups), so we know that they’ve been effective channels in the recent past. 

Pragmatism has to be part of the plan too. Influencers will probably end up becoming conduits of information around COVID-19 vaccines, whether good or bad, so they should be brought on board to share the right message. 

For some minority communities, faith and spirituality hold vital importance. This means reaching out to spiritual leaders to spread the message, and providing assurance on particular issues. In the UK, for example, the Mosque and Imams National Advisory Board has been assuring the Muslim community that the vaccine is halal.

We mentioned that public figures are now less important in encouraging vaccine uptake at the overall level, but they remain very relevant for ethnic minorities. 

And while public figures still have a role, it needs to be public figures that better represent them. 

NHS England’s slot featuring Sir Michael Caine and Sir Elton John has come under a bit of criticism here, and with some justification – its choice of faces isn’t particularly reflective of the BAME community, who, as we can see, should be prioritized in pro-vaccine messaging. 

Grassroots campaigns have made some headway. Actor Adil Ray has lead the #TakeTheVaccine initiative, in which TV channels across the UK simultaneously broadcast a 3 and half minute long message, given by BAME celebrities, encouraging their communities to get their shot. An impressive achievement, but it did ultimately come from a grassroots campaign, and more should be done by official messengers to engage with minorities.

There’s another interesting finding here, which touches on some deeper issues. 

In both countries, being able to see friends and family again is less important in convincing people to get vaccinated than it is for white audiences. 

This is probably down to the fact that in both countries, minorities are much more likely to live in multi-generational households. They’re more likely to have experienced the pandemic with parents, children and/or grandparents under the same roof, which has a huge bearing on cultural context. 

And this is a very important point. Much official messaging around COVID-19 has focused on separated families, and the ultimate goal of reuniting them. If there’s a symbol of the COVID “endgame”, what vaccinations are ultimately working towards, it’s the hug. Hugs that can be exchanged with family members who have had to be kept at a distance for months on end. It’s an image already widely used in public messaging, and we’re going to see more of it in the coming months.

But this isn’t the way everyone has experienced the pandemic, and it’s not everyone’s biggest clincher in getting vaccinated. For minority audiences on both sides of the Atlantic, communications should double down on assuring the safety of vaccines, as this is the biggest sticking point. But it should also consider cultural context more carefully. 

We’re heading in the right direction – but we can’t assume success. 

“A great day for science and humanity” is how Pfizer CEO Albert Bourla described November 9th 2020, the day his company revealed its vaccine was 90% effective following a phase 3 clinical trial.

The very existence of COVID-19 vaccines, and the speed at which they were made, is a scientific miracle. 

But they are also products that need to go to market and be accepted at a wide scale. As marketing professor Mark Ritson has pointed out, applying the lens of marketing theory can be highly instructive in understanding attitudes to vaccines. Science makes the vaccine, but it’s the right use of marketing and communications that gets it from the lab and into people’s arms. 

With that in mind, the key takeaways from our latest research are:

  • Vaccine hesitancy is decreasing as more people receive their first dose, but it remains a threat.
  • Concerns about safety and side-effects are still high. Evidence of real-world successes may soothe these fears but they mustn’t make people feel like guinea pigs. 
  • Vaccine complacency may emerge over the coming months. The importance of vaccination has to be stressed even as hospitalizations fall and life generally seems better.
  • Don’t stigmatize the vaccine hesitant, treat them with empathy and understanding. Shaming and guilt-tripping may strengthen any opposition to getting vaccinated. 
  • Minority groups are more vaccine hesitant, and much current messaging doesn’t reflect their values. There needs to be more understanding of their experience of the pandemic, rather than assuming a default that’s mostly relevant to white audiences. 
Click to access our connecting the dots 2021 report

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