“At a castle in Leicester, England, a group of nearly 100,000 protesters physically gathered to rally against the recently-instated Vaccination Act. The year was 1885. A new body of scientific evidence on the efficacy of vaccines had led to a political mandate for vaccination, and clusters of the general public reacted by mottling this scientific discovery with misinformation about vaccine-related death and disease. The crowd that gathered at the castle carried banners that exclaimed the injustices of required vaccination: ‘Compulsory vaccination is a usurpation of unjust power” and “Truth conquers.'”
Here we go again!
To avoid history repeating itself, it is essential that public health leaders, politicians and community leaders have every available tool at their disposal as we rollout the vaccines that are undoubtedly going to save lives. We can’t afford to be hesitant, though, and wait for everyone to catch-up. We need to get out into our communities and win their trust with the message that vaccines are safe, culturally acceptable, and are a sign that we share a sense social solidarity. The simple message must be that #vaccineswork.
Heidi Larson, Director of The Vaccine Confidence Project and Professor of Anthropology, Risk and Decision Science at the London School of Hygiene & Tropical Medicine, has studied the main reasons that people from different communities might be hesitant to take-up vaccines. She argues that often this is because we may be focussing on other concerns. As Professor Larson explains:
“One of the biggest changes is the sheer number of vaccines and combinations of vaccines that that have been developed. It’s fantastic from a scientific and public health point of view, but I think the number and variability of these vaccines, the different ways they’re made, means the public has more vaccines to question, and they are increasingly questioning even the ingredients…
Another major change is the hyper-connectedness of the social media environment. People have had questions about vaccines from day one. Even in the 1800s, there was anxiety about vaccination not being natural and being “against God’s plan,” similar to what we’re hearing today. But the scale of virtual connectedness nowadays is unprecedented, and this has emboldened scepticism about vaccines because people surround themselves with others who believe the same thing. Previously, these kinds of views didn’t have the scale and impact they do today.”
If vaccine hesitancy isn’t recognised early on it may result in large sections of the community not taking the vaccination effort on. Then the challenge of public health becomes much harder.
Rather than thinking in top-down communications transactions, Shadim Hussain, who is part of the management group for one vaccination trial, the Novavax vaccine trial at the Bradford Royal Infirmary, suggests that we need community-focussed solutions. Novavax is one of six vaccines preordered by the UK government, and according to Hussain, one of the “first trial of its type anywhere in the world.”
Hussain points out that Bradford is one of the most ethnically diverse parts of United Kingdom, with more than a third of the town nonwhite, and a quarter of Bradford’s residents originate from Pakistani. According to Hussain, “ethnic minorities were ten times less likely than the general population to participate in the vaccine trial,” and even though they “comprise thirty-six percent of the population,” only three percent of the participants in the trial where from these backgrounds.
As Hussain points out, “those same minorities who are more likely to refuse a vaccine are also twice as likely to catch Covid, and two to three times as likely to die from the disease.” What needs to be understood, according to Hussain, is that “many of the factors that make them more susceptible to Covid also make them more likely to refuse a vaccine.”
We need to begin now to understand and plan for any cultural and symbolic difference that are part of our community lives that make communication less straightforward. Moving quickly to adapt the communications strategies that public health authorities are using to communicate about the Covid-19 vaccination programme is therefore of utmost importance. This means changing tack from the behaviourist and transactional approaches that have dominated so far. It means developing a community-focussed plan based on shared development of the essential messages that will drive the uptake of the vaccine. As Hussain states,
“There… needs to be a shift away from top-down, almost dictatorial communications. These pressers (along with an aggressive social media strategy) have been a ratings hit and invaluable in providing a single, authoritative source of information. But what about communities who do not watch the mainstream channels or don’t actively use social media?”
We can learn a lot from how vaccination programmes are undertaken in other parts of the world, particularly in developing countries whose resources are limited, and where literacy and language levels pose real problems. Radharani Mitra is a creative content advisor with BBC Media Action, she argues that rather than pumping out information, a responsive community communications strategy should be telling stories. She quotes a Native American proverb:
“Tell me the facts and I’ll learn. Tell me the truth and I’ll believe. But tell me a story and it will live in my heart forever.”
Based on her extensive work supporting communities to tell their own stories, Mitra recommends five principles that will help to guide an effective community focussed communions strategy. First, she recommends acting now, and not waiting for either permission or the perfect model of communications to come along. In a situation like a pandemic, it’s essential not to let the perfect be the enemy of the good. Messages and stories should therefore be crafted using the simplest techniques, with the most basic production values, and on the basis that they are going to be shared within communities using limited and basic technologies.
There are messages and conversations that can be started now, so a community-communications policy should start by establishing a wide array of links and contacts with as many people in each community as possible, young and old, rich or poor. A community communications approach is about looking at the assets that a community has and using them. It’s about bringing people together to establish trust and empowering them to express their shared values. We don’t want to overload people with endless information.
One of the lessons of the first national lockdown is that many people turned away from the news, because the way breaking news and journalistic interrogation of news stories created anxiety, driving people to entertainment and alternative pastimes. We can’t put people’s wellbeing at risk by only focussing on information and news. We all need to relax and recharge our batteries.
The second pointer that Mitra gives, is to use some art and craft in the process. If we simply instruct people as to what they should or should not be doing, then they will eventually start to turn off and blank-out these instructions. Instead, we have to be creative. Turning instructions into songs or poems might not be everyone’s idea of a scientifically based model of communications, but it has more chance of being remembered and recalled. Especially if those songs and poems come from the culture and the heritage that each community shares. Creative expression comes in many forms, including dance, art, storytelling, and poetry.
We’ve largely excluded young people from the Covid-19 messaging, but if we ask our young people to create messages that they can share on Tik-Tok, or Instagram, or whatever platform they share with their friends and family, then these messages are more likely to be shared and passed within networks of people who might otherwise have switched off from the BBC or the mainstream commercial radio broadcasters.
We need to pull every lever, and involve everyone in the process of explaining and promoting community solidarity. Even if it is to keep our morale up while we wait in line for a jab. Everything is worth considering. But rather than doing this from the top down, Mitra recommends that these stories and messages should be created and shared locally.
The mass dissemination of pro-social stories can only go so far, people have to be involved as a community asset, not a problem, if we are to to drive the vaccination story forward. As Mitra argues, there is good evidence that humour is a great way to cross boundaries and get on the same level of people as they go about their lives. Mitra recounts how she came across “gags-for-good,” which included a lot of “toilet humour and condom-blowing competitions.” What they achieved was helping “people get over their self-consciousness and engage with topics like HIV and sanitation, which they might otherwise be reluctant to address. That’s not to mention all the satire putting transgressing politicians under the spotlight of public ridicule.”
Mitra adds that in addition to these individual stories, we also need to plan for a whole eco-system approach. This approach recognises that people get their information across a whole range of platforms. In an average day many people are listening to the radio, are watching TV, they are checking emails, flicking through Twitter, Facebook, Instagram. They are talking with one another on the phone. They are sharing WhatsApp messages. Whatever trusted messages we can share will have some effect. This means getting into communities and mutual aid networks and helping them, rather than talking at them, or wrapping them up in form filling.
This is about building trusted and long-lasting relationships, not just driving around a neighbourhood with a van with a poster, or putting up signs in the street. They might help, but we will always need to do more. The strategy has to be and/if not either/or.
Finally, Mitra suggests that this is a process for the long-haul. Any expectation that this is a one-off approach to getting one cooky-cutter message out is mistaken. We need to keep using these ideas and the community co-production processes that they are generated by until we are sure that the pandemic is over. Indeed, it’s almost certain that we will need to keep them going because we also need to deal with the deferred and displaced health needs that many will be facing, as other health and wellbeing priorities start to gain our attention again.
One final point must be about misinformation and the values that drive trusted communications within communities. The worst thing that could happen is for those with concerns, or a hesitancy to take up any vaccines, is for them to be belittled or admonished. The building of trust is a two-way process, and if we don’t listen to other people’s concerns about the vaccination process, and what it’s intended aim is, then there is no chance of changing anyone’s minds. Those who are easily dismissed will be reluctant to voice concerns or ask questions. Those who are simply talked-at and not listened to, will walk away and we may never bring them back into the circle of trust that needs to be built to ensure the widest rollout of the vaccination.
Putting in place a deliberative process where people can share and voice their anxieties, in an accountable and responsible civic space has to be out priority. There can be no trust without deliberation and discussion. There can be no trust without listening and engaging with people over time, on multiple occasions, and by demonstrating that any concerns have been acted on, incorporated and modified as best as we can.
Dealing with the infodemic means being upfront and consistent about deplatforming any coordinated and malicious antivaxxers. It also means ensuring that the personal networks that people connect to are open to trusted voices, and that recognisable and accessible sources of trusted information are at hand. If any media organisation seeks to divide people and antagonise opinion about the process and the effectiveness of the vaccination programme, then they will due a reminder from our political leaders, their advertisers as well as their readers, viewers and listeners. A reminder that tells them that the vaccine rollout isn’t an opportunity to secure profits by using outlandish and unsubstantiated claims by creating clickbait. Clear, quick and independent accountability processes are therefore going to be essential if we are to build trust for the vaccination rollout.
We all have a civic duty to ensure that the vaccinations are dispersed widely and quickly. Genuine inquisitiveness, genuine testing of ideas and testing evidence must be welcomed. However, any deliberate attempt to manipulate or misinform people must be seen as an anti-social act which gets shut down, not only by the media platforms, but by people acting in their trusted networks themselves.
Appealing to shared values that are accountable may no doubt feel alien to contemporary communications professionals, but this is what we have to do. There is a higher purpose￼￼ at hand, and we all have to play our part in ensuring that we achieve this aim together. As Seth Berkley CEO of Gavi, the leading international vaccination organisation says, “despite such challenges, the fact that we have come this far bodes well, not just for how quickly we end this pandemic, but for future preparedness and resilience for the next one.”