Mass vaccinations for Covid-19 are offering a glimmer of hope for communities around the world. To be successful and reach those that need a vaccine most, a coordinated approach will be essential. If all goes well there will be a concerted effort by national and local governments, acting collaboratively and internationally, to ensure that take-up of the vaccine is maximised. It’s often said, however, that the first ninety-five percent of any vaccine rollout is the easy part, but that ultimate success depends on reaching those in the last five percent. This last five percent is the most difficult to reach, either because many are sceptical of the benefits of vaccines in general, or they are reluctant to engage with any kind of vaccination process because they lack trust in those who are issuing them.
The mass uptake of vaccines relies on a number of well-defined factors which Government and healthcare providers must consider in planning the distribution of any vaccine. To be operating efficiently, with widespread functional availability, healthcare providers, governments, NGO’s and civil society organisations, all have to ensure that vaccination programmes are easy to access, are close to the points where people need them, and are explained in ways that are meaningful to the people who need them.
Vaccination programmes, therefore, need to be supported with both a symbolic, as well as a practical infrastructure. This infrastructure must be able to operate in a way that is both technically reliable, but also fits with the worldview and the social framework that those who must be vaccinated are able to understand. To ensure that a vaccine rollout programme is suited to the job, we need a plan that is both efficient and meaningful. An infrastructure that operates efficiently, but which offers no meaningful connection with the people that it is designed to serve, will fail.
Vaccine rollout planning, therefore, has to look at the wider social infrastructure and process of delivery, and not just the logistics of getting people with supplies of the vaccine into relevant positions. This is about creating demand as well as managing supply. If the demand isn’t managed correctly, then the supply will be squandered. As we found with the test and trace process, testing was often in the wrong place, accessible at the wrong times, and irrelevant to many of the people who were most at risk from Covid-19 infection.
The communications programme, therefore, must be easy to understand, it must be focused on the safety and reliability of the vaccination process, and it has to demonstrate high levels of trust by individuals and communities who may otherwise be sceptical about the motives of the people issuing the vaccines. Telling the story of why the vaccination is needed, and the process by which the vaccination will be distributed is going to take enourmous amounts of creative energy.
We should all be concerned that conspiracy theories, misinformation, manipulation and cognitive bias are all potentially rife within the social networks and platforms that we use to communicate with one another. While government can legally enforce public and broadcast content standards, no government can enforce what people share and discuss in their family groups, with their friends, or across their social networks. Enforcement isn’t an option, but neither is waiting for widespread scepticism, mistrust and propaganda to become endemic. We already have one pandemic, we don’t need a second information-pandemic.
Fortunately, here in the UK there is considerable expertise and experience of mass vaccination management, both at a national level, and within the established local systems for public health. While there are valid questions about the extent to which the UK government has relied on corporate contracts to deliver Covid-19 responses, at the expense of local responses, it is clear that we are still able to operate a public health system that can be activated at scale. We have the capacity to coordination and operate widespread healthcare and medical engagement across the whole healthcare system if needs be. This will ensure that a mass vaccination programme can be contemplated. The social care system for the elderly is a case-in-point where this provision failed, so one can never be too optimistic or critical enough. Groupthink in an emergency is a problem.
One of the other major lessons of the pandemic, has been the targeting of broad messages through the mass communications process. Driven by a behaviourist and marketing model of mass communication, governments, local authorities, and the public health authorities, have often failed to keep people across all social backgrounds informed of the challenges of the pandemic and the subsequent need for shielding, protection, and isolation. The fact that we are in a second lockdown suggests that the measures taken so far have not been robust enough to bring about lasting behaviour change. Indeed, there is evidence that behaviour change is becoming harder to achieve because message fatigue has set in. Combined with the fact that many people cannot afford to follow the self-isolation rules given their economic and family circumstances. When your choice is to work or go without food, then whatever your symptoms you will work.
However, and regardless of the economic and practical concerns related to the Covid-19 pandemic, it’s clear that the communications process has been badly managed. It’s largely been one-dimensional. It has focussed on mass media transactional models of information provision, which depend on the notion of mass audiences defined by consumer differentiation. This process has ignored many of the potential benefits of a locally defined, community sensitive communications appraoch.
A community-focussed model of communication would be a more appropriate responce to the pandemic because it would offer a wider range of alternative strategies, it would fill the gaps where engagement is falling short, and it would diversify and open-up more people’s thinking, so that the challenges of the pandemic can be addressed pragmatically, in ways that work in situ and not simply ex situ or in theory.
This is not to say that there should not be a government-led communications strategy. This is not an either/or situation. We are, instead, we face an and/if situation. This is a situation in which we might expect that government, and their agencies led by the Department for Culture, Media and Sport, and Ofcom, to be pullingl every available lever to ensure that communications are effective, widespread and relevant to the lives of people across all the different communities and cultures living in the UK. However, if the communications model is pitched largely at middle-aged, prosecco drinking, AB class people living in market towns in the South East of England, why would anyone else relate to the messages that are being communicated. No wonder young people are ignoring the efforts to lockdown, none of the messages are relvent to them.
The breakdown of the communication model is perhaps understandable in a society that has an almost total reliance on the process of mass-media models of news, marketing, communication and information management. These often blend into one single process, which is defined as an audience-driven model of media engagement. It’s very powerful, and it works, but it’s not the only answer. An example of how effective mass-media advertising can be was the radio advertising around the Eat Out to Help Out scheme. Many did eat out to help out. Many people returned to pubs and restaurants for a catch-up with friends and family, with a discount voucher provided from the Chancellor of the Exchequer to subsidise their food. The subsequent rise in the R-Rate, however, tells us that the push for a return to economic normality was premature. Radio is a powerful tool, and needs to be used sensibly and wisely.
The question, then, is would a more pluralistic model of communication be more effective. Would a process of communication that included alternative, independent, civic, mutual and community focussed approaches to communication have fared any better? It was remarked during the first nationwide lockdown back in March, that the spontaneous wellspring of mutual aid groups, neighbourliness, and offers to volunteering, provided succour for many of us who have become cynical and scorned by the unrelenting individualsim and consumerism that dominates our society. It was good to be reminded that we are not intrinsically selfish and self-obsessed consumers of wasteful and destructive consumer products. Many immediately started discussing how we can Build Back Better, or what our Renewed Normal might be like. There was a sense of hope that came from a renewed sense of solidarity and community concern.
It would be a shame, then, if we did not apply the lessons of these moments of potential renewal, and simply return to the hollow and one-dimensional communication practices of the past. There is a need for people to feel that they belong, and for them to share in mutual support for others that is nurturing and is caring. Our communication model matters, because if we let the mass media model dominate and take over again, then we will become dispirited and loose that sense of potential and energy that was momentarily glimpsed during the early stages of the lockdown. To put it simply, we need to ensure that both mass and community-focussed communications have the additional dimensions of care, contribution and inclusivity. The process of developing our communications matters as much as the products that form it.
The thing is, this idea isn’t new. It is practiced widely around the world, particularly in relation to communications within the developing world. There is much we can learn from community communications that we help to shape in other parts of the world. Organisations like UNESCO, Save the Children, BBC Media Action, Internews, all run media empowerment training so that communities can learn to tell their own stories, shape their own narratives, and be the subject of their own news. Better Media is an aim we should all support.
There was a recent webinar given by Gavi, an NGO supporting vaccine programmes. It was a good reminder of the principles of community media in the way that it is meant to opperate as a practical, accessible and progressive development tool. What was being explained through examples from India, Ghana, Somali and others, was that successful communications which supports the widespread rollout of a vaccination programme, must start with the core attribute of community involvement. This doesn’t mean adding on a comms-strategy at the end of a project, posting a couple of things on Facebook and sending out a press release. It means, instead, adopting a community development mindset and getting into the issues of community communication at the start of the project, and ensuring that it imbues the whole of the project with the attributes of community engagement, participation and co-development.
Here in the UK we can learn many things from the well established development programmes around the world. Particularly we can learn from countries and communities that don’t have the luxury of well-established supply chains for medical equipment, a budget to attract and train high quality medical staff, or an ability to permenantly situate healthcare and wellbeing services in the heart of the communities that are being served. As well as thinking about the infrastructure associated with the vaccination rollout, it is essential that developing communities also think about the communications processes that support them. If there is no money to waste on expensive PR agencies, pumping out generic advertising, then programmes of community communication have to get their messages right as it matches the context of their communities’ symbolic framework, and their ability to act on messages that they hear.
If the aim ist ot ask people in a community to act and behave differently, then they have to be given a social goal that they can go along with. This will be different for individuals and for communities . A couple of questions where proposed during the webinar that are relevant to anyone involved in developing messages and content relating to the rollout of the Covid-19 vaccine. There is a need to expand on these in more detail soon, but for now a list will be useful:
- What are the common problems associated with vaccination resistance in each community?
- How have community solutions played a role vaccination rollouts before?
- What are the community perceptions of vaccination and public health campaigns?
- How is community trust defined and what needs to be considered if these are low?
- Is the community used to being involved in the process off service or communications development?
- Is there a history of coordinated engagement in relation to health and wellbeing through community-focussed forms of media?
- Have lessons from the community developmental approach to community-focussed communications been taken on board?
- What are the main drivers for building trust in different communities, and different parts of these communities?
- Are people being met on their own terms or on the terms of the service provider?
- What is the emphasis on establishing relationships?
- To what extent are different social groups viewed as homogenous?
- What’s the mindset and symbolic reference points that people acting in different social situations and communities calling on and relating their experiences to?
We really should have been planning a community communications response to the vaccine rollout when we first realised that the initial lockdown responses were not working. But we are where we are, and we now need to move very quickly to establish coordinated lines of action so that there are consistent, accountable and accurate messages being developed with communities. The challenge is to overcome those layers of distruxt that are embeded in some communities, the sense of sceptcism in other communitie, and to help those who find it difficult to grasp the genuine need that everyone is vaccinated.
We need to start planning and acting now if we are to ensure that we have adequate community communication resources that fill-in the gaps left by mass media providers? At the end of the day we will be judged by how long it takes to get widespread uptake of the vaccinations. For some this will feel like an obvious and logical thing to do. For others, it will feel alien and disturbing to their beliefs, values and traditions. While respecting those beliefs, values and traditions, we also have to ensure that everyone is protected, and that we understand that this is a community act of solidarity that will have lasting repercussions for years to come.