South Florida Sun-Sentinel Palm Beach (Sunday)
Public health agencies try to regain trust
Data show skepticism around COVID-19 shots threatens other public health issues
OKLAHOMA CITY — By the summer of 2021,
Phil Maytubby, deputy
CEO of the health department in Oklahoma City, was concerned to see the number of people getting vaccinated against COVID19 slipping after an initially robust response. With doubt, fear and misinformation running rampant nationwide, he knew the agency needed to rethink its messaging strategy.
So, the health department conducted an online “sentiment search,” which gauges how certain words are perceived on social media. The tool found that many people in Oklahoma City didn’t like the word “vaccinate” — a term featured prominently in the health department’s marketing campaign.
“If you don’t know how your message is resonating with the public,” Maytubby said, “you’re shooting in the dark.”
Health officials nationwide have been trying to restore trust within their communities these past few years, a period when many people haven’t put full faith in their state and local health departments. Agencies are using Twitter, for example, to appeal to niche audiences, such as NFL fans in Kansas City and Star Wars enthusiasts in Alabama. They’re collaborating with influencers and celebrities such as Stephen Colbert and Akbar Gbajabiamila to extend their reach.
Some of these efforts have paid off. By now, more than 80% of U.S. residents have received at least one shot of a COVID-19 vaccine.
But data suggest that the skepticism surrounding COVID-19 vaccines now threatens other public health priorities. Flu vaccine coverage among children in mid-December was about the same as December 2021, but it was 3.7 percentage points lower compared with late 2020, according to the Centers for Disease Control and Prevention. The decrease in flu vaccination coverage among pregnant women was even more dramatic over the last two years: 18 percentage points lower.
Other common childhood vaccination rates are down, too, compared with pre-pandemic levels. Nationally, 35% of all American parents oppose requiring children to be vaccinated for measles, mumps and rubella before entering school, up from 23% in 2019, according to a recent KFF survey.
Part of the problem comes down to a lack of investment that eroded the public health system before the pandemic began. An analysis conducted by KHN and The Associated Press found local health department spending dropped by 18% per capita between 2010 and 2020. State and local health agencies also lost nearly 40,000 jobs between the 2008 recession and the emergence of the pandemic.
This made their response to a once-in-a-century public health crisis challenging. “We were not as flexible as we are now,” said Dr. Brannon Traxler, director of public health at the South Carolina Department of Health and Environmental Control.
At the start of the pandemic, Traxler said, only two people worked on the media relations and public outreach team at South Carolina’s health department. Now, the team has eight.
“We’re really just trying to dispel misinformation that’s out there,” Traxler said. The health department has partnered with local leaders to encourage vaccinations. Agency staffers have also become more comfortable talking to the press to better communicate with the public.
But some public health experts argue that agencies are still failing on messaging. Scientific jargon such as “mRNA technology,” “bivalent vaccine” and “monoclonal antibodies” are used in public health even though many find them hard to understand.
A study published by JAMA found that coronavirus-related language used by state-level agencies was often more complex than an eighth-grade reading level and harder to understand than the language used by the CDC.
“We have to communicate complex ideas to the public, and this is where we fail,” said Brian Castrucci, CEO of the de Beaumont Foundation, a charitable group focused on strengthening public health. “We have to own the fact that our communication missteps created the environment where disinformation flourished.”
Most Americans support public health, Castrucci said. But a minority pushes an anti-science agenda and has been effective in sowing distrust, he said.
The more than 3,000 public health departments nationwide stand to benefit from a unified message, he said. In late 2020, the foundation, working with other public health groups, established the Public Health Communications Collaborative to amplify easy-to-understand information about vaccines.
“The good guys need to be just as well-organized as those who seek to do harm to the nation,” he said.
Meanwhile, a report published in October by the Pew Research Center found 57% of U.S. adults believe “false and misleading information about the coronavirus and vaccines has contributed a lot to problems the country” has faced amid the pandemic.
“I was leery like everyone else,” said Davie Baker, 61, of Oklahoma City. When the shots became widely available in 2021, she thought they had been developed too quickly, and she worried about some of the things she’d read online about side effects. A pharmacist at Sam’s Club changed her mind.
“She just kind of educated me on what the shot was really about,” Baker said. She signed up for her first COVID-19 shot in May 2021, around the same time the health department in Oklahoma City noticed the number of vaccines administered daily was starting to decline.
The department updated its marketing campaign in early 2022. Instead of using the word “vaccinate” to encourage more people to get their COVID-19 shots — the term the agency’s social media analytics revealed people didn’t like — the new campaign urged people to “Choose Today!”
“People don’t trust like they used to,” Maytubby said. “They want to make up their own minds and make their own decisions.” The word “choose” acknowledged this preference, he said.
Maytubby thinks the campaign worked. A survey of 502 adults in Oklahoma City conducted during the first half of 2022 found fewer than 20% of respondents reacted negatively or very negatively to a sample of “Choose Today!” advertisements. And an estimated 86.5% of adults in Oklahoma City have received at least one dose of a COVID-19 vaccine — a rate higher than the state average of about 73%.
Meanwhile, the war against misinformation and disinformation wages on. Childhood vaccination rates for the immunizations students typically need to enter kindergarten are down 4.5% in Oklahoma County since the 2017-18 academic year as parents increasingly seek exemptions to the requirements.
That worries Maytubby. He said the primary tactic among those trying to sow distrust about vaccinations has been to cast doubt — about everything from the science to their safety.
“In that aspect, they’ve been pretty successful,” he said. “Misinformation has changed everything.”