INCREASING VACCINE UPTAKE IN DIVERSE COMMUNITIES - A Working Guide for Health Care CEOs
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INCREASING
VACCINE UPTAKE
IN DIVERSE
COMMUNITIES
A Working Guide for
Health Care CEOs
MARCH 1, 2021
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 1
About this This working guide will be made available to the public as a PDF on a
webpage with commenting functionality. New versions will be released to
Working Guide respond to feedback received and to the emergence of additional data and
best practices.
The Roundtable This document was developed by Fellows on the Roundtable on Community
Health and Advancing Health Equity, with support from Health Evolution staff
on Community and Benjamin Bolnick and with significant input from both the Work Group
Health and on Building Scalable Models and Community Partnerships to Address Social
Determinants of Health and the Work Group on Leveraging Data to Improve
Advancing Health Equity. Co-Chairs for the Roundtable and Work Groups include:
Health Equity Mandy Cohen, MD, Secretary, North Carrie Byington, EVP, University of
Carolina Dept. of Health and Human California Health;
Services;
Please note that the views in Laurie Zephyrin, MD, VP, Delivery
this document represent the Pat Geraghty, President & CEO, System Reform, The Commonwealth
GuideWell & Florida Blue; Fund;
collective views of the Fellows
and researchers and do not Rod Hochman, MD, President & Stephen Mette, CEO, University
represent the individual views CEO, Providence; of Arkansas for Medical Sciences
of any specific Fellow or Medical Center;
Wright Lassiter, III, President &
organization within the Forum CEO, Henry Ford Health System; Felicia Norwood, EVP & President,
or of Health Evolution. Chair-Elect of AHA; Government Business Division,
Anthem, Inc.
Mark Smith, MD, Founding
President & Former CEO, California
Health Care Foundation;
The Roundtable on Community Health and Advancing Health Equity supports
partnerships between payer, provider and life sciences companies that can
improve community health and advance health equity among racial groups
and vulnerable populations. The goal of this Roundtable is to accelerate
adoption of new models for improving the health of a community and
promoting health equity for and among local populations.
About the The Health Evolution Forum is a collaboration among over 200 CEOs and
other executives of payer, provider, and life science organizations and other
Health Evolution industry thought leaders designed to bring about near-term impact across
Forum the health care industry. The Forum is organized into Roundtables and Work
Groups that make industry recommendations on specific topics.
Underwritten by
Insight. Innovation. Transformation.
THE
ISSUE Although data around vaccine
distribution in America is sorely limited
and scattered,1 one pattern is becoming
increasingly clear – those who have
been affected by COVID-19 the most are
getting vaccinated the least.
Based on early data from 26 states, Black and Hispanic Americans are getting
vaccinated at approximately half and one-third the rate of white Americans
respectively (see Figure 1 below).2,3 This is true even after controlling for
the demographic makeup of health care workers, who were first in line to
receive the vaccine.2 Meanwhile, Black, Indigenous, and (other) people of color
(“BIPOC”) are contracting COVID-19 at nearly twice the rate, being hospitalized
for COVID-19 at nearly four times the rate, and dying from COVID-19 at nearly
three times the rate as white Americans (see Figure 2 below).4
CONTENTS
01 The Issue
05 10 Steps
06 Part I: Creating an Action Plan
10 Part II: Increasing Confidence
22 Part III: Increasing Accessibility
26 Top Resources
27 References
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 1
Figure 1. Vaccinations as a Share of Total Population by Race/Ethnicity3
LOCATION WHITE BLACK HISPANIC RATIOS OF VACCINATION RATES
1.0x
Total 2.0x
(26 states) 10% 5% 3% 3.3x
4.0x
Pennsylvania 8% 2% 2% 4.0x
3.2x
North Dakota 19% 6% 7% 2.7x
3.0x
Arizona 12% 4% 3% 4.0x
3.0x
Wisconsin 12% 4% 3% 4.0x
2.6x
Indiana 13% 5% 3% 4.3x
White-to-Black Vaccination Ratio White-to-Hispanic Vaccination Ratio
Based on data from KFF analysis. Vaccination data for Pennsylvania excludes Philadelphia.
Figure 2. COVID-19 Cases, Hospitalizations, and Deaths, by Race/Ethnicity5
Rate ratios compared to White, Non-Hispanic persons
CASES HOSPITALIZATION DEATH
American Indian or Alaska
Native, Non-Hispanic persons
1.8x 4.0x 2.6x
Asian, Non-Hispanic persons
0.6x 1.2x 1.1x
Black or African American,
Non-Hispanic persons
1.4x 3.7x 2.8x
Hispanic or Latino persons
1.7x 4.1x 2.8x
CDC, Nov. 2020
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 2
Disparities in vaccine uptake stem from both lower confidence in and less access
to the COVID-19 vaccination. First, many individuals in diverse communities
are less confident than white Americans in the vaccine, with 43% of Black
adults and 37% of Hispanic adults stating they would “wait and see” how it is
working for others before getting it (see Figure 3 below).6, 7 Although the roots
of this low confidence vary by community and individual, it often stems from
distrust of a medical system which has historically mistreated and neglected
BIPOC Americans.8, 9, 10, 11, 12, 13, 14 Second, vaccine distribution is commonly done
in ways that are less accessible to BIPOC Americans in both obvious ways (e.g.,
distribution sites are placed farther from BIPOC communities), and more subtle
ways (e.g., accessing the vaccine requires an individual to have resources—
time, transportation, computer and Internet access, knowledge of how to get
vaccinated, etc.—that are not equitably distributed by race and ethnicity).2
Figure 3. Young Adults, Black Adults Most Likely to Want to “Wait and See”
Percent within each group who say, when an FDA-approved vaccine for COVID-19 is available
to them for free, they would wait and see how it is working for other people:
Age 18-29 43%
Black adults 43%
Hispanic adults 37%
Urban residents 37%
Republicans 33%
Independents 33%
Total 31%
Essential workers (non-health) 31%
Suburban residents 29%
Health care workers 28%
Rural residents 27%
Democrats 26%
White adults 26%
Ages 65 and older 21%
Source: KFF COVID-19 Vaccine Monitor (conducted Jan 11-18, 2021). See topline for full question wording.
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 3
Health care CEOs are in a unique
position to increase confidence in,
and accessibility to, the COVID-19
vaccine because:
The very mission of health care organizations is to
promote healthier communities;
Health care organizations often have more access to
resources, data, and expertise than government and
community organizations;
Many health care organizations also have access to the
vaccines and/or trained vaccinators needed to support
critical community vaccination efforts;
Health care professionals are often seen as trusted
voices in their communities; and
Finally, health care organizations are often among
the largest employers in their communities, providing
an opportunity to have an outsize impact in the
vaccination efforts.
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 4
10 STEPS
HEALTH
CARE CEOS
CAN TAKE
Fixing the deep inequities embedded in the health care system is
beyond the scope of this guide, but CEOs can take the following
10 steps to increase vaccine confidence and accessibility in the
diverse communities they serve:
PART I: Creating an Action Plan
Step 1: Empower a Task Force to Provide Oversight
Step 2: Coordinate with Community Organizations and Local
Government
Step 3: Conduct a Rapid Root Cause Diagnostic
PART II: Increasing Confidence
Step 4: Identify and Train Trusted Messengers
Step 5: Be Transparent About Vaccine, Allocation, and Distribution
Step 6: Create Personal Messaging
Step 7: Use Evidence-Based Messaging
Step 8: Communicate Through Multiple Touchpoints Consistently
PART III: Increasing Accessibility
Step 9: Make Signups as Accessible as Possible
Step 10: Distribute the Vaccines in Local Places
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 5PART I:
CREATING
AN ACTION
PLAN
Step 1:
Empower a Task Force to
Provide Oversight
A : For those who have not already done so, set up an oversight committee
or leverage an existing task force. This task force should be customized
to the organization’s circumstances (e.g., whether playing a direct role in
vaccine distribution and administration; whether a national, regional, or
local organization; etc.).15 Ensure that those on the oversight committee
are demographically diverse and representative of the community that the
health care organization serves,15 ideally with some community member
representation.16
B : Set goals, collect race and ethnicity data, and develop a dashboard to
monitor progress.17 One health system in the Southeast pledged up front
to allocate vaccines in line with the racial and ethnic makeup of its patient
population. This served as a forcing function for the organization to consider in
advance what steps it needed to take in order to reach diverse communities.
To address potential tradeoffs between efficiency and equitable vaccine
distribution, organizations might consider setting goals that phase in over time.
Regardless, data should be collected throughout the process on race, ethnicity,
gender, ZIP code, and occupation.17 This data can then be used to determine
which groups and ZIP codes need more direct interventions.
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 6Step 2:
Coordinate with Community
Organizations and Local Government
A : Coordinate with public, private, and community organizations to bring in
any expertise, resources, or capabilities needed to accomplish the goals
set by the task force.18 Resources might include an accessible location,
security, vaccines, tents, trailers, signage, fencing, restrooms, vendors, website
infrastructure, power cables, laptops, Wi-Fi, staffing, storage, documentation,
etc.19 For example, local health departments can put out calls for health care
professionals to come volunteer at vaccination stations; local sports teams
can provide the space and technology;19 and churches can provide accessible,
trusted spaces for vaccine distribution, as they are doing in Philadelphia.20
Partners that bring strong cultural competence with the communities being
served or targeted should also be identified.
58,000 CASE EXAMPLE: One particularly compelling multi-
vaccines in
organization partnership occurred between UC San Diego
2 weeks
Health, San Diego County, and the San Diego Padres, who
worked to stand up a large-scale vaccination site in five
days that facilitated the vaccination of 58,000 community
members in its first two weeks of operations.19
B : Partner with local and state government. Partner with local health
departments to identify ZIP codes that are hardest hit by COVID-19 and
that have the least access to vaccination sites. Check to see if the state
government has specific goals around equitable vaccine distribution.21
Advocate for local government to use evidence-based messaging and
evidence-based methods for making the vaccine more accessible, as outlined
in the COVID-19 Vaccine Toolkit for Mayors.16
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 7Step 3:
Conduct a Rapid Root
Cause Diagnostic
Do not skip Step 3, as tempting as it may be to jump right into the next
steps. As will be seen throughout this guide, this step provides a critical
foundation for the remaining steps.
A : Review national resources and research to provide context for vaccine
concerns, especially of underserved populations. For example, the KFF
COVID-19 Vaccine Monitor Dashboard has up-to-date data on numbers and
trends regarding COVID-19 cases, vaccine confidence, and vaccine distribution
(for more, see the Top Resources list).22 KFF’s research highlights how Black
and Hispanic adults who indicated that they would like to “wait and see” before
taking the vaccine are “very concerned” about the long-term effects of the
vaccine, the potential for side effects, and overall safety and effectiveness.
Figure 4. Concerns about Vaccines for Black Adults, Hispanic Adults,
and White Adults (KFF)23
Among those who want to “wait and see” how the COVID-19 vaccine is working for others,
percent who say they are very concerned about each of the following:
65%
The long-term effects of the COVID-19 57%
vaccines are unknown
46%
55%
You might experience serious side
47%
effects from the COVID-19 vaccine
34%
47%
The COVID-19 vaccines are not as
44%
safe as they are said to be
28%
46%
The COVID-19 vaccines are not as 41% Black adults
effective as they are said to be
19%
Hispanic adults
31%
White adults
They might get COVID-19 from the vaccine 32%
13%
NOTE: Among those who have not been vaccinated against COVID-19
SOURCE: KFF COVID-19 Vaccine Monitor (conducted Jan 11-18, 2021). See topline for full question wording.
26%
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 21% 8Conversations should be ongoing,
occurring at regular, frequent
intervals, because the community’s
concerns may change rapidly.
B : Bring in local community representatives and organizations to learn
what concerns specific communities have around the vaccine.6 Have open
discussions with multiple local leaders who have an ear to the ground to learn
about concerns of specific populations in the community. These conversations
should be ongoing, occurring at regular, frequent intervals, because the
community’s concerns may change rapidly. For example, in Dayton, Ohio, these
one-hour discussions happen every week.16 Time and resources permitting,
consider also having these conversations with local community members, in
addition to the community leaders.15, 24, 25, 26, 27
All these discussions should include topics such as:
l How has COVID-19 impacted the social and economic fabric of the community?
l What specific questions do community members have about the vaccine?
l What conceptions and misconceptions do community members have about
the vaccine?
l Which populations in the community have lower confidence in the vaccine?
l How do these community members feel about the health care system and
accessing health care?
l How do these community members best access information (e.g., newspapers,
emails, flyers, word-of-mouth, social media, church announcements, etc.)?
l Who do these community members trust and listen to most regarding health
information?
l What language barriers exist in the community?
l What are the biggest barriers for community members to access the vaccine
(e.g., lack of information, transportation, Internet access/savviness, childcare,
time off)?
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 9PART II:
INCREASING
CONFIDENCE
Step 4:
Identify and Train
Trusted Messengers
A : Locate and partner with trusted messengers.28, 27, 16, 6 The information around
COVID-19 and COVID-19 vaccines is confusing, and a certain level of trust is
needed for an individual or community to believe a source of information.27
Although community messaging should be planned in collaboration with local
health departments,29 public health authorities should generally not be used
as the trusted messengers in working with BIPOC communities because Black,
Hispanic, and low-income communities tend to have lower trust in them when
it comes to vaccine recommendations.30
B : Start with own health care organization employees. It is reasonable to
anticipate that all employees within the organization will field questions (and
have questions of their own), so it is important to equip them with up-to-date
information on vaccine efficacy and availability. Those who are naturally in
direct contact with enrollees and patients should receive materials and training
on having non-judgmental conversations with those who have low confidence
in the vaccine. Finally, since the most trusted source of health information for
diverse communities is usually from family and friends working in the health
care industry, and health care professionals of the same race as the message
recipient are generally trusted,16 identify employees who are willing to be part
of a proactive campaign in their community.16 The Ad Council has produced a
useful COVID-19 Vaccine Education Toolkit with videos, FAQs, and social media
copy specifically for health care professionals.31
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 10C : Reach out to additional trusted messengers including family and
friends, local pharmacists, faith leaders, other community-based, non-
governmental leaders who represent the people of the community,27,
16, 6, 32, 33, 34
micro or local “influencers,”33 popular figures,13 and national
“influencers.”33, 13 Generally, the more local the messenger, the more
trustworthy (see Figure 5 below). As one person put it, “The vice president
matters, but it matters more that your barber got it.”35 In practice, health
care organizations should use the term “trusted messenger” rather than
“influencer” because “influencer” has the connotation of being manipulative.
Government messengers are usually seen as the least trustworthy, because
minority groups have historically been mistreated by the government.13, 36 Adult
children are often the most trusted messenger for their parents – many elderly
parents are getting vaccinated only because their children are encouraging
them to do so.37 As such, consider Tik Tok, Instagram, and Facebook
marketing campaigns targeting millennials and Generation Z to convince their
parents to get the vaccine. Work with local news media, which is generally
seen as being the most trustworthy and in touch with the community.16
Figure 5. Concentric Circles of Trust
Being a health care professional helps at all levels
Family & Local/Micro National Influencers
Friends (Best) Influencers (Next Best) /Celebrities
(Least Effective)
SOURCE: HEF, Feb 2021
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 11If people feel like their concerns are
be being downplayed, unheard, or
unaddressed, they are less likely to
listen to messaging about getting
vaccinated.
D : Equip trusted messengers to address the concerns of their
communities.28, 16, 38 , 27, 39, 33, 16, 29 Train and work with the trusted messengers in a
variety of ongoing ways to continuously promote the messages of safe vaccine
uptake. For great examples of how to equip trusted messengers, see the REAL
TALK Case Example below, or the sample conversations on pages 9-10 of the
COVID-19 Vaccine Communication Handbook.40 Establish forums for members
of the community to have their questions answered in nonjudgmental ways
by, and to have conversations with, these trusted messengers.38, 41 These
conversations should utilize active listening16, 40 and should be supportive,
reflective, non-judgmental, and without the intent to convince them to take the
vaccine.41 If people feel like their concerns are be being downplayed, unheard,
or unaddressed, they are less likely to listen to messaging about getting
vaccinated.16, 40 Help the messengers access multiple platforms (social media,
WhatsApp, etc.) so that their messages can “go viral” and be distributed within
communities, families, and friend groups.27, 39, 33, 32 Personal anecdotes from
trusted messengers are often the most persuasive.32 Share their stories.32
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 12SURVEY
Myth
Buster
What to
FAQ
Expect?
CASE EXAMPLE: Jefferson’s REAL TALK Campaign. After conducting a survey of its
health care professionals and measuring uptake of the COVID-19 vaccine in the first
two days of its availability, Jefferson Health noticed that there were stark differences by
race and ethnicity. In response, it developed a “REAL TALK” campaign—first among its
own workforce and then in the broader community—to have candid conversations with
individuals about their concerns.
As part of the campaign, it developed three documents—one on what to expect after
getting the vaccine, one with myth busters, and one with answers to frequently asked
questions—and held 30-minute training sessions with more than 130 trusted messengers.
The trainings focused on helping those trusted messengers know how to have
conversations about vaccinations in an understanding, non-threatening manner, rather
than on convincing or persuading others to get the vaccine.
Those speaking with trusted messengers were most likely to decide to take the vaccine
if they felt that their concerns were acknowledged and that they had a chance to ask
questions. Vaccine uptake increased dramatically in response to the REAL TALK
Campaign, particularly among employees.
E : Encourage those with low confidence in the vaccine to reach out to
a pharmacist or primary care physician for more information on the
vaccine’s development and their perspective on its effectiveness. Many
people have developed trusted relationships with their pharmacists and
primary care doctors and value their counsel. Look for opportunities to elevate
pharmacists’ voices in the conversation and encourage them to direct patients
to vaccine distribution sites. It may be useful to prepare materials for major
pharmacies to hand out so patients have another resource to learn more
about the logistics of getting a vaccine (e.g., vaccine distribution center hours,
what patients need to bring, how to make an appointment, etc.).
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 13Step 5:
Be Transparent About Vaccine,
Allocation, and Distribution
A : Create and distribute clear information about the vaccine. Many people
in the community may simply not know much about the vaccine – how it was
created, how it works, the cause of the side effects, the efficacy, etc.14 Where
possible, leverage materials already created for this purpose by respected
organizations, but be sure to customize based on language, literacy levels, local
community concerns, the best way to reach community members (e.g. mail
vs. email vs. social media vs. door-to-door canvassing), and local eligibility and
administration logistics. Regularly and transparently share easy-to-digest, data-
driven updates on how vaccine distribution is going.16
B : Be sure to note that the vaccine is free. Not everyone knows that the
vaccine is being distributed free of charge, regardless of insurance status, and
so there are many who are concerned about cost.16 In particular, undocumented
immigrants and communities are concerned about becoming a “public charge”
and vulnerable to deportation.16
C : Be upfront about who is getting a vaccine, in what order, and why.15, 27, 16
Many are concerned about the vaccine allocation and distribution, and so be
clear and simple in messaging about who has access to the vaccine, where, and
when.15 Some health systems have been careful to pair the message that the
individual has reserved “a spot in line” with a clarification that the exact vaccine
timing is uncertain and updates will be forthcoming.16
D : Make this information available in as many formats and places as
possible to reach as many community members as possible. Ensure that
this information – particularly the information about when and how individuals
can access the vaccine – is available on the platforms and media most used
by local community members. Create an easily accessible medium through
which community members can voice their concerns and have their concerns
addressed.27
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 14Step 6:
Create Personal
Messaging
A : Ensure that vaccine messages are personally relevant to the target
audience.27, 42, 43 Each community is different, with diverse experiences,
resources, beliefs, and values that must be considered in health
communications.27, 44, 32 Different narratives will resonate with different
communities.27, 45, 46 It is important to avoid over-generalization of groups,
and to be sensitive to diverse perspectives and needs within communities.
Communications that are not tailored to the community may be ineffective and
even backfire.27, 47, 6, 48, 49, 26
B : Promote the experiences of those who look like those in target
communities. Emphasize images of people who are of the same race and
ethnicity as those in target communities - working in the lab on the vaccine,38
getting the vaccine,38 and administering the vaccine.50 Work to promote the
expressed vaccine trial and vaccine uptake experiences of those who are of the
same race as those in the community; share their social media posts.38
C : Get feedback on the messaging. Elicit feedback, formal and informal, on
messaging, to see if it is resonating with community members.33, 13, 16 Find out
if they easily understood the message, if it influenced them to change their
behavior, whether they shared the message, what parts of the message were
most impactful, what part should have been left out, and what was missing.51, 16
D : Go beyond digital. Digital messaging alone will not go very far in increasing
confidence in the vaccine as many of the people with low confidence in
the vaccine are also not using digital technologies.41, 33 If people in targeted
communities have limited access to the Internet or do not engage heavily with
online or digital media, consider conference calls.33 Many people who have low
confidence in the vaccine need their concerns to be physically heard by a trusted
person in a supportive, non-judgmental context (see the Case Example above).41
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 15When discussing the vaccine
development, focus on the large
number of people already vaccinated,
and on the large number of people in
the clinical trials, because people are
afraid of being the guinea pig.
Step 7:
Use Evidence-Based
Messaging
A : Keep message simple, clear, and actionable.40 It is best to focus on one clear
point at a time, with as few words as possible.40 Have links and other information
available for those who want to learn more. Be specific with action-oriented
messaging, and pair action-oriented messages with a clear way to carry out
that action (e.g., if encouraging people to sign up for the vaccine, also provide
the links, phone numbers, and address where they can sign up).40, 52 Keep action
items clear and on top.40
B : Emphasize the specific people researching, taking, and benefitting
from the vaccine. When discussing the vaccine development, focus on
the large number of people already vaccinated, and on the large number of
people in the clinical trials, because people are afraid of being the guinea pig.16
When discussing the vaccine development, talk about the individual people
(the individual scientists, experts, and researchers), not the organizations or
companies, who developed the vaccine.43 Feature doctors and nurses getting
the vaccine and encourage people to talk to their health care provider about any
concerns.16 Highlight how getting the vaccine will keep the individual’s family and
loved ones safe.16, 43 Emphasize that getting vaccinated will get things back to
normal faster, allowing the individual to return to the activities they love.16, 43
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 16C : Avoid shaming. Do not minimize voiced concerns, shame people for having low
confidence in the vaccine,38, 42 or tell them that getting the vaccine is the “right” thing
to do.43 Doing so will show a lack of understanding of the roots of peoples’ lack of
confidence in the vaccine and deepen the divide between the community and the
medical system.43 Use empathic language and avoid judgmental language.43 Avoid
using the term “vaccine hesitancy,” which is taken in a demeaning fashion, and
instead use the term “low vaccine confidence.”41
D : Be visual and emotional. Be visual and simple with vaccine efficacy data16 – even
one powerful graph or infographic can make all the difference.38 Try and use images
instead of text whenever possible, as people remember them more, like them more,
and are more influenced to take action.16 And do not stick just to facts, as information
campaigns do not always increase confidence in the vaccine for many people.41, 53
Shared stories and images can go a long way.53, 16 When showing photos and pictures,
make sure the people in them represent those in the community.16
E : Know the specific audience. Which exact language and messaging to use
depends on the political, racial, and ethnic makeup of the community – for precise
language for different communities, see the de Beaumont Foundation’s Language
of COVID-19 Vaccine Acceptance,43 which is broken down by race54 and by political
party.55 Insights on precise language to use can also be found in KFF’s “Wait and
See” Survey Analysis by race (Table 5) and by political affiliation (Table 2).23 Make the
reference group as specific as possible when inviting people to join the larger group
in getting the vaccine (e.g., “Join your fellow members of City Church Philadelphia in
getting the vaccine…”).16 However, avoid using a city (e.g., “Join other Philadelphians
in getting the vaccine…”) as a reference group, as many feel negatively towards
their city and their city’s responses to COVID-19.16 Use local facts and figures when
marketing the vaccine, as these are perceived as more relevant and impactful.40
For precise language for different
communities see the de Beaumont
Foundation’s Language of
Covid-19 Vaccine Acceptance.
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 17When discussing the vaccine
development, focus on how
rigorous the trials were under
the FDA’s scrutiny.
F : Focus on vaccine safety. When discussing the vaccine development, avoid
discussing the speed at which the vaccines were developed as this makes
people nervous,16 and instead focus on how rigorous the trials were under the
FDA’s scrutiny.43 If people ask about the speed, discuss how the safety measures
that are always in place for vaccines were still in place for the COVID-19 vaccine.
Explain that the vaccine was able to be developed so quickly because the
vaccine production steps, which are usually done in a staggered, sequential way,
were done simultaneously at huge expense. Repeat the word “every:” “every
study, every phase, and every trial was reviewed by the FDA…”43
Although the main focus should be on the benefits of the getting vaccinated (i.e.,
keeping your loved ones safe), if discussing the harms of not getting vaccinated,
emphasize the high rates of the lingering, long-term complications from
COVID-19 – brain fog, difficulty breathing, extreme fatigue, and depression.38 Do
not try to downplay the side effects of the vaccine, as people are scared about
potential long-term, currently unknown side effects.16, 43 When addressing the
immediate side effects, emphasize the limited nature of the immediate side
effects.16, 43 When addressing the potential long-term side effects, emphasize
how long-term side effects in vaccines across the board are generally seen
within the first six months,16, 43 and that researchers have already been
monitoring those in the vaccine trials for almost a year.
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 18G : Use certain words while avoiding others.43, 41, 56, 16, 40
USE AVOID
America’s leading medical experts America’s leading health experts
Research Discover/create/invent/study
Medical researchers Drug companies
Damage from lockdowns Inability to travel easily and safely
A transparent, rigorous process The money spent on the trials
Safety Security
Pharmaceutical companies Drug companies
Your family Your community or country
A return to normal Predictability
The benefits from taking it The consequences from not taking it
Globally Internationally/around the world
Advanced/ground-breaking Historic
Vaccination Injection/inoculation/shot
Taking the vaccine will help keep you and your family safe (except Taking the vaccine is the right thing to do (except for
for the Latinx community, where these are reversed) the Latinx community, where these are reversed)
America’s leading experts The world’s leading experts
Skeptical/concerned about the vaccine Misled/confused about the vaccine
The benefits of taking it The consequences of not taking it
Low vaccine confidence Vaccine hesitancy
The vaccine is effective in 95% of cases The vaccine is ineffective in 5% of cases
If you don’t get the vaccine, you fail to take advantage of a If you get a vaccine, you reduce your risk of getting
95% chance of preventing COVID-19 COVID-19 by 95%
Taking the vaccine will protect your loved ones Taking the vaccine will protect you
Call the Vaccination Information Line to book an appointment (a
Get the COVID-19 vaccine (too vague)
specific action)
3 million people have been vaccinated in the US from
3 thousand people in your ZIP code have been vaccinated (local)
COVID-19 (not local enough)
3 in 4 say they will get the vaccine (emphasize the prosocial 1 in 4 say they won’t get the vaccine (best not to
behavior) mention the antisocial behavior)
A vaccine authorized by FDA based on clinical testing Operation Warp Speed; Emergency Use Authorization
Public Health Government
Medical experts and doctors Scientists
“I can see that you need your COVID-19 vaccine today/You are due “What do you think about getting the COVID-19
for your second COVID-19 vaccine” vaccine today?”
Find more evidence-based guidance on what communications work best from the Poverty Action Lab57 and U.S. Digital Response.58
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 19To impact people’s behavior,
messaging must be ongoing.
Messages repeated over time are
received as more credible.
Step 8:
Communicate Through Multiple
Touchpoints Consistently
A : Connect with community members through multiple touchpoints
consistently over time.42, 27 To impact people’s behavior, messaging must be
ongoing.27 Messages repeated over time are received as more credible.16 The
messaging should come from multiple trusted messengers, across multiple
relevant media.27 The messaging should also be updated to the current
concerns of the community, rather than static.
B : Promote factual information continuously to counter specific viral
misinformation. Misinformation is one of the largest contributors to low
vaccine confidence.59 , 60, 61 The misinformation spread both intentionally and
unintentionally is exacerbated by both the novelty of COVID-19 and the public’s
widespread reliance on social media for information.62, 63 Following Steps 1-7
is one important way to counter misinformation.27, 64, 56 Make sure to tailor
messaging to directly counter the specific pieces of misinformation circulating
in the community.27 This requires staying in touch with the community’s
concerns, including through close monitoring of social media to stay on top of
misinformation circulating in the community.64, 40
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 20Consider “prebunking” misinformation by proactively warning people that
they may be misled, and providing the factual information that is counter
to the misleading information they may hear.40 However, be very careful
when discussing misinformation, as discussing misinformation, even in the
context of actively dispelling it, may backfire and cause people to believe
the misinformation.56 Therefore, try to focus mostly on the facts, rather than
discussing the myths. Make these facts simple, few in number, and visual.56 If
choosing to address myths, each myth must be proceeded by both the factual
information and explicit warnings about the myth, and each myth must be
followed by an explanation of why the myth is false, and a reiteration of the
factual information.56, 40 For an easy-to-use visual guide to this process, see
pages 14-18 the COVID-19 Vaccine Communication Handbook.40
C : Promote trustworthy sources. Trustworthy sources include those that
share or report on the evidence put forth by public health experts. Encourage
these sources to be active on social media, and make sure health care leaders,
other employees within health care organizations, and trusted community
messengers are promoting their content (e.g., “retweeting” or “sharing”).65
The COVID-19 Vaccine
Communication Handbook
offers an easy-to-use
visual guide to address
misinformation.
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 21PART III:
INCREASING
ACCESSIBILITY
Step 9:
Make Signups as
Accessible as Possible
A : Coordinate with the community to centralize vaccine appointment
signups.66 People are understandably very confused about where they can
get a vaccine, as each vaccine distributor has its own sign up. Centralizing a
signup takes away the frustration of going from provider to provider to try to
find where vaccines are available. Coordinate with government officials and
technology vendors to ensure interoperability between systems where possible.
This clarity saves both the patient from shopping around for an appointment
and the organization from fielding as many questions about vaccine availability.
B : Utilize multiple mediums for signing up. It may be the case that many
people in the community do not have access to, or comfort with, the Internet.
Make sure there are multiple ways individuals in the community can both (a)
learn about when and where they can access the vaccine, and (b) sign up for a
vaccine appointment. Create telephone hotlines, in-person information booths,
text messaging hotlines, door-to-door canvasing campaigns, etc.67
C : Be proactive in addressing barriers. Barriers to signing up that may appear
insignificant on the surface may in fact feel insurmountable to many in the
community. Target high-need communities by ZIP code and address the
signup barriers that are unique to that location. Proactively call, text, and visit
those who are eligible to sign up for a vaccine appointment in order to sign
them up. Send teams of people into the community with tablets to sign up
individuals.67 Send those with vaccine appointments email, text message,68 and/
or phone call reminders, depending on how people are best reached in the
community.56 Consider forming a working partnership with community partners
with boots on the ground to make this happen.
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 22Do not overpromise – you do not want to
tell someone they have a vaccine available
and then have to turn them away.
D : Consider notifying patients that they have an appointment to take the
vaccine, rather than just telling them that they can sign up, but only
after vaccine supply is more predictable. Telling a patient that they have
an appointment that they can cancel or re-schedule rather than just telling
them that they can sign up for an appointment can improve overall vaccination
rates.69, 68 However, do not overpromise to avoid having to tell someone they
have a vaccine available and then turn them away.
E : Consider carefully providing financial incentives for getting vaccinated.
Incentives such as gift cards or cash compensation have been shown to
increase uptake rates, including a study at Swarthmore College where a $30
incentive doubled flu vaccination rates from 9% to 19%.70, 69 However, it is
critical to get feedback on this method before implementing it. Many people in
diverse communities may feel as if they are being treated as guinea pigs16 based
on historical events.8, 9, 10, 11, 12, 13 Offering incentives or fast tracking a particular
group may only exacerbate this sentiment,14 so tread carefully. In a particular
community, it may be the case that financial incentives are trusted when they
come from employers, but not from the health care system. One method that
has worked is employers giving their employees paid time (e.g., two hours of
pay), stipends, and free transportation to go and get vaccinated.71 Consider
implementing these types of programs among health care employees, and work
with local businesses to implement such programs for their employees.69
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 23Step 10:
Distribute the Vaccines
in Local Places
A : Distribute the vaccines in places that are safe, familiar, and convenient
to those in diverse communities.15, 27 Partner with community-trusted
organizations to set up distribution sites in safe, familiar, and convenient
locations.15 These places could include local pharmacies,72 community centers,
places of worship, schools, parks, COVID-19 testing centers, etc.13 COVID-19
testing centers in particular are often well-suited for this purpose because they
already have the general infrastructure in place including check-in staff, adequate
space and tents, etc. For those with access to their health care provider, their
health care provider is often their most trusted distributor of the vaccine.43
However, due to the widespread mistrust of the health care system, especially
amongst communities of color, first verify whether this is true in each community.
B : Those giving the vaccine should be representative of the community.73
To the extent possible, have those giving the vaccines be representative of
the community in terms of race, immigration status, religion, sexual identity,
socioeconomic background, and disability.73 Past studies have shown that Black
men were significantly more likely to agree to preventive lab work, screenings,
and the flu shot when seen by a Black physician.50 Not only will this make those
getting the vaccine more confident in getting the vaccine, but they will be more
likely to share their experience about getting vaccinated from someone they can
relate to with their friends and family.
C : Bundle the vaccines with other services community members are already
accessing.15, 27 If logistically feasible, try to deliver vaccines to people in their
homes when community health nurses visit to deliver other preventative health
services.74 But even outside the home, make vaccines available in locations
that people are already going to in order to receive other services such as food
assistance.15 Not only will this increase uptake, but it can reassure community
members that health care organizations are thinking about their overall
wellbeing, not just getting them vaccinated.15
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 24Many people in the community
will want the vaccine, either now
or in the future, but will face
barriers in accessing it.
D : Bridge the specific barriers to access faced by the community. Many
people in the community will want the vaccine, either now or in the future, but
will face barriers in accessing it. These barriers can include lack of information
about when and where to access the vaccine, lack of transportation to and from
the vaccine, lack of Internet access to sign up for the vaccine, lack of childcare,
lack of time off, or something else. If transportation and childcare are significant
barriers to members of community accessing the vaccine, consider setting up
transportation or childcare services or partnerships with organizations who can
provide these services. You may even want to set up mobile vaccination vans
to bring the vaccine directly to someone’s block or workplace.75, 76 Door-to-door
outreach for vaccination signup67 and administration is also a model that has
been successful for populations with limited transportation and technology
access, often with help from a local organization that has expertise and
resources in such door-to-door outreach.
E : Consider restricting access to certain vaccine distribution sites by ZIP
code. Even when vaccine distribution centers are set up locally in minority
communities, those living within the community are still often being left behind
because those who are more tech-savvy and have more resources are shopping
for early vaccine appointments online and driving in to get vaccinated, leaving
the local community around the distribution site still unvaccinated.35 If this is a
problem in a particular community, consider limiting vaccinations at particular
sites to those who are from specific ZIP codes, and request that individuals bring
a piece of mail with the relevant ZIP code.
HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 25TOP
RESOURCES
Tracking and Background Information
1. KFF’s COVID-19 Vaccine Monitor Dashboard (ongoing tracking and analysis of
public’s attitudes and experiences with COVID-19 vaccinations)
2. KFF’s “What Do We Know About Those Who Want to “Wait and See” Before
Getting a COVID-19 Vaccine?” (detailed analysis of survey of people who expressed
low confidence in the vaccine)
Communication Guides
3. Ad Council’s COVID-19 Vaccine Education Toolkit (videos, FAQs, and social media
copy for health care professionals)
4. de Beaumont’s Language that Works to Improve Vaccine Acceptance
(infographic on language to use and presentation on findings on hesitancy and
messaging for different racial, ethnic, age, and political affiliations)
5. SciBeh’s COVID-19 Vaccine Communication Handbook: A practical guide for
improving vaccine communication and fighting misinformation (detailed
research on public health strategies for addressing low vaccine confidence)
6. COVID-19 Vaccine Toolkit For Mayors: Public Engagement and Communications
(useful guide for coordinating efforts with local government and for advocating for
evidence-based approaches by local government)
Select Case Examples
7. Jefferson REAL TALK Campaign (public-facing website with training session links
and one-pagers for trusted messengers)
8. UC San Diego Health, San Diego County, and the San Diego Padres Partnership
(article about a successful multisector effort to launch a large vaccine site on a very
short time frame)
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HEALTH EVOLUTION | Increasing Vaccine Uptake in Diverse Communities 29You can also read
