Messaging is a big challenge when it comes to changing minds among N.H.'s unvaccinated
This story was updated Aug. 16, 2021 at 11:30 a.m. to reflect the state’s most recent contract with GYK Antler.
There is no shortage of vaccine “messaging” advice for states like New Hampshire, which appears at a standstill with 39 percent of residents eligible for a COVID-19 vaccine not yet vaccinated. Here’s the challenge: Messaging requires constant testing and tweaking.
In August 2020, Civis Analytics, a national data analysis company, recommended two messages for boosting vaccination rates: patient stories and statistics illustrating COVID-19’s health risks. The company retested those messages nine months later and found “scary” statistics had become ineffective and patient stories could backfire. Selling vaccines as a “personal decision” and a way to “get back to normal” had become the new talking points, and emphasizing the vaccine’s safety was shown to be counterproductive.
And the impact of the Delta variant may change messaging recommendations yet again.
In an interview last week, Owen McCarthy, an applied data science lead at Civis Analytics, attributed the change in large part to new worries after the vaccine was available, namely about the vaccine’s approval process, safety, and potential side effects.
“People’s perceptions of things really, really do change over time . . . which is why we want to keep studying different messages,” McCarthy said.
New Hampshire leaders consistently promote vaccinations as the best weapon in the state’s battle against the pandemic, perhaps most prominently in frequent televised COVID-19 updates and regular Zoom calls with hundreds of school and health care leaders.
Gov. Chris Sununu is particularly plain spoken about it. Asked at a COVID-19 update Thursday about the merits of school mask mandates, he said: “If you think this is about masks (or) no masks, you are missing the boat. The more we just sit here and debate masks, not masks . . . we’re missing the importance of vaccine, vaccine, vaccine. Masks are not the solution. The vaccine is the solution.”
The statement strayed a bit from comments made at the same briefing by state epidemiologist Dr. Ben Chan, who emphasized both masks and the vaccine.
Early on, New Hampshire was scrambling to keep up with demand, and it quickly became a leader in vaccination uptake. That rate began plateauing in July, according to the state’s vaccination tracker, and while Sununu noted Thursday that New Hampshire has among the highest vaccination rates in the country, the state has slipped to last place in New England.
As of Friday, 53.8 percent of all residents and 61.6 percent of those eligible for vaccines were fully vaccinated, and about 1,000 people a week are getting vaccinated now, not enough to make a dent in the unvaccinated rate in near future.
Surveys suggest persuading that group to get immunized will require more than new messaging and communication tools.
Tracy Keirns, assistant director of the UNH Survey Center, said she isn’t convinced any messaging will move the 21 percent of respondents in a June survey who said they “almost certainly” will not be vaccinated, a 4 percent increase from May. They cited distrust in the safety of the vaccines and drug manufacturers as their top two reasons, followed by skepticism about the vaccine’s ability to prevent sickness and a disbelief that COVID-19 poses serious health risks.
The center will release new survey results in late August, and Keirns will be looking to see if the arrival of the Delta variant, which is quickly increasing case counts and hospitalizations, has had an impact on that group.
New Hampshire has an advantage when it comes to messengers: Sununu’s popularity ratings are high, and the health experts at the state Department of Health and Human Services are routinely sought out for guidance.
But it’s unclear how state leaders are identifying, testing, and evaluating messaging as they try to persuade the unvaccinated, many of whom are between 12 and 39 and have vaccination rates ranging from 36.5 percent (ages 12-19) and 52.5 percent (ages 30-39.)
The state Department of Health and Human Services declined to make anyone available for an interview. Asked for details at Thursday’s COVID-19 update, Sununu said state public health leaders are exchanging ideas with their counterparts around the country, and plan to begin promoting vaccination at bus stops, in restaurants, and on buses to reach people as they return to offices and schools.
The state has targeted its messaging to people ages 40 and under in a $434,500 with GYK Antler, a Manchester marketing firm, via television and radio spots; banner and billboard promotions; and social media posts on Facebook, Snapchat, Instagram, and TikTok.
The Facebook page the firm created, Your Shot 603, has 22 followers and has two posts, both of graphics: one says “This is your shot to get back to normal” and a second reads “Get the COVID-19 vaccine.”
The page has spent about $20,000 on Facebook ads since May 2021, most of them featuring Patriots player Chase Winovich, according to Facebook ad analytics.
The company spent $15,000 on Snapchat ads and $8,000 on TikTok promotions between April and July, according to the contract, but none appeared in a web search. It also spent $50,000 on television and radio promotions in those four months, according to the contract.
GYK Antler did not respond to questions about its marketing strategy, and the state did not provide examples of the firm’s content.
More visible are the state’s other two other communication tools: mobile vaccine vans and the COVID-19 dashboard.
The dashboard is not short on information and has been a first stop for understanding much about the coronavirus statewide. And it will be an important tool for schools as they watch transmission and vaccination rates to determine mask and social-distancing protocols.
But unlike some states, New Hampshire is not reporting the number of cases and hospitalizations among unvaccinated residents, numbers messaging consultants say can convey the vaccine’s effectiveness. Where “safety” messages have backfired in some studies, promoting the effectiveness of the vaccine has been persuasive. And the state’s numbers are compelling: 99 percent of COVID-19 cases and 98 percent of deaths involve unvaccinated people.
“With talking about safety, one of the theories is that you’re basically putting the idea in people’s heads when it wasn’t there already,” McCarthy said. “We are not saying don’t talk about safety if people have specific safety concerns. But we recommend just leading with the effectiveness message and getting the concept in people’s mind that vaccines are effective at preventing hospitalization and death, and to some extent, infection as well.”
The department did not respond to questions about the dashboard’s included and excluded metrics.
The mobile vaccine van, introduced in July, is available to organizations and communities by request. It has delivered 200 shots across 27 sites, and will soon be joined by a second van.
The department has said the groups requesting the van are promoting stops among their communities. People outside those communities, who may also visit the van, won’t find the schedule easily if they are not on social media. The department posts the schedule on its Facebook and Twitter pages but has not updated dates on its website since mid-July.
A look at vaccination rates in other states and the country as a whole, which has stalled at about 51 percent, is evidence New Hampshire is far from alone in struggling to find the most convincing messages for the hard-to-persuade. The challenge is even more daunting given how much influence gender, political party, and education and income levels have on a person’s decision to forgo a vaccine.
“Campaigns have to be very local and rapidly adaptive to changing circumstances,” McCarthy said. “If there are folks who are on the ground doing outreach in New Hampshire, talking to the people who are still unvaccinated and asking what the reasons are is a good way to understand what the different communities need in terms of either persuasive messaging or increased access, or both.”
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