With Missouri leading the United States in new COVID-19 cases, having a vaccinated population is increasingly crucial to stopping the spread of the disease. But only 39.7 percent of residents are fully vaccinated despite the now-plentiful vaccine supply.

The key to increasing that percentage is convincing the vaccine hesitant – those people who are delaying making a decision about whether or not to get vaccinated, says Amber Reinhart.

Reinhart, who is the associate chair and graduate program director for the Department of Communication and Media at the University of Missouri–St. Louis, specializes in health communication and has worked on messaging around organ donation, increasing healthy behaviors and decreasing unhealthy behaviors.

Along with Professor Yan Tian, Reinhart has turned her attention to understanding what factors and reasoning leads individuals to be vaccine hesitant and how to motivate them to get vaccinated. They’re interested in media consumption, behavior adoption and empathy and altruism for others.

In order to learn more about vaccine hesitancy and persuasive messaging, UMSL Daily sat down with Reinhart for the latest edition of our Q&A series.

Why are people vaccine hesitant?

It ranges from personal concerns, like how can I trust something that was created so quickly, or not knowing if there could be long-term effects of the vaccine yet or that the vaccine hasn’t been formally adopted by the FDA yet. You have those kinds of things that are swirling around with people as they try to make a vaccine decision and it makes them hesitant.

We have to be honest that the science has been changing rapidly, in regards to the pandemic. Some people have anxiety about how quickly things are changing and this impacts their vaccine decision. Humans don’t like change, and it’s difficult for us to adapt to the continually evolving nature of this pandemic. People are hearing all sorts of conflicting information, so it’s difficult for them to know who or what to trust.

Then you also have groups of people who have valid historical mistrust of the medical community after things like the Tuskegee syphilis study, or people who don’t feel currently cared for by the medical community. If you don’t know somebody who’s getting vaccinated, and you don’t know a lot about it, that can breed more mistrust. You don’t know what that experience is like. You might only hear that people have really bad side effects, and that’s what you’re focusing on, maybe. Or it could be something as simple as people just can’t get the time off of work, or they’re worried that they would be sick after they get it, and they don’t have that time.

How has communication or misinformation contributed to the problem?

We’re inundated with information right now, and it’s harder for people to accurately judge quality information from non-quality information. Science has unfortunately become politicized. Then there’s this phenomenon of psychological reactance. When we take away individual freedoms people become angry and are motivated to regain them. There’s something within humans that once you tell me I can’t do something, I want to go the opposite way and do the blocked behavior even more. Some people boomerang hard and seek out information that supports those beliefs.

How can we start to reverse this mistrust?

Trust in government officials is at an all-time low right now. Trust in medical professionals and people from our community is higher. I think you start with people that you trust locally, and you work out from there.

We need to help people understand that everything’s changing all the time as we learn more. I think it’s important for public health officials to start using phrases, like “based on what scientists know today,” because that helps to acknowledge the fact that we don’t know everything about COVID-19. Things we believed a year ago, or things that we believe a month ago, are now obsolete or need to be adjusted based on new data. Acknowledging the fact that science changes helps to validate some of the anxiety people are feeling when things are changing so rapidly, and it helps them feel like they can trust new or adapted information from public health officials.

What communication techniques are most persuasive?

It’s important to meet people where they are. A lot of people who are very well intentioned are actually making their loved ones feel worse and not being persuasive. Somebody says, “I’m worried that the vaccine hasn’t been FDA approved yet.” Then the responses will be, “You just have to trust the science.” That causes somebody to boomerang the other way into opposition. Rather than drowning people in statistics, saying that their beliefs and feelings are incorrect, try asking, “What is it that’s most worrisome for you?” and talk through that. Show them a different path and be supportive about the anxieties or concerns that they have.

Another really good tactic that I’ve seen work is talking about the positive benefits or upsides to getting vaccinated. Rather than saying, “That’s not true,” you focus on a benefit of getting the vaccine and say, “I’m your best friend, and I want to be able to travel with you outside of the U.S. again. Remember how great those trips were?” You can talk about your experience of being vaccinated, and then leverage personal relationships to make it a positive experience, rather than just telling somebody, “You’re wrong, and this is what you need to do.”

Another thing is to try and get rid of barriers. We’ve seen some campaigns that have been doing that, which really help, offering a ride or childcare, employers offering time off. Some of those are also really good ways to help the vaccine hesitant. That’s why it’s good to ask somebody why they’re hesitant, and if it is one of those barriers, figure out a way around it.

What are some techniques for creating persuasive health messages on a large scale?

Two of the important things for those mass mediated messages are tailoring and targeting.

Targeting means that you’re ensuring your message is going to be delivered to the right demographic audience. For example, if you’re trying to reach vaccine-hesitant mothers with elementary school kids, sending your message to a Facebook group of retirees with no kids is not a good idea. You really zero in on what demographic group you’re trying to reach and what media channels are the best way to reach them. You can adapt messaging in terms of the cultural values of that group and target your message that way to reach them where they are and focus on what they care about in terms of the vaccine.

Tailoring looks more at the individual level. That could be something as simple as when I send out the email, it starts with your name. Or it can go more into psychological factors. We can get really specific about what your likes and dislikes are in terms of the messages that you like to receive or the ways that you’d like to be persuaded, and then have different types of messages go to different types of people. Now, that is really high-level, high-touch expensive. But depending on how much you know about your audience, and how important and how much money you had to put behind a campaign, tailoring can work well because the messages are personalized and aimed directly at an individual.

Are there methods for creating messaging that are specific to social media?

There, targeting becomes important again. If your audience on Facebook is really different from your audience that’s on Instagram, you want to change your message accordingly. If one audience is more visually motivated, for example, that’s how you should put your message together.

I think short, clear, transparent is the way to go no matter what because the denser and more difficult to understand, the more people you’ll lose. I’m seeing some really great videos put together with quick infographics where they just take something like the mRNA vaccine and explain it in the simplest terms. It’s a good way to wrap your head around something that’s pretty complex.

What do you think about Facebook disclaimers on everything about COVID?

There’s this thing called the Streisand effect, where if you censor these inaccurate messages, it actually makes people want to see the censored material even more and bolsters people sharing that information. That sometimes only fuels the fire for people wanting to find what they feel like is information that’s being hidden from them. That’s why censoring can backfire and have unintended consequences.

Have there been any significant missteps?

I think the way “OK, don’t wear masks anymore if you’re vaccinated” was rolled out was confusing. There was a jump on “rewarding” those who were vaccinated and a desire to make it feel like we were moving in a more positive direction. But I don’t think it was rolled out very well.

If you could have designed that campaign, what would you have done?

I would have thought through what endpoint I wanted. If it was lifting the mask mandate, when would that make sense? Also, how would I move people from where we were today to there, rather than just a quick, “Everybody take them off.” I think a stepped approach would have been more helpful because then people would have been more prepared for it. As you’re letting the information come out, say, “This is why soon, we’ll be able to take off masks, and this is who’s going to be able to take them off,” and all that kind of information so people can sit with that information and make informed decisions ahead of time.

A lot of people felt like if people were unvaccinated and not wearing masks, that nothing changed. Now it’s impossible to tell who’s vaccinated and who’s not. There was a lot said about your vaccine card, and people thought that was going to be a bigger deal than it has ended up to be, that you might need it to be let into major events, and then that was never the case. Something there was miscommunicated. I understand from a logistical perspective how that was going to be really difficult to do. Again, we have the rapidly changing information. It’s difficult to keep up with and know what to do at times.

Thinking about the near future, what do you hope to see as far as communications around the vaccine?

I hope to see clear, consistent, transparent information. Oftentimes, people are confused because the World Health Organization and the CDC are not always putting out the same information at the same time. I wish that there was more coordination at some of those higher levels for consistent messaging, so people didn’t feel as confused. The CDC should at least acknowledge what WHO is doing and tell us how things are being handled differently here in the United States. It doesn’t mean they always have to be aligned, but at least you’re acknowledging what the other is saying and helping people understand what to do with conflicting information.