Missouri’s first COVID vaccine doses are on the way. How do you get people to take them?

Nestled in the pages of Missouri’s initial plan for how to distribute the highly-anticipated coronavirus vaccine was a paragraph touting that “Missouri’s population understands the importance of receiving a COVID-19 vaccine.”

A month later, in a revised version of the report, the paragraph was gone. 

Instead, the updated plan featured a new section that targeted how the state would combat misinformation, complete with a website promising a page dedicated to “myth busters.”

The revisions came after the Centers for Disease Control and Prevention’s feedback was incorporated, scaling the state’s original 111-page Oct. 11 report down to 105 pages when it was revised Nov. 11.

“It is not the vaccine that will get us there — it’s vaccinations.”

– Randall Williams, director of the Missouri Department of Health and Senior Services

Lisa Cox, a spokeswoman for the Department of Health and Senior Services, said the paragraph was removed, “because we did not have data to fully support the statement.”

It underscores the challenge the state faces in ensuring that Missourians take a vaccine amid a pandemic where public health measures, like wearing masks, have been politicized.

State leaders have framed the vaccine as a path to normalcy that “is now lighted.” The first of Missouri’s vaccinations may begin as soon as Thursday. 

But receiving enough doses is just the first step. Missourians will also have to be willing to take them.

“It is not the vaccine that will get us there — it’s vaccinations,” Randall Williams, the state health department’s director, said late last month.

The state has outlined strategies in its plan for a media campaign that will continue six to eight months after the first vaccine is delivered. But getting the facts out on the safety and effectiveness of a vaccine may take more than billboards, social media posts and influencers.

Researchers say it will also need the support of community leaders residents trust — especially among Black, Latino, Indigenous and immigrant communities, who have unique concerns about taking a vaccine.

“Messaging is not a one size fits all approach,” said Monique Luisi, an assistant professor of strategic communication at the Missouri School of Journalism who studies communication around public health measures.

Repeated messages from all angles

Pfizer said its vaccine is 95 percent effective, and Moderna says its vaccine is 94.5 percent effective. But myths around a COVID vaccine have still evolved from safety concerns around its record pace of development to the government’s involvement in the rollout.

Take the recently circulated myth of microchips and vaccines. That’s difficult to combat, “because how do you prove a negative,” said Kolina Koltai, a postdoctoral fellow at the University of Washington’s Center for an Informed Public who studies the anti-vaccine movement.

One way is ensuring people see the facts and hear accurate messages repeatedly, Koltai said, which helps make them more effective.

With researchers still learning more about how the virus works, vaccine plans changing day to day and misinformation constantly arising, officials will need to be continuously addressing new myths and trying to reach residents in every way possible, Koltai said.

In a draft of a marketing campaign included in Missouri’s vaccine distribution plan, a proposal to spend nearly $600,000 aims to do just that, including tailoring social media posts to targeted audiences like in areas where there might be outbreaks; putting posters and billboards in communities with nursing homes; using Google Search to drive people to the state’s website as they search for a vaccine’s availability; and working with “minority influencers” and community newspapers to specifically reach the state’s Black residents. 

The state is trying to address specific myths with its website that explicitly states: “COVID-19 is not a hoax and neither is the vaccine.”

But some of the healthcare workers among those first in line to receive a vaccine under the state’s plan are still hesitant to do so, said Heidi Lucas, the state director for the Missouri Nurses Association (MONA).

While it’s improved, some nurses are still nervous about being the “guinea pigs,” and MONA is working on surveying its members to better understand where their fears are coming from. 

“We really need the nurses to be confident in taking it so that the general public will feel confident in taking it as well,” Lucas said, later adding, “If we politicize the vaccine like we politicized masks, we are in massive trouble.”

Rebuilding trust

In St. Louis, Angela Clabon already hears the hesitation among Black residents when it comes to taking a COVID vaccine.

Among the questions she’s heard: How would the vaccine affect someone that’s diabetic or has high blood pressure? Should they be worried clinical trials struggled to recruit Black participants? Is taking the vaccine another step for experimentation?

Clabon, the CEO of CareSTL Health, a Federally Qualified Health Center that provides affordable healthcare to underserved communities throughout St. Louis, said there needs to be a special emphasis on vaccinating healthcare workers that work with Black communities. She fears that if there’s a shortage, Black residents and underserved communities may not be prioritized in the way they should.

“I think that our community may be left out,” Clabon said. “If they hit the essential workers and the hospital systems, it may not get to poor people in the way that it should.”

While overall confidence in a vaccine has risen to 60 percent, in a recent Pew Research Center survey Black Americans were the least likely to get one compared to other racial groups. Only 42 percent of those surveyed said they would definitely or probably get a vaccine.

And they continue to be one of the groups disproportionately affected by the virus’ spread, in part, due to disparities in access to healthcare, jobs as essential workers on the front lines and more. Across the country, Black and Latino Americans are nearly three times more likely than white Americans to die from the novel coronavirus.

In addition to the current toll the virus has taken, the state will have to overcome trauma from past medical abuses, like the Tuskegee Study, in which roughly 600 Black men in Alabama were studied to understand the progression of syphilis. Participants were not told of the study’s true aims and those with syphilis were not informed of their diagnosis and were left untreated.

“These fears — some of it is historical — but some of it, too, is just based on people’s even current day experiences,” said Jannette Berkley-Patton, a professor at UMKC School of Medicine’s Department of Biomedical and Health Informatics, “because we know that for many African Americans, studies have shown they don’t receive quality care.”

Williams, the director of the state health department, said on a call with reporters earlier this month that the department is especially sensitive to those concerns, and one of the groups they’ve been in contact with is the Health Forward Foundation, which provides grants to organizations in the Kansas City area to tackle barriers and improve health for the uninsured and underserved.

Qiana Thomason, the president and CEO of the foundation, said their goal isn’t to promote the message that people get vaccinated — but instead to provide education to address the concerns “so that people can make an informed decision on whether vaccination is right for them.”

That means ensuring information is being translated in multiple languages and that residents are hearing from leaders in their own communities.

With a grant from the National Institutes of Health, Berkley-Patton is working with the Kansas City Health Department and Black churches to both increase the reach of COVID testing in underserved populations and also study what factors influence whether or not people will get tested.

The study will begin early spring and faith leaders will have a hand in every stage of the process from strategizing how to reach members through sermons and food pantries to interpreting the findings. Berkley-Patton, who also serves as the director of the UMKC Health Equity Institute, hopes the lessons learned can then be repurposed toward COVID vaccination efforts.

“We know that churches have a prominent position in the community, not just in the pews, but beyond the pews and into the communities that they serve,” Berkley-Patton said.

Ultimately, to convince someone to receive a vaccine requires understanding their motivations for getting one. For some, it may be to get back to work. And for others, “getting the vaccine for vaccine’s sake,” may not be enough, Luisi, the MU assistant professor, said.

Sometimes it takes the power of the personal. Luisi’s own grandmother lived through World War II when polio was emerging and at the time there was no treatment. Her grandmother can’t remember a time this bad since then.

“She said she can’t wait to be one of the first people in line — 80-plus year octogenarian — be in line for a vaccine,” Luisi said. “And that, to me, is inspiring.”