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1/21/21 COVID-19 Brief: Seven Communications Tips to Drive COVID-19 Vaccination

This waiting for vaccines feels a little like Disney World. Just a couple of months ago, we were waiting for the park to open. Now with vaccine distribution under way, we find ourselves in the queue for the ride.

A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman

Seven Communications Tips to Drive COVID-19 Vaccination

This waiting for vaccines feels a little like Disney World. Just a couple of months ago, we were waiting for the park to open. Now with vaccine distribution under way, we find ourselves in the queue for the ride. The line seems impossibly long, but it is moving, and while we wait with hope and anticipation of our turn, we hear from those who have gotten their shots. They are grateful, relieved, and happy (see my pic below).

Precisely because we look forward to our turn with such anticipation, it can be difficult to understand those who haven’t yet decided whether or not they want to be vaccinated, much less those who are actively campaigning against the vaccine. But that is our reality, and so in addition to the supply chain and logistical challenges companies need to navigate for successful workforce vaccination (relevant article here), employers face a difficult communications challenge.

Seven Tips

To be clear, my intent here is not to provide comprehensive strategic and tactical advice. There are some really good documents that provide more complete guidance, including this report from NIH on Vaccine Communication and a regularly-updated Communication Handbook, representing the work of multiple researchers and volunteers.

The tips below are provided to help you leverage your unique position as an employer to overcome vaccination communication challenges so you can efficiently and effectively protect your employees, families (and perhaps others) from COVID-19.

1. Establish a Shared Vision

At a time of deep division, we sometimes forget that we share much in common, including a strong longing to return to a more normal life. Companies provide another layer of common ground because employees – from executives to the front line – share a common interest in returning to normal at work and all that entails for both business performance and personal meaning, growth, achievement, security, and dignity.

Companies should use employee input to create a vivid and compelling vision of what it will mean to be on the other side of this pandemic. That vision is the “why” behind the “what” of vaccination. That vision is what will inspire those already inclined to be vaccinated to be role models and encouragers for others. That vision is what will give those who may otherwise hesitate to get vaccinated a reason to overcome their skepticism or fear.

2. Focus Your Efforts

As vaccines have gone from promise, to approval, to distribution and vaccination, public opinion has improved. This December report by the Kaiser Family Foundation (KFF) notes that 71% of the public would definitely or probably get the COVID-19 vaccine if it was determined to be safe by scientists and available free of charge. This compares with 63% in a September survey and implies that a significant majority of people are ready to be vaccinated. They need information, but not a lot of convincing. Particularly with a strong “why” (Tip #1) these employees are simply waiting for the who, what, where, and when so they can get vaccinated.

Of course, 70% isn’t good enough, so you still have work to do. To put resources where they can do the most good, I recommend thinking in terms of both people and sites.

  • On the people side, KFF research indicates higher rates of vaccine hesitancy among Republicans (42%) those aged 30 to 39 (36%), rural residents (35%), African Americans (35%), and those likely to be deemed essential workers (33%). Additionally, immigrants and refugee populations present multiple challenges related to language, culture, and overall health literacy.
  • Regarding site-based targeting, once you understand your person-level segments, pull back and think about how your people are distributed among different locations. A corporate office in a city is likely to require less messaging focus than a rural manufacturing site, and a pocket of immigrant and refugee workers will require something entirely unique to their needs.

Finally, know that there is a linear relationship between vaccine enthusiasm and flu shot behavior. So, sites where you have low historic flu shot participation should be flagged as potential trouble spots where you need to dig in and learn more.

3. Think Big to Do Good and Build Goodwill

I mentioned this in another recent article, suggesting companies leverage their vaccination infrastructure to also immunize family members, contractors, suppliers, and even people in the community. Expanding your circle of concern sends a strong message to employees about your company’s commitment to its shared vision and helps alleviate potential concerns that the company is “jumping the vaccination line” for its own gain.

4. Get Messaging Right

Consider these five elements:

  • First, you need a strong, high-level message that articulates your shared vision, the role of vaccines and the importance of vaccinations in a clear and compelling way.
  • Second, you need messaging that covers essential information about the vaccines (what they are, that they’ve been approved for safety and efficacy, anticipated side-effects, etc.).
  • Third, you need a simple framework to communicate basic instructions (who, what, where and when) at the site level as vaccines become available.

These first three elements will give those already inclined to get vaccinated what they need.

  • The fourth element should be built to improve health literacy by addressing concerns of those who are hesitating. Health literacy is defined by the CDC as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” Language and culture play obvious roles, but so does the information environment. Distrust of media, the fragmentation of information sources, and the proliferation of misinformation about vaccines makes it harder for many to “find, understand and use” information to make well-informed decisions.

With that in mind, survey data indicates that the sorts of issues you’ll need to focus on, including: A) Concerns over safety and side-effects; B) Concerns about how fast vaccines were developed (and can they be safe); C) Skepticism about the severity of COVID-19; D) Worries that the vaccine will cause them to get COVID-19; and E) Distrust of the healthcare system (particularly for African Americans and linked to historic abuses).

The above (and other) issues should be addressed using clear and fact-based information, presented in a way that is respectful. Consult with site-based leaders and local health officials to better understand the challenge and learn about what has/has not worked in the past to improve health literacy.

  • Finally, the message environment is a moving target. As new vaccines become available, and as information becomes available about vaccines already available, messaging will need to be updated and appended.

5. Leverage Trust/Trusted Messengers

Much of the time, the source of information is more important than the accuracy or credibility of the information itself. This is particularly true when the information is complicated and/or the audience has a general skepticism of science or medicine. Focusing on pockets (people and sites) where you expect vaccine hesitancy to be high, identify, engage, and equip people who have already earned trust from your target audience. Trusted voices may be found among your formal leadership ranks, among employee peers, or out in the community.

6. Partner with External Stakeholders

Consider partnership on a couple of levels.

  • First, strategic partners. Public health departments and health care providers can be a source of insight and collaboration to address specific challenges. Look for entities already in the trenches with hard-to-reach populations and look for ways to learn from and collaborate with them.
  • Second, as noted above, look for trusted people and organizations in the community (religious leaders, health care professionals, community organizers and others) to help deliver vaccine information and encouragement.

7. Incentives (?)

Certainly, it makes sense to enable employees to get vaccinated ‘on the clock,’ and for the vaccines to be free of charge. And, if your company has conditioned employees to expect incentives for healthy actions/behaviors, it may make sense to simply stay the course. But if your company hasn’t established those habits, I’d think twice about individual incentives. Perhaps instead, consider making a donation to help vaccinate people in underserved areas, with the donation tied to employee vaccine participation. This sort of approach could help to amplify your shared vision.

That’s a lot, but it’s really just a start. Clearly, having a strong communication strategy is going to be key for hitting vaccination targets. If you have other ideas or success stories to share, please let us know so perhaps we can share them with others who receive this newsletter.

Grateful and happy to get my first shot!

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

Dr. Hoffman was recently featured on an episode of Workplace Injury Prevention - A Fit For Work Podcast, covering topics including the science behind vaccines, developing herd immunity, mitigation measures for the workplace, and the importance of perseverance as the light at the end of this pandemic's tunnel grows brighter. Click this link to listen to the episode.

For more from Dr. Hoffman, connect with him on LinkedIn.

Medical:


Area Reported Cases Deaths Recovered
Global 97,078,572 2,077,038 69,625,500
United States 24,918,147 414,094 14,864,268

As of Tuesday this week, 400,000 Americans have died from COVID-19, as we approach the anniversary of country’s first known death in the pandemic. The pace of COVID-19 fatalities has been accelerated through the fall and into the winter. The single deadliest day of the pandemic was Jan. 12, with more than 4,400 deaths reported. Much of the latest surge has been attributed to people gathering over the holidays, from Thanksgiving to New Year’s Eve.

The COVID Exit Strategy website lists 8 states as Severely Constrained in terms of ICU bed availability: New Mexico (96%), Alabama (90%), Georgia (90%), Nevada (89%), Oklahoma (89%), Rhode Island (88%), Mississippi (87%), and California (85%). As with the data described above, these states are generally located on the East and West Coasts and the South. With respect to total hospital beds, no states are listed as Severely Constrained, and only 1 state is listed as Constrained: Rhode Island (89%). Notably, 20 states are listed as Normal for ICU beds, and 25 are Normal for overall hospital beds.

What we now know — and don’t know — about the coronavirus variants: By now, you have likely heard about different variants that first raised trouble in the United Kingdom, South Africa, Brazil, and now maybe California — though the jury is very much out on whether that last one is cause for concern. To make a messy alphabet soup even more jumbled, these variants have unwieldy names, and they each contain mutations with unwieldy names of their own. The result is that people are left trying to differentiate among B.1.1.7 and N501Y and E484K and C-3PO.

Emergence of SARS-CoV-2 B.1.1.7 Lineage — United States, December 29, 2020–January 12, 2021: Modeling data indicate that B.1.1.7 has the potential to increase the U.S. pandemic trajectory in the coming months. CDC’s system for genomic surveillance and the effort to expand sequencing will increase the availability of timely U.S. genomic surveillance data.

Ivermectin: Ivermectin, an antiparasitic drug with antiviral properties, has shown promise during in vitro studies by inhibiting replication of SARS-CoV-2 in very small concentrations. Observational studies, case series reports, and ecological analyses have also supported this finding. Today, EClinicalMedicine (published by The Lancet) published the first pilot clinical trial testing ivermectin as a treatment of COVID-19. The study used a double-blinded, placebo-controlled design to evaluate ivermectin’s ability to treat COVID-19 disease or mitigate transmission risk. The study included 24 patients, with half (12) receiving a single dose of 400 mcg/kg of ivermectin and the other half (12) receiving a placebo. The treatment was administered within 72 hours of developing a fever or cough. The researchers collected clinical data and nasopharyngeal swabs on Days 4, 7, 14, and 21 post-treatment to assess detectable SARS-CoV-2 RNA by PCR, viral load, symptom severity, and seroconversion. The treatment group had lower viral loads at Days 4 and 7 and lower IgG titers at day 21, but these differences were not statistically significant. Patients in the did have a statistically significant improvement in the time to recover from hyposmia/anosmia—76 patient-days in the treatment group compared to 158 patient-days in the control group.

Rogue Antibodies Could Be Driving Severe COVID-19 (Nature): More than a year after COVID-19 emerged, many mysteries persist about the disease: why do some people get so much sicker than others? Why does lung damage sometimes continue to worsen well after the body seems to have cleared the SARS-CoV-2 virus? And what is behind the extended, multi-organ illness that lasts for months in people with ‘long COVID’? A growing number of studies suggest that some of these questions might be explained by the immune system mistakenly turning against the body — a phenomenon known as autoimmunity.

Mitigation/Suppression:

WHO herd immunity not likely in 2021: The World Health Organization’s chief scientist warned that even as numerous countries start rolling out vaccination programs to stop COVID-19, herd immunity is highly unlikely this year.  At a media briefing on Monday, Dr. Soumya Swaminathan said it was critical countries and their populations maintain strict social distancing and other outbreak control measures for the foreseeable future.

FDA Warns of False Negative COVID Tests From Virus Mutations: US regulators warned about the potential risk for false negative results with molecular tests for SARS-CoV-2 due to mutations such as a recently detected B.1.1.7 variant of the virus.  The US Food and Drug Administration (FDA) on Friday issued an alert to clinical laboratory staff and clinicians. The agency warned that false negative results can occur with any molecular test for the detection of SARS-CoV-2 if a mutation occurs in the part of the virus's genome assessed by that test.  

Pfizer-BioNTech COVID-19 Vaccine Works Just as Well Against Variant First Detected in U.K., Study Indicates: The COVID-19 vaccine from Pfizer-BioNTech appears to work just as well against a fast-spreading variant of the coronavirus first identified in the United Kingdom as it does against earlier forms of the pathogen, the companies reported in a study Wednesday.

COVID-19 Vaccine Guidance for Those Who Are Lactating is Based on Faulty Assumptions, Experts Say: Government guidelines and news headlines alike have grouped those who are breastfeeding and pregnant together when talking about COVID vaccine safety. But as people try to make their own decisions without safety data, it might help to acknowledge that getting vaccinated during pregnancy and lactation carry different theoretical risks — and potential benefits.

A year into the coronavirus pandemic, the perplexing problems of COVID-19 long-haulers seem no nearer resolution — or even explanation — than when they first puzzled doctors and patients in the spring.

This much is known: Long haulers, recovering patients whose symptoms persist after their coronavirus infections disappear, are a mix of younger people who never needed hospital care and older people with chronic conditions that predate COVID. Their symptoms trail the infection’s path through their lungs, hearts, muscles, nerves, and brains. Deadening fatigue can dog them for weeks or months. Sometimes their problems wane, then resurface in a stuttering pattern that leaves them wondering if they’ll ever get over the malaise.

Advantages in the next round of vaccines released: Among the multiple vaccine candidates around the globe, next up in the arsenal against COVID-19 is likely the single-dose Ad26.COV2.S vaccine in development from Johnson & Johnson/Janssen, infectious disease experts predict.

And it got closer this week with promising interim phase 1/2a trial results, published online January 13 in The New England Journal of Medicine.

A single Ad26.COV2.S dose was associated with S-binding and neutralizing antibodies in more than 90% of the participants. The finding was observed in both adults age 18-55 years and participants 65 and older, as well as for participants given low-dose or high-dose vaccinations.

Corporate:

Rochelle Walensky, the incoming director of the U.S. Centers for Disease Control and Prevention, said she will start her new job with a big to-do list: helping states fix COVID-19 vaccination programs and persuading exhausted Americans to wear masks and take other precautions.

In an interview with The Wall Street Journal, Dr. Walensky said the agency will try to help people overcome doubts about COVID-19 vaccines and she vowed to increase public trust in the CDC.

Masks Protect You & Me “Masks are a two-way street”

Updated Jan. 7, 2021 by the CDC for public information posters:

The Work From Home WorkSTEPS Medical Team:

Ben Hoffman, MD, MPH
Chief Medical Officer

Tony Nigliazzo, MD
Medical Director

Loraine Kanyare, MSN, MPH, RN
Director of Case Management

Lynda Phillips, LVN
Nurse Case Manager

Codey Church, LVN
Nurse Case Manager

Kerry Womack, LVN
Nurse Case Manager

Chuck Reynolds
Strategic Communications Consultant

This Guidance (“Guidance”) is provided for informational and educational purposes only. It is not intended as Legal Advice or Medical Advice. Adherence to any recommendations included in this Guidance will not ensure successful diagnosis or treatment in every situation. Furthermore, the recommendations contained in this Guidance should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the medical condition. Similarly, this Guidance is based on current advice, comments, and guidance from the EEOC, CDC and the CMS made publicly available. The ultimate judgement regarding the propriety of any specific employment action must be made by the company and attorney in light of all of the circumstances presented by the company, state and federal rules existing at the time and the then current state of the National Pandemic. This Guidance and its conclusions and recommendations reflect the best available information at the time the Guidance was prepared. The results of future studies or changes in rules, regulations or laws may require revisions to the recommendations in this Guidance to reflect new data. WorkSTEPS does not warrant the accuracy or completeness of the Guidance and assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this Guidance or for any errors or omissions.

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Newsletter written by WorkSTEPS CMO Dr. Ben Hoffman and WorkSTEPS’ expert medical team.

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