How to Talk about COVID-19 Vaccinations: Building Trust in Vaccination

"Knowing people's specific concerns about the COVID-19 vaccination are like what we see when we stand outside a house - what is on the surface. To really understand and address people's hesitancy and to build trust in vaccination, we need to know what that hesitancy is built on."

This guide is for people in health, science, policy and community roles who want to talk effectively about COVID-19 vaccinations with different groups of people who may have hesitations or ambivalence about getting vaccinated. It is designed to: help the reader understand the foundations that underpin vaccine hesitancy; describe eight techniques and tools to address vaccine hesitancies; show these techniques in use; and provide tools and templates.

Developed and written by The Workshop, the guide is informed by: a literature review; qualitative research into COVID-19 vaccination attitudes and beliefs among Māori communities in Aotearoa, New Zealand in July 2021; and messages that were tested by the Department of Health in the Victorian State Government of Australia. Throughout the guide, there are reflections on some of the experiences and needs of Māori communities in relation to communication about COVID-19 vaccination. In some cases, specific research insights are provided, and in others, the guide suggests how messages could be made more relevant for Māori communities.

Section 1 of the guide outlines the foundations of vaccination beliefs and hesitancy. As The Workshop notes, hesitancy about vaccination is on a continuum. Many people who have hesitations go on to get vaccinated. There are three main overarching drivers of vaccine hesitancy:

• Individual/social group influences, which are beliefs, attitudes, and understandings of the vaccines that emerge from culture, personal experience with institutions, and information environments;
• Contextual factors, which include historical and political experiences of neglect, discrimination, lack of citizen participation, and politicisation of science and vaccination; and
• Vaccine and vaccination-specific issues, which include characteristics of the vaccine, vaccine development, and process and the accessibility of vaccinations. COVID-19 faces particular challenges because of the perceived novelty of the platform used and the speed of development.

Section 2 explains eight communication techniques and tools to address the drivers of vaccine hesitancy. In brief, they are:

1. Provide it - make access to vaccinations easy
2. Co-develop it - build trust in the process
3. Envision it - overcome fear and bias by describing the post-pandemic world
4. Motivate it - remind people of what they value most
5. Frame it - help people see it differently
6. Explain it - deepen understanding in simple ways
7. Normalise it - show how many others support vaccination
8. Inoculate - protect against false information

Section 3 provides tools and templates that can be used to implement the research and messages recommended in the guide.

Messages provided in the guide that are designed to build trust and motivate vaccination:

• Use values of care and love to build trust in the vaccination process instead of delivering facts about safety.
• Share knowledge and partner on the development of vaccination communications with all communities.
• Offer information (how, where, and when) to make access to vaccination easy.
• Provide a positive vision of life after the pandemic, getting back to the things and people we love (especially useful in lockdown or outbreak situations).
• Talk about caring for and keeping people they love and know healthy.
• Put health workers who care about people's wellbeing in the picture to help build trust in the system.
• Lead messages with the collective benefits of vaccinating, rather than focusing on the risks of not vaccinating.
• Avoid framing vaccination as an individual choice, with individual risks and benefits.
• Explain how when we all get vaccinated it gives all of us protection by keeping the virus out (collective immunity).
• Assume willingness to vaccinate, and leverage these good intentions.
• Avoid urgency framing: Frame vaccination as one of many effective tools we are using to keep ourselves well.
• Normalise vaccination: Tell stories of people moving from hesitancy, ambivalence, or delay to action.
• Have people who are trusted and perceived as experts within each community talk about why they got vaccinated.
• When dealing with false information, first alert people to the common strategies that people will use to spread false information and erode trust in vaccination.