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Behaviorally Informed Strategies for a National COVID-19 Vaccine Promotion Program

JAMA. 2021;325(2):125-126. doi:10.1001/jama.2020.24036

National efforts to develop a coronavirus disease 2019 (COVID-19) vaccine at “warp speed” will likely yield a safe and effective vaccine by early 2021. However, this important milestone is only the first step in an equally important challenge: getting a majority of the US public vaccinated. In a September 2020 survey of 10 093 US adults, only 51% indicated that they were definitely or probably willing to be vaccinated with a novel COVID-19 vaccine, 25% reported that they were probably not willing to get the vaccine, and 24% reported that it is unlikely that they would be vaccinated.1 This survey further revealed that acceptance was lower among Black individuals (32%, 263 of 822); those with lower educational attainment (47%, 676 of 1438 among those with high school or less education) compared with college graduates (56%, 1673 of 2988) or those with a postgraduate education (63%, 1693 of 2668); and among Republican voters (44%, 1817 of 4129).1

The US needs a national strategy for promotion of COVID-19 vaccines that unites the urgency and commitment of Operation Warp Speed with innovative behavioral science and social marketing approaches to increase COVID-19 vaccine confidence and acceptance in diverse populations.

Core to any successful strategy is to rebuild trust in the rigor of vaccine trials and the integrity of the approval process. Literature on vaccine acceptance identifies some essential strategies: simple, easy-to-understand language; messaging that emphasizes science over politics; endorsements by diverse and well-regarded celebrities and opinion leaders; and emphasis on facts and evidence over myths and disinformation. For the COVID-19 vaccine, attention must be given to rebuilding trust in communities that have historically experienced medical exploitation, unconsented experimentation, and social and economic marginalization.2 Those getting vaccinated also need to be warned about transient adverse effects of the vaccines to avoid negative publicity from unprepared individuals.

This Viewpoint proposes 5 strategies, informed by insights from behavioral science, for a national COVID-19 vaccine promotion program. These strategies are proposed with the recognition that many uncertainties remain: the timing of approval or authorization of 1 or more vaccines; the safety and efficacy profile of the vaccine(s); the implementation of priority allocation schemes by state and local authorities; the capacity of existing immunization programs and channels to support COVID-19 vaccine promotion and distribution; and the further politicization of vaccine approval and acceptance.

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