By Kristen V. Brown

As omicron looms, muddled government public-health messaging can power vaccine skepticism.

Midway into the pandemic, University of Alabama epidemiologist Bertha Hidalgo realized her Covid communication strategy needed a makeover.

She was skipping basic biology lessons in favor of simply telling people the best ways to moderate their behavior in response to the virus. Instead of helping people better understand the virus, her approach sometimes backfired, introducing more doubt instead of less.

“My method was, ‘These are the facts and this is what you need to do,’” she said. What she quickly learned was that people didn't have enough base knowledge to accept what she was presenting as fact.

“A lot of people have forgotten what they learned in science in high school or college,” she said.

One of the greatest — though least discussed — challenges of the pandemic has been effective public health communication. Give people too little information, and risk anti-vaccine forces swooping in to fill the information void with falsehoods. On the other hand, too much information without the necessary context can create confusion, too.

“Communications is always the forgotten cousin in public health,” said Angus Thomson, a social scientist at the United Nations Children Fund who studies vaccine demand. “We just don't invest in it at all.”

Disinformation and Context

In general, public health entities haven’t much focused on education about topics such as vaccine side-effects or efficacy rates. The result of this lack of investment is an information vacuum that can unwittingly provide an opportunity for anti-vaccine narratives to take hold.

Take the Vaccine Adverse Event Reporting System, or VAERS, a government-run clearinghouse for potential issues with vaccines that has become a favored talking point among anti-vaccine groups.

VAERS is a crucial monitoring system that helps both the Centers for Disease Control and Prevention and the Food and Drug Administration spot problems with vaccines early on. The rollout of the Johnson & Johnson Covid shot was paused, for example, after just six cases of blood clots were reported to VAERS out of nearly 7 million doses administered.

Accessing the database requires first agreeing to have read a long-list of disclaimers: Anyone can report an adverse reaction, and they haven’t been verified or fact-checked. In fact, vaccine providers are urged to report any health problem that occurs after vaccination to the database, whether or not it seems likely the vaccine was the cause.

The existence of VAERS is little discussed by public-health figureheads. If you already know about the database, you may have learned about it via anti-vaccine propaganda, which falsely promotes it as evidence that vaccines have harmful effects.

On Facebook, videos of people reading lists of reported side-effects have gone viral. Children’s Health Defense, an organization headed by Robert F. Kennedy Jr., one of the internet’s most influential anti-vaxxers, regularly touts VAERS statistics in its daily newsletter, and has encouraged its readers to report their own side effects.

It doesn’t take much to twist facts out of context. The Children’s Health Defense typically cites accurate statistics from the VAERS database in misleading newsletter headlines. But headlines often omit or misrepresent context, touting the numbers as proof of harmful vaccine side effects when they are nothing of the sort.

“VAERS Covid Vaccine Data Show Surge in Reports of Serious Injuries, as 5-Year-Olds Start Getting Shots,” read one earlier this month. “VAERS Reports of Deaths After Covid Near 16,000,” read another.

The statistic on the number of deaths in VAERS, for example, also fails to clarify that someone dying after vaccination does not mean the vaccine actually caused their death. (There is also suspicion that anti-vaccine activists have purposely inflated the number of reports in the database.)

‘Like Shark Attacks’

Transparent communication is especially key to gaining the trust of those skeptical or hesitant of vaccines. And trust — far more than facts — is critical to changing people’s minds.

“We could do a lot better in transparency when it comes to vaccines,” says Christopher Martin, a professor at West Virginia University School of Public Health “That is something we struggle with.”

Vaccines, he said, are like shark attacks — something we naturally and inexplicably tend to fear more than any data suggests we should.

“That is never going to change,” he said. “And our approach to hesitant people is to walk up to them on the beach and show them the data and say look you have nothing to worry about.”

Thomson, at Unicef, said that communicating with people about the risks of vaccines can be just as important as communicating about the positive aspects of them.

“Nobody will take a lack of information or silence as positives,” he said.

The tricky part, he said, is that not only do people tend to overestimate the risks, but they also tend toward what’s called an omission bias: they are more afraid of the slim risks of harm if they do vaccinate than the much more realistic risk of harm if they don’t. That means it’s crucial to not only be transparent about the possibility of a vaccine side-effect but also to frame it relative to other risks.

Effective Messaging

In doing so, though, Thomson said public health also needs to take a page from anti-vaccine groups and do a better job pushing messaging out to where people can actually see it. The VAERS website lists a host of disclaimers about the data in it, but people are more likely to encounter a misleading headline on social media about the number of severe side-effects reported in the database without any context.

“We have to get information in the right format for people,” he said.

In Bertha Hidalgo’s case, she found that sharing more in-depth detail often helped people be more open to facts about the virus.

“My approach became breaking down the science. Like, ‘This is exactly like what cells are. This is how the vaccine is made and this is how the vaccine works,’” she said.

In making the case for masks, she found she got more buy-in from people when she explained how the virus is trapped within saliva and mucus particles, and those particles could therefore also become trapped within the weave of a mask.

“I got so many aha moments from people after sharing information like that,” she said.

As Hidalgo adopted this new strategy, one vaccine-hesitant Instagram follower began sending her direct messages with questions about the virus and vaccine. Sometimes they shared misinformation with her. Hidalgo would always respond. Eventually, her follower got vaccinated, as did their significant other.

“That was a real big win,” she said.