A marketing campaign is underway in Hawaii to encourage residents to roll up a sleeve for the COVID-19 vaccine when it becomes available.

The public health ad blitz launched by the state Department of Health will also aim to allay the concerns of those who say they are hesitant to get vaccinated.

The goal is to inoculate a large enough portion of the population for the state to achieve herd immunity. State officials say about 70% of Hawaii residents will need to get vaccinated against COVID-19 to greatly reduce the likelihood that even those who are not vaccinated will catch it.

Queen’s Medical Center frontline COVID-19 worker, Dr. Lester Morehead, MD receives part 1 of the Pfizer COVID-19 vaccine given by right, Ruby Takahashi APRN at a press event held at Queen’s Medical Center. December 15, 2020
Dr. Lester Morehead, a hospitalist who works directly with patients affected by the disease in The Queen’s Medical Center COVID-19 unit, was the first person in Hawaii to receive a COVID-19 vaccine. He said his biggest fear about the vaccine is that people will choose not to take it. Cory Lum/Civil Beat/2020

Persuading vaccine skeptics to get the shots approved for emergency use by the federal government is expected to be a significant challenge. 

A November survey by the University of Hawaii’s Public Policy Center found that just 44% of Hawaii residents said they planned to get the vaccine when it becomes available.

That’s down 7 percentage points from a similar study in August.

Most Hawaii residents will likely not have a chance to get vaccinated before spring. So for now, the state Department of Health’s public messaging campaign is targeting health care workers, first responders and residents and staff of long-term care facilities who are the first in line to get their two doses of either the Pfizer-BioNTech or Moderna vaccines.

It is critically important physicians understand how the vaccines were developed, how they function and how effective they are in protecting against COVID-19,” DOH spokesman Brooks Baehr said in an email. “Physicians are trusted. They will play an important role in conveying information and advice to their patients.”

Total funding for the campaign has not yet been allocated and there is not yet an estimate, but the DOH expects most will be covered with federal funds, Baehr said in an email.

People with concerns about the safety of the vaccine should not be written off as anti-vaccine extremists, said Emily Brunson, a medical anthropologist at Texas State University who studies vaccine skepticism. 

Legitimate concerns — about whether pregnant or breastfeeding women should get the vaccine, for example — need to be dealt with head-on through targeted messaging that clears up misconceptions, she said.

“This is something that really has to be addressed at the local level because someone’s concern in Honolulu may be really different than someone’s concern in Texas,” Brunson said.

Results are expected early next month from a mid-December survey of 3,846 Hawaii residents about their willingness to be inoculated against COVID-19 and any hesitations they may harbor. By comparison, the vaccine acceptance survey conducted in November by the UH Public Policy Center had just 616 respondents.

This newer, larger study is being conducted by Olomana Loomis, the Honolulu communications agency, under a $200,000 contract with the DOH to assist in delivering its vaccine messaging to the public.

The agency has also conducted more than 30 focus groups and three virtual town hall meetings bringing together thousands of health care workers and medical experts across the state. 

All of this research will help guide the DOH’s vaccine messaging — first for health care workers, a group that appears to be more willing than the general public to be inoculated against COVID-19, and eventually for the broader public, said Alan Tang, chief executive officer of Olomana Loomis.

Because the COVID-19 vaccine landscape is changing rapidly, the majority of the messaging disseminated so far to health care workers has been through email, Tang said.

“People in our focus groups are saying, ‘I want my freedom,’” — Alan Tang, Olomana Loomis

The general public will most likely start encountering public messaging about the vaccine sometime in January, Tang said.

The main messages? The vaccine is safe, effective and, along with mask wearing and physical distancing, it’s a tool that can help Hawaii return to normal.

“People are motivated by different things,” Tang said. “Unlike the mainland, our virus counts are fairly low per capita so we don’t see the drastic impact of losing our friends or seeing a lot of our friends’ suffering.” 

“What we’re seeing is economic suffering and suffering from the loss of our island lifestyle,” he said. “We’re finding that people in our focus groups are saying, ‘I want my freedom,’ because there seems to be a sense of loss of freedom because of the restrictions.”

But getting vaccinated will not be a ticket to freedom — at least not right away.

That’s because there are still uncertainties about how long the vaccine’s protection lasts. It’s also possible that vaccinated people can carry the virus without symptoms and transmit it to others.

“Just because you’re being vaccinated doesn’t mean you’re completely protected,” said Sandra Chang, a professor in the University of Hawaii’s tropical medicine department.

“So during this period of being vaccinated, we’re still recommending that people follow the guidelines for wearing masks and staying six feet apart from people and not gathering in crowds,” she said. “As we see the numbers of cases declining in the community, then the decision can be made to reduce the regulations as far as social distancing, et cetera.”

As more people get vaccinated and infection counts dwindle, Brooks said restrictions will loosen — but the Health Department can’t predict a timeline for when this will occur.

“The ultimate goal is to create enough immunity in the population to end the pandemic, revive the economy and get life back to normal,” he said in an email.

The DOH plans to reach the public through television, radio and social media. Public service announcements will likely feature medical experts and testimonials from people whose lives have been disrupted by COVID-19 or those who have already been vaccinated.  

The department said it will continually update hawaiicovid19.com with vaccine facts and answers to common questions.

Messaging will specifically target communities disproportionately sickened by COVID-19, such as non-Hawaiian Pacific Islanders and Filipinos.

The DOH launched a talk-story series with influential Native Hawaiian and Pacific Islander community leaders. The goal is to share information about the COVID-19 vaccines, gauge awareness and increase vaccine willingness through influential community leaders.  

The department is also supporting other organizations interested in promoting vaccine education, such as COVID Pau, professional groups and employers.

“Luckily in Hawaii people seem to be more open and have not necessarily developed firm negative reactions towards the vaccine,” said Sandra Chang, a professor in the University of Hawaii’s tropical medicine department who is helping advise the DOH on its campaign. 

“I think if we provide the education and encouragement in this community, there is the potential to get more people vaccinated here than maybe other parts of the country,” she said. “But there is an element of hesitancy and in some cases opposition to vaccination and we just have to address those as best we can with information that helps them make the decision.”

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