The shape-shifting messaging and politics of the COVID-19 vaccine

The national conversation about the coronavirus shot seems to touch on everything but health

Behold the McDonald’s coffee cup this month, and you see everything you need to know about the shape-shifting nature of arguments about the COVID-19 vaccine.

The cup is designed to promote vaccination but says nothing about medicine or health. It doesn’t even mention COVID-19.

Instead the message “We can do this” is overlaid on an image of the U.S., evoking the iconic “We can do it!” message promoting women working during World War II. The cup also urges coffee drinkers to “protect yourself and the people you love” and directs them to a government website promoting vaccines.

The campaign is emblematic of messaging around vaccination for COVID-19, both for and against. Often the disease itself is a bit player in a conversation built around other issues such as patriotism, freedom, winning a million dollars or college tuition, or standing athwart government overreach. Vaccination, or lack thereof, is even entering into the immigration debate. And one’s position on the vaccine has become, to some people, an indication of loyalty to one’s political party.

“The problem here is, almost from the get-go, we have not made this a health conversation. We have made this a political debate,” said Brian Castrucci, president and CEO of the de Beaumont Foundation, a nonprofit based in Bethesda, Maryland, that focuses on public health.

With the recent increase in COVID-19 infections, the vaccination drumbeat is getting louder, as is criticism of those seen as vaccine skeptics. Here’s a look at the diverse messaging on the subject, how it’s evolved over the course of the pandemic, and why some people are saying the the country needs to move from messaging to mandates.

A McDonald’s coffee cup with a pro-vaccine message on it is pictured in Salt Lake City on Thursday, Aug. 5, 2021. | Kristin Murphy, Deseret News

Changing the conversation

Early in the pandemic, the de Beaumont Foundation partnered with pollster Frank Luntz to develop messages that would bolster confidence in public health measures, such as masking and COVID-19 vaccines. Through a survey of Americans, they identified language that would best achieve that goal and developed a “communications cheat sheet” that showed words and phrases deemed to be most useful in the conversation.

One significant finding was that people are more receptive to messages about keeping their family — rather than their community — safe. When asked who they would be most willing to take the vaccine for, other than themselves, 53% answered their family, compared to 20% who said they would do it for their country, and 13% for the economy.

“Family is by far the most powerful motivator for vaccine acceptance,” the report said.

Americans are also more receptive to messaging from “America’s leading experts” rather than “the world’s leading experts” and to “medical experts” rather than “scientists/health experts.” The guidelines also recommended that vaccine proponents talk about pharmaceutical companies rather than drug companies, and about vaccinations rather than injections or inoculations.

The importance of using exactly the right words was evident this week when President Joe Biden’s chief medical adviser Dr. Anthony Fauci pushed back on suggestions that an additional dose of the coronavirus vaccine would be a “booster” shot.

“Giving them an additional shot is almost not considered a booster; it’s considered part of what their original regimen should have been,” Fauci said earlier this week, as reported by Politico Pulse.

Booster shots for fully vaccinated Americans are already controversial. The World Health Organization on Wednesday called for a moratorium until disparities in global vaccination rates ease. But discussion about them, combined with breakthrough infections, is also perceived by some as evidence that vaccinations don’t work.

As of Wednesday, 50% of Americans were fully vaccinated, and some health officials believe the U.S. is at, or at least approaching, the point where minds can’t be changed.

“You’re always going to have an immovable ‘no.’ And each day that we vaccinate more people, we get close to that immovable ‘no’,” Castrucci said in an interview.

“So what we need to focus on is getting people who are willing to take this vaccine to do so,” he said. “And we need to stop ridiculing and harassing people who haven’t done it, and ask them what their concerns are and see how we can answer their questions.”

We’re No. 30

Biden used the Fourth of July holiday to appeal to the 20% of Americans who said they would take the vaccine for the sake of their country, saying that getting the COVID-19 vaccine “the most patriotic thing you can do.”

The government’s “We Can Do This” website shows pro-vaccine advertisements tailored to age groups; an ad for young adults, for example, suggests that they can be influencers by getting other people to get the vaccine; an ad for older Americans suggests that getting the vaccine makes them more powerful.

But despite the optimism of that campaign, there are signs that some people within the Centers for Disease Control and Prevention are convinced that the messaging isn’t working.

The Washington Post recently obtained an internal CDC document that spoke of “communication challenges,” including waning confidence about the effectiveness of the vaccines among both the public and some local health departments. The emergence of so-called “breakthrough infections” — people who are getting COVID-19 after being vaccinated — is a problem for public-health officials trying to move America higher on the list of countries with the highest vaccination rates. (As of press time, the U.S. is 30th on the list, behind countries such as Chile, Singapore, Mongolia, Qatar and China.)

“We’ve done a great job of telling the public that these are miracle vaccines,” Matthew Seeger, a risk communication expert at Wayne State University in Detroit, told the Post. “We have probably fallen a little into the trap of over-reassurance, which is one of the challenges of any crisis communication circumstance.”

Meanwhile, much of the discussion about health and the vaccine is taking place among people known as “vaccine hesitant,” or vaccine skeptics like Dr. Joseph Mercola (cited by one nonprofit as one of the “Disinformation Dozen.”) Mercola, an osteopathic physician in Florida, questions the safety and efficacy of the vaccines — and the motives of individuals and groups who support them — on his social media accounts. He has more than 2 million followers on Twitter and Facebook.

In an email, Mercola said that vaccine messaging, in large part, is driven by the pharmaceutical industry.

“The health officials know they can only carry one simple message — get vaccinated or die. That isn’t true, but they treat people like incapable children — they won’t give them all the information they need to make a logical choice,” he said. “The demands to vaccinate the naturally immune is a perfect example of how they won’t accept logic; they have one narrative and want mandatory vaccinations from cradle to grave.”

Others in opposition to vaccination and other public-health measures, like masks, completely dismiss the coronavirus in their conversation. In Nebraska last fall, a billboard company took down two billboards that said, “It’s not about a virus! It’s about control!” after some community members objected.

And lately, immigration is being drawn into the vaccine debate, with prominent conservative commentators and politicians suggesting that COVID-19 cases are rising because of people coming across the southern border.

“Part of the problem is the southern border is open and we’ve got 88 countries that are coming across the border and they don’t have vaccines so none of them are vaccinated and they’re getting dispersed throughout the country,” Iowa Gov. Kim Reynolds, a Republican, recently said.

Meanwhile, governors such as Florida’s Ron DeSantis are finding it increasingly difficult to find balance in advocating for the vaccine while staying on good terms with the vaccine skeptics of their voting base. DeSantis has been vaccinated and urged Floridians to do the same, while calling out Biden for allowing “every variant on the planet” to enter the U.S. because of the administration’s immigration policies.

A move to mandates?

Castrucci believes that public-health messaging around the coronavirus was political from the start and he blames former President Donald Trump for politicizing the pandemic and the nation’s response. “We’ve not made this a health conversation; we’ve made this a political debate,” Castrucci said. As early as March of 2020, Trump was saying America would “soon” reopen for business as political and business leaders from both parties grappled with the “lives versus livelihoods” calculus of pandemic strategizing.

Alex Azar, secretary of Health and Human Services in the Trump administration, also rues the partisan aspects of the pandemic in a recent op-ed in The New York Times, writing, “While the vaccines have had doubts cast upon them by politicians throughout their production and rollout, whether a person lives in a red or a blue state has no bearing on the vaccines’ efficacy. They work incredibly well, and more than 160 million fully vaccinated Americans are proof.”

Azar lauded the Trump’s administration’s “Operation Warp Speed” plan that resulted in vaccines in production in January, but said the administration could have done more to address vaccine hesitancy, which is more prevalent in Republicans than Democrats. (Forty-three percent of Republicans either haven’t been vaccinated or likely wouldn’t be, compared to 10% of Democrats, in one recent poll.)

 “Political, public health and thought leaders must educate about the benefits of the vaccine, not hector or preach. This information must come from respected and trusted figures in the various hesitant communities,” Azar wrote.

Regardless of how vaccine messaging is presented, there is a growing sense among public health officials that it’s time for a new strategy if the United States want to improve vaccination rates.

“I think we’ve hit a point where we’re almost beyond messaging and need to start to move to mandates,” said Castrucci. “The political gridlock has made the nation vulnerable and we need to look to private businesses, to the private sector, to get us through this pandemic.”

In addition to the federal government, some large employers, such as Walmart and Disney, are now requiring some of their employees to be vaccinated.

He said the problem will persist as long as people are still seeing the pandemic as a political issue to debate.

“Public health isn’t one side of the aisle or the other. It’s the dirt on which those very aisles are built,” Castrucci said. “And if we don’t realize this, if we don’t come together and realize that health is a nonpartisan issue, then our nation remains vulnerable to death and disease.”