The Public's Role in COVID-19 Vaccination: Human-Centered Recommendations to Enhance Pandemic Vaccine Awareness, Access, and Acceptance in the United States

"If poorly designed and executed, a COVID-19 vaccination campaign could undermine increasingly tenuous beliefs in vaccines and the public health authorities that recommend them."

The United States (US) government programme Operation Warp Speed is working to facilitate the development and dissemination of a vaccine to fight COVID-19, with the goal of delivering 300 million doses of a safe, effective vaccine by January 2021. Vaccine uptake, and especially the widespread acceptance of vaccines, is a social endeavour. To facilitate the consideration of human factors that a future COVID-19 vaccination campaign in the United States (US) requires to be effective, the 23-person Working Group on Readying Populations for COVID-19 Vaccines presents this synthesis of associated challenges, opportunities, and recommendations to advance public understanding of, access to, and acceptance of vaccines that protect against SARS-CoV-2. It is based on an earlier report that is available at Related Summaries, below.

Convened in April 2020, the working group, whose members are authors of this paper, include experts in the fields of vaccinology, vaccine hesitancy/confidence, health disparities, infectious disease, bioethics, epidemiology, bioinformatics, public health law, pandemic mitigation, public health preparedness, mass vaccination campaigns, community engagement, and crisis and emergency risk communication. They undertook: literature reviews on vaccination, pandemic planning, and health crisis communication; an assessment of current news and social media trends regarding COVID-19 vaccines; and key informant interviews. This process led to 6 key recommendations:

1. Value social science as key to the success of COVID-19 vaccination - This involves approaches/actions such as:
   • Embedding rapid social, behavioural, and communication science in the response, delivering timely data and empirically based advice;
   • Involving communities as active partners in the vaccine research enterprise;
   • Applying human-centred design (HCD) principles to COVID-19 vaccination programme planning and implementation;
   • Including social/behavioural research and recognising minority-serving institutions as well-placed partners to study community-specific vaccine access and acceptance issues; and
   • Partnering with grassroots groups to learn how their communities are thinking about, and wanting to learn more about, SARS-CoV-2 vaccines.
2. Inform public expectations bout COVID-19 vaccination benefits, risks, and supply - This involves approaches/actions such as:
   • Forecasting a range of vaccine possibilities, from best case to worst case scenarios, regarding vaccine supply and effectiveness;
   • Actively working to protect the integrity and transparency of vaccine safety systems;
   • Seeking the input of communities of colour that may have historic reticence toward public health; and
   • Developing a coordinated national promotion strategy before vaccine rollout, using HCD-informed interventions that enable a broad network of champions to communicate about risks, benefits, allocation, and availability.
3. Communicate in meaningful ways, crowding out misinformation - This involves approaches/actions such as:
   • Putting public well-being at the centre of vaccine communication, rejecting any political trappings;
   • Investing in both qualitative research to identify specific community concerns and hopes about vaccination and in quantitiative research (surveys) to gauge attitudes and beliefs across the US population, among specific subgroups, and over time;
   • Engaging a broad network of trusted community spokespersons to deliver and reinforce a unified message that is vaccine-affirming and personally relevant; and
   • Applying capabilities in risk communication and community engagement with broader local coalitions involving, for example, universities and community organisations.
4. Earn the public's confidence that allocation and distribution are evenhanded - This involves approaches/actions such as:
   • Taking racial, ethnic, and social factors into account when developing allocation and distribution strategies;
   • Implementing allocation and distribution guidelines consistently across providers and locations;
   • Reassessing the pandemic vaccine allocation and targeting strategy, using multiple forms of widespread public engagement; and
   • Involving nontraditional civilian partners in developing consistent guidelines and rubrics for evaluating operational systems on principles of effectiveness and equity.
5. Make vaccination available in safe, familiar, and convenient places - This involves approaches/actions such as:
   • Developing clear communication strategies for describing where vaccines are available and who should be seeking them;
   • Preparing educational materials and training for those tasked with vaccination at nontraditional sites (e.g., places of worship, grocery stores);
   • Anticipating hesitancy among marginalised populations toward historically fear-inducing sites and developing contingency plans to assure access; and
   • Strengthening partnerships between health departments and media news sources to communicate about availability and access.
6. Establish independent representative bodies to instill public ownership of the vaccination programme - This involves approaches/actions such as:
   • Establishing public oversight committees to review and report on systems affecting public understanding, access to, and acceptance of COVID-19 vaccines; and
   • Sponsoring a national panel convened by a neutral entity to review, synthesise, and report on best practices for engaging communities in vaccine allocation, deployment, and communication systems to achieve equity, solidarity, and good health outcomes.

The working group stresses that: "With the current lag time in vaccine availability, vaccination planners and implementers in the US and around the world have the opportunity to exercise foresight and take proactive steps to overcome potential hurdles to vaccine uptake and maximize public acceptance. These steps, however, must be taken now before this critical window of opportunity closes."