OKLAHOMA CITY — By the summer of 2021, Phil Maytubby, deputy CEO of the Department of Health here, was concerned that the number of people being vaccinated against Covid was falling after an initially robust response.
With doubt, fear, and misinformation rife across the country — both online and offline — he knew the agency needed to rethink its messaging strategy.
Therefore, the health department conducted a so-called online mood search, which measures how certain words are perceived on social media. The tool found that many people in Oklahoma City didn’t like the word “vaccinate” — a word that featured prominently in the Department of Health’s marketing campaign.
“If you don’t know how your message will resonate with the public,” Maytubby said, “shoot in the dark.”
Phil Maytubby, Deputy CEO of the Oklahoma City County Health Department. (Nick Oxford for KHN)
Health officials across the country have sought to combat misinformation and restore trust in their communities in recent years, a time when many people do not fully trust their state and local health officials. For example, agencies use Twitter to target niche audiences, such as NFL fans in Kansas City and Star Wars enthusiasts in Alabama. They work with influencers and celebrities like Stephen Colbert and Akbar Gbajabiamila to expand their reach.
Some of the efforts have paid off. More than 80% of US citizens have now received at least one vaccination against Covid.
However, the data suggests that the skepticism and misinformation surrounding Covid vaccines are now threatening other public health priorities. Child immunization coverage in mid-December was about the same as December 2021, but 3.7 percentage points lower than at the end of 2020, according to the Centers for Disease Control and Prevention. Even more dramatic is the 18 percentage point drop in immunization coverage among pregnant women over the past two years .
Other common childhood vaccination rates have also fallen compared to pre-pandemic levels. According to a KFF poll released Dec. 16, 35% of American parents nationwide disapprove of children being vaccinated against measles, mumps and rubella before they start school, up from 23% in 2019 and the fatigue from so many shots probably to blame.
The story goes on
Maytubby, center, meets with Oklahoma City County Department of Health officials to review data on Covid case counts and hospitalizations. (Nick Oxford for KHN)
Part of the problem is a lack of investment that eroded the public health system before the pandemic began. An analysis conducted by KHN and The Associated Press found that from 2010 to 2020, local health department spending per capita fell by 18%. State and local health officials also lost nearly 40,000 jobs from the 2008 recession to the onset of the pandemic.
That made their response to a century-long public health crisis difficult and often inadequate. For example, in the early days of Covid, many local health departments used fax machines to report case numbers.
“We weren’t as flexible as we are now,” said Dr. Brannon Traxler, director of public health at the South Carolina Department of Health and Environment.
At the start of the pandemic, Traxler said, only two people worked on the media relations and public relations team at the South Carolina Department of Health and Human Services. Now the team has eight.
The agency has also changed its communication strategies in other ways. For example, this is the first year South Carolina has released biweekly flu shot data with the goal of raising awareness of the effectiveness of the shot. In South Carolina, less than a quarter of adults and children eligible for flu shots were vaccinated as of early December, despite increases in flu cases and hospitalizations. The influenza vaccination rate across all ages in the US last season was 51.4%.
Those who chose both the Covid and flu shots appear to be correlated, Traxler said.
“We’re really just trying to dispel misinformation that’s out there,” Traxler said. To that end, the Health Department has partnered with local leaders and groups to promote vaccination. Agency staff also feel more comfortable speaking to the media, she said, to better communicate with the public.
However, some public health experts argue that authorities are still failing at delivering messages. Scientific terms such as “mRNA technology”, “bivalent vaccine” and “monoclonal antibodies” are commonly used in public health, although many people find them difficult to understand.
A study published by JAMA found that the Covid-related language used by state-level agencies was often more complex than an eighth-grade reading level and harder to understand than the language commonly used by the CDC.
“We have complex ideas to convey to the public, and that’s where we fail,” said Brian Castrucci, CEO of the de Beaumont Foundation, a nonprofit group focused on strengthening public health. “We must acknowledge that our communication missteps have created an environment where disinformation thrives.”
Most Americans support public health, Castrucci said. At the same time, a small but vocal minority is pushing an anti-science agenda, and it has sowed mistrust, he said.
The more than 3,000 health departments across the country could benefit from a unified message, he said. In late 2020, the foundation partnered with other public health groups to create the Public Health Communications Collaborative to spread easy-to-understand information about vaccines.
“The good guys need to be just as organized as those trying to harm the nation,” he said. “You’d think we’d learn from it.”
Meanwhile, a report released in October by the Pew Research Center found that 57% of US adults believe “false and misleading information about the coronavirus and vaccines have contributed much to the problems the country is facing amid the pandemic.” .
“I was suspicious like everyone else,” said Davie Baker, 61, an Oklahoma City woman who owns a store that sells window treatments. When the recordings became widely available in 2021, she thought they had been developed too quickly, and she worried about some of the things she’d read online about side effects. A pharmacist at Sam’s Club changed her mind.
“She just sort of enlightened me on what the shot was really about,” Baker said. “She cleared a few things for me.”
Davie Baker from Oklahoma City. (Nick Oxford for KHN)
Baker signed up for her first Covid shot in May 2021, around the same time the Oklahoma City Health Department noted that the number of shots given daily was beginning to decline.
The department updated its marketing campaign in early 2022. Instead of using the word “vaccinate” to encourage more people to get their Covid vaccinations – the word the agency’s social media analytics revealed people didn’t like – urged the new campaign encourages people to “Vote Today!”
“People don’t trust the way they used to,” Maytubby said. “They want to form their own opinions and make their own decisions.”
The word “choose” confirmed that preference, he said.
Maytubby thinks “Choose Today!” campaign works. A survey of 502 Oklahoma City adults conducted in the first half of 2022 found that fewer than 20% of respondents responded negatively or very negatively to a sample of Choose Today! Advertisement. And an estimated 86.5% of Oklahoma City adults have received at least one dose of a Covid vaccine — a rate higher than the state average of about 73%.
Other factors most likely play a role in helping increase Oklahoma City’s immunization counts. In the same survey of Oklahoma City adults, some people who had recently been vaccinated said family members or church leaders had urged them to get vaccinated or knew someone who had died from Covid. One person said money was the motivation after receiving $900 from work to get the vaccine.
Meanwhile, the war on misinformation and disinformation rages on. Child immunization rates for the immunizations students typically need to enter kindergarten have fallen 4.5% in Oklahoma County since the 2017-18 school year as parents increasingly seek exceptions to the requirement.
This worries Maytubby. He said the primary tactic among those trying to sow distrust about vaccines has been to cast doubt – from the science to its safety.
“They’ve been pretty successful in that regard,” Maytubby said. “Misinformation changed everything.”
Kaiser Health News and NBC News have partnered to produce this story.
This article was originally published on NBCNews.com