The Onion recently satirized the disjointed nature of information around the vaccine rollout, suggesting that the best shot at staying informed is to cobble together information from Twitter accounts of “reporters, medical researchers, and politically engaged musicians… [and a] Tacoma-area mom who shares screenshots of vital information.”
It was a sharp take on a real issue: a gap in vaccination information, and fears about what a lack of public knowledge could mean for vaccine uptake. It’s down to the states to plan vaccine distribution, and most have adopted a version of the CDC’s recommended phasing plan, to prioritize certain populations. But what’s less clear is how those states will notify residents—if at all—when it’s their turn. Some states have been more transparent, while others are purposely holding out on information so as not to create confusion or misinformation.
But, in many cases, people still seem unsure as to where to find the information when the time comes, as evidenced by a recent Twitter thread. “My 90 yo mom in Chicago & her dr have no idea & can get no info,” said one user, just as another said her tech-friendly, 90-year old grandfather in Louisiana was pulled off a waitlist due to overwhelming demand, but wasn’t told how to reapply. One user in Virginia, who said they were in the high-risk health category (1c), the next group to be tackled in much of the state, said they were worried that they wouldn’t know when they’d be eligible.
50 different states, 50 different strategies
“Because public health in this country is run locally, there’s going to be a ton of variability for how well it’s working,” says John Brownstein, chief information officer at Boston Children’s Hospitals, and a professor of biomedical informatics at Harvard. “Fifty different states, 50 different strategies.” Tara Kirk Sell, an assistant professor at Johns Hopkins Bloomberg School of Public Health, says that every state has such different distribution plans, even down to the local level. “Some states are communicating a little bit better than others,” she says.
Communication is somewhat easier at this early stage, because the first recipients in what’s being called “Phase 1a” are a very specific group: primarily nursing home residents and frontline healthcare workers. Individuals in those categories are generally being vaccinated privately within their nursing homes or hospitals, and so have direct communication with those facilities. Communication is likely to become more complicated in later phases, when the targeted groups become more nuanced, say for those with pre-existing health conditions, and when it opens up to the broader population, because of the huge scale.
States are differing in their communication approaches, according to emails to Fast Company from various state health departments. South Carolina’s plan is still in development, but it plans to use press releases, social media updates, public services announcements, print, radio and TV ads, and direct mailers, while providers are also expected to reach out to their patients. Washington State is already running a statewide communications campaign, set to reach 90% of adults, through different media and in 37 languages. Minnesota will balance “broad public appeals” using the news media, social media, and paid ads, with targeted outreach to traditionally underserved communities, both digitally and through community events.
In Arkansas, while there are broad statewide pro-vaccination campaigns, individual pharmacies are also playing a large role in disseminating information to local residents. The Arkansas Department of Health says the pharmacies are coordinating with each other to decide which areas each should target. “We are working to provide the vaccine providers in each county with lists of the appropriate priority groups located in their counties so that they may arrange for vaccinations,” says Danyelle McNeill, public information officer.
One such pharmacy is Market Place Pharmacy in Little Rock. Kayely-Morganne Shields, a senior pharmacy student who works there, says the location was part of a regional news push for the vaccine, and was mentioned on a local TV station and in the Arkansas Democrat-Gazette. Soon after, phones started ringing, and it was “chaos,” with too many people coming in for social distancing to occur. Now, Market Place has a registration form on its website to book an appointment; when you call the pharmacy, the automated message also directs you to that form. At the time of reporting, the pharmacy had given out 223 shots to eligible people.
Online registration forms are becoming a widespread tool across states, including Tennessee. Users simply enter their details, and answer a questionnaire about their age group, health conditions and workplace, and they are added to a text or email alert list, to be notified when it’s their turn to schedule a vaccine. For transparency’s sake, users can view a continually updating map dashboard and click on any county to see what phase that county is on, and to sign up within that particular location.
Other states are delegating such tools to local levels. Texas’s Dallas County had 50,000 sign-ups within the first two days of launch of its registration website for those in phases 1a and 1b. This week, Dallas opened its first “mega-site” for COVID vaccines, at recreational area Fair Park, where it aims to vaccinate at least 1,000 people a day. The county will be doing a “media blitz” to promote both the registration website and the mega-site, both at a county level and within its 26 cities. The county also expects the State of Texas to roll out “a more robust site towards the end of the month that will be able to match individuals with nearby locations that have vaccine availability.”
Brevard County, Florida, is a narrow, 72-mile stretch of land down the East Coast of Florida, encompassing areas like Cocoa Beach that are prone to hurricanes. The county last week received its first 3,500 doses, which its reserved for adults aged 75 and older (“Phase 1b”). Communications Director Don Walker says they’re using the same “ALERTBREVARD” text alert system for vaccines as they use for hurricanes. Those alerts direct residents to EventBrite, which it’s using for sign-ups, for which they had 2,400 register in a two-hour period. Walker recognizes there are holes in the communication plan, such as the lack of tech know-how among older people, but he hopes community members help them while they figure out alternatives—such as the idea to have Meals on Wheels immunize folks at home. “We know there’s a lot of gray areas that we’re gonna have to address,” he says. “But, right now, we’re just trying to get shots in arms.”
Not too fast, not too slow
Brownstein, the Harvard professor, says there’s good reason not to rush to prematurely send out information. Giving people maps and addresses before locations are ready, or before enough doses are even available, could send people out scrambling to get a vaccine, leading to virus-spreading crowds like those in Daytona, Florida, last week. “We know mobility is a driver of this pandemic,” he says. “Vaccination sites become super-spreader sites.”
Brownstein is also the founder of VaccineFinder.org, a website that started during the H1N1 vaccination process to match vaccination sites, including clinics, pharmacies, and community sites, with people who need doses. Even though its COVID vaccination technology is ready to roll out, they are holding off. The site will come into play when the general population is eligible, when more doses are available, and when chain pharmacies and grocery stores start vaccinating. “It doesn’t make sense to make it now,” he says, “because you don’t want to create confusion.”
(CVS and Walgreens also told Fast Company they would be rolling out communications when the time comes: CVS though emails, texts, and through its app and online; Walgreens on its app and online, to schedule a slot at one of the 9,000 stores across the country.)
Sell agrees that launching communications too early could create confusion. “They’re not getting people all riled up before they actually can get it,” she says. Still, Sell is not only worried about misinformation, but also deliberate disinformation, and says and the void of information can easily now be filled with lies from anti-vaxxers and those pursing political goals, which could reduce the vaccine uptake ultimately.
That’s why the big communication priority so far has been on vaccine safety education: ensuring people actually trust the science and plan to take the vaccine in the first place. The various state health departments have been running such campaigns, as has the non-profit Ad Council. Since the H1N1 vaccine rollout in 2009, she says, there is much more political divisiveness, an eroded trust in authority, and a dependency on social media. “So, I think it’s going to take some topical approaches that may be new,” she says, “and not based on an old playbook.” She adds that it’s important that the messengers are those trusted by certain minority and age groups, like religious or community leaders.
Still, communications tools are slowly and surely rolling out; seemingly out of nowhere, just over the weekend, for instance, Virginia’s slick registration portal appeared. Ultimately, Brownstein is confident that people will get the updates they need without much difficulty, or even much proactivity. People are already so focused, he says, to COVID news: they’re tuning into governors’ and mayors’ briefings and scrolling social media, which is why alerts about curfews and mask mandates have been received easily so far. Any gaps right now are little cause for panic. “One way or another,” he says, “people are going to figure it out.”