Applying public health lessons learned to COVID-19 vaccination
The concept of social norms is useful in thinking about how to apply learning from prior public health campaigns to COVID-19 vaccination.
A social norm is “a generally accepted way of thinking, feeling, or behaving that is endorsed and expected because it is perceived as the right and proper thing to do. It is a rule, value, or standard shared by the members of a social group that prescribes appropriate, expected, or desirable attitudes and conduct in matters relevant to the group.”
Over the last 20 years, we have experienced many positive and changing norms in our community:
- Increasing use of seatbelts in motor vehicles
- Decreasing rates of smoking amongst all age groups, particularly children
- Increasing rates of pediatric vaccinations, including HPV vaccines
- Increasing use of bike helmets
Most societal norms are created without the use of mandates and are a result of changing beliefs and feelings among community members. Different forces help shape social norms, including schools, pediatricians, local legislators, and elected officials.
Successful public health campaigns
Seatbelts in motor vehicles
Drivers using seatbelts (1980) – 14%
Drivers using seatbelts (2022) – 90%
- Seatbelt safety laws in the 1980s faced resistance
- Campaigns reframed laws as a concern for child safety as seatbelts significantly prevented traffic deaths for children
- Neighboring states without seatbelt laws began to adopt similar behavior as a response to social cues
Pediatric vaccinations
19- to 35-month-olds vaccinated for HepB (1993) – 16%
19- to 35-month-olds vaccinated for HepB (2000) – 90%
- Social networks and neighboring beliefs are a strong predictor of vaccine acceptance
- Promoting vaccines as “normal” and “the right thing to do” and focusing less on altruism and disease prevalence may be more successful strategies
- Some parents are motivated to vaccinate their children to avoid violating social norms
Tobacco use
U.S. adults smoking (1960) – 50%
U.S. adults smoking (2022) – 12.5%
- Research and data showed smokers the harm they were causing to their loved ones
- Campaigns deglamorized and denormalized smoking to make it less socially acceptable
- Through these normative messages, smokers reframed how smoking was viewed by others in society
Bike helmets
5- to 14-year-olds who always wear helmets (1994) – 25%
5- to 14-year-olds who always wear helmets (2002) – 48%
- Peer, family, and school pressure played a role in a child’s decision to wear a helmet
- Reduced anxiety and feelings of safety were strongly associated with wearing a helmet
- Those who perceived they were exempt from harm were less likely to wear a helmet
How to frame pediatric COVID-19 vaccinations as a social norm
- Focus messaging on both sides of the story: the harm of contracting COVID-19 AND the powerful benefits of the vaccine
- Utilize the same channels that spread misinformation to disseminate accurate information
- Individuals who are not vaccinated can share stories of regret after contracting severe COVID-19
- Highlight that hospitals are strained and that adequate and timely care is not guaranteed—individuals who are not vaccinated typically assume they will have access to care if they become sick
- Emphasize that individuals who are unvaccinated can cause infections to family, friends, and community
- Use trusted community members and known celebrities as “vaccine champions” in campaigns