Effective communication and messaging is a key component of state vaccination programs and policies. Confusion, misinformation and questions around vaccine efficacy and safety are common and can impact immunization levels in a community or state.
Immunization rates for vaccine-preventable diseases vary significantly by age, race or ethnicity, or location, often due to misinformation, mistrust or a lack of appropriate messaging. For example, while human papillomavirus (HPV) vaccination rates are on the rise, the numbers are still low and vary greatly for different demographic groups. Overall, 49% of adolescents were up to date on the vaccine in 2017, but rates were lower for adolescents in rural areas, non-Hispanic white adolescents and males. For influenza, immunization rates during the 2019-2020 season increased from 49% to nearly 52%, the highest season coverage to date. While rates increased overall, Black and Hispanic adults have lower flu vaccination coverage than white adults, as do Black children compared to other racial and ethnic groups.
Similar disparities exist with COVID-19 vaccinations. A Census Bureau survey indicated significant differences in the percentage of adults who stated they would “definitely” get the COVID-19 vaccine by age, race and ethnicity. Younger respondents, non-Hispanic Black adults, non-Hispanic adults of other races or two or more races, and Hispanic adults were less likely to indicate that they would get a vaccine compared to older respondents, non-Hispanic Asian adults and non-Hispanic white adults. This may result in lower vaccination rates among populations that also experience disproportionately higher rates of hospitalization and death from COVID-19.
One key factor that contributes to low vaccination rates and disparities is confidence in vaccines. State legislatures, state agencies, health care providers and community organizations may seek to increase vaccination rates by building and maintaining confidence in vaccines through communication and messaging efforts. These may encourage the public or specific populations to get vaccinated, dispel vaccine myths or misinformation, or provide accurate information to achieve recommended levels of vaccination.
Understanding why vaccination rates remain low is important when considering immunization messaging. In the Census Bureau survey, respondents who indicated uncertainty about receiving a COVID-19 vaccination were most likely to report concerns about possible side effects and plans to wait to see if the vaccines are safe. These results, coupled with lower vaccination rates for vulnerable populations across vaccine-preventable diseases, indicate the potential role robust, high-quality communication efforts may play in increasing confidence in vaccines.
Building vaccine confidence, combating misinformation and ensuring health equity are all key aspects of state immunization messaging and communication. Public awareness campaigns that include communities of color and other disenfranchised groups in their creation can stress scientific rigor and the safety of vaccines in a culturally sensitive way.
State Policy Options and Examples
State legislative strategies to address vaccine communication and messaging include raising public awareness, combating misinformation, building vaccine confidence in all demographics and addressing health equity.
States have raised public awareness around vaccinations by calling attention to specific vaccines, diseases or populations. For example, Illinois adopted HR 196 in 2019, declaring a week in August as Adolescent Immunization Week to increase public awareness of the importance of preteens and adolescents receiving vaccines against meningococcal disease, HPV, influenza, tetanus, diphtheria, pertussis, measles, mumps and rubella, and to promote outreach and education efforts concerning vaccination. The legislation also encourages dissemination of educational resources on infectious disease. South Carolina HR 5226, adopted in 2020, calls attention to the connection between HPV and cervical and other cancers and spreads awareness of vaccine protection.
Policies can also play a role in disseminating accurate information and combating vaccine misinformation. For example, several states proposed or enacted legislation to specifically combat COVID-19 vaccine misinformation. Arkansas HB 1547, enacted in 2021, requires all data and information about the safety and effectiveness of any FDA-approved vaccine be available on a public website maintained by the health department. Florida enacted HB 9 in 2021, prohibiting the dissemination of false or misleading vaccine information with specified intent. New Jersey AB 5203 proposed requiring public awareness campaigns regarding potential fraud related to the COVID-19 vaccine.
Some states ensure that health equity is part of the conversation around vaccine access, distribution and communication. Massachusetts enacted HB 5164 in 2020 to require health equity in design, development, implementation and oversight of the state’s vaccine plan. It also requires the vaccine plan to take into consideration recommendations made by the Massachusetts health equity task force, prioritization of communities disproportionately impacted by COVID-19, and a culturally and linguistically diverse public education and outreach campaign. Minnesota proposed HF 397 in 2021 to create COVID-19 messages, information and community engagement services for diverse communities and populations.
State legislators can also assist in the spread of accurate information by communicating evidence-based messaging from the state health agency to their constituents. For example, at least 10 of the original state COVID-19 vaccination plans submitted to CDC included policymakers in the communications plan, including challenging disinformation on the vaccines or participating in a public communications plan, or both. Additionally, more than 15 plans included information on how legislators can work with health departments to increase distribution of the vaccine. By working with state health departments, state legislators can combat misinformation and build the public’s confidence in the effectiveness and safety of vaccines.
Federal, State and Private Industry Partners
In addition to working with legislative partners, state health departments often work across multiple state agencies as well as in partnership with the federal government and community and private organizations. States often leverage communication tools, messaging and resources from partners to promote accurate vaccine information.
To assist states in their messaging of vaccine safety and efficacy, federal partners offer toolkits and other communication materials that states can adapt to fit their needs. CDC produced several toolkits with sample communication materials for a range of immunizations, including seasonal influenza, routine childhood vaccinations and COVID-19. CDC’s suite of COVID-19 resources includes toolkits for varying target audiences, such as a toolkit for employers of essential workers and a toolkit for staff of organizations serving communities.
Additionally, national organizations share public engagement and communication strategies that states can use to build trust in vaccines and combat misinformation. The National Public Health Information Coalition offers a vaccine communication toolkit for parents of babies and young children with safety information and sample messaging. The American Academy of Pediatrics also provides tools and resources for communicating with parents about the importance of childhood vaccinations, as well as the HPV vaccine. The National Academy of Medicine and the American Hospital Association provide COVID-19 vaccination toolkits aimed at supporting local communities and hospital and health systems, respectively. To address higher levels of mistrust in underserved communities, the Ad Council and COVID Collaborative produced a public health toolkit offering strategies for COVID-19 vaccine messaging, including specific recommendations for communicating with Black and Latino audiences.
Many state health departments also provide sample vaccine communication materials that other states can leverage and tailor to their needs. For example, Arizona, Louisiana, Michigan and Washington all supply sample flu vaccine graphics, social media posts and messages. Michigan’s toolkit is specifically aimed at college-aged young adults and Washington’s sample materials are available in 17 languages. These messaging variations allow states to target communication efforts to specific audiences that may have shown higher levels of vaccine hesitancy in the past.
California, Indiana, Minnesota, New Jersey, Tennessee and Texas share sample COVID-19 vaccine communication materials on their health department websites. Minnesota’s toolkit is specifically designed for community organizations, including social service organizations, faith-based organizations, school organizations, meal delivery services, senior centers and other community-based organizations. Minnesota’s department of health website also houses sample HPV vaccination videos for health care providers on how to message the HPV vaccine. As an example of how states can leverage sample resources from other states for their own needs, North Dakota includes the HPV vaccine videos created by Minnesota on their health department website, along with other information and sample communication materials for health care providers and the public.
Several states also have public-private partnerships in place to assist with vaccine communication. The Immunize Kansas Coalition (IKC) is made up of a diverse group of health care providers, local health departments, researchers, health care payers, advocacy groups, nonprofit organizations and other stakeholders with the goal of improving vaccination rates across all vaccine-preventable diseases in Kansas. IKC provides toolkits for the HPV, meningococcal and Tdap vaccines. The California Immunization Coalition (CIC) is a nonprofit public-private partnership governed by a volunteer board of directors with the aim of full immunization protections for all Californians. CIC collaborates with the California Department of Public Health on a Don’t Wait Vaccinate campaign that includes a toolkit and sample social media messages and images.
At the national level, CommuniVax is a coalition of social scientists, public health experts and community advocates. CommuniVax’s goal is to strengthen equitable vaccination rollout by involving historically underserved Black, Indigenous and Latino communities in the process. Local, state-based teams engage communities of color to identify improvements to vaccine delivery and communication strategies in their communities.
States have many vaccine communication and messaging tools at their disposal. Policies that build trust and tackle misinformation can be coupled with inclusive public awareness campaigns and messaging on vaccine safety to create a comprehensive vaccination communication plan.
- Flu Vaccine Communications Resource Guide, Association of Immunization Managers (AIM)
- Communicating Effectively About Vaccines: New Communication Resources for Health Officials, Association of State and Territorial Health Officials (ASTHO)
- Finding Credible Vaccine Information, Centers for Disease Control and Prevention
- Building Confidence in COVID-19 Vaccines, Centers for Disease Control and Prevention
- National Immunization Awareness Month, Centers for Disease Control and Prevention
- Building COVID-19 Vaccine Confidence, National Academies of Sciences, Engineering, and Medicine, Societal Experts Action Network (SEAN)
- Local Public Health: An Integral Partner for Increasing Vaccine Confidence, National Association of County and City Health Officials (NACCHO)
- COVID-19 Vaccine Communications Resources, National Governors Association (NGA)
- COVID-19 Vaccination Communication: Applying Behavioral and Social Science to Address Vaccine Hesitancy and Foster Vaccine Confidence, National Institutes of Health (NIH)
- Vaccine Central, National Resource Center for Refugees, Immigrants, and Migrants (NRC-RIM)
- Resources, Public Health Communications Collaborative
- Effective Communication and Consistency in Increasing Rural Vaccination Rates, Rural Health Information Hub