BONUS: Addressing Vaccine Hesitancy With AM Trace

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Robert Johnson:
This is Public Health Review. I'm Robert Johnson. On this episode, building campaigns to get more COVID-19 shots into arms using data and community strategies to reduce vaccine hesitancy. We hear from Jens Dakin, managing director of information operations and strategic communications at AM Trace.

Welcome to Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials. With each episode, we explore what health departments are doing to tackle the most pressing public health issues facing our states and territories. Today, a conversation about Americans unwilling to get COVID-19 vaccinations with an expert whose company is working on strategies to reduce vaccine hesitancy.

On this bonus episode of the show, we visit with Jens Dakin, managing director of information operations and strategic communications at AM Trace, an information communications technology firm based in Leesburg, Virginia. In this conversation, he tells us how data informs outreach to vaccine hesitant communities and shares why he thinks we've had a hard time selling COVID prevention strategies to some audiences.

Jens Dakin:
I think because it's been hugely disruptive to our way of life. It's been disruptive to families and to people who've lost their jobs, people who have lost loved ones.

And then, you know, on top of all of that, we have all this advice—information, directive, mandates, mask-wearing rules and regulations—coming at us from all directions—from the government, from the federal government, from local government.

And we are just overwhelmed with information on a daily basis as the situation has changed. You know, this week the government has revised its mask mandate, which is great, but it still doesn't necessarily mean that we're out of the woods.

AM Trace has responded to these various needs. Can you give us an overview of the kind of work you've been doing to support public health over the last year?

In the last year, we started deploying or developing concepts and methodologies to deploy contact tracing strike teams. So, we deploy to California and then recently to New York, and we're about to deploy teams to the Northeast. But also, you know, supporting health authorities in Alaska, and Texas, and elsewhere, and that has evolved. Because, a year ago, the focus was very much about tracking and tracing, the vaccine, and protecting people and ensuring that we did as much as we could to mitigate the spread of the disease.

And then, that evolved into vaccine safety mitigation. So, briefing people, informing people about what they could do to stop the spread, protect themselves and their families from catching the virus. And then, over time, we've morphed into vaccine management and distribution.

And this is something we didn't envisage a year ago, but as the need has changed, so have we. You know, we have learned as we've gone along, and we've understood what the needs are from our local health partners, and we've risen to the challenge and we deliver the solutions.

And now, what we're moving into is a new phase where vaccine and the vaccination uptake has reached such a scale that the question we're being asked by our partners is how do we address vaccine hesitancy? How do we get more and more people to take the vaccine so that we can reach this goal, this objective of herd immunity. And no one really knows how many people we need to vaccinate to reach herd immunity, but that is an issue that we're dealing with at the moment.

Can you share any of those strategies or approaches that the company is developing on behalf of its partners?

So what we're doing is our approach to community outreach and addressing vaccine hesitancy is that we've been using the lessons and the methodologies that we've developed with a lot of our overseas work in terms of research and community engagement. And our approach is that the community comes first. The people come first.

We don't come into a situation with any preconceived ideas, with any assumptions on what the solution should be. We start with the environment. We understand, you know, who the target audience is, what their environment is, what the information environment is like, who the influences are within their communities.

And then, we start building a plan around that. And then, we take all this data, we take all this contextual information, we combine it with the views and opinions on certain issues that we ask them, and then we develop a campaign. We develop messages, we test the messages.

You know, one of the last things we do is we work out, you know, the vehicle, the channel, the medium of how we are going to communicate this. Because what we found is that mass marketing campaigns don't necessarily always work, especially when we're trying to target niche audiences.

Especially with vaccine hesitancy, because research has told us that about 30% of the U.S. population are vaccine hesitant. And within that 30%, you probably have a small percentage who are committed anti-vaccine believers, who will never take any vaccine of any sort. And then, somewhere in the middle, you have people who are just sitting on the fence. They're waiting and seeing what will happen with the side effects of the COVID vaccine.

So, understanding people's motivations, the drivers behind their hesitancy—once we've, you know, analyzed a lot of that, then we can really start to craft messages that will hopefully persuade them to take the vaccine.

How long do you think it will be before we've done everything we can? Before everyone that wants a shot, or can be convinced to get a shot, will actually have a shot?

That's a great question, and it's very difficult to say because this is a novel virus. It's a new situation. We're learning. We don't officially know, or the CDC don't officially know, what level of herd immunity, what level of the population we have to vaccinate to reach herd immunity.

Dr. Fauci, a few weeks ago, gave an interview to The Economist and he suggested that we're looking at anywhere from 70 to 85% of the population. But he also said that for measles, we have to vaccinate about 90% of the population. And we won't know how many people we need to vaccinate until we know. So, it's very hard to pin down.

And in terms of the vaccine hesitancy and trying to persuade people to take the vaccine, it's a very difficult situation to understand and also, you know, to determine whether we'll ever reach, you know, some vaccine end-state where we do reach herd immunity. I think we won't know until we reach that, but that's a road with no end in sight at the moment.

So right now, AM Trace is working with a handful of states to put boots on the ground, to help them deal with the hesitancy question. Is that the key offering in the hesitancy space that you're putting on the table at this moment?

That's one of them. What we do is we have a research framework—and it's a very detailed methodology—where we ask specific questions so we can go to these communities, we can really drill down into the context, the environment, and also what the drivers are, you know, what people are really thinking in those neighborhoods. And then, we develop a plan. So, it's the research, it's the planning, and also the implementation.

And if the solution—the analysis tells us if the solution is boots on the ground, community engagement, face-to-face discussions with people on the street, or in the church, or in the doctor's surgery, or wherever, then that's the plan we will implement. But if it's also a social media campaign, targeted Facebook ads, or a billboard campaign, then we will do that.

But it all depends on the environment that we're operating in. Because the vaccine hesitancy or the issue is not specific to one particular demographic, it's not unique to one particular race, or one particular religion, or one particular location.

What we have found and the research that we've conducted with our teams around the country—and also using research from the likes of the Kaiser Family Foundation—is that there are vaccine hesitant people everywhere, you know, regardless of income levels, religion, location, rural, urban, race.

And each one of those audiences require their own messaging, their own campaign—you really have to speak to them individually. And what we pride ourselves in is that we take a local approach—so, we localize the issue and we personalize the message. That is what we find has the greatest impact.

Let's say I called you today and asked you to do this work for me as a state. How long does it take to get something going?

It really depends on the scale. We can scale up quite quickly. In a matter of days, we can begin planning and collecting some raw data, some open source, or you can use previously conducted research, you can use that data.

Then, as soon as you hit the ground, you are collecting data, you're talking to people, and you are building up the processes to conduct your analysis and to do your planning so that, you know, you have all these concurrent activities taking place at the same time.

And within a couple of weeks, you can be pushing out messages.

Wrapping up then, can you pull together the AM Trace approach to helping public health departments deal with vaccine hesitancy?

Sure. Ultimately, what we are trying to achieve and help local health authorities with is decreasing complacency towards the risks that the virus poses so that we can get people vaccinated. And then, also, we want to increase the confidence that people have in the vaccine, the vaccination process, and, also, the authorities who are managing this effort. So, we directly address the positive effects of the vaccine and the whole process itself.

And then lastly, we want to increase or try to increase the convenience of getting the vaccine. And what we've found is that people are busy, and, especially now, that we have people who've received the first shot, but they're too busy or complacent or can't be bothered to get the second dose. So, increasing the convenience could help that as well. So, there's lots to be done and I think we'll have our work cut out for us.

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This show is a production of the Association of State and Territorial Health Officials.

For Public Health Review, I'm Robert Johnson. Be well.

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