The United States has invested more than $10 billion in Operation Warp Speed to fast-track SARS-CoV-2 vaccines from conception to market in 1 year. The result is 11 candidates reaching the final stage of Food and Drug Administration testing — a phenomenal improvement over past development timelines. Indeed, two SARS-CoV-2 vaccines are already available to Americans.

Given this level of investment, skill, and good fortune in developing a vaccine, it will be tragic if we fail to curtail the virus because Americans refuse to be vaccinated. Despite widespread suffering from Covid-19, credible surveys indicate that the proportion of the U.S. population willing to be vaccinated has fluctuated from 72% in May to 51% in September and 60% in November; of the 39% of respondents who indicated that they probably or definitely would not get the vaccine, only 46% said they might be open to vaccination once others start getting it and more information becomes available.1

These findings underscore the tremendous undertaking facing vaccine communication teams, who must persuade many of these people to be vaccinated if we’re to achieve the vaccination rate — as high as 80%2 — needed to return to normalcy. Even then, 100% of people who said they would “definitely or probably” get vaccinated must follow through, and 100% of people who said they didn’t plan to but could change their mind must be persuaded and motivated to act. Vaccine promoters will have to be creative in marshaling their resources and broad-minded in considering tools for addressing this enormous challenge.3

The slow adoption of even the most beneficial new product is unsurprising to researchers who study the diffusion of innovation.4,5 From electrifying homes to developing personal computers, history has shown that “if you build it, they will come” makes a terrible marketing plan.

As with many disruptive trends and the innovations they spawn, Americans’ attitudes toward Covid-19 and related health behaviors have been shaped by a complex combination of information, relative benefits, and social identity.6,7 Consider that although the use of face masks was promoted on the basis of strong relative benefits (high efficacy of slowing viral spread and low cost), what predominated in many peoples’ decisions about masking was its symbolic relationship to political identity.8

So how should we promote vaccination? The data surrounding vaccination are still evolving, and different vaccines may come to market. The likely mixed messages about these products’ safety and efficacy (even if they reflect small relative differences arising from clinical trial design) may exacerbate the challenge of vaccine adoption. Add to this the interaction of attitudes toward the virus and vaccines, and it’s clear that we will need myriad communication strategies to ensure widespread vaccine uptake.

Strategies for Promoting Covid-19 Vaccination. Key Actions for Players in Various Health Care Roles. Prioritization of Communication Tactics Based on Vaccine-Hesitancy Level.

Survey data are from the Pew Research Center’s American Trends Panel (ATP).1 To move the public from intent to action (completing the two-dose vaccine sequence), a specific communication strategy needs to be developed for people in each of the four different response categories (Definitely yes, Probably yes, Probably no, Definitely no). WOM denotes word-of-mouth.

Any successful marketing strategy will be multifaceted.9,10 Consumer research and behavioral economics suggest 12 key strategies for an effective vaccine-promotion effort (Table 1). Not all strategies are equally actionable for all health agents, who range from leaders of federal agencies to leaders of local clinics; different actions are best suited for different players (Table 2). But by combining relevant strategies for various persuasive tasks, we can develop a comprehensive plan, incorporating multiple actions and tactics to promote vaccine adoption. The tactics used can be prioritized according to each population’s degree of vaccine hesitancy (Figure 1). We believe that the following elements should be considered in a national strategy and reinforced by local public health officials and individual clinicians.

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