- A focus group with conservatives points to the need for decoupling of science and politics, to the role of trusted sources of information, and to the power of personal narrative.
- “Freedom and individualism are very strong values. And we don’t want to … impugn those values because that could … make [people] less likely to get the vaccine,” says Brian Castrucci, president and CEO of the de Beaumont Foundation, a public-health think tank.
All through the spring and summer of 2020, former New Jersey Governor Chris Christie had been cautious about COVID. He maintained social distance; he wore a mask; he washed his hands often. In the weeks leading up to his late-September White House visit — when he’d help prepare former President Trump for a debate — he tested negative for COVID again and again. All visitors to the White House were tested and retested for COVID, he recalls — and so, at a Saturday reception for newly established Supreme Court Justice Amy Coney Barrett, he decided to put his mask aside. “I felt like we were safe,” Christie recalls. “We were in the safest place in the world, in fact — in the White House.”
The September 26th reception would turn out to be a “superspreader” event, with eleven people at the indoor and outdoor gatherings later testing positive for COVID, including Christie. By Saturday, the former governor had landed in the intensive-care unit, where he spent the next week, separated even from his nurses by a thick pane of glass. “A lot of what folks don’t understand is how isolating that circumstance is,” Christie says now, “and how that plays on your ability to get better as well.” Treated with steroids, remdesivir, and an experimental monoclonal-antibody therapy, Christie eventually recovered. Now, he’s using the experience — along with stories of family members who died of COVID complications — as its own sort of medicine, hoping to encourage others to reflect on the risks of COVID and choose to get vaccinated.
Politically conservative Americans have been among the least likely to say they’ll get a COVID vaccine — making for a widening partisan divide in vaccination rates. This gap has prompted Christie and others to search for new ways to build vaccine confidence. In this episode of EPIDEMIC, Getting on the Right Side of Conservatives and Vaccines, Dr. Céline Gounder explores findings from a focus group of conservative Americans, and probes how public-health officials can most effectively make their case.
Sources of skepticism
Early in the pandemic, efforts to build vaccine confidence focused on communities of color — cultivating trust in communities that had long been overlooked or exploited in public-health campaigns. “Communities of color had a disproportionate burden of disease and death,” says Brian Castrucci, president and CEO of the de Beaumont Foundation, a public-health think tank. But vaccine confidence has grown in these groups. Where it wasn’t budging was among Republicans. “It’s our responsibility, then, to pivot to the group that is the most hesitant,” says Castrucci, “because we’re only going to be as safe as the group that is vaccinated the least.”
In March, Castrucci and Republican pollster Frank Luntz led an online focus group of nineteen people who’d voted for Trump last November. These voters were not “anti-vaxxers” — they’d gotten vaccines for measles, polio, and hepatitis in the past — but they felt anxious about the COVID vaccines, calling them “rushed” and “experimental.” Along with the focus-group members, well-known political and public- health officials joined the call, including Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC); Republican Senator Bill Cassidy; House Minority Leader Representative Kevin McCarthy; Republican Representative Brad Wenstrup; and Christie.
The participants’ biggest concern about vaccines was safety: They worried about long-term side effects; they were skeptical about the vaccines’ swift development; and they wondered if the vaccines even worked. Yet when it came to reassurance, the group had little use for messages from the top: Former CDC Director Frieden didn’t sway them, nor did a public-service announcement from the Ad Council that featured past U.S. presidents — including George W. Bush — urging Americans to “‘do [their] part.’”
Respondents pointed to inconsistent messaging early in the pandemic, and to a sense that with each new pandemic chapter, “the goal posts … move[d] again.” Those early shifts in messaging — No masks? Masks? — stirred skepticism in the first weeks pandemic, says Castrucci: With so much unknown about a novel virus, “We were too declarative early in the pandemic, and that has led to some confusion.” In retrospect, says Castrucci, “I think we needed to be honest and transparent early on and just say, ‘We’re not sure yet,’ but that’s not what we said.”
Focus-group participants also pointed to the timing of vaccine-development announcements — just after the November election — as a source of their current hesitation. “If you really want us to trust the science,” said one participant, “I think politics has to be taken out of it.” That wariness of government, says Christie, was one of the biggest takeaways from the focus group: “The biggest single surprise for me was people’s deep-seated suspicion of anything that government does.”
Respondents didn’t want to hear from Republican lawmakers, from public-health leaders, or even from Trump. Thirty minutes into the focus group, recalls Castrucci, “What went through my mind was, ‘Oh, dear God, we’re not going to change these folks’ minds.’”
The power of science — and story
What did help change their minds was simple facts and personal stories: “It was things like, ‘If we get enough people vaccinated, we can prevent a hundred thousand deaths or more,’” says Castrucci. “That nearly all doctors who have been offered the vaccine have taken it. [That] the speed of the vaccines’ development was due to cutting red tape, not corners. That the vaccines are more effective than the flu vaccine. And that the trials for these vaccines had tens of thousands of people in them.”
Christie’s own story seemed to cut through the focus group’s skepticism, too. And while Christie himself had preexisting medical conditions that made him more vulnerable to COVID, he also shared his grief and incredulity at the fate of his cousin and his cousin’s husband — healthy adults in their early 60s who got COVID and died of complications while they were intubated. “And so their one child … lost both of her parents within six days — without any reason to believe, when they first got sick …, that they were at significant risk for serious illness or death,” says Christie. Such startling stories — of COVID’s unpredictable course, of the way it can suddenly ravage a family, of the stunned sense of loss for those left behind — may transcend partisan skepticism.
After the focus group, Castrucci’s organization continued polling Republican voters and has since released a messaging guide, Changing the COVID Conversation, exploring how organizations can reach conservatives about vaccines. The guide has been used by the City of Boston, the National Association of Republican Mayors, and by departments of health in Utah and Virginia.
Castrucci is now convinced that efforts to build vaccine confidence must decouple science and politics, and “need to lead with doctors. We’re going to have to rely on people that other people trust — and that’s our clergy; it’s our physicians. And honestly, a lot of the vaccination questions … are going to be answered across a kitchen table. And so it’s family talking to family.”
Critical to those conversations, too, is an awareness of the values undergirding them. “No one wants to be manipulated or forced into doing something to their body,” says Castrucci. Given that many on the right see freedom and individualism as sacred subtexts in conversations on vaccines, “we don’t want to in any way impugn those values, because that could … make them less likely to get the vaccine.”
Christie points to the mood of the conversation as well as its mode, and to the importance of humility, even — or especially — among those who are adamantly pro-vaccine. “You know, there is an air in some people … that to think otherwise means you’re either blind or stupid,” he says. “I think people have really interesting, valid questions to ask.” The key, he says, is to respond with calm and deliberate truth — whether the questions are for family doctors; for public-health experts ready to reply with science shorn of political undertones; or for people like Christie, who’ve had COVID or lost loved ones to the disease, and seen its ravages firsthand.