For more than 12 months, Michigan’s health officials have been working to get the word out that COVID-19 vaccines are the safe and effective way out of the pandemic.
It’s an advertising campaign that has cost about $62.6 million in state and federal funding, and is expected to cost another $15 million before the end of the first quarter of 2022, according Department of Health and Human Services (MDHHS) data requested and obtained by MLive.
Dr. Natasha Bagdasarian, Michigan’s acting chief medical executive, has called some aspects of the campaign a success, while noting that other goals remain a bit more intangible. She said the ads aren’t going away anytime soon, but acknowledged a need to continue with more creative messaging if Michigan is going to improve on its vaccine uptake, which ranks 33rd in the nation.
“We vaccinated over 6 million Michigan residents,” she said. “It would be hard to say vaccinating that many people is a failure by any measure. But I think we also have to keep in mind, for whatever reason, there are people that are reluctant and we need to think about more creative ways to direct messaging toward those individuals.”
Advertising experts noted that such public health campaigns are expensive and can be difficult to assess the return-on-investment while the campaign is ongoing. Still, they said a drop-off in vaccine uptake requires a change of direction.
“When you see the curve flatten out, it’s time to do something different,” said Nancy Rhodes, an associate professor at Michigan State University, whose research focus has been on persuasion and its effects on health and safety behaviors.
“If they’re spending $15 million this quarter, they should be doing something different from what they’ve been doing.”
Rhodes’ colleague, Monique Turner, is an associate professor and chair of MSU’s department of communication. She said it can be difficult to measure the return on investment of a public health campaign before it’s concluded, but noted that it would be irresponsible to cut off advertising the vaccine at this point.
“That would send a message to some that it’s not a big deal anymore, and that’s a dangerous message,” Turner said. “They’ll have to keep adapting the message to the new environment.”
As of early February, Michigan’s vaccine uptake trailed the national average by 6 percent. It had gotten first-dose vaccines to 64.6 percent of its 5 and older population, or more than 6.08 million residents. About 5.5 million got their second dose, and more than 2.7 million have gotten a booster dose to refresh their protection.
The Campaign
Michigan’s vaccine ad campaign was born in January 2021 in response to research about attitudes toward the vaccine and to address hesitancy among Michigan residents, especially in communities of color. A statewide survey conducted by MDHHS in November 2020 found only 34 percent of respondents planned to get a vaccine as soon as one was available.
Communication efforts have been largely orchestrated by the Protect Michigan Commission, an advisory committee created within the MDHHS by Gov. Gretchen Whitmer.
Advertising has been spread across a multitude of channels, including television, radio, streaming audio, YouTube, search, print in minority publications, social media, and digital media. There have also been signs posted on billboards, transit and bus shelters, and gas pumps, as well as in doctor’s offices, malls, airports and other businesses.
Among the most prevalent in the campaign has been a series of black and white videos and screengrabs known as “My Why,” which offer personal testimonials from Michiganders explaining why they chose to get vaccinated. The direction of those messages has continued to evolve to tackle common questions and misconceptions linked to vaccine hesitance, and as new groups have become eligible.
To date, Michigan has spent or earmarked nearly $78 million for the first 15 months of the campaign. Of those dollars, about $71.78 million were allocated from the CDC and Federal Emergency Management Agency ( FEMA). The remaining $5.8 million came out of the state’s general fund.
The vaccine advertising campaign has had two goals at its core: To make residents aware that there is an effective vaccine available to them, and to convince them it’s a good idea to get the shot(s).
Dr. Bagdasarian called the first goal a success.
“We don’t want lack of awareness to be a barrier,” she said. “Not only are they available, but they’re safe and effective against COVID. That goal to put info out there has been successful based on dialogue — people are talking about vaccinations and rates have continued to go up since they’ve been available.”
The second goal, however, has been tougher as about 35 percent of the eligible population has remained hesitant.
“We’re seeing that younger adults don’t have the same vaccine uptake of older adults,” Bagdasarian said. “We’re seeing the children still don’t have the same vaccine uptake as people who are middle-aged or older adults. We’re seeing that vaccine uptake really varies by geography and so again, that messaging has to change and we have to target those who have a lower rate of vaccine uptake.”
Vaccinations Have Stalled
Individuals most likely to get vaccinated did so in the early months of availability. Through the first six months of 2021, there were more than 8.9 million primary-series doses administered in Michigan. That accounted for 82.4 percent of the primary doses given during the calendar year.
Since the summer, uptake of the vaccine has largely slowed to a crawl.
“Looking at vaccination rates now, we’ve pulled off all the easy ones,” Rhodes said. “With health messaging, often, you need to take a longer-term view. We may be chipping away at attitudes and beliefs and not seeing the behavior right away, but we don’t have the luxury of taking the long-term view because we need to get people vaccinated to slow the virus mutations and relieve our hospitals.”
Last month, the state reported its lowest count of primary doses administered (213,709) in a given month since vaccines became available. Michigan’s at-least partially vaccinated population climbed 1.2 percent during that time, leaving more than 3.3 million eligible residents remaining unvaccinated.
The mass-vaccination effort against COVID-19 has been most effective among the state’s oldest, and generally most at-risk populations. More than 85 percent of the 75 and older population is vaccinated, as is nearly 90 percent of the 65-to-74 age bracket. Even the 50-to-64 crowd is more than 75 percent vaccinated.
Vaccinating younger populations haven’t been as successful. About 25 percent of children 5 to 11 have gotten a shot as of late January. That rate is about 47 percent for the 12-to-15 crowd, and 53 percent for the remaining teens. Michiganders in their 20s are about 52 percent vaccinated, while the 30s age bracket is at about 63 percent vaccinated.
Those younger and less-protected groups have been among the hardest hit by the omicron variant in recent months. Residents 20 to 29 have seen the highest case rates per million people, followed closely by the 30 to 39 population. Additionally, pediatric hospitalizations reached a pandemic high last month.
“That’s concerning and I think it really talks to the fact that we’re not safe as a society,” Bagdasarian said. “We can’t withstand these types of surges unless we’re protected across the board; unless we don’t have communities or certain demographic groups or certain age groups or certain racial and ethnic groups that are being left behind.
“It’s not that we haven’t done a good job. It’s now we need to do really focused messaging to people who have been reluctant thus far.”
An Evolving Message
When you see the behavior you’re promoting — in this case vaccination — flatten out or dip, it’s time to stop and re-evaluate, experts say.
“Do we pull the campaign or do we adapt?” Turner said. “The suggestion, if you were in my class, would be determine who is left and what do we know about them. Then start adapting strategy to meet them, but that is very financially contingent. It’s more expensive than people probably realize.”
She and Rhodes agreed there are likely still people throughout the state who can be persuaded to get vaccinated. But it will take more pro-vaccination messaging from people they already trust and turn to for information, including primary care physicians, religious leaders and other valued community leaders. Those messages should be localized in areas with lower vaccination rates like in parts of western and northern Michigan, as well as the city of Detroit.
They also recommended messaging that combats hyper-individualistic reactions to the vaccines and focuses on how vaccines impact the greater good by protecting your high-risk neighbors and opening hospital beds for those who need care.
“We’ve lost the sense of responsibility to each other,” Rhodes said. “It’s become individualized. ‘I don’t want to take that risk,’ yet our society is failing because we’re beyond capacity for health care right now.”
Evaluation of the cost-benefits of Michigan’s ad campaign will depend on a return-on-investment analysis that looks at lives and dollars saved by keeping people out of the hospital, Turner said. She noted it’s “hard to gauge during the campaign,” especially when vaccine providers aren’t surveying residents to see if they were persuaded by an ad or what they thought of the campaign.
In the meantime, health care workers like Dr. Dennis Cunningham are in favor of the public spending if it means reducing the number of patients needing hospital care for COVID-19.
“I’m not an expert on ad campaign costs,” said Cunningham, system medical director of infection control and prevention for Henry Ford Health System. “But what we’re seeing is people who are vaccinated, especially if they’re boosted, they’re not being admitted to hospitals unless they have an otherwise compromised immune system.
“So I’m in favor of (the spending). We need to get the message out. Will it prevent all symptoms, no. But will it reduce severe illness, absolutely.”
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