A new report, Infrastructures of Trust: The Case for Investing in Vaccine Demand, from researchers at the Information Futures Lab at Brown University’s School of Public Health calls for investment in community leadership; provides key strategies for public health officials, institutions, and policy makers.

As the United States has begun the rollout of second generation updated Covid-19 vaccines, a new report from researchers at the Brown University School of Public Health with support from The Rockefeller Foundation finds that despite dramatically expanded capacities to develop, manufacture, and deliver effective vaccines, it will be people’s confidence in and widespread access to vaccines that will decide whether this critical public health solution will be successful. With one third of Americans having gotten only one Covid shot or none, the report calls for a significant investment in vaccine demand generation to address the rampant disinformation, the erosion of trust in public health, and the lack of access to health services that has undermined the United States’ vaccination efforts to date.

Calling it an ‘all-of-society’ challenge, the new report examines how “if we build it, they will come” strategies can backfire, and how a better understanding of a significantly changed media environment and structural barriers to vaccine uptake impact decision making can improve vaccination efforts. The report delivers a new framework to guide vaccine demand generation strategies overall and calls for investment in people and programs, adjustments in policies and regulations, and a commitment to building new infrastructures to increase trust, health equity, and meet the information needs of diverse communities.

“Under-vaccination remains a key reason why we haven’t emerged more resilient one-and-a-half years after vaccines became widely available,” said Stefanie Friedhoff, co-director of the Information Futures Lab at the Brown University School of Public Health and the lead author of the report. “It is easy to blame people for making bad choices but if we do not understand the underlying reasons for why so many aren’t accessing these lifesaving measures, we risk staying stuck in the same cycle.”

The report provides a set of policy recommendations for public health officials, institutions, and policy makers to build and maintain a stronger public health system that protects Americans from a lingering pandemic – and future ones. The recommendations include:

  • Invest in a communications infrastructure – similar to other aspects of pandemic preparedness – that builds trust in public health guidance over time and makes public health communications everyone’s job. This includes building in flexibility to address evolving information needs and to fight disinformation tactics that sow fear and doubt in vaccinations.
  • Be in solidarity with community by aligning with their priorities, needs, and values to make it easier for individuals to see how the vaccine fits into their life and frame vaccination as a decision that makes sense. This is an essential component that builds trust, integrates interventions into other needed services, and creates a more equitable public health system.
  • Integrate vaccine demand assessments and strategic planning into pandemic preparedness and resilience efforts at all levels of government, industry, and the nonprofit sector – from the start.

“The supply and demand sides of vaccine rollouts are often run as largely separate activities so crucial details about how a policy might impact some communities, or how false narratives are impacting communities, can be missed,” said Gregory Johnson, Managing Director of the U.S. Equity and Economic Opportunity Initiative at The Rockefeller Foundation. “For shots to go into arms, vaccination efforts need to be deeply informed by people’s lived experiences and current realities, by their questions and concerns, and by how they form and maintain trust, because trust plays a key role in our attitudes towards vaccination. Nobody understands this better than those who are in the community and work with the community.”

This report is based on learnings from The Rockefeller Foundation’s Equity-First Vaccination Initiative (EVI) – which funded community-led work on vaccine access and confidence in communities of color in five U.S. cities – as well as an extensive literature review and interviews with key experts, advocates, practitioners and authorities. The research finds:

  • Accumulating vaccine doubt and fatigue are not just affecting one particular group – they are affecting Americans from all races, backgrounds and political leanings, all across the country, just not in the same ways.
  • Community organizations have overcome these challenges and moved the needle on vaccinations by integrating vaccination work into broader efforts to overcome health disparities and information challenges.
  • While integral to pandemic response efforts, demand generation activities are inconsistent, undervalued and underfunded. With the depletion of federal funding and Congressional reluctance to renew funding, vaccination efforts may be even worse off during future waves of Covid-19.

“Vaccines are the great equalizer – where available, vaccines have consistently led to improvements in life expectancy, economic stability and upward mobility. I know many people are tired of the forces pushing against vaccination efforts and ready to move on, but in the end, this is about protecting people and preventing health disparities,” said Estelle Willie, Director of Health Policy and Communications at The Rockefeller Foundation. “As we continue to face pandemic threats, our resilience will increasingly depend on our ability to build and maintain demand for lifesaving public health measures, including vaccines. We must invest in the infrastructures needed to build and rebuild trust in vaccines – and public health more broadly.”

Building on its $20 million investment in the Equity-First Vaccination Initiative (EVI), The Rockefeller Foundation has launched a $55 million Global Vaccination Initiative (GVI), building on lessons learned from its EVI work in the United States. As part of the GVI, a new community-based approach to building vaccine demand on the African continent has just been announced.

Friedhoff’s contributions to this report occurred prior to her taking a temporary role in the federal government and reflect her personal views only.