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Covid-19 Vaccine Acceptance, Social Vulnerability, and Effective Message Design in the U.S.

Direct Relief and Facebook team up to explore successful Covid-19 vaccine promotion strategy.



Direct Relief's Associate Director of Pharmacy & Clinical Affairs, Alycia Clark, prepares a Covid-19 vaccine. Vaccine acceptance rates vary across the U.S., and Direct Relief and Facebook worked together on a recent messaging campaign to encourage vaccination and information seeking from medical professionals. (Direct Relief photo)

Editor’s note: This report was written in collaboration with  Facebook Data for Good.

Direct Relief, in partnership with Facebook Data for Good, recently released the results of an online campaign aimed to promote the Covid-19 vaccine in the United States and found that messages on social norming, social responsibility, and the purity value can all be effective at combatting vaccine hesitancy. These results may be effective in future message design strategy in the U.S. and may be particularly relevant for young to middle-aged adults in communities with low vaccine adoption.

The campaign, which reached approximately 2 million individuals, targeted adults ages 18-40 in states considered to be mid- to low-vaccine acceptance, according to Facebook and Carnegie Mellon’s Covid-19 Trends and Impacts Survey. According to CDC data collected during the planning phase of this campaign, there has been lagging vaccine uptake among young adults and an opportunity to build vaccine demand among this cohort.

Furthermore, within these states, the campaign targeted counties with moderate to high social vulnerability, according to the CDC’s Social Vulnerability Index to ensure populations with a high need for social resources would be reached.

Counties included in targeting based on social vulnerability index factors and vaccine hesitancy.

Direct Relief and Facebook tested different messages, including those that focused on social responsibility, social norming and purity value-based messaging and all encouraged individuals to talk to their doctor if they had questions regarding the Covid-19 vaccine.

Each of these types of messages had been tested in previous public health research and showed potential for influencing vaccine hesitant groups. The campaign also included a link to the Ad Council’s Get Vaccine Answers – Hear from Healthcare Providers resource page.

The ad using social responsibility messaging included the main phrase, “You’re not just getting the vaccine to protect yourself but also to protect the people you care about and others in your community.” This campaign used real-life images depicting everyday people not just protecting themselves but also protecting their loved ones by being vaccinated themselves.

The ad using social norming was comprised of a message outlining, “Data shows most Americans and doctors want the COVID19 vaccine” and “Over 75% of Americans want to get the COVID-19 vaccine.” Lastly, the purity value ad focused on demystifying the contents of the COVID-19 vaccine and its effects on the body. This ad consisted of an interactive carousel, with several creative cards that listed facts addressing the contents of the vaccine.

Across all three messages, the campaign reached approximately 2 million people and led to approximately 62,000 clicks to the Ad Council’s resource page. To understand how well different approaches performed with the target audience in terms of shifting attitudes towards the Covid-19 vaccine, the research team conducted a brand lift survey comparing viewers who saw the ads (the test group) and those who did not (the control group) on a range of questions related to vaccine acceptance.

Survey results indicated that each campaign message performed well at increasing vaccine accepting attitudes in different ways.

For example, the social norming ad yielded the strongest statistically significant results across all of the survey’s questions, improving perceptions of vaccine safety, the perceived social approval associated with getting a vaccine and improving the frequency of people recommending that their friends talk to a doctor if they had questions.

At the same time, the social responsibility message had the highest recall and the highest click-through rates, and was best at improving perceptions that it is important for people to ask their doctor about the vaccine. Lastly, the purity value messaging worked best for promoting the safety of Covid-19 vaccines across both men and women, but the impact on perceived safety was especially high among women, achieving a +3.4 percentage point difference in this question compared to the control group.

As such, each message led to changes in attitudes affecting vaccine acceptance, depending on the unique content of the message and underlying drivers of hesitancy it most directly addressed.

Table 1. Campaign Results Highlighting Where Ad Exposure Caused a Positive Shift in Attitudes Between Test and Control Groups

These outcomes are highly significant, as they may inform future message design for effective online health outreach campaigns, as well as communication among friend and family networks. Social norming, for example, is not limited to formal campaigns — vaccine profile frames, vaccination selfies/testimonials and influencers posting about their stories can all be important tools for contributing to vaccine acceptance. Similarly, this study points to the effectiveness of purity value-based messaging to inform people about the contents of the vaccine and its effects on the body among those who believe vaccines are innately unnatural.

“Being able to share insights that help public health officials share the right messages about COVID19 vaccines is a top priority for Facebook’s Data for Good team. We’re proud of the partnership with Direct Relief and hope these insights prove valuable to additional organizations doing health outreach,” said Laura McGorman, Public Policy Manager, Data for Good at Facebook

“The reactions of different communities to the Covid-19 vaccine have been complex and diverse. Reaching people in a way that resonates most with their values and beliefs has been at the heart of this effort. The more people that are prompted to take positive action for their health and the health of others, the faster this pandemic ends,” said Andrew Schroeder, Direct Relief’s Vice President of Research and Analysis. “Direct Relief is grateful to collaborate with Facebook Data for Good in the sharing of key learnings from this historic effort.”

Code3 provided support in generating the creative content of this campaign.

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