Marketing The Jab - The Caribbean’s Challenge of Vaccine Hesitancy

The Caribbean has always been known to be one of the most vaccine progressive territories in the world.  Many nations in Africa and Asia still struggle with basic vaccination requirements for smallpox, measles, mumps and rubella. In developed countries, celebrity-driven vaccine hesitancy and New Age accusations of vaccines causing autism has ushered a return of once near-eliminated, 19th Century diseases. In wealthy, developed countries, diseases like measles are making a comeback.

From January 1 to December 31, 2019, 1,282* individual cases of measles were confirmed in 31 states. This is the greatest number of cases reported in the U.S. since 1992. The majority of cases were among people who were not vaccinated against measles. Measles is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated.

- Centers For Disease Control And Prevention

However, the Caribbean has always kept its footing firmly in medical science. This is largely in part to a high degree of cultural respect for education and prioritization of the wellbeing of children. Parents faithfully follow the regulations and vaccinate their children before their first day of primary school. There has always been a deep level of trust and respect for medical science and the experts in the profession.  Vaccine hesitancy has never been an issue in this region….until COVID19.

“Even if some territories of the Caribbean are leading the regional effort in terms of vaccination coverage, we can say that the [Covid19] vaccine uptick is suboptimal in most of the Caribbean countries,” says Dr. Sylvain Aldighieri, the Covid-19 incident manager at the Pan American Health Organization, which is part of the W.H.O. This is very concerning especially in territories where the issue is not a ready supply of vaccines (such as in developing countries in Africa) which accounts for the lack of vaccination. Vaccines readily available and accessible but the populations in many of the Caribbean territories are not taking them. Some territories have a surplus to give to other territories because of low vaccine uptake in their own countries. This new serious mistrust of the validity and safety of the vaccines has led to some dire consequences. “In the eastern Caribbean, health services have been — or are still — overwhelmed by the influx of patients requiring hospitalization,” Dr. Aldighieri said.

In August of 2021, Dr. Carissa F. Etienne, Director of the Pan American Health Organization (PAHO) released an urgent plea to the people of the Caribbean to get vaccinated. She stressed the importance of looking at the evidence, “The proof,” she said, "is that of the people that are now hospitalized, in severe illness and death, more than 95% of those have not been vaccinated.” She also expressed that “I don’t know the sources of the information that is triggering this level of vaccine hesitancy. I can tell you that they are not scientifically proven, and I want to appeal to you to listen to the sources where you have truthful, scientifically based information and evidence.”

While it is the duty of health experts to keep pointing people in the right direction, it is the business of a marketing agency to know why a demographic is not responding favorably to a particular product or service or brand or messaging and how to change that. To that end we have identified the following as the major barriers to vaccination uptake in our region:

The Unfortunate Politicization Of The Pandemic

Sadly, the COVID19 pandemic hit a few Caribbean islands such as Trinidad and Tobago, Saint Lucia, Antigua and St. Vincent and The Grenadines during their electoral season and certain political parties decided to seize upon the more authoritative stance the incumbent regimes were taking to protect citizens as a wedge issue for their own political gain. Much like the USA, where Right Wing Conservatives tend to lean towards vaccination hesitancy, while Liberals and Progressives lean towards trusting the medical experts, certain territories in the Caribbean have also become divided on the vaccine issue along clear political lines.

The evidence shows that in populations living in poverty and in ethnic communities, there is a higher prevalence of Covid-19, and a higher risk of mortality, regardless of age and the existence of comorbidities. However, these populations have not been prioritized in vaccination plans in all cases.

- UNESCO

The Influence Of Second-awakening American Protestant Sects

While more mainstream and long-established Christian denominations such as Roman Catholicism, Anglican, Methodist, Presbyterian tend to lean more towards the side of trusting science and medical experts and have a cooperative attitude towards agencies such as the UN, the same cannot be said for certain sects that sprung up in the 19th Century in the USA, with a more apocalyptic dogma that casts such agents as evil and untrustworthy. Many of these sects and newer unregulated Christian sects, colloquially called, “small churches”, have a deep footing in several Caribbean territories and preach from their pulpits that the vaccine is the work of the devil or the mark of the beast. Faith-healing is promoted over vaccinations.

The Influence Of Rastafarianism, Pan-African, Black Conscious Groups

“Babylon System” is where the virus and vaccine fall for many in the Caribbean. While these groups may not be the majority, they do have a major cultural influence.

Overall Distrust Of The USA, Big Corporations And Foreign Agencies

Sadly, the distrust is not entirely unmerited as there have been so many widely reported scandals, corrupt practices, exploitation and ineffectual interventions done by these entities in the developing world. In the Age of Information, the awareness about the dark dealings of Big Corporations is becoming commonplace which fuels more distrust and conspiracies about what the “end goal” is for these organizations. Now that we need people to trust these foreign bodies, we have to overcome this wariness.  

Social Media Platforms And Speeds Up Transmission Of Misinformation

If this pandemic had occurred in the 80s or late 90s or even in the early 2000’s, it would have been easier to override the misinformation but now, social media allows for nearly anyone to become an “expert” and spread information that is misleading.

My cousin in Trinidad won’t get the vaccine cuz his friend got it & became impotent. His testicles became swollen. His friend was weeks away from getting married, now the girl called off the wedding. So just pray on it & make sure you’re comfortable with ur decision, not bullied.

- Nikki Minaj Twitter Post September 13, 2021

Younger Population With The Typical “Invincibility” Attitude 

The Caribbean has a larger than average younger population, between the ages of 18 and 35. Many do not see COVID19 as detrimental to their health.  From the outset it was the elderly population dying. However, what many of the Millennial and GenZ generation do not realize is Long-COVID can seriously degrade their health over time and they too have NCDs (often undiagnosed) in their younger population that can make COVID19 fatal if they are not vaccinated. 

When the Bureau Of Health Education (BHE) of the Saint Lucian Ministry of Health Wellness and Elderly Affairs, contacted Accela Marketing to help with the uptake of vaccines, our journey into understanding the situation as we would any brand or product intensified. What aided us tremendously was the extensive groundwork already done by the BHE. 

Nataha Lloyd-Felix, Director of the BHE explained, “Our starting position was one listening and more importantly hearing (which meant adopting a neutral, non-judgmental approach) the reasons for vaccine hesitancy. This included hearing the public’s views through listening to call-in programmes, social media posts and related comments, feedback given when we conducted seminars, presentations and other related health promotion interventions. We also able to feel the pulse of the public through two KAP surveys conducted; one done nationally by the Ministry of Health and the other through the support of the Caribbean Public Health Agency. One learning opportunity this approach provided our team with was the appreciation that vaccine hesitancy did not equate to disinterest or opposition to COVID-19 vaccination. By so doing it allowed us to adopt a more agile and audience-specific strategy to implementation moving us from the generic to the specific as by knowing the needs of the populace were able to continually iterate and tailor our programmes to be responsive to the needs of the populace. This social listening also helped us in complimenting education and information with a discussion orientation.”

As a health education unit we have found conversations, especially with topics which are complex, is one of the most effective approaches in “moving the needles in behavior change” and as such, we have utilized this approach in response to vaccine hesitancy.

- Natasha Lloyd-Felix, Director of the Bureau Of Health Education

From Accela’s first engagement with the BHE in creating PSAs, the goal was keeping the messaging simple and effective. Medical, health and safety information often is created with cognitive uptake in mind but not emotional uptake. However, as a marketing agency we know that most decisions are made not with the head but the with the heart. It also helped that the BHE insisted upon utilizing the local parlance and the local Creole language instead of an austere authoritarian voice.

It was also important to show people the human, economic, cultural values of vaccination using the voices of those who had been vaccinated and could testify truthfully.

Accela not only aided with messaging but also with the practical aspect of getting the vaccines to people through the joint initiative of a Vaccination Mobile Drive that took the vaccination to the people instead of asking them, especially the elderly, busy single mothers and frontline workers, to take time out of their schedule to go to a Wellness Center. The Mobile Vaccination Unit also brought in the participation of the private sector who not only helped with promotion but also incentives for those who got vaccinated.

This prong in one of many kinds of outreach being done simultaneously by the BHE, helped to bring the local vaccination numbers up to the mid 30% mark but there is still a long way to go.

There is also a need to manage the expectations of the vaccine. Many audiences in the Caribbean need to understand the vaccinated person will still encounter existing and potentially new strains of the COVID virus and having it in their system while their (now informed) immune system beats it, during which time they may potentially pass it to others if they are not socially distancing, wearing a mask, and sanitizing hands and surfaces. The risk is lower, but it is there. Now vaccinated people are being blamed in various social platforms for spreading COVID and another anti-vaccine argument is solidifying.

COVID-19 vaccines are effective at preventing infection, serious illness, and death. Most people who get COVID-19 are unvaccinated. However, since vaccines are not 100% effective at preventing infection, some people who are fully vaccinated will still get COVID-19.

- Centers For Disease Control And Prevention

Herein lies the challenge for Marketing the Jab. You are marketing “risk” and percentages and not definitive outcomes the way most products and services can promise in their promotional material. The well-respected book, “Risk as Analysis and Risk as Feelings: Some Thoughts about Affect, Reason, Risk, and Rationality” by Paul Slovic, Melissa L. Finucane,Ellen Peters, and Donald G. MacGregor, deals with how to effectively help humans weigh risk rationally and emotionally.

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The Winton Centre for Risk & Evidence communication for the Medicines and Healthcare Regulatory Authority in the UK utilizes dynamic graphics to help consumers compare risk of being vaccinated vs. being unvaccinated. It may be time to use these methods in the Caribbean as well.

Saint Lucia and most of the Caribbean is particularly vulnerable because of its high NCD population, particularly when it comes to diabetes, prostate cancer (for which many men are still unchecked), breast cancer and hypertension. There is still a lot of work to be done before the introduction of sweeping vaccine mandates by the private and public sector. Accela will be bringing as much Marketing Thought Leadership to the process to enable effective public education around the issue.