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Can social media influencers boost coronavirus vaccination rates?


In April, a Breckenridge stylist who uses the Instagram name @ilikeprettyhair sat down in front of her phone and recorded a message for her roughly 5,000 followers.

“What’s up, my mountain mamas?” the stylist, LaRissa Marie Chapa, said in a serene voice. She wore a bright red wide-brimmed hat and a sleeveless top that displayed her intricate arm tattoos. Behind her, the vines of a pothos plant creeped down a shiplap wall.

“So I wanted to pop on here and talk a little bit about an upcoming campaign that I am doing over the next few weeks with the state of Colorado. They’ve reached out to people across the state and local communities to help spread factual, proper information about the vaccine and getting vaccinated.”

A couple weeks later, Chapa posted about an upcoming vaccination clinic in Frisco. For a feed primarily devoted to sharing pictures of eye-catching hair styles, the turn to public health messaging might have appeared odd, especially since the messenger seemed a little cautious in the role.

“There’s just so much information out there it’s overwhelming,” Chapa said in the April video. “This will help to kind of decipher fact from fiction and then empower you to make the best decision for yourself. By no means is it me pushing it on you.”

Chapa’s post, though, was part of a coordinated, multimillion-dollar marketing campaign by the state to enlist social media influencers in the effort to persuade reluctant Coloradans to get vaccinated against the coronavirus.

More than 120 influencers are included in the campaign — from doctors and nurses to teachers to professional runners and mountain bike racers to community leaders and small business owners to musicians and yoga teachers to college students to a priest. Their posts on Instagram, Twitter, Facebook, TikTok, YouTube, LinkedIn and other social networking sites have so far generated more than 41 million impressions.

This is a new frontier in public health messaging, testing the outer bounds of the argument that the most persuasive voice is the one that’s most trusted in a community.

For most public health campaigns, this means putting a physician in front of the camera to deliver a conclusive message — get vaccinated, doctor’s orders — which the state did early on in the COVID vaccination campaign. But, in an age of polarization and fractured social dynamics, that kind of authoritative voice reaches only so far.

Later, the vaccination campaign came to include community leaders speaking at churches or making personalized phone calls, sharing their vaccination stories. In other words, it involved outreach within physical communities among people who know one another personally.

But, as the state’s vaccination rate moves sluggishly upward, there is also this leap into the experimental. Most of the influencers have little background in health. They don’t often know the people they are speaking to. They provide information, but the campaign encourages them to stop short of directly telling people to get vaccinated.

So, if you won’t get vaccinated because your doctor instructs you to, will you do it when your favorite travelogger or bike racer suggests you should maybe think about it?

“It doesn’t matter if they’re (usually) talking about bicycles,” said Patricia Lepiani, the president of The Idea Marketing, which is organizing the campaign. “It doesn’t matter. Because you trust me when I talk about bikes, so you will trust me and trust my people when I tell you, ‘You know what, this is information. You make your decision. But it’s really important, if we want to keep doing what we love, to get vaccinated.’”

How a theory about memory explains social media’s power

The research on the effectiveness of this kind of social media-driven public health persuasion is decidedly early stage. And what does exist is often more concerned about the role social media plays in promoting anti-vaccination beliefs.

That’s because studies show social media can create a kind of negative feedback loop around trust in vaccines. Every post raising a question about the science of vaccines, every video of a person’s bad experience with vaccines becomes an obstacle to convincing people that vaccines are safe and effective.

Last year, a group of researchers in Canada published an article in the journal Human Vaccines and Immunotherapies that attempts to explain why. The researchers pointed to something called the “fuzz-trace theory” of memory. The theory posits that memories come in two flavors — verbatim memories, which capture precise information and nuance, and gist memories, which save just the bottom line.

The problem, according to the researchers, is that humans do not appear to use the more detailed verbatim memories when making important decisions. Instead, we rely on our gist memories. And social media is a massive gist memory factory.

“Social media posts expressing gist are more likely to be shared,” the authors write. “In contrast, quantitative information offered by evidence-based medical literature on pro-vaccine platforms may be less evoking than personal anecdotes offered by social media.”

Moderna Covid-19 vaccine vials are seen during a vaccination clinic for residents of zip code 80010 and existing refugee patients at Ardas Family Medicine in The Mango House in Aurora, Colorado on Thursday, March 4, 2021. (Eli Imadali, Special to The Colorado Sun)

Public health leaders have long looked for a way to use social media to their advantage.

In 2017, a group of doctors and researchers in Colorado published the results of a clinical trial that split patients into three groups to study the best ways to reduce vaccine hesitancy among pregnant women. One group of moms-to-be was given the usual messages about vaccination, a second group was given access to a website with information about vaccines and the third group was given access to an interactive website with vaccine information as well a social media component.

At the end of the study, the children of the moms in the third group were more likely to be up-to-date on their vaccinations.

That means, as other studies have also found, social media can be used to boost vaccine confidence. But there’s still a problem.

The Colorado study looked at controlled space — social media components attached to a website built by doctors. But the social media networks people typically use exist in the information wild. Out there, pro-vaccine information has to compete for survival, and medical professionals may not be well-suited for the challenge.

This is something the Canadian researchers warned about in their article last year.

“In light of the presence of social media echo-chambers, health care providers working alone on Twitter may not readily reach isolated anti-vaccine communities,” they wrote.

So, who do you get to carry your message across social media?

Influencers.

It’s not about having the most followers, but the right followers

The influencer campaign is just one component of the state’s overall pro-vaccine marketing effort — “a campaign that has, like, seven campaigns within it,” Lepiani said.

All told, the state is paying up to around $16 million to The Idea Marketing for all the work, in a contract that runs through the end of September. All but $2 million of the money is coming from federal funds designated for efforts to increase COVID vaccination rates.

Most of the money budgeted to the overall campaign — at least $12 million — gets spent on ad buys for the campaign’s more traditional components, things like radio and television ads, according to contract documents provided to The Colorado Sun. About $1 million is designated for “agency fees,” meaning what The Idea Marketing makes for its labor.

The company worked with community organizations and local public health authorities across the state to select influencers. The goal was to find a collection that spans Colorado’s diverse demographics, Lepiani said.

Her company also developed specific “archetypes” of vaccine-hesitant people it wants to reach. Young outdoorsy people who might feel like they don’t need the vaccine, for instance. People of color who, because of historic discrimination, may not trust the vaccine.

Some of the influencers selected have large followings. Among the most popular, a Rifle police sergeant named Carlos Cornejo, has more than 660,000 followers on Facebook and 350,000 on TikTok and posts almost entirely in Spanish. But some of the influencers have only a few thousand followers.

For Lepiani, the key is that they have the right followers — the people who most need to hear a message in support of vaccination.

“Even more important isn’t that number but the trust their communities have in them,” she said. “We really wanted to make sure we had the right team advocating for us.”

The Idea Marketing then worked with state officials to connect the influencers with credible information about the COVID vaccines. But it told them not to try to take on the role of an expert. Some of the influencers were open about their own concerns around whether to get vaccinated. Others adopted a laid-back approach: Here’s this information — take it or leave it.

“All the research,” Lepiani said, “is, ‘I don’t want you to tell me what to do. I want you to provide me with information that I can use to make my own decision.’”

The dynamics make measuring the effectiveness of the campaign difficult.

The state’s COVID vaccination rate is ticking up — as of Tuesday, about 74% of people eligible to be vaccinated had received at least one dose.

The number of doses of vaccine administered per week in the state has also been rising since mid-July. But it’s unclear what role the state’s persuasion campaigns have played in that, and a state health official on Tuesday said the increase is at least partially attributable to a new sense of urgency brought on by the rising number of infections due to the virus’s delta variant.

Meanwhile, state officials say that, even if it’s successful, the influencer campaign won’t necessarily result in a huge across-the-board increase in vaccination rate.

“At this point in the vaccine rollout, we aren’t always seeking the widest reach,” a state health spokesperson wrote in an email to The Sun. “We often need to pinpoint our efforts.”

Creating the perception of social norms around vaccination

The reason influencers may be able to succeed in public health where medical experts cannot has to do with deep-seeded social dynamics.

Jennifer Reich, a professor of sociology at the University of Colorado Denver, studies why people refuse vaccines. (Provided by Jennifer Reich)

Jennifer Reich, a sociologist at the University of Colorado Denver, said researchers have long noticed that vaccine hesitancy is not distributed evenly across the populace. Instead, it clusters within certain communities — as does vaccine acceptance. One of the best predictors for whether a family will choose to vaccinate their children is how many other families they know who have vaccinated their kids, Reich said.

This suggests that a decision to get vaccinated isn’t made by each of us, individually, looking at available information and making a choice for ourselves. In other words, it’s not necessarily about the evidence. It’s about something bigger.

“People tend to respond to community norms,” said Reich, whose work focuses on vaccine hesitancy. “If we think about it, it’s somewhat logical. We tend to look to people who we think are either similar to us or who share our beliefs.”

There have been previous public health campaigns, for instance, that provided information about breast cancer to hairstylists, knowing that customers were already talking with their stylists about their health, Reich said. In a more unified era, giving Elvis Presley his polio vaccine during a staged photo op attempted the same feat.

In the modern world, this is where social media influencers come in. The whole reason they have influence is because they are seen as exemplars of those community norms and ideals. It’s why companies target influencers for their viral marketing campaigns — they are trendsetters, thought leaders.

And the pandemic has likely strengthened influencers’ power, Reich said. People have spent less time interacting face-to-face and more time in online communities.

“That definitely limited the cross-pollination of ideas and perspectives,” Reich said. “As a result, I think online communities have become more important.”

But entering into a public health campaign comes with some peril to the influencers.

For one, it may cause them to lose credibility in their community. After one influencer — an ultra-marathoning cattle rancher named Ryan Goodman who posts on Instagram as @beefrunner — talked to NPR about his pro-vaccination work, he said he received criticism.

“The most critical comments came from my neighbors and peers in the agriculture community,” Goodman wrote on Instagram.

“I have never claimed to have medical expertise,” he added, “but I am sharing the information from those who do.”

Reich said the risk of losing credibility is greater if the influencers are being paid — which Colorado’s are. The Idea Marketing is paying them between $400 and $1,000 a month, depending on their online reach, according to the state.

Some influencers disclose this fact explicitly. For instance, Goodman places a notice that says “paid partnership” at the top of every one of his vaccine posts.

Others mention the affiliation more casually. And some do not appear to have mentioned it at all, The Sun found in looking through influencer posts.

If followers take these payments as a sign that the influencers have sold out, then their message will be diminished.

“That perception is really important in understanding how trustworthy that message is,” Reich said.

The state has defended paying influencers. For one, this is how the social media economy works — influencers get paid to promote things in the same way that television stations get paid for ad time. But state officials have also talked about the payments in terms of social justice.

“We know that all too often diverse communities are asked to reach out to their communities for free,” the Polis administration said in a statement in July to The Unaffiliated, The Sun’s political newsletter. “To be equitable, we know we must compensate people for their work.”

The political polarization surrounding the coronavirus vaccines also creates a pitfall — both for influencers and for the campaign.

The Unaffiliated reported in July that several of the influencers in the campaign are politicians or political operatives — most with ties to the Democratic Party or to liberal groups and causes. After being contacted by The Sun, the state canceled its contract with one influencer who is running for a seat on Sheridan’s City Council. “[O]ur policy is to not hire candidates as influencers,” the Polis administration wrote in a statement.

The incident, though, highlighted something else about the collection of influencers assembled to reach Colorado’s most vaccine-hesitant populations. Partisan affiliation is among the best indicators of COVID vaccine hesitancy across Colorado, with counties that lean conservative far more likely to have below-average vaccination rates than counties that lean liberal. But the state is not working with any prominent political conservatives as influencers.

Lepiani, the president of The Idea Marketing, said this is intentional. Asked specifically about the lack of conservative voices, she said she didn’t want to politicize the campaign. And she said some influencers who were selected — such as a fire chief in rural southwest Colorado — likely have followers who are conservative even though they do not typically post partisan messages. She called it a strength of the campaign

Reich said it is a wise choice.

“The messenger whose primary identity is political can be really divisive,” she said.

Having a good conversation — on sites not known for them

In late July, Danielle Shoots posted a photo to Instagram of herself standing at the front of a conference room.

“I missed story telling in a room full of thinkers and learners,” she wrote to her more than 28,000 followers. “Speaking feels like the safest place in the world for me. I missed it so much and I am so grateful to be back. #Vaccinated and back.”

465 likes.

Shoots is a vice president and the chief financial officer for The Colorado Trust, a charitable organization focused on health equity. She’s also a prominent speaker and activist with Colorado’s Black community. She runs her own business coaching firm. She is the former chief financial officer for the Colorado Department of Public Health and Environment. 

All these things make her a natural to work with the state as an influencer — “I feel like I’m right back home,” she said in an interview.

But making the decision to act as an influencer was difficult and came with recognized risks.

“I did a lot of research and really thought that through,” she said. “I talked to my network, especially people in the Black community because I do recognize how important it is that when I do use my influence I use it in a way that is responsible.”

Shoots said she also talked with her family, knowing that spreading a vaccine-friendly message could lead to backlash. “Most-trolled posts ever,” she said.

But she said far more responses have been positive. In her posts, Shoots has talked about how vaccines can help end the pandemic and help people return to doing things they love, like traveling or going to events. She’s talked about the devastation COVID has wreaked on the economy, especially on businesses owned by people of color.

Followers have sent her questions — Where did you find this research? What should we do to protect kids? — which Shoots has tried to answer as best she can or direct to credible sources.

Shoots said she is paid about $700 a month for her work as an influencer, and she said she is open about being part of a state-directed campaign. But she doesn’t think that changes her relationship with her followers.

She tells the story of one follower who reached out to her. He was a young Black man, healthy and nervous about getting vaccinated. She didn’t know him personally, but she said he told her that her voice mattered to him. He knew how much she cared about the Black community.

To her, these are signs of success that matter more than any.

“We’ve really been talking about as a community versus politicizing it,” she said. “And that’s been good. I feel pretty proud of that.”

“We’ve stayed in conversation,” she added. “On social media.”

Staff writer Jesse Paul contributed to this report.

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