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. 2025 Aug 5;57:103193. doi: 10.1016/j.pmedr.2025.103193

Was health skepticism accounted for in communication about the COVID-19 vaccine? A content analysis of federally-sponsored public service announcements about the vaccine to protect against COVID-19 in the United States

Margaret E Tait a,⁎, Erika Franklin Fowler b,c, Sarah E Gollust d
PMCID: PMC12355484  PMID: 40821921

Abstract

Objective

To examine the content of public service announcements (PSAs) sponsored by the United States federal government to promote the COVID-19 vaccine and reveal if PSAs included content that countered health skepticism.

Methods

A content analysis of televised PSAs airing from December 15th, 2020 through June 30th, 2021 in the U.S. was performed. Coders reviewed PSAs for the visual and audible appeals used to encourage vaccination, such as the opportunity vaccination provided for getting back to ‘normal’, as well as the spokespeople depicted. Messages that could mitigate health skepticism, such as content about safety and efficacy, were also coded for.

Results

The first PSA aired in April of 2021, close to five months after the first person was vaccinated in the U.S. Less than 20 % (17.1 %) of PSAs explicitly encouraged vaccination and just over a quarter (25.4 %) provided details about the safety and efficacy of the vaccine. Health professionals were more commonly depicted as spokespeople in content, appearing in just under a third (29.4 %) of PSAs.

Conclusions

Content that addressed and potentially reduced views of health skepticism and that may have promoted vaccine uptake, broadly, was largely absent from federally sponsored televised PSAs about the COVID-19 vaccine.

Keywords: Mass media, Health communication, Health promotion, Health policy, Health equity

Highlights

  • •

    Health skepticism is rising in the United States, limiting population health efforts.

  • •

    Few federally sponsored COVID-19 vaccine messages addressed health skepticism.

  • •

    Health messaging must address skepticism to help increase vaccine uptake.

1. Introduction

Since early in the COVID-19 pandemic, vaccines were regarded as a critical means of combatting the spread of infection and reducing morbidity (CDC, 2022). Prior to the emergence of COVID-19, vaccines garnered public support and individuals holding skepticism or mistrust of vaccines were a small minority (Johnson et al., 2020). This has shifted as an increasing number of prominent individuals, such as the Secretary of Health and Human Services, Robert F. Kennedy Jr. and the Surgeon General of Florida, Joseph Ladapo, have used their platforms to publicly endorse and amplify vaccine misinformation (Yang, 2025). Examples of vaccine misinformation include claims that vaccines lead to infertility or are a way of implanting microchips in individuals (Skafle et al., 2022). In parallel, trust in institutions, including public health agencies and the health information they provide, continues to decline (KFF, 2025).

As so, communication about the vaccine for COVID-19 needed to address misinformation and assert the safety and efficacy of the vaccine in effort to combat skepticism and build trust (Sharfstein et al., 2021). Health or medical skepticism is mistrust or doubt in the ability of conventional medicine and care to improve one's health (Fiscella et al., 1998). While individuals who identify as White and who are without health insurance were previously more likely to report this skepticism (Fiscella et al., 1998), given the spread of misinformation and declining trust in institutions, skepticism is now more widespread (Motta, 2024). Unaddressed, skepticism may lead individuals to delay or forgo vaccination and encourage those within their social networks to do the same, which has consequences for individual and population health.

Experts working to craft vaccine-related content also faced challenges with the politicization of science and an evolving and conflicting information environment containing messages of both controversy and clear directives from experts, all potentially reinforcing skepticism (Franklin Fowler and Gollust, 2015; Nagler et al., 2020). Speaking to the former, there has been a rise in the promotion and adoption of beliefs that align with specific interests, despite their inaccuracy (Dietz, 2013). This politicization of science is also occurring amidst an “infodemic” or when too much information, to include misinformation and disinformation, overwhelms digital and physical environments during a public health emergency (Schillinger et al., 2020).

Public service announcement (hereafter, PSAs) are strategic messages that are designed to reach large segments of the population, encourage health promoting behaviors, and affect behavior change (Wakefield et al., 2010). PSAs were one component of the U.S. government's COVID-19 public education media campaign. Since the 1940s, PSAs have been a tool to inform the public about pressing health and social issues and to offer education about the actions necessary to redress them (O'Keefe and Reid, 1990). In the context of the COVID-19 vaccine, PSAs could be an opportunity to share messages with the public in ways that address skepticism and counter it with clear directives about the safety and efficacy of the vaccine.

2. Background

2.1. Federally sponsored COVID-19 vaccine education campaigns

In March of 2021, the Biden Administration announced a $1.5 billion television, radio, and digital advertising campaign to encourage vaccination among Americans who were “...outright skeptical of vaccines' safety or effectiveness as well as those who are potentially more willing to seek a COVID-19 immunization but don't yet know where, when, or how,” (Facher, 2021). This work was done in partnership with the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Department of Health and Human Services (U.S. DHHS), and community organizations to tailor messages to reflect local context. The campaign was oriented around the tagline, “We can do this,” and had goals of “…strengthening public confidence in the vaccines so people have the science-based information they need to make decisions about getting vaccinated and get protection from the worst outcomes of COVID-19; and increase vaccine uptake by informing Americans about how and where to get vaccinated,” (U.S. Department of Health and Human Services, 2022).

Evaluations of the We Can Do This campaign provide evidence that exposure to campaign content, which included PSAs, increased individuals' confidence in vaccines and ultimately, vaccine uptake (Kim et al., 2024). Race and ethnicity moderated this relationship; among individuals who identified as Black or Latino, a larger effect of exposure on vaccination was observed when compared to Whites (Luchman et al., 2024). These evaluations leverage data from public surveys and paid media from a single campaign. While public health education campaigns may purchase airtime, many PSAs rely on donated airtime from media partners (The Ad Council, 2022).

The administration also partnered with the Ad Council, a non-profit advertising agency with a long history of creating PSAs, on a separate $50 million vaccine campaign (Montgomery, 2021). Message testing conducted by the Ad Council revealed that certain content, such as messages that getting a vaccine is “the right thing to do”, were not as effective in encouraging individuals to pursue vaccination (The Ad Council, et al., 2021). Appeals are messages used to promote attitudes, beliefs, or behaviors. These include messages that may scare people into a better behavior (a fear appeal) as well as those that evoke emotions and convey a hopeful message, such as getting a vaccine to protect your loved ones, to promote the efficacy of and opportunity with a behavior. These messages may also highlight the popularity of a behavior, such as wearing a seat belt, to encourage social norms (Jiang et al., 2023). The team responsible for the campaign, done in partnership with the multisectoral COVID Collaborative, ultimately settled on a single tagline, “It's Up to You,” with the hope that it emphasized values of freedom and liberty, and conveyed to Americans, “...that it's their choice to be vaccinated, while also conveying that doing their part to get vaccinated is the best way to protect themselves and their loved ones against COVID-19,” (The Ad Council, 2021).

Both campaigns shared a goal of relaying information to encourage individuals to vaccinate, a behavior that is distinct from others targeted by past public health education efforts. Evidence from other public health campaigns to encourage different health-promoting behaviors is not directly applicable to efforts to encourage vaccination (Rimal and Lapinski, 2021). Vaccination campaigns needed to strategically factor in the distinct nature of vaccinations and account for skepticism and mistrust many individuals held about vaccines, medical professionals, and the government (Semino et al., 2025). Among individuals surveyed in December of 2020 who indicated they would probably or definitely not get the vaccine, 37 % indicated that a major reason was because they didn't trust vaccines in general, 35 % responded that they did not trust the health care system, and 55 % reported not trusting the government to make sure the vaccine was safe and effective (KFF, 2020).

2.2. PSAs as a tool for addressing skepticism

With the initial campaigns in the 1940s, PSAs focused on issues related to national security and war-time efforts (e.g., Women in War Jobs and Rosie the Riveter) (ANA Educational Foundation, n.d.). PSAs also have a long history as a key component of government efforts to share health information with the public, including about infectious diseases, risky health behaviors, like tobacco and illicit drug use (Allen et al., 2015). Past efforts to encourage vaccination incorporated PSAs: PSAs were used as part of print media campaigns to encourage people to get all three of the vaccines to protect against polio in 1958 (ANA Educational Foundation, 2025b).

Given the rise in health-related misinformation and disinformation on social media before the pandemic, including anti-vaccine content (Burki, 2020), there was a need for PSAs with clear and accurate information about the COVID-19 vaccine. Health-related misinformation and disinformation and increasing mistrust in conventional medicine and health care providers was already present before the pandemic across different sub-population (e.g., not limited to certain racial and ethnic groups), and may contribute to vaccine skepticism (Benkert et al., 2019). Televised mass media PSA campaigns have the potential to counter misinformation and mitigate the potential for skepticism because they offer widespread and passive exposure to credible content; they can be developed by public health experts; and the content can be shared by a variety of messengers (e.g., spokespeople) (Kornfield et al., 2015).

In the specific context of COVID-19 vaccination, PSAs could be a tool for acknowledging the fear and distrust that contribute to skepticism and that presented early in the pandemic (Priniski and Holyoak, 2022). In highlighting the process of developing the vaccine, related safety and efficacy, and clearly stating the potential for side effects, including COVID infection, PSAs could counter skeptical beliefs (Chou and Budenz, 2020). Considering declining trust in institutions and negative affect toward people that represent institutions (e.g., policymakers or health care providers) (Motta, 2024), PSAs could utilize a diverse group of messengers to convey content. PSA content could also evoke positive emotions, such as the potential for a return to normal that vaccination may afford individuals and communities, and this could reduce mistrust in the vaccine (Chou and Budenz, 2020).

2.3. COVID-19 PSAs

A previous analysis of federally-sponsored televised COVID-19 PSAs from March 12th through December 16th of 2020, before vaccines were available to the general public, revealed there were no PSAs that mentioned a vaccine (Tait et al., 2022). In separate work to understand what factors might have predicted where PSAs aired, researchers did not find an association between COVID-19 case rates and PSA airings. Instead, they found that more PSAs were aired in areas that lean Democratic (Gollust et al., 2022). Taken together, prior research reveals a missed opportunity to convey information about the vaccine as it was being developed that may have bolstered confidence in its safety and efficacy and countered skepticism.

This study examines the content of PSAs about vaccination (including both paid and donated media), addresses the time period immediately following that of the previous study, December 15, 2020 through June 30, 2021, and addressed two research questions:

1. What appeals, if any, were used in PSAs to encourage vaccination?

2. Do these appeals align with approaches to address health skepticism?

3. Material and methods

3.1. PSA airings

Data were provided by Kantar/CMAG and available through a partnership with the Wesleyan Media Project (WMP). WMP had access to all unique PSAs airing on local broadcast television or national cable from December 15, 2020, through June 30, 2021, and about the COVID-19 vaccine. These included PSAs that were donated and a part of paid media campaigns. This time period was selected given the first individual was vaccinated in the U.S. on December 14th and in the following six months, many states gradually made vaccines available to the general population. Adults were eligible for vaccines in all states after April 19, 2021. In total 338 PSAs were provided. Importantly, the sample of televised PSAs provided by Kantar did not comprehensively reflect all vaccine-related PSAs, as it did not systematically or completely include those sponsored locally. This is a limitation of the process Kantar uses to retrieve content. Therefore, the analytic sample in this study was restricted to only those PSAs that were sponsored by the CDC, the Ad Council, or the U.S. DHHS and for which there was a more complete census in the available data. After limiting to these three sponsors, there were 88 PSAs that aired 47,645 times.

3.2. Content analysis instrument

A team of three trained graduate students began an inductive process of reviewing PSAs for messages about the vaccine. Numerous appeals to encourage vaccination (e.g., “Now is your chance. Get the shot.” or “Talk to your health care provider and get the COVID vaccine today.”) were revealed during inductive instrument development work and included in the coding instrument. Evidence-based appeals for encouraging vaccination, such as messages asserting the safety and efficacy of the vaccine, the potential for vaccination to enable “normal” activities with family and friends, acknowledging side effects, as well as the potential to get COVID after getting vaccinated were also coded for. During the inductive work of reviewing PSAs, we considered other evidence-based approaches for bolstering vaccination rates (e.g., details about what individuals stand to lose if they do not get vaccinated), but these were largely absent from content and we ultimately settled on a small subset of evidence-based appeals for which to code. We also coded for the extent that PSAs included messages that aligned with other, community-level policies (e.g., continue to wear a mask or practice social distancing); included various spokespeople as messengers; and referred viewers to different resources for more information. A guide that included definitions for each element of the instrument was developed and used during the coding process (Appendix 1).

3.3. Coding

One individual coded all of the Spanish-language PSAs and some of the English-language PSAs; in total 20 % of the English-language sample was double-coded to establish intercoder reliability (ICR). Krippendorff's Alpha, commonly used in content analysis involving more than two coders was used to assess ICR values (Hayes and Krippendorff, 2007). All data presented in the tables exceed an ICR of 0.65.

3.4. Data analysis

STATA version 17 was used to compute descriptive statistics.

3.5. Ethics approval

This study does not involve human subjects and was exempt by the University of Minnesota Institutional Review Board.

4. Results

4.1. Descriptive statistics

Most PSAs (72.8 %) were aired in English and were 30 s long (63.8 %). More PSAs were sponsored by the Ad Council and their collaborators (58.7 %) than by the U.S. Department of Health and Human Services (41.3 %). Close to half of the PSAs (44.1 %) included the Ad Council and COVID Collaborative campaign tagline “It's Up to You”, while fewer than one-third referenced “We Can Do This”, the tagline of the U.S. Department of Health and Human Services campaign. The sample is described in Table 1.

Table 1.

Characteristics of 88 Public Service Announcements about the COVID-19 vaccine aired in the United States, December 2020 – June 2021.

Airings (N = 47,645) % of sample
Language
English 34,675 72.8
Spanish 12,970 27.2



Length
<30s 11,733 24.6
30s 30,391 63.8
45 s 280 0.8
60s 5241 11.0



Sponsor
Ad Council 10,810 22.7
Ad Council & CDC 13,511 28.4
Ad Council & Other 3627 7.6
U.S. DHHS 18,988 39.8
U.S. DHHS & Other 709 1.5



Tagline
“It's Up to You” 21,007 44.1
“We Can Do This” 13,576 28.5
Other 12,886 27.1
“Mask up! / Mask up America!” 167 0.3
Open in a new tab

Results are presented at the airing-level.

CDC: Centers for Disease Control and Prevention; DHHS: Department of Health and Human Services.

The volume of PSAs airing over the data collection period is depicted in Fig. 1 with vaccine eligibility dates noted.

Fig. 1.

Fig. 1

Open in a new tab

Volume of vaccine Public Service Announcement airings in the United States, December 2020 – June 2021.

While the U.S. Food and Drug Administration (FDA) granted an emergency use authorization for the Pfizer-BioNTech vaccine on December 11, 2020, the first PSA in the sample aired more than two months later on February 27th, 2021. More PSAs were aired beginning in April and vaccine eligibility was expanded to all individuals ages 16 and older on April 19th, 2021. The highest volume of PSAs aired on May 31, 2021, which marked Memorial Day in the U.S.

4.2. Content analysis

Results of the content analysis are detailed in Table 2, Table 3.

Table 2.

Behavioral guidance messages and appeals used in 88 Public Service Announcements about the COVID-19 vaccine aired in the United States, December 2020 – June 2021.

Airings (N = 47,645) % of sample
Appeals
Vaccination is a way to get back together/for family/to get back to normal 32,947 69.2
Vaccine is “safe” or “effective” 12,086 25.4
Encourage vaccination 8132 17.1
Vaccine is free 5281 11.1
Details of where to get vaccinated 79 0.2
Includes a personal story about the impact(s) of COVID 6 0.01



Behavioral guidance
Wear a mask 1157 2.4
Social distance 787 1.7
Wash hands 0 0.0
Stay home 0 0.0
Avoid large gatherings 0 0.0
Open in a new tab

Behavioral guidance and appeals are not mutually exclusive; many could have appeared within the same PSA.

Table 3.

Vaccine-related information and spokespeople included in 88 Public Service Announcements about the COVID-19 vaccine aired in the United States, December 2020 – June 2021.

Airings (N = 47,645) % of sample
Vaccine-related information
Vaccination depicted 12,632 26.5
Eligibility details 9271 19.5
Where to get a vaccine 79 0.2
Benefits for a particular group 0 0.0
Mention of a booster 0 0.0
Mention of side effects 0 0.0
Mention of getting COVID after vaccination 0 0.0



Spokespeople
Health professional 14,166 29.7
Entertainment figure 2097 4.4
Children's entertainment 644 1.4
Political figure other than President Biden 475 1.0
Athlete 205 0.01
Local celebrity 13 0.01
President Biden 0 0.0
Former President Trump 0 0.0
Open in a new tab

Appeals to get vaccinated were observed in fewer than 20 % (17.1 %) of airings. We defined an appeal to get vaccinated as an explicit directive regarding vaccination, such as “Talk to your health care provider and get the COVID vaccine today” or “Get the shot”. Slightly more PSAs (25.4 % of airings) mentioned that the vaccine is “safe” or “effective”, and a little more than 10 % (11.1 %) mentioned that the vaccine was free. Messages about getting back together or with family and implicitly implying that vaccination was key to these outcomes appeared in a majority of content in the sample (69.2 %).

Table 3 details the frequency of vaccine-related information and inclusion of spokespeople.

Just under 20 % (19.5 %) of PSAs provided information on the populations that were eligible for vaccination; those that did mentioned age-based eligibility, that is, noting that people 16 and older and people or children 12 and older were eligible. The majority of messages about age-related eligibility were included in PSAs aired after children ages 12–15 became eligible on May 10th, 2021. Close to one-third (29.7 %) of airings included a health professional; this includes individuals dressed up as providers or identified as a health care provider in the information audibly or visually. Other studies have explored the potential for identity-based messages to increase intentions to vaccinate with mixed results (Reddinger et al., 2022). We coded for identity-based appeals in the form of whether or not PSAs detailed the benefits of vaccination for specific groups (e.g., African Americans or Latinx) and did not observe any in our sample. Evidence suggests a marginal effect of specific spokespeople in encouraging vaccination (Reddinger et al., 2022) and different audiences may find different people more compelling. Fewer PSA airings (4.4 %) included an entertainment figure, defined as a person well known such as an actor, musician, model, reality television figure, national news anchor, national television show host, public intellectual, or social media influencer. Given the timing of the data collection period (spanning two presidential administrations) and available evidence on presidential endorsements, we assessed content for U.S. presidents and found that neither former President Biden nor President Trump were observed in any PSAs. A single PSA, airing 475 times (1.0 % of airings), included former Presidents Obama, Bush, Clinton, and Carter, the only political figures in the sample.

5. Discussion

Among the most striking findings of this analysis were the few details in PSAs that are consistent with addressing health skepticism, including evidence-based appeals encouraging vaccination, and thus promoting population health. PSAs had the opportunity to clearly assert and repeatedly emphasize the safety and efficacy established through rigorous clinical trials and to use a variety of individual and organizational messengers to convey this information and counter skepticism. This could have been particularly impactful for racial and ethnic populations that were already disproportionately burdened by the negative consequences of COVID. One study revealed that greater knowledge about the safety and efficacy of the vaccine was associated with an increase in vaccination among non-Hispanic Black people and the decreasing gap in vaccination rates among Black people compared to White people (Romer et al., 2024). Yet messages about safety and efficacy were used in just over a quarter of PSAs in the sample (25.4 %).

Fewer than 20 % of PSAs included a message encouraging vaccination. This was an approach distinct from PSAs that are a part of other public health campaigns where behaviors are explicitly encouraged or discouraged. The approach of not explicitly encouraging vaccination does align with the tagline associated with the Ad Council vaccine education initiative of “It's Up to You,” and message testing done in advance of the campaign (The Ad Council, 2021). Undoubtedly, those involved with the campaign faced challenges in conveying messages to an American public that was divided in their views about COVID-19, its severity, and science; and increasingly skeptical (Montgomery, 2021).

We also observed less diversity in the spokespeople used as messengers (see Table 3). Given that those who are vaccine hesitant and skeptical reflect a diversity of racial, cultural, and socioeconomic backgrounds, a single spokesperson is unlikely to be the most effective. Yet, given the growing mistrust of institutions, including spokespeople from outside of the health care system (e.g., community members) may have been effective in countering skepticism and promoting the vaccine. Further, neither President Trump nor President Biden were featured as spokespeople in PSAs aired. One experiment tested a Trump endorsement by creating a video featuring Trump endorsing the vaccine and sharing it on YouTube; this study revealed that exposure to this endorsement was associated with additional vaccinations at the county-level (Larsen et al., 2022). This suggests another missed opportunity for vaccine PSAs to influence vaccine uptake.

6. Limitations

This study has limitations. PSAs airing on local television or national cable do not reflect the universe of information about COVID-19 vaccines that individuals have access to. Importantly, digital PSA campaigns may be much more targeted to communities based on demographics and health-related need. While we did attempt to check whether the content that was a part of digital campaigns shared on social media aligned with what was televised, our efforts were limited by time and available resources. We observed PSAs in this televised sample that were also a part of digital campaigns, but we cannot say conclusively that all the content that was aired digitally was also televised and was part of this sample. This is also a select sample of PSAs that aired, reflecting only those campaigns that were federally affiliated, and aired in the first half of 2021.

This analysis is also limited by what was included in the codebook. In the interest of feasibility and relevance, we coded for a select number of variables and did not identify all of the possible elements of a PSA that have evidence supporting their use in encouraging vaccination and that may mitigate skepticism. One example is a loss-frame, or messages detailing the negative outcomes associated with not getting vaccinated, which can be effective in encouraging vaccination (Gong et al., 2024). We did not observe this appeal during the inductive work to develop the content analysis instrument and believe it was largely absent from our sample, though we did not systematically code for it in the initial instrument. One author re-reviewed ads and confirmed that it was not present. Another key limitation of this work is that it is an observational study and not a media effects study: we do not have evidence of the effects of exposure to vaccine PSAs with information about safety or efficacy, the potential for COVID infection, or with different messengers on attitudes or behaviors. Further, most PSAs rely on donated airtime and competition for airtime is high (The Ad Council, 2022). We do not have insight into the station-level decisions that are made about what PSAs to air in which markets and at what times.

7. Conclusion

This study adds to existing literature about COVID-19 vaccine education campaigns and provides evidence that televised PSAs infrequently encouraged vaccination or provided details that may have countered skepticism. The latter in particular is worth reflecting on and responding to, as vaccine hesitancy and health skepticism continue to be amplified in the U.S. In the winter of 2025, reports surfaced that the Centers for Disease Control and Prevention, at the request of the Secretary of Health and Human Services Robert F. Kennedy, Jr., was ordered to limit existing advertising about the flu vaccine and instead focus on sharing messages that focus on “informed consent” as part of the vaccine decision-making process (Branswell, 2025). If the appeals about the COVID-19 vaccine are like those used in existing federally-sponsored flu vaccine campaigns, such a focus on informed consent and the risks associated with vaccination may overwhelm meager messages about safety and efficacy. This approach could reinforce skepticism and limit vaccine uptake. Additional research is needed on solutions for countering health skepticism and their inclusion in federally-sponsored public health education campaigns.

Author contribution

Margaret E. Tait: conceptualization; formal analysis; data curation; writing-original draft; writing – review & editing; project administration; final approval of submitted version.

Erika Franklin Fowler: conceptualization; acquisition of data; writing – review & editing; funding acquisition; final approval of submitted version.

Sarah E. Gollust: conceptualization; writing – review & editing; supervision; funding acquisition; final approval of submitted version.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

We are grateful for the research support of Xiomara Santana and Shantanu Mallick who provided insights for the content analysis instrument and assisted with ad coding and to Laura Baum for her assistance gathering data.

Funding for this work was provided by the University of Minnesota School of Public Health Health Equity Work Group and the Robert Wood Johnson Foundation (grant I.D.: 79754).

Footnotes

Appendix A

Supplementary data to this article can be found online at https://doi.org/10.1016/j.pmedr.2025.103193.

Contributor Information

Margaret E. Tait, Email: Margaret.tait@richmond.edu.

Erika Franklin Fowler, Email: efowler@wesleyan.edu.

Sarah E. Gollust, Email: sgollust@umn.edu.

Appendix A. Supplementary data

Supplementary material

mmc1.docx (25.1KB, docx)

Data availability

Data will be made available on request.

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Supplementary Materials

Supplementary material

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Data Availability Statement

Data will be made available on request.

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