Promoting COVID‐19 vaccination through music and drama—Lessons from early phase of the pandemic

1. INTRODUCTION

When the World Health Organization (WHO) declared COVID‐19 as a pandemic on 11 March 2020, and governments worldwide began to take serious actions towards prevention, the creative arts industry responded. While some musicians turned their lyrics to COVID‐19 prevention themes, others also created new songs. In Sierra Leone, a group of film makers have created the film “Survivors,” which details how the country prevented Ebola spread, and how lessons from Ebola could be used to fight ongoing pandemic. ¹ Largely missing as a theme from these COVID‐19 music and drama initiatives is vaccination messaging.

Some COVID‐19 vaccination sites in high‐income countries such as the United States and United Kingdom have observed the power of the creative arts, as those who are vaccinated at such sites are treated to live music. Now is the time for scientists including clinical pharmacologists to harness the power of the creative arts industry to promote vaccination through culturally relevant music, drama and animations.

Recent literature shows ² that individuals, on average, are spending more time on social media as a result of social distancing and shutdowns. Given this observation, social media could be a particularly effective platform to spread the word on safety and efficacy of available vaccines. Endorsement from organizations such as Twitter, Facebook and Instagram could boost the impact for various measures, so as to nudge individuals into responding.

As seen in the literature, one main reason for vaccine hesitancy is the tendency of many individuals to sharply, or hyperbolically, discount future rewards such as not contracting an illness. ³ Both financial and nonfinancial incentives of small or large magnitude have shown promise in nudging health behaviours. ⁴ Making the relevant information persist in memory towards positive health behaviour is a challenge that can possibly be achieved through music. ⁵ We acknowledge that one current limitation is the scarcity of COVID‐19 vaccines, particularly in low‐ and middle‐income regions such as Africa where only 2.91 per 100 people had taken at least a dose of a COVID‐19 vaccine compared with the UK figure of 67.73 as of 13 July 2021. ⁶ However, a secondary limitation as being observed in high‐income countries such as the United States is vaccine hesitancy. ⁷ As more individuals are vaccinated and additional vaccines are produced, countries may have saturated the population of vaccine‐willing individuals before reaching herd immunity. At such a time, health communication could become vital in the push towards eradication of the pandemic. Below, we suggest strategies for using music, drama and animations as health communication approaches for promoting COVID‐19 vaccinations.

2. LEADERS OF ORGANIZATIONS AND COUNTRIES MUST LEAD

Within the first few months of the WHO declaring COVID‐19 as a pandemic, the President of Liberia, George Weah, created a project that included the release of a song on COVID‐19. The song's main theme was prevention, but the song did not include vaccination as a preventive measure. ⁸ While not all presidents can sing like Weah, the use of music as a health communication strategy for preventing COVID‐19 by a politician was innovative and worthy of emulation. Political leaders might consider either working with the creative industry to produce songs on COVID‐19 vaccination using Weah's strategy or support the creative industry to create more songs and short dramas on COVID‐19 vaccinations.

3. SONGWRITERS, MUSICIANS, ACTORS AND CLINICAL PHARMACOLOGISTS MUST PROMOTE COVID‐19 VACCINATIONS

Recently, we are starting to see musicians performing at vaccination sites. ⁹ Musicians could consider using previously created songs to produce derivative works focusing on vaccinations. Earlier in the pandemic, songwriters and musicians used this approach to promote preventive measures. For example, artists belonging to the American Society of Composers, Authors & Publishers (ASCAP), which has a membership of about 800 000 US composers, songwriters, lyricists and music publishers, composed at least 30 COVID‐19‐themed songs. ¹⁰ Some of the songs use the power of animations. Musicians from African countries such as DR Congo, Ghana, Nigeria and Uganda have also produced several COVID‐19 songs. ¹¹ A common theme of these songs is the need to wash one's hands with soap and water, use sanitizers, or practice physical distancing. While these approaches are still relevant to the fight against COVID‐19, the availability of vaccines and vaccine hesitancy call for similar songs that specifically target vaccinations.

Given the tendency of COVID‐19 vaccine hesitancy issues to stall COVID‐19 vaccination programs, there is a need for clinical pharmacologists and other health experts to engage with songwriters, musicians and actors to produce songs, drama or animations on COVID‐19 vaccines. For these creative arts to be effective, vaccine programme managers should consider identifying artists with large followings across various demographic characteristics. Very popular musicians could either produce solo songs or collaborate to produce songs on COVID‐19 vaccines.

4. IDENTIFY KEY ELEMENTS OF THE CREATIVE WORKS FOR PROMOTING VACCINATION

Creative works such as songs and drama have essential elements that need to be tapped for aiding COVID‐19 vaccination. In the case of drama, key elements including the audience's prevailing values and norms, ¹² how the various scenes are arranged (also called plots), characters and dialogues could be used to make a strong case for COVID‐19 vaccination. Characters displayed in a drama need to show the values and norms of the priority population. Thus, clinical pharmacologists and others with interests in using drama to promote COVID‐19 vaccination would need to be aware of the prevailing social norms and values of the priority population. For example, in a culture where individualism is valued highly than communism—beliefs, behavioural intentions, and behaviours that promote solidarity and concern for others ¹³ —drama with characters displaying individualism such as characters taking COVID‐19 vaccines to protect themselves may be more culturally acceptable than those with characters taking COVID‐19 with a goal of protecting others. Conflict is another key element that could be used. Such conflict can be considered to be internal when it involves the character's mindset or external when social factors act as barriers to the characters or protagonists following their conscience. ¹² For example, characters representing a group deemed to be hesitant to COVID‐19 vaccines should ideally be seen as portraying vaccine hesitancy behaviours but when they are seen as telling others about the benefits of vaccination after they have been convinced, conflicts could arise.

As people often relate themselves to fictional characters and empathize with their stories, delivering information through narratives could be an effective health communication strategy. The story‐based communication method also closes the gap between their lived experiences and scientific information, helping public awareness and understanding of the benefits of COVID‐19 vaccines. Additionally, accompanied songs or rhythms in a narrative‐based animation or drama could make information more memorable.

Songs have key elements such as instrumentation, lyrics and choruses ¹⁴ that if harnessed well could make COVID‐19 vaccination songs effective. The instrumentation of COVID‐19 vaccination songs would also need to be aligned to the values of the priority population. Forms of music such as rap and pop songs may be attractive to vaccine‐hesitant youth. Lyrics represent the words in a song. Such words can be used to construct a story within the song to highlight issues such as the need for vaccination, how vaccines work and messaging that would counteract COVID‐19 vaccines misinformation. Choruses tend to be statements that capture the main focus of songs. For example, in President Weah's “Let's Stand Together To Fight Corona” song, ⁸ the main chorus is “We must arise. Let's stand together to fight Corona. We must arise. Let's stand together to fight Corona.” Good choruses are usually very memorable. ¹³ Content creators, clinical pharmacologists and others aiming to produce COVID‐19 vaccination songs would need to come together to create exciting choruses that would leave listeners wanting to listen to the song more, and hopefully cause those who are hesitant to finally go for their shots.

5. IDENTIFY CULTURALLY RELEVANT MEDIA TO PROPAGATE COVID‐19 SONGS AND DRAMA

Creating culturally relevant content should be given consideration towards reaching the priority audiences. One strategy is to use channels used for spreading COVID‐19 vaccine misinformation and conspiracy theories to promote the songs and short drama. Thus, social media channels such as Facebook, WhatsApp and YouTube could be used for their promotion. However, in populations where internet access is a challenge, alternative popular channels such as radio could be used to promote the songs and drama.

6. TEST THE EFFECTIVENESS OF ARTS APPROACHES

A final consideration is to evaluate the effectiveness of music and drama interventions for promoting COVID‐19 vaccination. Population‐based surveys on COVID‐19 vaccination knowledge, attitudes, beliefs and hesitancy can be conducted prior to nationwide promotion of COVID‐19 vaccinations through songs and short drama. Surveys being conducted across countries should include items about potential exposure to COVID‐19 vaccine songs or drama to help determine their potential effectiveness. Lessons from such studies may be useful to generate the evidence regarding the use of songs and drama for addressing the current and future pandemics. A recent review of arts‐based health communication in the United States identified only three music/song and six film studies out of the 78 that met inclusion criteria. ¹⁵ The review focused on outcomes research and descriptive studies, the use of arts in nonclinical settings in the United States, arts interventions that influence health or health‐related experiences, and outcome measures such as knowledge, awareness, beliefs, risk perceptions and cultural acceptance. Other arts forms studied included photography, theatre and dance, and digital arts. This review mirrors a previous scoping review that identified more than 900 publications globally including 700 individual studies demonstrating the importance of arts‐based communication in disease prevention and control, and health promotion. ¹⁶

Several publications that have thus far explored health communication approaches for addressing COVID‐19 in the earlier phase of the pandemic have largely not focused on use of music or drama. ¹⁷ , ¹⁸ A study in Spain that explored COVID‐19 and musical initiatives found that 38% of 1857 of respondents had heard about COVID‐19 musical initiatives. ¹⁹ Vaccinators who plan to test their health promotion strategies could ask prospective vaccine recipients whether they have heard COVID‐19 songs or watched COVID‐19 vaccine drama or animation. Health communication scholars must also study the use of music and drama in the fight against COVID‐19.

In sum, while the early phase of COVID‐19 pandemic eradication efforts included art approaches such as music, drama and animations that focused on preventing measures including physical distancing and washing of hands with soap and water, attention should now be turned into also promoting COVID‐19 vaccination. Doing so has the potential to address COVID‐19 vaccine hesitancy and promote increasing use of the vaccines to fight the pandemic. Repetition of any effective measures used is vital; humans have a tendency to forget. And as shown in the literature, simpler techniques are easier to remember compared to complex methods. ²⁰

COMPETING INTEREST

The authors have no conflicts of interest to declare.

Appiah B, Walia B, Nam SH. Promoting COVID‐19 vaccination through music and drama—Lessons from early phase of the pandemic. Br J Clin Pharmacol. 2022;88(2):437-440. 10.1111/bcp.15027