Table 3.

Example of a message for tailoring a variable postiterative development process.

Vaccine concern			Example message
Category 1: vaccine development
	“Human protections in research” [adult and parent]	Many people wonder about taking part in research and if they will be protected. We know there have been past research studies that were not done right [provides examples of historical research abuses]. To begin to address this issue, we give a few examples to show every person is protected when they take part in research and how the community could benefit after the research study is done [provides examples of human protections in research].
	“Who is at the table?” [Adult and parent]	Many people wonder if people of all racial backgrounds were involved when the vaccines were developed. Individuals from all races were at the table to help guide the process [provides examples of scientists of all racial/ethnic backgrounds and their role in the development process].
Category 2: vaccine safety
	“mRNAa and DNA” [adult]	We all have mRNA in every cell in our bodies. mRNA is known as messenger RNA. It is the “recipe” that tells the cells in our body to make certain proteins. The mRNA protein in the Pfizer and Moderna COVID-19 vaccines shows up, teaches the immune system how to develop antibodies against SARS-CoV-2 (the virus that causes COVID-19), and then quickly dissolves. mRNA never enters the nucleus of the cell where your DNA is kept. Your body learns how to protect itself against future SARS-CoV-2 infection without ever having to risk getting the virus or the serious outcomes of getting sick with COVID-19.
	“Infertility” [adult]	The antibody to the spike protein does not make a woman infertile or unable to get pregnant. There was a false claim that there were similarities between the SARS-CoV-2 spike protein and the surface of a protein on placental cells. Placental cells are needed for a successful pregnancy. SARS-CoV-2 spike protein and the placental cells are not the same. This means the vaccine will not cause the immune system to make antibodies against the placental protein.
	“Your child’s heart” [parent]	Many parents ask about the COVID-19 vaccine and how it can affect the hearts of children. In the United States, there has been an increase in myocarditis and pericarditis cases after getting the mRNA COVID-19 vaccine. Myocarditis is mild inflammation of the heart. Pericarditis is mild inflammation of the sack around the heart. For children under 16 years of age, myocarditis risk is 37 times higher for children with COVID-19 than the children without COVID-19. So, myocarditis does not happen often. The American Academy of Pediatrics says children and teens should get the COVID-19 vaccines.
	“My child has underlying medical conditions.” [Parent]	The Pfizer vaccine can be given to children 5 [years] and older with underlying medical conditions like diabetes or autoimmune diseases. It cannot cause COVID-19, even in those with weak immune systems. Children with underlying medical conditions took part in the clinical trials and serious reactions to the vaccine [were] rare. However, children with underlying medical conditions are more apt to have problems from COVID-19.
Category 3: vaccine effectiveness
	“Boosters. Why?” [Adult]	All routine [vaccines] require booster doses to have full protection [adds examples]. So the COVID-19 vaccine is not any different. Booster shots are given to jumpstart the body’s immune system to produce more antibodies against the original SARS-CoV-2 (the virus that causes COVID-19) and help protect against new variants. Because antibody levels decrease over time, boosters are needed to keep us protected.
	“Variants and the vaccine” [adult]	As SARS-CoV-2 (the virus that causes COVID-19) continues to infect people, it is more likely to mutate. This means that the virus makes a new version of itself also known as a mutation. It is common for this to happen. Mutations affect how viruses work, like to help the virus better attach to our cells or lower the virus’s ability to attach to our cells. So it is important for people to complete COVID-19 vaccination. More mutations and new variants may lower or stop the protection provided by the vaccines.
	“Natural immunity or vaccine immunity”	Natural immunity happens when your child’s body gets infected with the SARS-CoV-2 virus, the virus that causes COVID-19. While your child’s body will make antibodies against the virus, the danger is in your child getting very sick and maybe even dying. Immunity from getting a vaccine is very similar to immunity developed through natural infection but does not carry the increased risk of your child getting very sick or even death. Natural immunity provides less protection over time than the immunity gained by COVID-19. While people can gain immunity after getting the virus, studies show that more than one third of COVID-19 infections results in low levels of protective antibodies.
	“Too many vaccines” [parent]	We all got different vaccines when we were babies, adolescents, and event adults [gives an example of multiple vaccines being given]. These vaccines are routinely given at the same time without serious side effects. So, getting more than one vaccine is something we have been doing since birth.

^amRNA: messenger RNA.