A Social Media‒Based Public Health Campaign Encouraging COVID-19 Vaccination Across the United States

Abstract

Tailored public health messaging encouraging COVID-19 vaccination may help increase vaccination rates and decrease the burden of COVID-19. We conducted a three-part COVID-19 vaccine uptake public health campaign disseminated on Facebook between April and June 2021. Our first campaign focused on reaching Black and Latinx communities; our second campaign focused on addressing vaccine access and scheduling in Latinx communities; and our third campaign focused on religious communities. Overall, we reached 25 million individuals with 171 million views across the United States. (Am J Public Health. 2022;112(9):1253–1256. https://doi.org/10.2105/AJPH.2022.306934)

Our goal was to promote COVID-19 vaccination across the United States with a focus on reaching minoritized groups, a priority engendered by a striking disparity in vaccination rates for racial minorities in March 2021, when the vaccination rate among White people was more than 2.5 times that for Latinx and twice that for Black people. ¹ We also sought to address the infodemic that evolved alongside the COVID-19 pandemic by disseminating high-quality health information on social media platforms. ^{2, 3}

INTERVENTION AND IMPLEMENTATION

We developed video and still-image advertisements encouraging COVID-19 vaccination, designed specifically for our target audiences, which were disseminated on Facebook as part of a three-part public health campaign. On the Facebook advertising platform, we selected “reach” as our primary campaign objective throughout. This attempts to maximize the number of Facebook users seeing the ads over the course of the campaign.

Our first campaign focused on Black and Latinx communities nationally through short (30–60 seconds) videos from eight racially diverse physicians conveying their own messages that the COVID-19 vaccine is safe and effective. Our second campaign focused on addressing vaccine access and scheduling in Latinx communities in California, linking our ads to a vaccine scheduling telephone helpline in Spanish and English. Our third campaign focused on promoting vaccination in religious communities nationally through videos from 14 religious leaders from five different faith traditions (Christianity, Hinduism, Islam, Judaism, and Mormonism). See Figure 1 for examples of how an ad appeared on the Facebook platform. All ad content is available to view at https://pcrt.stanford.edu/projects. Facebook provided advertising credit for ad dissemination.

FIGURE 1—

Example From Each Campaign of How an Ad Appeared on the Facebook Platform: United States, April‒June 2021

PLACE, TIME, AND PERSONS

Video and still-image messages were disseminated to Facebook users throughout the United States from April to June 2021. In our first campaign, which focused on reaching Black and Latinx communities, ads were geotargeted to zip codes in the United States that had among the highest COVID-19 death rates and also had greater than 50% Black or Latinx population, to reach those who had already been worst affected by the pandemic and for whom low vaccine uptake rates were liable to further drive health care inequalities.

In the second campaign, which focused on addressing vaccine access and scheduling in Latinx communities in California, we geotargeted the whole of California with content in both English and Spanish. Spanish content was specifically targeted to Spanish-language speakers. Messages were translated by coauthor V. N., who identifies as Mexican American and is a bilingual Spanish and English speaker. We put additional ad spend behind all zip codes in California with Healthy Place Index percentile less than 50%.

In our third campaign, focused on religious communities nationally from five different faith traditions, interest-based targeting on the Facebook ad platform allowed us to reach Facebook users with messages from their respective faith communities.

PURPOSE

Tailored public health messaging encouraging COVID-19 vaccination targeted to specific communities may help increase vaccination rates and decrease the burden of COVID-19. Despite widespread suffering from COVID-19, survey results throughout 2020 indicated that the proportion of the US population willing to be vaccinated was less than 70%, with Black communities having notably low vaccine intention rates. ⁴ For both Black and Latinx Americans, survey results indicate that confidence in vaccine safety and effectiveness are the number-one predictors of intentions to receive vaccination, highlighting the importance of these messages. ⁵

Survey data also suggest that Black Americans are twice as likely to trust a messenger of their own racial group compared with a White counterpart, ⁵ and we ensured a racially diverse group of health care professionals was featured in our campaign. Yet, vaccine mistrust is not the only barrier, with issues around vaccine access also arising. ⁶

Furthermore, high rates of vaccine hesitancy among certain religious groups highlighted the need for focused messaging for religious communities. ⁷ In a cross-sectional survey, high religious commitment was associated with less overall trust in science. ⁸ Lack of trust in science has been shown to be negatively associated with intention to get vaccinated, ⁹ highlighting the need for tailored messaging for certain religious groups for whom conventional public health spokespeople such as medical professionals might lack credibility, but whose trusted religious leaders are potential liaisons for public health messaging.

EVALUATION AND ADVERSE EFFECTS

From April 9 to 30, 2021, video ads from our first campaign centered on physicians appeared on Facebook newsfeeds 54 million times, reaching 9.9 million individuals an average of 5.5 times each. From May 10 to 31, 2021, video and still-image ads from our second campaign focused on vaccine access content in Spanish and English appeared on Facebook newsfeeds 70 million times, reaching more than 10 million individuals an average of 6.9 times each. We also tracked 60 416 unique link clicks (24 371 from Spanish content and 37 552 from English content) from our ads to the scheduling helpline with which the campaign was linked. From May 26 to June 15, 2021, video ads from our third campaign centered on religious leaders appeared on Facebook newsfeeds more than 47 million times, reaching 10.5 million individuals an average of 4.5 times each.

Overall, across the three campaigns, our ads appeared on newsfeeds 171 million times, reaching 25 million individuals an average of 6.8 times each. In total, the ads received 28 803 reactions and 2802 shares (Table 1). All metrics were recorded directly by the first author from the Facebook ad manager platform. To our knowledge, the intervention had no adverse consequences. Comments were disabled on all video ads to limit negative sentiment comments toward the individual doctors and faith leaders participating in the campaign and to prevent inadvertent dissemination of vaccine misinformation alongside named individuals.

TABLE 1—

Reach and Engagement Outcome Metrics for Ads on Facebook Platform: United States, April‒June 2021

Metric	Campaign 1a	Campaign 2b	Campaign 3c	Total
Reach (unique no. of people who viewed an ad)	9 851 842	10 107 831	10 469 982	25 223 949
Impressions (total no. of times an ad was viewed)	54 362 221	69 714 648	47 379 479	171 456 348
Average frequency (average no. of times each person saw an ad)	5.5	6.9	4.5	6.8
Post reactions	10 054	7272	11 477	28 803
Post shares	1 161	638	1 003	2 802
Video playsd
At 25%	1 753 241	32 293e	990 197	2 775 731
At 50%	669 856	12 709e	328 138	1 010 703
At 75%	404 592	8 927e	182 981	596 500
At 100%	266 066	6 953e	125 195	398 214
Investment, US $	247 300	267 440	178 438	693 176
Cost per 1000 people reached, US $	25.10	26.46	17.04	27.48

^a Top performing piece of content (classified by reach) in campaign: https://youtu.be/meZKlPtTMZY.

^b Top performing piece of content (classified by reach) in campaign: https://pcrt.stanford.edu/access-campaign

(artwork by Rich Black).

^c Top performing piece of content (classified by reach) in campaign: https://youtu.be/8Rqm64HZuOM.

^d Video plays at X% refers to the number of times the video was played to at least X% of its length.

^e Note this campaign only contained one video; the rest of the content was in still-image form.

SUSTAINABILITY

We demonstrate the feasibility of a widespread, rapid, social media‒based, tailored public health campaign, the principles of which are applicable across widespread public health domains. Based on learnings from our US-based campaign, we advised the nongovernmental organization Prolepsis Institute on the implementation of a social media‒based campaign to promote COVID-19 vaccination throughout Greece, which ran from October 10 to December 31, 2021 (https://www.prolepsis.gr/en/programs/campaign-to-promote-vaccination-against-covid-19). We have demonstrated that Facebook ads can produce considerable engagement and visibility. Long-term sustainability of this model beyond the context of COVID-19 vaccine promotion depends upon ongoing collaboration and financial investment from social media platforms to support dissemination of accurate public health information online.

PUBLIC HEALTH SIGNIFICANCE

Vaccination has proven to play a critical role in reducing widespread societal harms associated with the COVID-19 pandemic. ¹⁰ This public health campaign enabled us to reach more than 25 million individuals with 171 million views across the United States with messages promoting COVID-19 vaccination. Furthermore, in the face of the widespread dissemination of misinformation on social media and evidence that false news can influence social well-being, ¹¹ including vaccination intent, ¹² it is crucial that we work to improve the quality of health information available on social media platforms and utilize established marketing techniques to disseminate high-quality health information. This work is underpinned by unprecedented collaboration among doctors, public health scientists, religious leaders, and technology companies toward the common goal of ending the COVID-19 pandemic. We are now focusing efforts on strategies to measure the impact of social media‒based public health messaging on health-related behaviors, including vaccination rates.