Big Shots: A Social Media Campaign to Honor Local Heroes who Promote COVID-19 Vaccine Literacy and Increase Vaccine Acceptance

Abstract

Big Shots is a graduate student-developed social media campaign that aims to promote COVID-19 vaccine literacy and build vaccine confidence through the power of storytelling. Here we describe the development of the partnerships underlying the campaign and detail the campaign’s achievements thus far, including its recognition and celebration (to date) of 12 individuals and groups who have broken down barriers to COVID-19 vaccination in their communities. The ongoing campaign may serve as a model to guide future “grassroots” social media campaigns aimed at addressing public health issues.

Introduction

As the COVID-19 vaccine rollout began in the United States in late 2020 and early 2021, it was unclear how many people would be willing to take the shot. In December 2020, 34% of U.S. adults reported that they would get the vaccine as soon as possible, 39% planned to “wait and see,” 9% said they would only get the vaccine if they were required to do so, and 15% said they would “definitely not” get the vaccine. Although the proportion of U.S. adults reporting that they have been vaccinated increased to 73% in February 2022, 4% continue to “wait and see,” while 3% report willingness to get the vaccine only if required and 16% persist in their unwillingness to get the vaccine under any circumstances (KFF, 2022).

Factors that contributed to early COVID-19 vaccine hesitancy and continue to hamper efforts to increase vaccination rates include concerns related to the speed of the vaccine development process; fear of adverse effects of the vaccines, including possible adverse effects on fertility; mistrust of government and the medical establishment; and the belief that vaccination against COVID-19 is not necessary or effective (Diaz et al., 2021; King et al., 2021; McFadden et al., 2022). Some of the beliefs underlying vaccine hesitancy stem from anti-vaccine rhetoric spread via social media and elsewhere; however, for some, vaccine hesitancy traces back to legitimate experience- and history-based reasons for mistrust of the government and health-care system (Dada et al., 2022). Politicization of the vaccine and lack of consistent messaging from a trusted source have also exacerbated the problem, leading to increased or sustained vaccine hesitancy (Bolsen & Palm, 2022; Ratzan et al., 2020). Countering these barriers is crucial to increasing vaccine uptake and may require efforts to combat misinformation and address mistrust, while also increasing access (Dada et al., 2022).

Storytelling as a public health messaging strategy is gaining in popularity (McCall et al., 2019) and first-person narration may be an effective way to increase vaccine confidence and uptake (Dada et al., 2022; Finnegan et al., 2018). In a study of Chinese college students, narrative messages were more effective than non-narrative messages in persuading study participants to get vaccinated (Ye et al., 2021). Additionally, storytelling may be particularly powerful when the stories are being told by trusted messengers. For example, Black physicians and other health-care providers—a group likely to be viewed as trusted messengers in the Black community—have successfully used social media to disseminate COVID-19 vaccine information and convince previously vaccine-hesitant individuals to get the shot (Dada et al., 2022). Storytelling has also been shown to engage with harder-to-reach audiences and, by sharing relatable experiences, can help inspire and model positive behaviors (Kreuter et al., 2010).

This background underlies the development of Big Shots, a unique campaign to promote vaccine literacy and build vaccine acceptance using the power of storytelling. Developed and implemented by students and faculty at the City University of New York Graduate School of Public Health & Health Policy (CUNY SPH), the Big Shots campaign has celebrated “local heroes,” or “Big Shots,” (including community members, local health-care providers, and high school students) who have broken down barriers to COVID-19 vaccination in their communities. The individuals recognized by the campaign have aided their communities in several ways, including setting up vaccination sites, helping older adults find vaccination appointments, transporting people to vaccination sites, and correcting misinformation about vaccine safety and effectiveness, while also inspiring others to find their own way to contribute to the effort to increase COVID-19 vaccination rates. Lessons from the development of Big Shots could guide future social media campaigns aimed at addressing public health issues.

Program Development

Beginning in the early stages of the COVID-19 pandemic, CUNY SPH was invested in building vaccine literacy and promoting immunization programs through its work with the global initiative COVID-19 New Vaccine Information, Communication and Engagement (CONVINCE); (Larson et al., 2020). Interest in further countering vaccine hesitancy through communication efforts led to discussions among CUNY SPH faculty members regarding additional proactive steps that could be taken to make positive change happen. Recognition that local media outlets around the country were publishing inspiring, but one-off stories of everyday people taking action to encourage and help others to get vaccinated resulted in the development of the Big Shots campaign as a way of cumulatively honoring such people to amplify the message and help to increase vaccination rates. These faculty members relied on their professional and academic experience in health communication, health literacy, social marketing, behavior change, and public relations to conceptualize a campaign where the recognition of the important work of these “heroes” could be collected, amplified, and celebrated. Where contemporaneous campaigns were vaccine message driven, Big Shots was created to be story driven.

The campaign founders obtained funding from the CDC Foundation and leveraged a relationship with a former student to obtain pro bono creative assistance from a health communications and marketing firm (McCann Global Health) in the form of graphics, social media templates, and logos. Big Shots was created to be run and directed by graduate students at CUNY SPH. As such, graduate students, including students in a new Master of Science (MS) in Health Communication for Social Change program at CUNY SPH, were recruited to work on the campaign, as part of their fieldwork requirements or as volunteers.

Early in its development, Big Shots partnered with various national and international organizations that are recognized as leaders in vaccine advocacy, including Made to Save and the Vaccine Confidence Project. Made to Save, an initiative of Civic Nation, was a national grassroots campaign that increased COVID-19 vaccine awareness by empowering community organizations (About Made to Save, n.d.). Made to Save provided the Big Shots campaign with access to their community of grassroot organizations committed to increase vaccine awareness and uptake and amplified the Big Shots campaign through their social media pages and internal emails, newsletters, and other forms of communication. The Vaccine Confidence Project, an interdisciplinary research group at the London School of Hygiene and Tropical Medicine dedicated to addressing vaccine hesitancy and misinformation, provided web and social media support for Big Shots by hosting the campaign videos on their platform, thereby increasing campaign visibility. These partnerships were based on a shared goal of confronting vaccine hesitancy and misinformation. It was also important to the design, tone, and goals of the campaign to rely on cross-promotion and amplification, as well as utilizing relationships with other organizations.

Campaign in Action

The Big Shots campaign was launched on July 1, 2021, with a national online awards show, which was hosted by celebrity chef and TV personality Carla Hall and honored eight Big Shots from around the country. These Big Shots—whose efforts included participating in COVID-19 vaccine clinical trial recruitment, finding vaccine appointments for local older adults, setting up a vaccination clinic, and providing neighbors with accurate vaccine-related information—were identified by a CUNY SPH student who organized the Big Shots award show as part of the field work component of her Master of Public Health (MPH) degree program. This student found potential Big Shots by scouring local and national news sources, looking for inspiring stories and especially those highlighting the stories and work of those in communities with higher vaccine hesitancy and/or lower vaccination rates. She then reached out, vetted them, and organized their acceptance of the awards. The awards show was promoted using social media accounts and a website set up for this purpose.

The Big Shots campaign did not end with the launch of the award show. Indeed, Big Shots was designed to function in two phases: an awards show to introduce the campaign and an ongoing campaign with peer-nominated awardees. Big Shots can still be nominated by colleagues, neighbors, friends, or others via the Big Shots website. Individuals who are nominated are assessed for their acceptability by a CUNY SPH graduate who is currently running the program and contacted via email if they are chosen for inclusion. If an awardee accepts, they are asked to provide materials for use on the website and in social media posts, including several photos and an optional video. These materials are then combined and edited by CUNY SPH graduate students and posted to the social media accounts and Big Shots website.

Thus far, the campaign has recognized individuals and organizations in California, Nebraska, Kentucky, Illinois, Oklahoma, New York, and Maryland. To date, Big Shots participants have not received any compensation beyond recognition of their good works. Although there has been discussion among program directors regarding the possibility of future monetary compensation, such as in the form of a gift card, no decisions have been made regarding this potential plan.

Since its launch, the campaign has exceeded its original goal of 1,000 unique visitors, with over 2,500 views from 1,200 unique visitors from around the globe, reaching as far as Thailand, Pakistan, and South Korea. Big Shots has had many nominations from communities across the country. Although the campaign has received fewer than the 100 nominations originally anticipated, more nominations are typically received after the announcement of each awardee, suggesting that with an increased presence, the initial goals may be reached or exceeded. Additionally, each time the Big Shots campaign shared content, online engagement with the campaign increased through likes and shares from the past awardees’ social media accounts. This is significant, in that it suggests that Big Shots continues to be a viable tool to recognize and support voluntarism in vaccine advocacy and the improvement of vaccine literacy, not just through identifying and honoring new Big Shot awardees, but by adding to the ripple effect of multiple, credible, independent programs in the same space.

Big Shots content has been amplified and shared with partner organizations, including Made to Save, Teens for Vaccines, and various organizations at CUNY. The number of people following the campaign on Instagram has increased by 20% over the last few months, coinciding with an increase of posts and engagement. In addition, the campaign’s Twitter following has grown and content has been retweeted several times. The Big Shots campaign has been covered in several publications, most notably The Nation’s Health, a publication of the American Public Health Association.

Lessons Learned

The launch of the Big Shots campaign has provided valuable lessons about the potential utility of social media campaigns aimed at addressing public health issues. It demonstrated that truly grassroots public health campaigns are possible, especially when they are delivered via social media. Social media campaigns require minimal equipment (a smartphone or laptop computer and an account with a graphic design website) and minimal technological expertise, and allow content to be viewed, amplified, and engaged with, both nationally and internationally. The campaign also illustrated that, even during the time of political division and rampant misinformation, controversial topics can be addressed in a celebratory and nonjudgmental tone to build the trust and authenticity needed to reach vaccine-hesitant or hard-to-reach communities, while avoiding messaging that may be regarded as patronizing. The broad definition of what makes a Big Shot allows the campaign to be used, embraced, and applied to various communities. A Big Shot nomination can be seen as a lens through which to see and understand communities; a way to align with that community’s values and priorities.

Big Shots has also proved to be a useful teaching tool for graduate students at CUNY SPH. The inception of the Big Shots campaign coincided with the introduction of a new Health Communication for Social Change MS degree program at CUNY SPH. This program provides students with the tools needed to advance public health through health communication, social marketing, and other behavior-change strategies using various multimedia formats (CUNY Graduate School of Public Health & Health Policy, 2022). Both CUNY SPH and the MS in Health Communication for Social Change provided an ideal environment to develop and implement the Big Shots campaign. Program directors P. Christopher Palmedo, PhD, MBA and Scott C. Ratzan, MD, MPA coordinated with former students and faculty members in the development and implementation of Big Shots. Students in both this program, as well as in MPH programs, gained valuable, real-world experience in building the campaign, from the ground up, with the supervision and mentorship of established health communicators, practitioners, and public relations experts.

The success of Big Shots has been hampered by a limited budget and small team size. A larger team with greater time commitments would allow for increased content creation, nominee and media outreach, and other coordinating efforts that could maintain momentum and inspire nominations. A larger team might also allow Big Shots to grow its brand, such as by adding subcategories that focus on specific communities and share their stories in engaging and interesting ways. It is easy for a small, grassroots campaign like Big Shots to be overshadowed by larger campaigns run by larger organizations that compete for user engagement and audience.

Studies have shown that narrative or storytelling-driven campaigns can help promote single-event behavior change, such as vaccine uptake (Kim et al., 2020; Lee et al., 2018). Narrative Communication Theory suggests that the inherent logic of storytelling will influence, shape, and change attitudes. Through transportation and identification, narrative storytelling can help influence and facilitate behavior change, especially when the story being told is culturally relevant to the priority audience (Bokhour et al., 2016). Big Shots is similarly harnessing the inherent power of storytelling, identification, and transportation by sharing and uplifting the stories and experiences of Big Shots. Furthermore, as social media and digital communication techniques become more accessible and normalized, storytelling can similarly be embraced by public health practitioners and communications.

Next Steps

The Big Shots campaign continues to accept nominations. Two partnerships, with Made to Save and the American College Health Association (a well-established organization of college health professionals committed to advancing the health and wellness needs of 20 million students at over 800 higher education institutions), have helped increase the campaign’s reach and impact. Similarly, Big Shots continues to search for and facilitate other partnerships to increase impact and reach.

The Big Shots campaign—as well as the grassroots, nonjudgmental Big Shots approach—could be used in various communities, by various community-based organizations, and perhaps for other vaccination efforts. Although Big Shots was created within the context of COVID-19, its peer nomination and recognition template could be used as a model for other vaccination awareness efforts such as those focused on childhood vaccinations and the human papillomavirus (HPV) vaccine. Furthermore, Big Shots can be used in other countries and communities outside of the United States. Further study and utilization of this model is warranted.

Author Biographies

Tanja Schub is a graduate student in the Health Communication for Social Change MS program at the CUNY Graduate School of Public Health & Health Policy with an expetected graduation date of December 2022. She has worked in various capacities in biomedical and medical publishing, including as a writer and editor.

Lauren Swan-Potras is a graduate of the CUNY, Graduate School of Public Health and Health Policy Health Communication for Social Change program. Her background is in storytelling and public health, investigating the use of narrative in effective health messaging. She is currently the Managing Editor of the Journal of Health Communication, and has experience in social media campaigns, live performance, and storytelling. She holds an MS from CUNY SPH and a BFA in Drama from New York University, with a Minor in American and British Literature.

Dr. Kenneth Rabin is a Senior Scholar at the City University of New York, Graduate School of Public Health and Health Policy. He retired after a 30-year career in health care communications consulting, preceded by an academic appointment as associate professor and director of the graduate public relations program at American University in Washington, DC, and as a Foreign Service Information Officer in the former US Information Agency. He holds a BA Degree cum laude in English from Cornell; an MA in teaching from Yale University; an MA in Literature from the University of North Carolina, Chapel Hill, and a PhD in higher educational administration from the George Peabody College of Vanderbilt University, Nashville, TN.