Four months into Manitoba’s COVID-19 vaccination campaign, the province has taken its message beyond senior citizens.
While provincial officials constantly bemoan the limited supply of vaccines, public-health experts say Manitoba needs to prime all segments of the population for their eventual vaccination, or risk having unused doses and a longer road to herd immunity.
That requires more than just photos of older people getting their shots.
"If we see a great deal of older and white-population perspectives and stories being put out there, it doesn’t necessarily do anything to encourage other people of colour, or other communities to want to come forward," said Michelle Driedger, a community health professor at the University of Manitoba.
"It absolutely needs to be broadened, because you need to have both a targeted and a broad approach."
Manitoba bureaucrats and grassroots groups tell the Free Press they face a delicate balance between trying to drum up interest while managing expectations, while real-time data is guiding how the province will try to communicate to different groups.
A sphere of influence
Even before COVID-19 vaccines were approved in Canada, Manitoba officials anticipated having difficulty getting enough people to roll up their sleeves, particularly with an adult-immunization goal of 70 per cent.
In recent years, Manitoba has trailed other provinces in flu-shot vaccinations, logging 26.3 per cent uptake in the last flu season before COVID-19 took hold in March 2020, compared with roughly 30 per cent in Ontario.
A senior official overseeing Manitoba’s COVID-19 communications explained the strategy under the condition of not being named, as the province permits only medical experts to give on-the-record interviews about the coronavirus.
The official said that in order to drum up interest in COVID-19 vaccines, Manitoba is leaning on the Concentric Circles Theory, which was first devised in the 1940s by pollster Elmo Roper.
The idea — much like the ripple effect when a rock is thrown in the water — is to first target people who are closer to the goal, and gradually move on to groups that are less aligned.
For vaccines, that means starting with messaging aimed at those who are enthusiastic about getting vaccinated — about 69 per cent of people, according to the province’s polling early this year — to show them how they can do so.
After that, officials move on to those who need more information, or are on the fence, which make up about 21 per cent.
The 10 per cent of people who are hardest to reach, such as vaccine skeptics, come last, with the idea that peers will have already helped persuade them about the merits of getting an injection.
Manitoba launched the #ProtectMB campaign a month ago, with ads featuring an elderly woman in a cardigan. It has included online testimonials from people who’ve been vaccinated, including medical staff and people with disabilities.
The campaign has recently expanded to include images of Black women and a young adult with tattoos. The ads will appear online and in some newspapers in areas with limited internet.
The province has also recorded radio ads in English, French, Spanish and Tagalog, all leading people to the #ProtectMB site.
Many communication strategists focus on five Cs: clear, good content, with credible information that is comprehensive (enough to make a decision) and provides a way to take concrete action. That last part is a challenge when most Manitobans are months away from being eligible for a vaccine appointment.
That’s why the #ProtectMB website allows those who are interested in getting vaccinated to sign up for a weekly newsletter, which includes testimonials from people who got the shot, and updates on how vaccination eligibility has broadened.
It’s the same thinking with the queue calculator, in which Manitobans input their age and health conditions to see where they stand in line. The whole point is to give people something to do and keep them interested during the months-long rollout, said vaccine task force medical head Dr. Joss Reimer.
"Flexibility and adaptation are the keys to a successful vaccination strategy," Reimer said, adding the campaign "will evolve in the coming months to target messages, materials and images to target communities with lower uptake."
Doctors Manitoba has largely taken up the mantle of dispelling myths via the ManitobaVaccine.ca website, which explains the science and urges people to ask their trusted physician about what they’ve read online.
Drumming up interest
The Saskatchewan government chose a model designed to drum up interest from everyone from the start with TV spots that launched two weeks ago.
"I want to get back to being a 27-year-old, right? Back to having something to look forward to," says Brad, a hockey player skating in an empty Yorkton arena.
Another features the mother of an immunocompromised toddler. "I will get the vaccine; I will protect you because you can’t protect yourself," says Kyla from Swift Current, her voice shaking. "Because I will do anything, at all cost, to protect my daughter."
The campaign, called Stick It To COVID, is based on the idea that everybody needs to be proactively engaged in the vaccine rollout, even if their shot is months away.
"Making sure everybody is willing to go get their vaccine when it’s their turn is an important message to keep reminding people of, because eligibility keeps changing," said Driedger, an expert in public-health communications.
"When you have to pivot and make decisions like that on the fly, it’s really important that everybody be targeted around getting the vaccine is a good thing (for) protecting yourself and protecting others in your community."
Driedger is researching how public-health messages are resonating in real time with Canadians. She said focus-group participants say they want to hear from people who’ve been vaccinated about the experience, and also want to see people who look like them in the ads.
"Those kinds of communication strategies are important, but it’s equally important that the faces and the stories you have represented capture the spectrum and the diversity of the population that will ultimately be coming forward to receive those vaccines," she said.
"If they don’t see themselves in those faces, it doesn’t resonate in the same way. We know because of differential experiences of racism that Black, Indigenous and people of colour have experienced in the health-care system."
Meanwhile, the province reported Friday an uptick in people under the age of 50, including teens, admitted to hospital.
"It’s important to remind people that it’s not just a disease for older people; it can effect younger people and have very serious outcomes as well," Driedger said, emphasizing that has become even more of a concern with the steady increase in cases involving highly infectious COVID-19 variants.
A reconciliation lens
One of the challenges has been getting content featuring Indigenous people. Currently, the ProtectMB website has testimonials from two Indigenous public-health leaders who are provincial employees.
The online and print ads published so far overwhelmingly feature older people who appear to be white despite eligibility for off-reserve First Nations members currently at age 37 and older, and as young as 18 on reserves.
In the past month, chiefs have cited a need for more vaccine promotion to convince Indigenous people to roll up their sleeves, particularly on reserves that had tight controls and never experienced large outbreaks.
The province is now working with Winnipeg marketing firm Vincent Design, which specializes in Indigenous projects, to help ramp up content designed by Indigenous partners that will resonate with their communities in different languages.
The ads will likely feature far less provincial branding. The province’s bison logo that resonates with many Manitobans can have a patronizing feel in communities that want to assert their autonomy.
The effort has overwhelmingly involved First Nations, with the Manitoba Metis Federation boycotting some of the province’s talks over frustration with the Métis having a much more limited role.
Manitoba officials say the provincial government tries to pivot as fast as a bureaucracy can as new trends emerge.
Twice weekly, officials hold "knowledge transfer" meetings, to go over official current epidemiology and historical data from the Manitoba Centre for Health Policy, as well as lived experience and anecdotes from the public.
They try to link it all together to find out how to improve things, such as addressing low uptake in a particular Winnipeg postal-code, or if certain demographics are noticeably less likely to have signed up for a shot than others inside a health-authority region.
"In each situation where we begin to see low uptake, we begin to ask: is this a policy, a service-delivery or communications problem, and then adapt to meet that challenge," Reimer wrote.
"For example, on Thursday we announced we are expanding vaccine eligibility criteria to include all adults in priority communities as well as first responders. This was in response to the threat of a third wave of the COVID-19 pandemic."
She said the data can also lead to a targeted ad campaign, or a pop-up vaccination site.
The Manitoba government has taped Tagalog-language radio spots and placed English-language ads in local Filipino newspapers, in part because of a gap in vaccine uptick rates between intensive-care nurses and the nurses who work in personal-care homes, the latter of which include many Filipino workers.
The data analysis has also shown some surprises.
Officials had expected poor uptake among seniors in the Southern Health region, because that demographic has historically avoided vaccines, possibly due to skepticism in some religious communities.
In the flu season that ended just as the coronavirus took hold in March 2020, the areas of Winkler, Stanley and Hanover each reported less than 12 per cent uptick for flu shots, compared with several Winnipeg suburbs that logged more than 30 per cent.
A senior official said it probably won’t be until about half of eligible adults get their first shot that Manitoba will start to get a better sense of where gaps are emerging.
"As Manitobans get vaccinated, we’re able to review public-health data to better understand who has been immunized — but more importantly who hasn’t," Reimer wrote.