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Health literacy seen as an important tool in increasing COVID-19 vaccine uptake

Vaccine confidence is increasing, but more needs to be done to convince Americans to get their shots.

Jeff Lagasse, Associate Editor

Healthcare professionals largely see vaccines as key tools in ending the COVID-19 pandemic, but they will only work to that end if enough Americans become inoculated in order to achieve herd immunity.

The vaccines themselves are largely effective. The challenge is in convincing the public to take them.

Skepticism about vaccines was high at first. Last fall, nearly half of older adults were on the fence about COVID-19 vaccination – or at least taking a wait-and-see attitude, according to a University of Michigan poll taken at the time.

But a follow-up poll released in March shows that 71% of people in their 50s, 60s and 70s are now ready to get vaccinated against COVID-19 when a dose becomes available to them, or had already gotten vaccinated by the time they were polled in late January. That's up from 58% in October.

Still, there's more work that needs to be done in terms of getting the public fully on board. The Biden Administration has championed a $1.5 billion campaign aimed at boosting vaccine confidence and uptake across the country.

That's on top of $500 million the administration already pledged for related activities, including $250 million to fund grants for state and local health literacy projects, and $255 million for the Centers for Disease Control and Prevention to fund local government efforts to focus on equity and confidence in underserved communities.

The underlying philosophy behind all of this is health literacy. Dr. Ryan Bosch, practicing physician and president and cofounder of healthcare analytics company Socially Determined, said health literacy is about more than just educating people.

It's about listening to patients' concerns, and he hopes the administration places an emphasis on listening as a vital component of broader communications about vaccine efficacy.

"I think we're seeing some evidence that's where the administration wants to go," said Bosch. "We seek to get more shots in arms, yes, and I see people who are apprehensive. And yes, I listen first and try to understand what might be their obstacles.

"But the second part is to show through commitment and investing in access … that it's more about increasing their awareness of the move toward public health."


It isn't enough to simply distribute vaccines and tell people, "Inoculation is good." An effort needs to be made to bring vaccines to critical and underserved communities, and to commit to a broad range of preventative health measures.

Bosch sees health literacy as a continuum that starts with getting information, understanding it, making a decision based on that information and then getting context and perspective from a trusted advisor. That's what the administration's campaign seeks to promote among the general public.

Importantly, there are factors that help to facilitate each of those steps along the continuum, such as access to broadband Internet, language options for non-English speakers and a breakdown of risk factors to effectively create the equivalent of FICA scores around health literacy.

"Those components in sequence provide the ability to make a health literacy-supported decision independent of your education level or language proficiency," said Bosch.

This is based on the principle that informed access is better access, which means any successful education campaign needs to factor in such elementary concepts as language and basic literacy.

"We've got to get these individual patients to make a different decision," said Bosch. "The ability for folks to understand as a community is huge.

"One example is that 20 years ago, smoking was a lot more common. I would have discussions about tobacco cessation, and the patient listened, but often [wasn't] making that decision.

"But all of a sudden they have children, or they're employed as a school teacher, and things change. They see how their decisions affect others.

"I think that's what you're hoping for. It's more the awareness and perspective so they can make a decision that benefits the community."

It all goes back to the theme of trust, and the idea of health literacy goes well beyond a simple vaccine education push. If properly nourished, it can have far-ranging public health effects that are beneficial. The pandemic has only intensified the need for an educated public.

"We still see a need for more vaccines in many states," said Bosch. "I'm optimistic that, not just through health literacy, but through commitment, it will lift the public health infrastructure into a stronger place."

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Twitter: @JELagasse
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