Talking about COVID breakthrough infections: Recommendations for public health practitioners

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Talking about COVID breakthrough infections: Recommendations for public health practitioners

Wednesday, August 11, 2021Media coverage on breakthrough infections in people who are vaccinated make talking about COVID more complicated. We hope these initial talking points will be helpful. As this issue evolves, the talking points may evolve as well.

Breakthrough infections

Reporters often focus on extreme cases — they report on the planes that crash, not the ones that land. We can expect the media to focus on breakthrough cases, and while this is important information, it may dominate the news rather than information about public health's daily work to ensure people get vaccinated. These talking points will help you answer questions about breakthrough cases without minimizing your main strategies — getting people vaccinated, wearing masks, and using any other protections your health department has approved. We've used the "truth sandwich" to structure the talking points because that format has been useful for combating misinformation and communicating complexities. The basic format is to sandwich information on breakthroughs within messages about our core public health efforts:
  1. Start with your core message, which emphasizes your values and names your solution, whether it's getting vaccinated, wearing your mask, social distancing, etc. Acknowledge people's concerns that these are challenging times, or that they may be worried about the Delta variant.
  2. Add a talking point about breakthrough infections, but stay high level rather than getting into extremely detailed information. If possible, avoid repeating false claims about breakthrough infections; doing so may reinforce misinformation.
  3. Return back to your core message about getting vaccinated, and reiterate the idea that the more people who get vaccinated the safer everyone in the county will be.
Following the sample talking points below, we provide other resources that we have found useful for explaining COVID.

Sample talking points

Example main message: Like most of you, we wish COVID were over, but it is not. The most important things we can do for one another while we are still learning about the Delta variant are get vaccinated and wear our masks indoors. These are the best protections we have. If you are unvaccinated or have friends and family who are unvaccinated, we can answer questions you have if you contact us [add info]. Using masks, vaccines, and social distancing is like wearing a seatbelt, having airbags, and driving the speed limit. All of those help keep you, and those around you, safer when you are driving. Breakthrough message: We know people are concerned about breakthrough infections. The good news is that as more people protect themselves, the less COVID will be circulating in our county, which means fewer breakthroughs, fewer severe cases of COVID, fewer hospitalizations, and fewer deaths. People who are vaccinated are much less likely to get sick or be hospitalized than those who are unvaccinated. People who protect themselves with vaccines and masks increase their own odds of staying healthy and help our whole community stay healthier. Repeat main message: We know these are challenging times, and we all hoped we would not be seeing the rise in cases. The vast majority of cases are in unvaccinated people, so we want to reach people who need vaccines, answer their questions, and get everyone vaccinated who wants one. In our county, we take care of one another by wearing masks indoors and [add your county's specific recommendations if they include other protections].

Additional resources

Breakthroughs in Provincetown

This Twitter thread is explains why as the vaccination rates increase, the percentage of cases that are in vaccinated people will increase.

Vaccine hesitancy

Planned Parenthood has online training for talking to people about vaccines and a helpful vaccine hesitancy guide with very specific responses to concerns people have. The Colorado Health Foundation's COVID-19 Vaccine Messaging Guide is based on public opinion research and focuses on messaging strategies for the vaccine-hesitant and for people of color. It is available in English and Spanish.

Vaccinating children

Parents Together has a helpful document on parental attitudes, which is available here.

Metaphors

For complex issues, metaphors and analogies can make it easier for people to understand the issue. Here are a few that might be helpful. Swiss cheese metaphor (helpful for talking about masks and vaccines): Each layer of protection, like vaccines, masks, and social distancing, is like a slice of Swiss cheese. No one layer is perfect, but when you stack multiple layers, they protect you and those around you. Driving (helpful for talking about the need for masks and vaccines): Wearing your mask while you are vaccinated is like using your seatbelt, driving at safe speeds, and having air bags. They keep you and the people around you safe. Smoking (helpful for talking about vaccine hesitancy): It used to be that smoking was considered an individual decision, but people saw it differently when the science confirmed that secondhand smoke also kills people. We changed our behavior to protect everyone. Vaccination protects everyone, too — it protects the vaccinated person who is less likely to get sick, and it protects the whole community when more people are vaccinated because COVID will have less chance to spread.

Resources on misinformation

We know there is a lot of information circulating on misinformation, including the recent report from the Surgeon General. Here are a few we think are helpful: Alerts from the Public Health Collaborative: Outlines how to address specific types of misinformation (i.e. which ones to directly address and which ones to ignore), taking into account the risk that repeating misinformation can inadvertently amplify it. First Draft News tracks vaccine misinformation and offers tools and resources to address it. The Virality Project, including their blog post on rumor control. This approach may be helpful in addressing misinformation that you are hearing in your jurisdictions and/or that is listed in the Alerts from the Public Health Collaborative and First Draft News. We also recommend using the truth sandwich format from above when you must speak about misinformation. Be cautious with the myth/fact format, as seeing the myth in print can solidify it in people's mind as a plausible concern.

Fear-based messages

Fear-based messages tend to work only when there is an easy way to resolve the fear. Messages about the contagiousness of the Delta variant may prompt people to get vaccinated, tested, and wear masks. The personal stories from people who are not vaccinated, got sick, and regret not getting vaccinated may move some people toward vaccination. Fighting COVID is important for all of us, and we appreciate the work being done in health departments and community organizations in California and across the country. Please feel free to contact us at info@bmsg.org with examples of messages and strategies that have been working in your local context.