Journal of Health Communication: Building Confidence to CONVINCE

This article was published on March 13, 2021 in the Journal of Health Communication and was co-authored by Heidi J. Larson, Nancy Lee, Kenneth H. Rabin, Lauren Rauh & Scott C.

This paper describes the inception and evolution to date of CONVINCE – COVID-19 New Vaccine Information, Communication and Engagement – a rapidly expanding, voluntary global initiative to promote the use of effective public communications and engagement to build vaccine literacy and expedite immunization programs to protect communities against the COVID-19 Pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

CONVINCE emerged from initial conversations among a few people who for some time have studied issues affecting vaccine acceptance.

Driven by well-funded, well-organized, tech-savvy vaccine opponents, hesitancy has spread so widely in recent years that in 2019 the World Health Organization labeled it as one of the ten most important threats to global health.

CONVINCE stemmed directly from our work during the first stage of the COVID-19 Pandemic. In early March 2020, some of us wrote a widely circulated article in the US National Academy of Medicine’s Perspectives called “COVID-19: An Urgent Call for Coordinated, Trusted Sources to Tell Everyone What They Need to Know and Do”. Its key message was that, “History tells us that an informed, the activated population is vital to protecting the public’s health.” Another of us was putting the final touches on the manuscript of a book called Stuck: How Vaccine Rumors Start – And Why They Don’t Go Away, which was published later in the year and has become widely accepted as the standard source of information on the triggers of vaccine hesitancy.

By late March, two things had become clear to us. The first was that a coordinated, expedited and well-funded scientific effort had led to a prompt elucidation of the genetic code for SARS-Cov-2 and was likely to lead to the rapid development of COVID-19 vaccines. The second was that the highly polarized and political environment in many countries was equally likely to preclude the development of coordinated, trusted sources of information to inspire people to adopt basic behaviors that could slow the spread of COVID-19, or ultimately to accept a new vaccine against it.

The specific statement that challenged us to look for new communication solutions came from Dr. Anthony Fauci, head of the US National Institute of Allergy and Infectious Diseases. On 30 March, 2020, he told journalists that a vaccine would be “the ultimate game changer” against COVID-19, and that based on the initial research he had seen this “game changer” could be in play within a time frame of 12–18 months. By December 2020, while Dr. Fauci still saw vaccines as a game changer, he started to call out some of the hurdles – including the risk that not enough people will take it.

We see four interrelated communication factors that could be obstacles to achieving the potential “game change” that COVID-19 vaccines could allow: (1) The lack of public trust in government information about COVID-19, (2) childhood vaccine opponents pivoting quickly and aggressively to spread disinformation about potential COVID-19 vaccines; (3) denialism that the COVID virus and disease actually exist; and (4) inadequate investment in communications programs to prepare communities to accept a COVID-19 vaccine based on social research to inform the development of messages and identification of relevant and influential messengers to explain in basic terms how these vaccines worked.

Opening the Dialogue to CONVINCE

To start global a global vaccine literacy and communications dialogue to try to tackle some of these issues, Wilton Park, together with the Vaccine Confidence Project and CUNY, organized a series of strategic discussions about COVID-19 vaccine communications and engagement that we hoped would inform the development of an international communication, engagement and advocacy initiative.

The first of these discussions, “Building public support for a new vaccine to Prevent COVID-19”, took place on May 20, with more than 40 international stakeholders representing such organizations as the World Health Organization and national public health agencies from several countries, NGOs, media such as BBC Media Action, and several academic public health and health policy programs.

The participants identified three key challenges: (1) achieving the right balance between common global messages and diverse, locally, linguistically and culturally appropriate communication; (2) distinguishing the different approaches needed to address the psychological and emotional differences between extreme vaccine opponents and genuinely concerned vaccine-hesitant individuals; and (3) adopting a more pressing, urgent and creative approach to communications media – online and traditional – that speak more directly to the emotions of relevant audiences.

The objective of the discussion was to develop an initiative that would take a ‘whole of society’ approach to vaccine literacy that would mobilize expertise both within and outside of the health sector to optimize global immunization against COVID-19. The group agreed to identify additional colleagues who were interested in working with us to address these challenges, and organize ourselves into separate sub-groups and workstreams to develop vaccine messages, communication strategies, networks and tactical initiatives within a time frame that was consistent with the emerging timetable for vaccine development, regulatory approval, and availability for distribution under the pressures of bewildering financial and logistical complexity.

Much of this initial dialogue also centered on the viability of launching a global coalition that would issue a “Call to Action” in support of COVID-19 vaccination. A working name was discussed – CIVIC (the Coalition for Informing Vaccination Internationally for COVID-19). No decision was made, and we later found that another group had already adopted the acronym for a related but slightly different purpose.

Arriving at CONVINCE

We spent much of our time from late May through most of June 2020 creating an identity and framework for a sustainable long-term COVID-19 vaccine communications initiative to present at our second strategic discussion on June 22.

In choosing an identity, given the absolute necessity of driving the 70–80% global vaccine acceptance rate epidemiologists say is necessary to bring the COVID-19 pandemic under control and restore peoples’ lives and livelihoods, we chose a name that would emphasize the urgent role of communications to help achieve this coverage goal in the near term.

After extensive conversations we arrived at CONVINCE – COVID-19 New Vaccine INformation, Communication and Engagement.

We determined that “Our mission is to provide a forum and clearing-house for multi-stakeholder efforts to manage the complex, nuanced and immense public health challenge of controlling COVID-19.”

Our vision was less constrained: “We envision a world where society accepts and trusts the importance of vaccines to keep people healthy and the global economy functioning.”

We then mapped out the scope of CONVINCE activities (Figure 1).

To establish the initiative’s credibility, we defined three large spheres of activity consistent with the dominant skill sets of the three founding organizations: Listening from the Vaccine Confidence Project (VCP) of the London School of Hygiene & Tropical Medicine prime focus being listening (social media analytics, surveys, focus groups), issue detection and rumor management; “Multisector Engagement” from Wilton Park; and “Messaging and Creative Implementation” from the Health Communication for Social Change program at the City University of New York Graduate School of Public Health and Health Policy (CUNY SPH).

The three additional points of intersection we mapped include “Thought Leader Expertise”, “Diverse Audience Outreach” and “Dissemination Partnerships”.

We also identified five workstreams that would require distinctive vaccine communications-related competencies: Healthcare workforce communications, media, technology, community engagement and public–private sector partnerships (the first of which to be advanced was business partnerships).

These concepts were reviewed and accepted at our second Wilton Park dialogue, “Engaging the private sector in a multisectoral campaign for vaccine literacy,” which also engaged more than 40 participants.

In addition to the full group’s agreement to support a multisectoral CONVINCE coalition, participant breakout teams identified the following areas for coordinated action: (1) Establishing the integral role of the employer as a source of trusted information and leadership in building vaccine literacy and confidence; (2) Drawing on the talents of diverse, innovative content creators to impact on a variety of media platforms; (3) Advocating COVID-19 vaccination and other appropriate preventive behaviors as essential components of an informed, safe and healthy workplace; (4) Developing and implementing a coordinated plan to combat vaccine misinformation and disinformation relative to specific scenarios, such as adverse event reports, different dosage schedules and shipment and scheduling delays and (5) Maintaining clear and open channels for ongoing cross-sector discussion and sharing of “best practices”.

Growing and Expanding CONVINCE

An ever-increasing array of CONVINCE projects took place throughout the second half of 2020, as summarized in Figure 2.

CONVINCE was announced formally to the global health policy community at an official side event during the United Nations at High Level Political Forum in July 2020, attended by delegates from United Nations, World Health Organization, GAVI and others.

Meanwhile Wilton Park hosted a separate dialogue focused on community health workers and preparing for COVID vaccines. This session was organized in collaboration with the Sabin Vaccine Institute and Ariadne Labs, a joint center for health systems innovation at Brigham and Women’s Hospital and the Harvard T H Chan School of Public Health. Healthcare workforce communications was seen as especially important since almost all public opinion research identifies “my healthcare provider” as the most credible source of health information. As the first COVID-19 vaccines began to roll out in December 2020, following Emergency Use Authorization, some communities saw emerging resistance to vaccination even within the healthcare workforce itself. Collaborative proposals for communications interventions are now being developed by CONVINCE partners.

A separate Business Partners to CONVINCE was launched in collaboration with the US Council for International Business (USCIB) and the USCIB Foundation in September 2020. This included the partnership of the International Chamber of Commerce, the International Organization of Employers, and Business at the OECD. The importance of this sectoral effort has been highlighted in articles by CONVINCE leaders in the Financial Times and Harvard Business Review, and a “Vaccination for a Healthy Planet” company challenge is in final review for launch during Q1 2021.

In November 2020 the CUNY Graduate School of Public Health and Health Policy (CUNY SPH) CONVINCE team, was fortunate to receive a generous grant on behalf of CONVINCE from The Commonwealth Fund to undertake a qualitative research project, “Building Trust in Health Services and Vaccinations During the Covid-19 Pandemic”. The main components of this project are: (1) a scoping review of methodologies and survey tools to measure trust in vaccines carried out in collaboration between CUNY SPH and VCP, (2) a high-level advisory board to help assess the key learnings from this review and assist in the development of a screening survey and interview guide for (3) a series of 30 one hour-long in-depth interviews with vaccine-hesitant individuals, particularly in Black and Latinx communities, and (4) the development and dissemination of specific messaging and communication outreach strategies.

The CUNY SPH team has also received project funding from the US CDC Foundation and the Community Health Acceleration Partnership (CHAP), which launched a CONVINCE USA chapter.

An initial online conference with CONVINCE USA and its expert advisors on December 22 yielded these refined recommendations for 2021:

  • Build consensus for communications strategies with a focus on key messengers, messages, and communications channels to reach groups that have expressed a desire to “wait and see” before readily accepting COVID-19 vaccines.

  • Develop technologies as an information source, a conversation starter, and a tool for amplification.

  • Collaborate to reframe COVID-19 vaccine acceptance as a social movement, starting at the grassroots with opportunities for multisectoral engagement.

  • Position CONVINCE USA to support multisectoral efforts to diffuse quickly with adoption into best practices.

  • Develop specific vaccine confidence-building strategies to build trust and promote acceptance among healthcare workers, faith leaders and employers.

The Commonwealth Fund has also introduced CONVINCE USA to Phreesia, a developer and provider of customized patient intake software for healthcare systems representing tens of millions of US “covered lives”. This alliance will allow CONVINCE to obtain “real world” survey data on drivers of hesitancy from tens of thousands of US patients who are currently being contacted by Phreesia to sign up for COVID-19 vaccination through their local provider organization.

Understanding that local-level factors will be paramount to informing COVID19 vaccine literacy, a number of CONVINCE initiatives are been launched, as shown in Figure 3. To support and serve as a communication hub for these regional initiatives and multiple CONVINCE chapters across the globe, a CONVINCE global secretariat has been established, co-led by the Vaccine Confidence Project, CUNY and Wilton Park which will work closely with all partners and across workstreams.

Figure 3. Global organization of CONVINCE

CONVINCE in a Vaccine-literate World

Creating and leveraging effective vaccine communications to stop the spread of COVID-19 through global immunization program is our overriding goal. But, COVID-19 is not the last pandemic the world will face, and vaccine hesitancy will remain an obstacle to successful immunization against a range of otherwise vaccine-preventable diseases.

For these reasons, CONVINCE projects will align with the definition and principles of vaccine literacy more broadly:

Vaccine literacy occurs when people understand, in their own language and relevant to their context, the content, processes and systems needed to access and get vaccinated.

Vaccine literacy means knowing how and why vaccines work, the diseases they prevent, and their value to yourself and to society.

Eight principles (Ratzan & Parker, 2021) underlie a health communicator’s ability to foster vaccine literacy:

  1. Knowledge that is informed by clear, trustworthy, up-to-date evidence;

  2. Ability to discern fact from fiction;

  3. Willingness to listen, encourage questions, and engage in dialogue;

  4. Answers that are understandable, trustworthy and up-to-date;

  5. Understanding the benefits and risks of vaccination for self and society;

  6. Connection to systems that make vaccination easy and safe to obtain;

  7. Prudent public health policies to incentivize vaccination and equity; and

  8. Transparency, clarity, and confidence in vaccine quality, safety, and efficacy.

Scientists, clinical researchers and regulatory decision makers worldwide have joined forces to make, safe, effective new COVID-19 vaccines rapidly available. CONVINCE has also come together rapidly to support the overall effort. It now remains to be seen if our communications research, knowledge and skills can help the public health community seize the opportunity to bring an end to this Pandemic as soon as humanly possible.


  • Ratzan, S. C., & Parker, R. (2021).Vaccine Literacy—helping everyone decide to accept vaccination. Journal of Health Communication. [Google Scholar]

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