NEW RESEARCH: CBD companies exploiting academic partnerships for marketing purposes

January 20, 2022

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org or (412) 945-3242

Washington, DC—The Journal of Studies on Alcohol and Drugs today released new research that reveals the various tactics cannabidiol (CBD) companies use to thwart the Food and Drug Administration (FDA) review process and assert that their therapeutical claims are backed by science.

The study, The Use of Academic Research in Medical-Cannabis Marketing: A Qualitative and Quantitative Review, illuminates the need for FDA regulatory approval and stronger oversight to address the risks to consumers and patients alike when companies exploit that system. The findings reveal nearly 1,000 health claims touting CBD’s ability to mitigate symptoms or treat mental health, autism, pain, sexual health, AIDS, cancer, COVID-19, and more, providing just a snapshot of the current, unregulated marketing tactics being used to mislead the public.

The research was commissioned by Consumers for Safe CBD, a campaign spearheaded by the National Consumers League and conducted by Data Science Solutions. The research took place in the summer of 2020 and was published today in the Journal.

“It’s important that consumers understand what they’re up against when it comes to the current marketplace,” said Sally Greenberg, Executive Director of the National Consumers League. “Day in and day out we see CBD products promoted by celebrities and ‘health experts’ who have no clue what is truly in the products they push. This research helps give a snapshot of just how many misleading claims are out there and will help consumers better understand how to identify — and know to question — marketing red flags.”

“Unfortunately, many CBD manufacturers talk quite a bit about research, but have rarely engaged in the kind of large-scale randomized controlled trials necessary to establish that a drug is safe and effective,” said Theo Caputi, M.P.H, M.SC. author of the study. “CBD products are flooding the retail marketplace — readily available to consumers — and this review shows a serious need for adequate research and testing to ensure safety of these products and effectiveness for the claims companies are making.”

Most of the top medical marijuana companies analyzed:

  • use the existence of academic partnerships and observational relationships in an effort to legitimize health claims, despite having little to no clinical trial activity;
  • routinely use academic research in marketing strategies (“research as marketing”) to mislead the public; and,
  • evade FDA approval process by creating their own pseudo-approval process, making products appear legitimate, safe, effective, and eligible for insurance coverage for a range of health claims through these “research as marketing” tactics.

“It is alarming to see so many companies purposefully evading the FDA process — the gold standard in consumer protection — and making therapeutic claims with little to no real, clinical evidence,” said Greenberg. “Many of these companies have received warning letters from the FDA, yet these harmful and misleading tactics continue. It’s time for Congress to empower FDA to use its full authority to protect consumers. Consumers for Safe CBD will continue to serve as a watchdog to ensure CBD products are safe and effective.”

The CBD market continues to grow despite the FDA stating that CBD cannot be generally regarded as safe (GRAS) for use in food and beverage products. According to a Statista report, CBD sales in the U.S. reached $4.6 billion in 2020. By 2026, the market is expected to grow to $16 billion. Consumers, through these “research as marketing” tactics, have been led to believe that CBD has both medical benefits and health maintenance effects. However, there is only thorough, scientific-backed proof of medical benefits in the one and only FDA-approved CBD prescription drug product available.

“It is arguably unethical and certainly misleading for commercial entities to use the legitimacy of early scientific research — and the announcement of such endeavors — as a marketing tool,” Caputi added, “In fact, this ‘research’ used — or even simply announced in press releases — is not nearly substantial enough to ensure safety and effectiveness of these products for therapeutic use. We must rely on the rigorous FDA approval process to be sure these products meet the gold standard for safety and efficacy.”

Click HERE to read the full study in the Journal of Studies on Alcohol and Drugs.

To  learn more about the risks of unregulated CBD, visit 4safecbd.org.

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Jeanette Contreras portrait

Reason to celebrate: No more surprise medical bills in the new year!

By NCL Director of Health Policy Jeanette Contreras

Consumers have grown to expect surprise medical bills as a given in the fragmented U.S. healthcare system. Even people with large employer-sponsored health insurance coverage could expect to receive a surprise bill for an out-of-network medical service. A 2021 report from the U.S. Department of Health and Human Services outlined how more than half of U.S. consumers reported recently receiving an unexpected medical bill — many related to essential services like childbirth, elective surgeries, or emergency services. Thanks to the No Surprises Act, signed into law as part of the Consolidated Appropriations Act of 2021, surprise medical bills will be a thing of the past.

Beginning January 1, 2022, federal protections ban surprise medical bills any time a person receives emergency care, including some non-emergency services. For example, the new law bans out-of-network charges for out-of-network providers who work at an in-network facility. It also requires that cost-sharing for emergency services, like co-pays and co-insurance, be based on in-network rates.

Healthcare providers and facilities will be required to give patients easy-to-understand notice regarding out-of-network care, explaining that it could be more expensive. Providers will also need to tell patients whom to contact if they think the provider or facility has violated the surprise billing protections. Patients will be able to dispute a claim if they receive a medical bill that is higher than the estimated cost given in advance of care.

Whether or not a patient has insurance, they can submit a complaint about a medical billing issue if they have a question or are concerned that their provider may not be following the new rules. For more help, consumers can go to the CMS.gov webpage to submit a claim online or call the No Surprises Help Desk at 1-800-985-3059, 8am-8pm ET seven days a week; (TTY: 800-985-3059).

NCL offers support for Increasing Access to Biosimilars Act (S. 1427)

December 16, 2021

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org or (412) 945-3242

Washington, DC—The National Consumers League (NCL) is pleased to support the Increasing Access to Biosimilars Act (S. 1427), as introduced by Senators Michael Bennet (D-CO) and John Cornyn (R-TX). This Act directs the U.S. Department of Health and Human Services (HHS) to launch a pilot program that increases Medicare payments for providers who use biosimilars. Representative Tony Cárdenas (D-CA) introduced a similar bill (H.R. 2869) in the House of Representatives.

Since 2014, the growth in pharmaceutical spending has been primarily driven by increased spending on biologic drugs. Biosimilars demonstrate no clinically meaningful differences in terms of safety, purity, and potency against their FDA-approved biologic counterpart, and are generally 15 percent to 35 percent lower in price. Therefore, biosimilars pose great potential to reduce health care costs.

The Increasing Access to Biosimilars Act would create a new pilot program administered by the Center for Medicare & Medicaid Innovation (CMMI) that aims to encourage physicians to prescribe less expensive biosimilars through shared savings. Shared savings is a payment strategy that offers providers a percentage of any net savings generated in order to reduce health care spending overall.

The following statement can be attributed to NCL’s Health Policy Director Jeanette Contreras:

“This legislation would not only broaden access to cost-saving biosimilars and reduce unnecessary spending on costly biologics, but it could also foster greater competition. In addition, it signals to future participants the viability of the biosimilars market, which is a win for consumers.

NCL believes that well-aligned payment incentives can steer providers toward cost-saving behavior with the overall objective of reducing Medicare expenditures. We strongly urge Congress to pass the Increasing Access to Biosimilars Act as the FDA continues to approve new biosimilars to market at increasing rates.”

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Jeanette Contreras portrait

Listen up: FDA’s proposed OTC hearing aid rule

By NCL Director of Health Policy Jeanette Contreras

Whether it be listening to your grandchildren share a story or having dinner with a friend, many consumers rely on devices to help them hear and understand speech every day. Hearing loss is something that we need to be mindful of at all ages, and as consumers, we look to our nation’s regulators to make sure these devices are safe to use.

Some people with hearing loss are able to work closely with hearing care professionals to finely adjust their hearing aids at sound levels that enable them to hear speech at comfortable levels without causing any harm. But, as more Americans struggle with their hearing, accessible hearing aids becomes increasingly important. Proposed regulations by the Food and Drug Administration will allow hearing aids to be sold over-the-counter to adults with mild-to-moderate hearing loss, a step forward in making them more affordable and accessible.

While these regulations are positive for access, the FDA’s proposed thresholds for volume or output for over-the-counter hearing devices are more in line with those for earbuds people use to listen to music for short periods than they are for hearing aids that are worn for several hours a day. These draft rules would allow a maximum sound output level of between 115 and 120 dBA, which is the equivalent to the volume of a chain saw. According to the CDC, exposure of sounds at 120 dB could become dangerous in as little as nine seconds. As you can imagine, being exposed to this level of sound for long periods of time is unsafe and could increase hearing loss and significantly damage the ear.

Hence, there is widespread concern among hearing care professionals that allowing an unnecessarily high level of amplification can lead to further hearing loss. Leading hearing care associations recommend a maximum output limit of 110 dBA for OTC hearing aids and establishing a gain limit of 25 dB.

As the leading consumer healthcare organization, we applaud the FDA’s efforts to increase access to hearing aids for those who need them. We do hope that the FDA will adjust its proposal, so it is in line with the recommendations of hearing care professionals before finalizing the regulations. Consumers shouldn’t be concerned that they may find their situation worsened by devices that are intended to help.

To learn more about gain and output and how to protect yourself from hearing loss, check out our new infographic.

NCL applauds approval of the pediatric COVID-19 vaccine

November 2, 2021

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org or (412) 945-3242

Washington, DC—The National Consumers League (NCL) applauds the coordinated efforts of the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) to approve the Emergency Use Authorization (EUA) of the Pfizer-BioNTech COVID-19 vaccine for children ages 5 to 11. Consumers should be reassured that an unbiased advisory committee composed of medical and scientific experts have reviewed the data and have held public meetings to provide Americans with a transparent approval process.

“NCL is committed to educating consumers about vaccine safety and efficacy in order to increase vaccine confidence. Every day, parents make tough decisions to keep their children safe. We want parents to feel informed and empowered in their decision to vaccinate their children. As a parent of two boys ages 8 and 10, I’m looking forward to being able to protect my children from COVID-19 and put this pandemic behind us,” said NCL Director of Health Policy Jeanette Contreras.

Parents and guardians are encouraged to use the CDC’s V-Safe mobile app to tell the CDC about any side effects experienced after getting vaccinated. Parents will be able to add dependents to their account and get reminders if you need an additional dose. Register here: https://vsafe.cdc.gov/

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Jeanette Contreras portrait

¿Buscando cobertura médica? Healthcare.gov open enrollment begins November 1

By NCL Director of Health Policy Jeanette Contreras with contributions by NCL Intern Grace Mills

The 2022 open enrollment period for the Health Insurance Marketplace is about to begin! Consumers can enroll in a health plan on Healthcare.gov beginning November 1.

As we commemorate Hispanic Heritage Month, the National Consumers League (NCL) wants Latino consumers to better understand their health coverage options through the Health Insurance Marketplace. Latinos make up approximately 18 percent of the U.S. population and represent the largest minority population (62.1 million). However, it is concerning that 22 percent of non-elderly Latinos are uninsured – the highest uninsured rate of any racial group in the United States.

Under the American Rescue Plan, more consumers are now eligible for increased tax credits that further reduce the cost of monthly premiums. An estimated 69 percent of uninsured Latino adults can access a zero-premium plan and 80 percent can access a plan that costs less than $50 a month. Additionally, consumers can use the Healthcare.gov platform to find out if they or their dependents can qualify for Medicaid or the Children’s Health Insurance Program. Here is what you need to know to make sure that you and your loved ones are insured during 2022.

  • The open enrollment period starts on November 1, 2021, and runs through January 15, 2022. In order for your coverage to start on January 1, you must enroll by December 15, 2021.
  • Your income will determine what you will pay for your health coverage plan.
  • Applications will be accepted online, by calling 1-800-318-2596, or through a certified enrollment partner. Learn more about the different ways to apply.

This year, the Centers for Medicare and Medicaid Services (CMS) has issued $80 million in grants to fund Health Care Navigators across the country that are trained and certified to assist consumers with enrolling in a health plan. While agents and brokers are also available, Navigator Grantees are often a trusted source of information in their communities and can offer culturally competent enrollment assistance. Consumers can find local in-person assistance or an agent/broker in their area by clicking here.

¿Buscando cobertura médica? La inscripción abierta de Cuidadodesalud.gov empieza el 1 de noviembre

¡La inscripción abierta para el Mercado de Seguros Médicos por el año 2022 empezará muy pronto! Los consumidores pueden inscribirse en un plan de salud por medio de CuidadoDeSalud.gov empezando el 1 de noviembre.

Para conmemorar el Mes de la Herencia Hispana, la Liga Nacional de Consumidores (“NCL” por sus siglas en inglés) desea que los consumidores latinos conozcan sus opciones de cobertura de salud a través de los Mercados de Seguros Médicos. Los latinos constituyen el 18% de la población de los Estados Unidos y representan la población de minorías más grande (de 62.1 millones). Sin embargo, nos preocupa que solamente el 22% de los Latinos adultos (que no son mayores) no tienen cobertura de salud y representan la tasa más alta sin seguro médico de todos los grupos raciales en EE. UU.

Bajo el Plan de Rescate Americano (conocido como “American Rescue Plan” en inglés), más consumidores están elegibles por los créditos fiscales que reducen el costo de sus pagos mensuales. Aproximadamente, el 69% de los Latinos (no asegurados} pueden acceder a un plan sin costo alguno y el 80% pueden acceder a un plan que cueste menos de $50 por mes. Además, los consumidores pueden usar la plataforma CuidadoDeSalud.gov para ver si ellos o sus dependientes califican para Medicaid o el Programa de Seguro de Salud Para Niños (conocido como “CHIP” por sus siglas en ingles). Aquí está lo que necesitan saber para que usted y sus seres queridos tengan cobertura médica durante el 2022.

  1. El período de inscripción empieza el 1 de noviembre del 2021 hasta el 15 de enero del 2022. Para tener cobertura empezando el 1 de enero del 2022, necesitas inscribirte para el 15 de diciembre del 2021.
  2. Lo que tú pagarías por un plan de cobertura médica dependerá de tu ingreso anual.
  3. Se aceptarán solicitudes: En-línea, llamando al 1-800-318-2596, o cualquier sitio web de inscripción, que esté certificado. Para obtener más información sobre las diferentes formas de como inscribirse use este enlace: https://www.cuidadodesalud.gov/es/apply-and-enroll/how-to-apply/

Este año, Los Centros de Servicios de Medicare y Medicaid ha dado un subsidio de $80 millones para financiar los navegadores de salud a través del país que están calificados y certificados para ayudar con la inscripción en un plan de salud. Mientras que los agentes y corredores también están disponibles, los navegadores son una fuente de información en las comunidades latinas y ofrecen a sus comunidades asistencia confiada sobre la inscripción. Los consumidores pueden encontrar asistencia en persona o con un agente/corredor en donde viven, usando el enlace: https://ayudalocal.cuidadodesalud.gov/es/#/

What’s in that gummy bear could be hazardous to your kid’s health

CBD-infused foods and candies are often packaged and marketed to appeal to children, but buyer beware – there are a number of harmful ingredients that could be in a seemingly harmless gummy bear. Parents, teachers, guardians, and loved ones should know that none of the non-prescription CBD products on the market today – and the false medical claims often used to market these to consumers – have been tested or approved by the FDA.

Intern Spencer Cramer

Redesigning our communities to fight health disparities

Intern Spencer CramerBy Spencer Cramer, NCL Health Policy Intern

Spencer is a student at Brandeis University, where he is studying Politics and Health: Science, Society & Policy.

The COVID-19 pandemic has fostered a better understanding of how a public health emergency can devastate different groups of Americans already negatively impacted by health problems. These health disparities, which are differences in health outcomes based on factors such as race, ethnicity, or socioeconomic status, are deeply influenced by “social determinants of health.” Social determinants of health are factors in our environments and societies that have a large impact on someone’s health status, independent of their personal choices or lifestyle.

These social factors are the main contributors to health disparities, which represent one of the ugliest faces of inequality in America today. An example of how social determinants of health and health disparities are inextricably linked can be seen in the maternal mortality crisis, where Black women are more than three times more likely to experience a pregnancy-related death than white women. This disparity can be attributed to institutional racism, lack of access to maternal health services, and the aggregate stress of dealing with discrimination on a daily basis.

Even more illuminating, one of the best predictors of health outcomes is a person’s zip code. In many major U.S. cities, the gap in life expectancy between the highest and lowest zip codes is 20+ years. Similar gaps can be seen between different cities and states. Additionally, it is clear that locations with predominantly low-income populations and many people from racial or ethnic minority groups generally experience worse health outcomes than wealthier, white areas. Geographic location is an excellent predictor of health status for a couple of reasons. Our society still has a tremendous amount of segregation, as people of the same race, ethnicity, and socioeconomic background tend to live near each other. This means that the health inequities facing these groups become disproportionately concentrated in certain neighborhoods.

Another reason for these geographic health disparities is how under-resourced the physical neighborhoods are. Poorer and heavily minority neighborhoods are less likely to have parks, green spaces, quality grocers, and health services, and they are more likely to be afflicted by environmental pollution and other societal abuses. Urban planning has a huge impact on public health. Ensuring that we build our cities to equitably distribute public services and amenities will be a critical strategy in addressing social determinants of health and eliminating health disparities.

One way to create healthier communities for all would be to increase the amount and quality of green spaces like parks or urban forests. A large body of research suggests that urban green spaces provide a wide variety of health benefits to residents ranging from increased opportunities for exercise, cleaner air, and improved mental well-being. Urban trees are proven to be particularly important for removing pollutants and addressing other environmental risks, while improving many different health outcomes. Unfortunately, green spaces, parks, and urban trees are concentrated in whiter, richer, and healthier neighborhoods. Investing in parks and green urban spaces in disadvantaged communities can go a long way towards boosting health outcomes and increasing economic opportunities for those residents.

Perhaps nothing is more important for a community’s health than access to quality, nutritious, and affordable food. Unfortunately, millions of Americans live in food deserts, areas where there is little supply of nutritious, whole foods. Again, food deserts predominate poorer neighborhoods and racial and ethnic minority communities. Living in a food desert means that people cannot access healthy or substantial food at an affordable price, inadvertently resorting to more expensive, lower nutrition food from places like convenience stores. Poor diets driven by this lack of food access cause tons of health problems and are a key driver of health disparities. As a society we often associate diet with personal choice. However, people living in food deserts usually have no option other than to eat low-quality food, and subsequently suffer from the health consequences. Ensuring that all neighborhoods and communities can easily access healthy food at affordable prices will surely help to reduce disparities in areas such as obesity, diabetes, heart disease, and others. What we eat everyday has an astronomical impact on our health, so we must make equitable access to good food a priority when creating healthier communities.

Similarly, many of the same neighborhoods plagued by food deserts also suffer from a stunning lack of access to health and medical services. Many healthcare resources are concentrated in areas with higher insurance rates, especially places with high rates of private insurance, leaving neighborhoods with many uninsured or Medicaid-eligible residents without needed health providers. The health consequences caused by the uneven distribution of health services can be devastating and can result in the delay in crucial preventive health screenings. To address this, we can provide incentives, like additional funding or student loan forgiveness to health care providers who practice in underserved communities, and implement public policies to achieve an equitable geographic distribution of medical resources.

A final factor that leads to these health inequalities between zip codes is pollution. It is certainly no secret that environmental pollutants are often horribly damaging to human health. They can cause diseases ranging from asthma to cancer, and are devastating for any community that they afflict. And of course, pollution has a disparate impact on lower-income and predominately minority communities. Developers frequently choose to build factories and other waste-producing sites in these communities because their residents have fewer resources and less political and social capital to advocate against them. Nobody should be subjected to residing in the midst of toxins and waste.

This will require a massive shift to clean energy, responsible development, and safer waste disposal. We can create more health equity by eliminating the health costs brought upon poor and minority communities by pollutants. Designing our neighborhoods and cities with a focus on public health and health equity will help to close the gaps in health outcomes between different zip codes, and should be one of our top priorities as we battle health disparities and social inequities.

Addressing vaccine hesitancy with community-driven messaging

Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy, featuring an interview with Jens Dakin, Managing Director of AM LLC

After months of vaccine review and approval informing an arduous national vaccination campaign, nearly half of the country has been fully vaccinated against COVID-19. However, despite these efforts, we’ve narrowly missed the national goal of 70 percent of Americans receiving at least one dose by July 4. Even though there is overwhelming evidence in support of the COVID-19 vaccines and their safety, vaccine hesitancy still looms.

On July 8, the NCL health team met with Jens Dakin, Managing Director of Strategic Engagement at AM LLC. AM LLC is a health and research informatics firm that provides public health related, mission critical services in information, communications, and technology to federal, state, and local government clients. Since March 2020, AM has partnered with government agencies to control, isolate, and mitigate the spread of COVID-19 through various community engagement and vaccine quality assurance measures. Below is a snapshot of our conversation.

Nissa: For over 120 years, the National Consumers League has advocated for consumer protections in health care. A big part of our work involves fostering vaccine confidence. We do this through direct consumer engagement, testifying before federal vaccine committees, like the CDC and FDA, and our Script Your Future campaign, where we engage with pharmacy students to increase vaccine uptake. We would love it if you could tell us a little about AM Trace work in vaccine confidence.

Jens DakinJens: Thank you, and nice to meet you both. AM was founded about 10 years ago to provide services to the federal government in research, communications, and healthcare IT. When COVID-19 spread to the US there was a lot of effort by the federal and state governments to keep people safe with COVID-19 threat mitigation, and then to get people to take the vaccine. AM now provides capabilities in five critical services to state and local governments, including staffing and training of public health personnel, technology support infrastructure, public awareness outreach campaigns, stakeholder collaboration. We work with key public servants to help increase capacity pertaining to COVID operations.

Spencer: When you first enter a community, how do you get your foot in the door and begin to understand the specific needs of the community so you can begin to build your campaign strategy?

JD: Ultimately, we don’t like to enter a community cold. We undertake lots of research before hitting the ground to understand the demographics and the local context. It is important for us that our local partners know the area, the people and have the access we need. Whether it’s an African American community, or a White, rural Republican-leaning county, we can make some educated guesses, but we certainly cannot make assumptions about the individuals without the local data and insight. This initial research frames how we empathize and engage with the community, allowing us to develop more credible messages that will resonate better. We don’t tend to advocate mass media campaigns, especially now when there is a need to persuade the vaccine holdouts, because the mass campaigns haven’t worked with them.

NS: On mass vaccination campaigns, I recently came into contact with an old friend that has become increasingly anti-vaccine and cited vaccine lotteries and giveaways as suspect. Do you think that these mass efforts are causing more harm than good?

JD: I believe that they have achieved what they set out to do. They have worked to an extent, to get the people who want to be vaccinated, vaccinated. Unfortunately, there is now considerable distrust in government authority in our society – much of it caused by the spread of misinformation and disinformation. Your friend views her belief as completely rational based on the information she has. For the vaccine holdouts, the message needs to come from a trusted voice and delivered in a non-intrusive way. What we are seeing working in some cases is developing a series of different “micro-interventions”, in the form face-to-face conversations, a series of emails or chats on a group message board. We can even learn lessons from deradicalization programs that have helped to sway people away from the path towards terrorism, where we listen, understand, and engage with empathy.

NS: I really like the idea of “micro-interventions”. Is there a designated period of time you allow yourself in a particular community to test these messages and strategies to see if they land before moving on from that group?

JD: We have to test and adjust all the time. This is an evolving situation. You really just need to remember that when you convince someone to get vaccinated, you’re potentially saving their life. If you keep building that relationship with the community, that can end up going a long way. This is why it’s so important that our local messengers, or canvassers, are all from the communities we are engaging within.

NS: Could you provide some examples of success stories as a result of these interventions?

JD: In NYC, AM’s teams have spoken with over 180,000 residents and as a direct result of our personalized messaging campaigns and direct engagement within [mainly minority] communities, encouraged over 50,000 people to book vaccination appointments. In Anchorage AK, AM’s teams identified, contacted, and built relationships with individuals living in both urban and rural communities with the goal of addressing vaccine hesitancy and booking vaccination appointments. During a single 6-week span of all the unvaccinated people they spoke with, they arranged for nearly 20 percent of them to get vaccinated.

NS: Who do you use in community outreach to build these relationships?

JD: We don’t tend to use professional canvassers. We prefer to recruit and train local canvassers specifically from their community. We speak with the community and individuals to find out who the local influencers are – who they trust. We meet with them and ask them to work with us because need them to become our message multipliers within that community.

NS: The COVID-19 vaccine development and approval process has been as novel as the disease itself. We’ve had the privilege of witnessing science unfold in real time, and along with that, comes a lot of trial and error, as we’ve seen with the momentary pause in the J&J vaccine and the new cases of myocarditis in pediatric populations. How do you mitigate the derailment of messaging, which have been extensively tested, by rise in these developments?

JD: Well, we know that with these holdouts, and these “wait and see” groups, science and facts won’t sway them. The issue is not necessarily about vaccine information, there is a lot of information out there. So, if you’re using science to try to convince people who are ideologically entrenched in one belief or another, they might not understand what you’re trying to say which will turn them off, or they may come up with counter arguments or “counter-facts” that support their own beliefs. They may also exist in information silos, or information echo chambers, that feed them information which confirm their biases. So no, using science will often not work with hold out groups. Which is why we need to find more innovative methods that focus on more accessible and personal benefits of vaccination.

NS: AM trace has a great vaccine confidence toolkit for community leaders which mentions the importance of decision autonomy for patients in vaccine confidence. With public sentiment headed towards vaccine mandates, to possibly issuing vaccine passports– do you see any challenges with that? How can advocates help reduce weariness around these initiatives in a way that is aligned with an individual’s constitutional rights?

JD: As communicators, we should not have any say in developing policy. Whether vaccine mandates are right or wrong, is not an issue I will discuss here. What I will say is that for those employers and institutions who are mandating it, when developing their campaign is that words matter, and the messaging and messengers matter. Employers need to understand that their ‘single’ workforce is made up of many separate communities each with their own concerns and beliefs. You need to understand the behavioral and emotional context that people exist in order to have the best chances of success. The toolkit you mentioned provides communication planners with an overview of what to consider when developing behavior change campaigns. It works very well in the COVID-19 context.

NCL Health Policy Intern Spencer Cramer contributed to this blog.