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Covid Breakthrough Cases Pose Test for Vaccine Messaging Efforts

Aug. 11, 2021, 9:35 AM

The rise in Covid-19 infections among the vaccinated is hastening the need for Americans to get immunized and for clearer, more effective communication to convince holdouts to get their shots, health policy experts say.

Covid-19 breakthrough infections are rare, and the number of those suffering serious complications is exceedingly small. The Centers for Disease Control and Prevention as of July 26 pegged the rate of hospitalizations or deaths among the vaccinated at less than 0.01%.

But some observers say certain headlines are sensationalizing breakthrough cases and muddling the messaging that vaccines fend off serious illness. They also say government attempts at communicating and guiding the nation through an ever-changing pandemic leave some people confused about how to best protect themselves—and others unmotivated to get their jabs.

“The messaging has not been as clear and as helpful as it could have been,” said Wendy Parmet, director of Northeastern University’s center for health policy and law. “Health officials, media, and folks who support vaccination perhaps oversold it in ways, so now the breakthrough cases seem inconsistent and undermining.”

Quick-changing guidance may contribute to the confusion due to developing information on virus transmission, fluctuating infection statistics, and variants of varying infectiousness.

“It’s very hard for anyone to hold onto the fact that information is changing, that where we were in February isn’t where we were in May, isn’t where we are now, that science works through the accumulation and analysis of new data,” Parmet said. “It’s not that people are playing Three-card Monte, but things are really changing. Advice that was accurate on Monday might not be the same so Tuesday.”

Policy experts say that messaging efforts have focused too much on the vaccine as an end-all to the pandemic, and that individuals in positions of trust need to communicate the individual responsibility of those who are vaccine hesitant to contribute to the greater good.

‘Kind of Panacea’

The CDC says about half the country has yet to be fully vaccinated. The trajectory of the virus has also taken an unexpected turn in recent weeks, shifting the focus from a return to normal to an increase in infections.

“Until a month ago, all the stories were about vaccination. Now all of us had to shift and talk about spikes, breakthrough cases, mask guidance, revisiting indoor restrictions,” said Kasisomayajula Viswanath, a health communication professor at Harvard University.

“People are just tired of this, and we sort of unintentionally implied the vaccines are a kind of panacea—Just get a vaccine and you will be alright. And that’s true, but maybe we unintentionally implied you won’t get the disease,” he said.

Some may point to breakthrough cases as evidence of vaccine flaws, but health professionals say that may be because of a misunderstanding of what vaccines actually do.

Whether it’s treatment for cancer, Covid-19, or any other disease, “people always want to know if they’re fully protected,” said Ismail Nabeel, associate professor at Mount Sinai specializing in public health.

“People want to get a shot or drug that can eradicate a disease completely,” Nabeel said. But getting a disease “to a point where it’s completely suppressed” allows an individual to “live a healthier, normal life” and marks a major milestone for a treatment, such as was done with HIV.

With the Covid-19 vaccine, “we have seen a significant decline in hospitalization and death. That itself lends to a very specific thing the vaccine does—it prevents severe morbidity,” Nabeel said.

But communicating that to the public gets complicated as breakthrough cases continue to occur. Such cases aren’t unheard of for non-Covid-vaccines, Nabeel said, noting they’re “very normal” for those inoculated against the flu.

Generally, “the messaging around breakthrough cases made it seem like they just didn’t happen,” Parmet said. “I don’t think the public was prepared,” and for some, “it’s out of the blue, a whiplash.”

‘Same Page’ Messaging

Communications during the pandemic’s early stages focused too much on herd immunity, and instead should have been centered around getting “anyone and everybody vaccinated,” said Viswanath, who has studied Covid-19 social media misinformation.

While the current administration is beating its predecessor in keeping a sound message together, the government would benefit from a single point person communicating pandemic updates “every day in a way you can trust,” Viswanath said. A slew of health officials and government personnel have discussed pandemic updates and guidance with the public.

Transparency and “all of us being on the same page” is better than having “five spokespeople commenting on different networks,” Viswanath said.

Inconsistency has plagued messaging on masks, vaccine strength, spacing, and more from government officials and others, largely because experts are learning as the pandemic propels forward.

The need for those in charge to act on their feet amid a rapidly changing environment is a fact often lost on the public. Still, government leaders communicating pandemic response efforts and guidance need to “understand a lot more about the social and political and cultural dynamics of our health policy,” Parmet said.

Knowledge of your audience is critical. For example, when the CDC said in May that only vaccinated people need to wear masks, they should have been aware that those without jabs would also drop their face coverings as well, Parmet said.

Another communication misstep has been tailoring communication around “individual tolerance for risk” rather than the greater good, she said.

That messaging “gives rise to the idea that if it’s all about me, and I think I’m healthy and young and am not a risk-adverse person, I don’t have to get vaccinated,” Parmet said.

Gaining Trust

Gaining trust is also key to effective vaccine communications, experts say.

“One of the strongest early predictors” for “discounting the risk associated with Covid-19 was medical distrust,” Keith Holyoak, a UCLA psychology professor who studied public perceptions of Covid-19, said, referring to a study he did with graduate students last year.

Conversations between doctor and patient can make the difference in convincing someone to get a jab. Keeping the message “as consistent as possible” while providing “proper information” from reliable sources helped Tanisha Taylor, CMO at health-care system RWJBH Corporate Care, “reeducate” a skeptical staffer and persuade them to get vaccinated.

“There’s still a lot of fear just regarding the vaccine,” she said. And when informing others, “you don’t want to be condescending. You have to meet them at their level of understanding. You don’t want to be the know-it-all or authority. You have to gain their trust or confidence.”

But variants and breakthrough cases only complicate these efforts.

“The science itself is always messy. It’s evolving, and our understanding continues to evolve,” Nabeel said.

To contact the reporter on this story: Ian Lopez in Washington at

To contact the editors responsible for this story: Fawn Johnson at; Alexis Kramer at