Campaign Approach to Reaching American Indian/Alaska Natives

Overview

• In many places, American Indian/Alaska Native (AIAN) people have treated COVID as a serious public health threat throughout the pandemic. Multiple tribal governments have kept mask mandates on their tribal lands even when local or state governments have ended these requirements. By nearly all accounts, AIAN people were quick to embrace vaccines upon their availability in early 2021, and many tribes reported high vaccination rates. The Indian Health Service (IHS) received a positive response to its rapid rollout of vaccines, despite a widespread perception that the agency has a poor track record of effectively serving AIAN people.
• The AIAN population faces disproportionate risks from COVID due to significant underlying disparities in health, social and economic factors, and challenges in accessing quality health care. At the beginning of the pandemic in 2020, the Navajo Nation and other tribes in the Southwest reported among the highest rates of infection in the entire United States.
• Although specific data can be difficult to obtain, AIAN people have experienced reduced uptake of boosters, in comparison to the delivery rates of the initial vaccine regimen. Vaccination rates of AIAN children also are below the initial rates of AIAN adults.
• Testimonials from trusted messengers, particularly tribal elders and leaders, are key for this audience. Acknowledging the importance of preserving culture is also a motivator for protecting the community from COVID.
• Many tribal nations have experienced great cultural and traditional knowledge loss due to deaths among elders and other cultural leaders from COVID and spikes in mental health issues, including depression and suicide, due to lockdowns and social isolation.
• To address these barriers, the Campaign has been taking a regional approach to messaging and outreach, incorporating authentic voices and images of tribal leaders, influencers, and community members to provide relevant messages from trusted sources.

Audience Market Research and Testing

A robust and continuous cycle of research drives all Campaign activities, including the approach to reaching AIAN audiences.

• Primary research includes focus groups and interviews, creative testing surveys, and a weekly current events survey (a probability-based survey of 1,000 representative U.S. adults ages 18 and older), with findings provided by key demographic groups. Additional research includes audience segmentation and monitoring of news stories, social media, and secondary research. Findings are summarized for use across the Campaign.
• Additional outcome surveys and analysis, along with social listening, enable performance tracking and real-time impact assessment to inform quick adjustments to messaging in a rapidly changing environment.

Key Messages for Audience

The Campaign’s approach is based on the premise that each AIAN community wants to hear from authentic voices of tribal leaders and community members who can provide information that acknowledges the importance of preserving culture as a motivator for protecting the community from COVID.

Messaging guidance is based on qualitative and quantitative message testing insights, guidance from the Centers for Disease Control and Prevention (CDC), expert recommendations of audience-specific creative agencies, environmental scans, credible external research results, social listening, and iterative testing, among other inputs.

Current Campaign messaging centers on encouraging boosters among the highest-risk populations—older adults and those with chronic medical conditions that make poor COVID outcomes more likely. Specifically relevant messages for speaking about boosters to those who are 50 and older:

• During the peak of the Omicron surge, people ages 50 and older were hospitalized with COVID at twice the rate of younger adults, and those ages 65 and older were hospitalized with COVID at 4 times the rate of younger adults.
• Nine out of 10 people who have died from COVID in the United States have been ages 50 or older and three out of four have been 65 or older.
• Rates of diabetes and hypertension are higher in the AIAN population than among non-Hispanic White people, and these conditions, as well as cancer or lung, heart, or kidney disease, can make it more likely that people will die from COVID if they get infected.

Campaign research has demonstrated that, across all audiences, messages indicating that vaccines and boosters together protect against the worst outcomes of COVID and that boosters extend protection to keep one safe from emerging variants have generally been the most effective at driving intent to get a booster shot. Our research has not found unique booster messages that are effective to this audience specifically; however, the following messages were the top performers for all audiences to encourage boosters:

• COVID can cause severe disease, hospitalization, or death. Vaccines and boosters offer you the best protection from the worst outcomes of COVID.
• Over time, vaccines may become less effective at preventing COVID. Getting your COVID booster extends your protection and keeps you safer from emerging variants.
• We’ve entered a new phase of the pandemic, and we know more about the virus than ever before. We know that if you’re vaccinated and boosted, you’re 2 times less likely to get COVID than if you’re unvaccinated. Getting vaccinated and boosted is your best defense against COVID.
• Just because you had COVID doesn’t mean you can’t get it again. A COVID vaccine and booster are the best way to protect yourself against serious illness, hospitalization, and death.

Other Campaign messages continue to encourage parents to vaccinate their eligible children. Fewer than 70 participants in Campaign message testing for parents were from the AIAN community, but these two messages appeared to be the most effective at driving vaccine intention for their children.

• Our children rely on us from day one, and as they grow, we do everything we can to protect them. Protect your child from severe disease with a safe and effective COVID vaccine.
• Children who get vaccinated against COVID usually have the same type of temporary side effects as they’ve had with other childhood vaccines that they’ve gotten previously.

For parent audiences overall, Campaign research indicates that messages about the benefits of being vaccinated worked better than those that focused on the risks of children having COVID. These messages, in addition to the top message for the AIAN community above, were the top overall performers:

• Even though many children have had mild cases of COVID, you can’t predict how COVID will affect your child—even if they are completely healthy. The best protection is vaccination.
• Decades of research on dozens of vaccines have demonstrated that side effects usually show up within six weeks of vaccination. COVID vaccines have been studied and tested for almost 2 years in tens of thousands of adults and children, and serious side effects are very rare.
• The vaccine offers the best protection available for your child from severe illness or death if they get COVID.
• COVID has had a tremendous impact on all children. Their lives have been interrupted by the pandemic. COVID vaccines help us keep kids in school and daycare and helps them enjoy their lives again.
• COVID vaccines have helped prevent severe disease, including hospitalization and death, against all COVID variants we’ve seen so far.

Partnerships and Outreach

Key Activities and Metrics to Date

• We have routinely held virtual AIAN town halls, featuring experts from the IHS and local communities and jurisdictions, which have led more people to volunteer as trusted messengers in their respective communities.
  • Speakers have included tribal leaders, IHS representatives, tribal community advocates, Native American health care providers and parents, and other health care providers who serve the AIAN population. More than 150 AIAN organizations have participated in the town halls.
  • Town halls are live streamed on YouTube Live and Facebook Live, and each event averages a reach of 10,000 people, both from people watching the town hall live and watching the recording 1 to 2 weeks after the event. Moreover, video highlights are produced to point viewers to the We Can Do This website and to generate interest in future town halls.
• AIAN toolkits were developed and provided to regional tribal nation consortia and tribal leaders with regionally appropriate materials designed to instill vaccine confidence and encourage preventive measures against COVID.
  • The messages, design, and imagery are specific to each region and include factsheets, talking points, drop-in newsletter articles, social media templates, and posters.
  • Customized toolkits have reached 12 regional tribal consortia, with a combined membership of 352 tribal nations.
• To date, we have produced four culturally competent videos for use in partnership activities. The videos are available across Urban Indian Organizations’ social media platforms, websites, and e-newsletters.
• We recently held an HHS booth promoting boosters at “America’s largest pow-wow,” the 39th Annual Gathering of Nations Pow-Wow in Albuquerque, NM. More than 75,000 people, representing the 750 state and federally recognized tribes throughout the United States and Canada, attended this event. Over 3 days, we not only promoted COVID boosters and vaccinations but also reached out personally to our audience by gathering their stories on how COVID has impacted them. These authentic testimonials are being prepared for use as an earned and paid media AIAN audience direct public service announcement (PSA).

Paid Media

Key Activities and Metrics to Date

• Comprehensive paid advertising is directed at total market audiences, including national and local television and national radio. Custom creative for the AIAN community has additionally developed for local radio, digital, social, and print in regional markets that vary by campaign.
  • Ads are tailored to population needs to increase vaccine confidence while reinforcing basic prevention measures.
  • Ads align with the total market campaign, with a focus on young adults ages 18 to 25, older adults ages 65 and older, the Movable Middle audience (adults ages 18–40), and parents of children ages 5 and older.
• Nearly 90% of the media spend for AIAN audiences to date has been spent with AIAN-owned and operated media partners.

Milestones

• Early in the Campaign, Slow the Spread efforts included customized AIAN collateral and reinforced basic prevention measures with ads in radio, newspaper, digital, and social media.
• Building Vaccine Confidence efforts, the Campaign’s advertising push, focused on building vaccine confidence, initially focusing on older adults as the first-eligible group for the vaccines, then targeting health navigators (the health care decision-makers in families), young adults, and adding parents of children eligible for vaccination as CDC announced new eligibilities. Encouraging COVID boosters among high-risk populations is the current focus of paid advertising.

Earned Media

Key Activities and Metrics to Date

• Local and regional media interviews with AIAN trusted messengers, such as tribal leaders and health care providers, were arranged in the top 25 AIAN markets, as well as the 10 AIAN markets with the lowest vaccination rates.

Trusted Messengers

Knowing that the AIAN audience is best served overall on a regional level, local tribal leadership, tribal health care directors, and other representatives are our most trusted messengers for reaching the six regions representing over 500 state and federally recognized tribes in the United States, including Alaska.

The creative campaign has also featured a nationally known AIAN talent to broaden its reach.

Creative/Partnership

Snapshot: Creative for Partnership Resources and Toolkits

• Sample Social Media Post for American Indians/Alaska Natives – March 2021

• Together We Can Do This – Fact Sheets for NE, NW, Plains, SW and All Regions – March 2021

• Together We Can Do This – Flyers for NE, NW, Plains, SW and All Regions – March 2021 

• Let’s Do Our Part – Posters, NE, NW, Plains, SW and All Regions – March 2021 

• Mommy’s Baby :15 – PAID ADVERTISING – Launched January 2022 

• Modern Day Warrior :15 – PAID ADVERTISING – Launched June 2021   

• Let’s Get Back to Making History :15 – PAID ADVERTISING – Launched August 2021 

• Digital PAID ADVERTISING – Launched November 2021

• Digital PAID ADVERTISING – Launched January 2022 and May 2022

Contact Us

Please visit cdc.gov/coronavirus for more information on COVID, or visit WeCanDoThis.HHS.gov and click on “Contact Us” for questions about HHS’s work to boost public confidence in vaccines.