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Impeccable data, trusted messengers and convenient access, that’s what works. Judgy finger-wagging? Not so much.

Those are the keys to turning vaccine hesitancy into vaccine uptake according to experts in the coalition, a national multidisciplinary effort launched in 2020 in collaboration with the ����ɫ��. Dedicated to changing behaviour and building confidence in COVID-19 vaccines, they are asking for your help to get the message out. 

“We need vaccine champions!” says Heather Bensler, RN, MSN, an instructor in the Faculty of Nursing working with 19 to Zero. “When someone you know and trust gets the vaccine, it increases confidence in people who are maybe on the fence. Those conversations are probably the most effective thing we can do.”

To spur those conversations, 19 to Zero recently helped launch , enlisting an array of celebrities from Hayley Wickenheiser and Michael Bublé to Ryan Reynolds and Chris Hadfield to post their support for vaccines. “These are folks who already have a voice, so if we can partner with them it strengthens our message,” Bensler says.

And it’s not just celebrities that carry sway, she says. “Every friend I have is posting photos of themselves getting the vaccine. When we share that, we build a sense of solidarity, and that has an impact.”

Bensler walks the talk. She says right now she’s having three or four one-on-one conversations a day about the vaccine, whether it’s with a woman who is pregnant and in doubt, or an old friend who is reticent about the vaccine. “I want to hug my parents and gather again,” she says. “Vaccines are an individual intervention, but they only work if the majority of the population gets it.”

Building confidence, battling complacency, and providing barrier-free convenience

“Just correcting misinformation alone doesn’t work,” says Dr. Cora Constantinescu, MD, an assistant professor in the Cumming School of Medicine working alongside other experts with the 19 to Zero coalition. “We think that if people just have the right facts, it will make all the difference, but that’s not it.”

People need to see how those facts relate to their own lives, their own view of the world, and what matters to them personally, says Constantinescu, whose work at the vaccine-hesitancy clinic at the Alberta Children’s Hospital informs her contributions to the 19 to Zero effort.

“Overcoming vaccine hesitancy is usually about three things: Confidence, complacency, and convenience,” she says. That is, people need to feel confident in the safety and efficacy of the vaccine and in health agencies; to believe the vaccine is necessary and the disease is actually a threat; and to have convenient access to the vaccine through measures like paid sick days, transportation, worksite clinics or translation services.

“It’s a constant shift where the hesitancy is coming from and that’s the power of 19 to Zero. We have people analyzing in real-time the reasons for hesitancy, and then people working to address those specific concerns,” she says. “What works is being fluid. There is a different hesitancy of the week, and it’s changing all the time.”

Constantinescu says the 19 to Zero coalition has broadened the scope of available approaches. “It has opened my mind to solutions and possibilities I could never have done otherwise,” she says. “All of a sudden the solutions that you come up with are so much bigger than your own niche.”

Driving attitude change with in-depth, real-time data

19 to Zero takes a multimodal approach to understanding and engaging with shifting perception toward COVID-19. Its contributors have provided in-depth research, created educational tools for , done , and engaged governments. Its “Nudge Unit” is led by behavioural economists, there’s a social media analytics team tracking vaccine sentiment across North America, and there are grassroots initiatives like #ThisIsOurShotCA and broader-based national advertising campaigns. The team is going all-out, acutely aware of the stakes.

“If Cora could have a conversation with every Canadian one-on-one, we could get a very large number of people vaccinated, but Cora doesn’t have the time to have a conversation with 35 million people,” says Dr. Jia Hu, MD, co-chair and co-founder of 19 to Zero, and clinical assistant professor in the Cumming School of Medicine. “So that’s where we begin to activate other loci of trust, with more voices telling people that getting vaccinated is important and why.”

“We have to go a level beyond just telling people to go get vaccinated, and be data-informed,” Hu says. “For instance, we saw in our weekly survey that after NACI (National Advisory Committee on Immunization) suspended AstraZeneca for under-55s there was a 30 per cent decline in people wanting that vaccine. Having that ability to collect data in real time is incredibly useful.”

UCalgary sets a Canadian example

Like Constantinescu and Bensler, Hu emphasizes the necessity of a whole-society approach, and includes not just individuals doing their part but also institutions like the ����ɫ��, which he credits for helping 19 to Zero launch and succeed.

“The extent to which ����ɫ�� has worked with public health and government is unprecedented,” Hu says. “I’m so grateful, it’s really beautiful actually the support from across campus. A great example is the med students stepping up to do contact tracing in the first wave. This was the only place that was happening.”

Hu and his 19 to Zero colleagues are cautiously optimistic. “We have the key out of the pandemic, and that’s really good,” he says. “We will get there, but the pace will depend on how quickly we get people vaccinated.