How many celebrities would need to get the COVID vaccine for you to decide to get it, too? Faced with a crisis of public trust, public health experts are asking themselves exactly that.

The development of the COVID-19 vaccine is perhaps the fastest effort of its kind ever, fueled by a collective urgency from governments, healthcare workers, businesses, and ordinary citizens desperate to return to a normal way of life. Flush with funding, major vaccine producers have hurdled technical challenges, logistical impossibilities, and problems of sheer scale only to reach their last obstacle: convincing a skeptical public that vaccines are safe, effective, and necessary.

To build trust in the vaccine (and rebuild trust in public health institutions), governments and nonprofits alike are turning to influencers, who they hope will leverage their social media power to promote the vaccine’s necessity. Early in the pandemic, the Trump administration reached out to major celebrities urging them to spread preventative public health information to slow the spread, with mixed results and false starts (the celebrity-oriented plan was scrapped). There was Youtube’s call for Content Creators to #StayHome, later championed by influencers and celebrities from their own luxury houses. There was the #SafeHandsChallenge, shuffled between major celebrities from Ariana Huffington to Selena Gomez. There were bedazzled masks, Instagram Lives, live-streamed concerts, at-home fashion campaigns. There was the unforgettable, now-infamous "Imagine" cover.

Influencers may have fumbled in their clumsy participation in social movements and their out-of-touch (and out of tune) delivery, but they have long been at the forefront of wellness trends—and they wield incredible power over public opinion. Following the guidance of researchers like Carly Goldstein, who proposed that we “will need a variety of influencers to effectively motivate different segments of the population to achieve herd immunity (estimated at 75 to 85%),” everyone’s trying out their own version of an influencer-driven public health campaign. The UK’s NHS has launched a program asking “sensible” celebrities, like popular soccer players and the Royal Family, to get vaccinated publicly in order to build trust. In the US, there’s a robust industry of private healthcare companies advertising through influencers. WEGO Health, which works with major healthcare companies like Pfizer, specializes in “pharmaceutical grade marketing,” connecting the industry with “Patient Leaders.” 

The FDA has taken steps towards influencer regulation, offering guidelines for communication. Doctors have also launched their own social media programs to #VerifyHealthcare. And the Ad Council, the non-profit consortium of agencies behind some of America’s most iconic campaigns, has been tapped to guide the COVID-19 Vaccination ad campaign. They’ll take a multi-pronged approach that includes, “uniting trusted messengers, influential voices and large-scale platforms around consistent, research-based messaging.”

Ad Council CEO and President Lisa Sherman said that a successful campaign “can transform life as we know it today and save hundreds of thousands of lives.” Their $50 million project, potentially the largest public health campaign in American history, is multifaceted: promoting mask adherence, correcting misconceptions, and encouraging vaccine uptake.

This trust-building has been especially effective in the case of micro-influencers. In a study conducted by researchers from Northwestern University and The Public Goods Project, micro-influencers (social media presences with less than 10,000 followers) were commissioned to promote flu vaccination to their audience with unbranded, native content. The results—increasing vaccination through influence—were encouraging, promoting vaccine awareness and uptake in marginalized communities. The researchers concluded that “large-scale campaigns must take a ground-up rather than top-down approach” and that “by strategically leveraging community- and state-based influencers, and more tactically employing paid and earned media opportunities, flu campaigns can better reach priority audiences, increase positive perceptions about flu vaccination, and ultimately increase vaccination coverage.” 

For marginalized and high-risk populations, tapping micro-influencers is even more important than leveraging celebrities and mega-influencers. Joe Smyzer, the CEO of PGP, told Fast Company. “If messages come from people who you perceive to be basically more like you⁠—your friend, neighbor, coworker⁠—the more likely it is to have an impact or be more open to performing certain behaviors.”

But while influencers are popular, they’re not universally-liked—and they make mistakes. More than anything, their prioritization has raised questions of fairness: should influencers, who are usually wealthier and work non-essential jobs, get the vaccine before others in greater need? While the vaccine remains scarce, some have argued that it should go to the ultra-wealthy first, but most people reason that it should go to the most vulnerable populations, and those working to keep us all safe.

On Sunday, the CDC voted on new guidelines for vaccine delivery and administration, placing frontline essential healthcare workers at the front of the line in Phase 1a, followed by other frontline essential workers and people over age 75 in Phase 1b and 1c. On the ground, it’s been more complicated. From hospitals to elderly care facilities, questions remain for who might access the vaccine, and those most at risk have advocated for more equitable vaccination schedules. 

At the Stanford Medical Center, nurses and residents staged a major walkout in protest of their hospital’s decision to assign nearly all 5,000 vaccine doses to administrators working from home, rather than frontline residents. On a national stage, Americans watched prominent politicians receive the vaccine despite their inability to protect Americans from the pandemic itself.

The question of fairness remains: are influencers leading the charge, or are they merely skipping the line?

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