Can Pro-vaccine Influencers Win Instagram?

In a pinch, local governments are turning to influencers. Lots of them. As many influencers as they can get. “More is better,” says Jeff Niederdeppe, a communications professor at Cornell University who studies the effectiveness of public-health campaigns. The “level of exposure to the message makes a huge, huge difference.” The biggest public-health campaign of the 21st century so far will involve all the classic tools—TV and radio spots, flyers, and billboards—but an army of influencers may end up being just as central.

Whether that army will be successful, though, is another question. No offense at all to the boys with the immaculate biceps, but it’s worth asking what might happen when the nation’s health outcomes are put in the hands of the boys with the immaculate biceps.

Influencers look like a simple solution to a common problem for public-health communicators: They need to reach people who don’t want to be reached, but who spend a lot of time on the internet.

Familiar faces can affect health-related behaviors, for better or worse. (Imagine a Millennial who vapes because she saw it on Instagram and who gets an annual mammogram because she read about Angelina Jolie’s double mastectomy.) So a local health department might try to use that influence for highly targeted outreach that fills the gaps in traditional media campaigns. Rob Perry, the CEO of XOMAD, told me that his public-health efforts tend to draw on influencers with fewer than 10,000 followers. “What’s important is that they’re not professional influencers,” he said. “They have jobs. The vast majority have never even been paid for a post before we contact them. They have real connections with their followers, and their content is seen as organic.”

These campaigns are built on good information, because influencers are able to confer with experts on XOMAD’s custom-built forums. But the campaigns are not specifically about information. They’re about personal stories, emotional appeals, and that buzzword, authenticity. The tactic is a borrowed one, taken from anti-vaccine activists and the vaccine-suspicious wellness influencers who have been parroting their talking points on social media for the past decade. Prior to the pandemic, “the phenomenon of anti-vaccine messaging was going through these networked, authentic voices,” says Kate Starbird, a disinformation researcher at the University of Washington. “The rhetoric is, You can’t trust the government; you can’t trust science; you can’t trust the pharmaceutical companies.” If the government’s top-down communications aren’t getting through, why not try doing what the anti-vaxxers do, and go bottom-up?

As far back as 2013, parent groups were floating just this idea, that the anti-vaccine movement’s strategy—its use of personal stories and “authentic” messaging from online influencers—could be weaponized against it. Some public-health researchers have come to similar conclusions, noting that facts alone are often not enough to inspire positive feelings about vaccines. Meanwhile, there is evidence that “social information” encountered on the internet—comments on an online article, for example—can be effective at shifting attitudes and behaviors. Starting with the 2018–19 flu season, Kaiser Permanente put these findings into practice, sponsoring an outreach effort managed by the nonprofit Public Good Projects, specifically targeting Black and Hispanic populations with low immunization rates in several states. In its first year, the company paid more than 100 small-scale influencers to share their personal stories about getting flu shots, tagged #StopFlu. The posts look like any other influencer content: a mom doing yoga, a young couple popping a bottle of champagne, a woman in elegant white pants reclining beneath a mid-century-modern lamp. But they’re paired with text about vaccines: “This year I’m really focusing on my health, and trying to develop healthier habits. One way of doing that is getting myself and my child a flu shot …”

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