As Delta variant cases of the coronavirus continue to rise in states with unvaccinated residents, attempts to persuade Americans to take those potentially life-saving jabs are only growing more targeted and personalized. President Joe Biden on Thursday called on states and local governments to pay $100 to newly vaccinated Americans, for instance.

A large number of marketing efforts around vaccine hesitancy have been aimed at a national audience or targeted in cities with large concentrations of poor and Black and Latinx communities where data pointed to increased levels of vaccine hesitancy. There’s evidence, however, that the focus is starting to shift. 

The Advertising Council, the American nonprofit organization behind the multimillion-dollar national COVID vaccine campaign “It’s Up To You” in partnership with the COVID Collaborative, has been a leading force in the nation’s efforts to increase the number of vaccinated Americans with both national and local initiatives. But the group says there’s more to be done in Republican, rural states such as Louisiana and Alabama where new data illuminates the highest levels of unvaccinated Americans. So it is ramping up efforts across creative and media, community partnerships and influencer-focused efforts to reach people in those locations, including using groups affiliated with farmers and evangelicals.

“As we are all seeing, especially with the emergence of Delta and other variants, there is a heightened need to deliver ‘It’s Up To You’ fact-based and empathetic campaign message in states like Alabama, Arkansas, Georgia, Louisiana, Missouri and Tennessee where COVID cases are on the rise and vaccine uptake remains low,” says Heidi Arthur, the Ad Council’s chief campaign development officer. “These geographies represent an ongoing priority and we are escalating our urgent programs of local promotion to help prevent regional outbreaks now through the fall and winter.”

Conflicted messaging 

Still, the Ad Council and other groups pushing out vax campaigns are facing new messaging hurdles in wake of new reporting on concerns from within the Centers of Disease Control and Prevention about the severity of the Delta variant. A document obtained by The Washington Post shows that health officials are concerned that “vaccinated individuals infected with delta may be able to transmit the virus as easily as those who are unvaccinated,” the newspaper reported. Still, vaccines have been shown to prevent severe disease. But to prevent spread to unvaccinated individuals, vaccinated individuals are again being told to wear masks in indoor public spaces. For instance, Walmart today said it would require masks "inside our facilities in areas of substantial or high transmission," according to media reports.

The Ad Council is pausing its "Mask Up" campaign that stressed people wear masks “until you’re vaccinated" and is updating other content and its website as it looks to "evaluate our messaging in the context of the new guidelines," says the Ad Council.

The fast-moving situation shows how campaigns must adjust on the fly while also dealing with misinformation spread on social media, all while finding ways to break through to increasingly skeptical audiences.

"Institutional trust has eroded significantly over decades. More than ever, there are heavier, perhaps unrealistic, expectations for advertising to be a voice of reason," says Brent Vartan, managing partner at New York-based agency Bullish. "With everything so politicized these days, approaches must be thoughtful, and dealt with on a deeper, fundamentally cultural level because politicians, celebrities and even health officials can be viewed as biased, non-trustworthy voices."

Indeed, polling and public health data is revealing an increasing cultural and political divide on vaccine attitudes. At the end of June, the New York Times found that only 34% of people in an average U.S. county that voted for Donald Trump are fully vaccinated, compared with 45% of people who voted for Joe Biden. Some 50%-60% of Republicans are vaccinated compared with 80%-90% of Democrats, according to the KFF Vaccine Monitor. (KFF is a nonprofit focusing on national health issues.)

The Ad Council is leaning into creating more fact-based TV, radio and digital ads that aim to represent rural audiences. It is partnering with major broadcast networks CBS, NBC, FOX, ABC as well as iHeart Radio and the National Association of Farm Broadcasters (NAFB) to create more content for select states including Alabama and Louisiana where COVID cases are rising and vaccine rates are low. The creative will all be hyper-local with messaging tailored to specific states.

At the same time, the Ad Council plans on furthering its national and local partnerships within agriculture and state health departments. The council already works with the American Farm Bureau Federation across 50 states, for instance, and will continue to work with state health departments to create “turnkey methods of informing their residents.”

There’s also an emphasis on creating more video and radio interviews and hosting events with experts and influencers such as evangelical or other faith-based leaders, doctors, pharmacists, country music stars, athletes and neighbors. “We know that the messenger is just as important, if not more important, than the message itself,” the Ad Council states. Last week, for instance, the Ad Council hosted a community ambassador event with Fox News’ Dana Perino that was designed to inform more communities about the vaccines.

Evangelicals and country music fans

The work continues efforts already underway by the Ad Council that has resulted in $158 million worth of media targeted at rural America in the past 20 weeks. 

One of the largest ongoing initiatives has been to target vaccine-hesitant evangelicals, who represent 24% of the U.S. population, the Ad Council says. The cohort has one of the higher religious conservative bases, with 56% of members identifying as Republican and membership stretching across the U.S. but especially concentrated in red states, according to the Pew Research Center. In April, the Ad Council partnered with ChristiansAndTheVaccine.com and Values Partnerships to spearhead the effort with content, virtual events and resources to address their concerns around vaccines with doctors and medical leaders like Dr. Francis Collins, the director of the National Institutes of Health and Bishop Scott Jones.

The Ad Council in April used a partnership with the Academy of Country Music to run public service announcements that ran during the annual awards show that featured musicians including Eric Church, Ashley McBryde and Darius Rucker. In March, the Ad Council partnered with sports organizations such as the WWE, PGA Tour and Nascar on a campaign comprising PSAs and virtual roundtables.

Meanwhile, ongoing partnerships with Facebook, National Association of Farm Broadcasters, American Farm Bureau Federation, National Farmers’ Union and others include content featuring Republican celebrities such as former Gov. Chris Christie and doctors in red states to drive people to GetVaccineAnswers.com.

Using influencers to get the word out has become a crucial part of the strategy. The Ad Council says its research has shown that personal testimonials from family and friends are even more impactful than using famous faces. “Everyone really needs to hear it from people they trust,” says Arthur. The Ad Council is currently working with over 700 macro and micro-influencers with a reach of 36 million to target vaccine-hesitant individuals. Creators like Wisconsin-based Wyatt and Beau with 600,000 TikTok followers and Nebraska-based Katie Felton with 105,000 Instagram followers have been tapped as well as gamers in a partnership with Enthusiast Gaming. 

"When a Gen Z gamer sees Tori Pareno (@toripareno) encouraging them to seek more information, it’s different from a politician or a doctor giving that same message from a podium," says Adrian Montgomery, CEO of Enthusiast Gaming.

Overall, the Ad Council says its efforts in these areas have driven over 6 million sessions to GetVaccineAnswers.org and 67 million engagements on social media and search. Streams of content have included 464,000 sessions from people in the top eight states with the lowest vaccination rates. But “our work is far from done,” says Arthur.

An uphill battle

A new Ad Age-Harris Poll illuminates the challenge, with 64% of respondents saying residents in states with increasing COVID-19 cases need more attention from vaccine campaigns. The survey was conducted among 1,000 U.S. adults ages 18 and older from July 23 to July 26; 52% of respondents were fully vaccinated and 24% of respondents have not received a COVID-19 vaccine.

The poll found that Republicans who haven’t been fully vaccinated are less influenced by PSAs and outreach across the board, including influencer efforts. While 42% of unvaccinated or partially vaccinated Democrats said hearing from a celebrity would be influential, only 22% of unvaccinated or partially vaccinated Republicans said the same. Similar percentages can be seen whether the messaging comes from influencers, current politicians, former presidents, or sport stars. While ad agency Mischief might have joked the U.S. should rename the vaccine as the Trump Vaccine so more Republicans would get it, only 25% of Republicans said former presidents would encourage them to get vaccinated, compared to 36% of Democrats.  

The highest form of influence is seen through personal acquaintances, with 36% of Republicans saying they would find family, friends and neighbors to be influential compared to 50% of Democrats. 

There are a number of reasons why people in such areas are hesitant about getting vaccinated. While some might disagree with political leaders, others are believers of conspiracy theories or tune in to misinformation spread over social media. Then there are others with a general distrust of the science, have pregnancy-related concerns, or are fearful about long-term effects. 

There are some strategies that the Ad Council has found to be particularly motivating with conservative audiences: Reassuring that it’s ok to ask questions, reminding people that it is a choice, not an obligation, to take the vaccine and encouraging medical professionals to have vaccine conversations with their patients. The fact that Republican governors are now speaking out to encourage people in their states to get vaccinated might help.