When Phil Graham, an Irish ad man who began his career hawking whiskey and wine for Pernod Ricard in the ‘90s, signed on with the then-upstart Truth Initiative as its marketing director 20 years ago, he was tasked with a monumental goal: ending youth smoking.

At the time of the campaign’s inception, around one in four American high schoolers used tobacco and the Philip Morrises of the world controlled the few anti-smoking narratives that existed. But Graham took a fact-based approach to cigarettes, staying the course as Truth’s messaging saturated local billboards and Super Bowl ad slots alike. The result: “Through 2004, approximately 450,000 adolescents were prevented from trying smoking nationwide,” a 2009 study published in the American Journal of Preventive Medicine said of the Truth Initiative, which is now cited as one of the most successful public health campaigns in recent memory. 

With a post-Truth résumé that includes a decade-long stint at Mother New York, and now as the founding partner and CEO of consultancy Verdes, Graham is turning his attention to the next major health issue facing Americans: the push to inoculate millions against (and amid) a global pandemic. Early clinical trial results from Pfizer and Moderna are promising, but the body politic remains skeptical, with some reports suggesting fewer than half of Americans would opt to get vaccinated as soon as possible.

In a recent conversation with Ad Age, Graham offered some insight on how to run a public health campaign, how marketers should approach a polarized populace, and how to apply lessons learned from the crusade against Big Tobacco—and, years earlier, polio—to the current fight against COVID-19.

Why was the Truth Initiative successful?

I think one of the core reasons for Truth’s success was that it was so focused in its targeting and audience, aimed at what we called “sensation-seeking kids.” Basically, there were the teenagers who were using smoking as an expression of rebellion, and we knew early on that it was going to be really hard to take away that expression unless we were going to replace it with something. But if we could arm these teens with the knowledge that Big Tobacco has been manipulating them, then we’d give them a very different direction to point their rebellion, because an act is not rebellious if you’re being manipulated into it.

What angle of attack should marketers take to sell a COVID-19 vaccine to the public?

The sad part of it is that when a vaccine is actually available to people, we'll have experienced much of the worst of what COVID-19 is bringing on. So, fear messaging isn't going to work, because people will have already sacrificed so much, and the death toll is just going to get more and more horrific. On societal messaging, I think it's tempting to implement strategies such as “do it for the greater good,” but that’s probably unrealistic with the current environment we're in and the division in the country. That sort of leaves you with what has to become, potentially, the most localized, grassroots marketing approach that's ever existed in the country. Ultimately, this is personal, and I think a message of hope about a vaccine is going to have to happen on a very personal level—more than with any other public health initiative that predates it.

How can the challenge of a politicized pandemic be overcome?

We know about half of the U.S. is going to be fine with getting the vaccine as long as it’s deemed safe, so that means the other half of our population is, for whatever reason, ultimately skeptical about getting vaccinated. The good news is we don't have to talk to everyone, only that half. There's been so much talk for quite a long time now of the things that do divide Americans, but I have to believe that there are still a lot of binding agents in America that the vaccination campaign will potentially have to lean into. 

What are the parallels between the push against youth smoking and the current vaccine marketing dilemma?

At Truth, we had a hyper-skeptical audience that simply wasn’t open to the message of “don't smoke.” But we realized that people don’t just naturally love smoking, they smoke because it’s a tool of rebellion. And I think if people are similarly seeing not getting a COVID-19 vaccine as a tool of expressing their values and beliefs, that's where we’ve got to target and say, “this isn't a tool to express yourself,” because the consequences of not getting vaccinated are so dire.

Tell us about Elvis

In the 1950s, there were many efforts to try to persuade Americans to get the polio vaccine, and some of them were successful, but among young people—who were the ones that really needed it—those efforts failed to gain much traction. One day (in 1956), the New York Department of Health heard that Elvis Presley was going to be on the Ed Sullivan Show, and they asked him if he'd be willing to have the polio vaccine backstage and be photographed to help promote it. He agreed, and the results were astonishing; within eight months or so, Elvis’ stunt had driven youth vaccination rates from around 10% to over 80%.

Do you have any contenders in mind to take on such a “vaccine ambassador” role in 2021?

There aren’t many ubiquitously popular people like Elvis left in this country today. Tom Hanks might be a name that pops to mind as someone who is this fatherly figure, and whose message might have some efficacy. Or even people like Dr. Anthony Fauci, God love him, who is still a voice most Americans look to for truthful information. But it's probably not going to be one person; it'll probably be many people appealing to different populations.