S1E73 / Getting on the Right Side of Conservatives and Vaccines / Former Governor Chris Christie & Brian Castrucci

If we debate the vaccines and we don't have the uptake that we need, then we're all going to lose.

In the end, what people want is to be educated by people who really understand what's going on here and to be able to make their own decisions.

You're listening to Epidemic, the podcast about the science, public health, and social impacts of the coronavirus pandemic. I'm your host, Dr. Celine Gounder. When the pandemic started, former New Jersey Governor Chris Christie says he took COVID seriously.

I was personally very careful because I'm an asthmatic, and so I was always concerned about getting COVID and how it might affect me personally.

So he followed all the CDC's recommendations: social distancing, handwashing, and wearing a mask when he left the home.

So I was doing all the things, and for, for 7 months, just about, I stayed away from COVID and COVID stayed away from me. I then went at the very end of September to the White House to prepare President Trump for the first presidential debate.

He was at the White House for 4 days.

I was given a rapid test to see the president, and I tested negative every time. All the people coming to visit the president have been tested and tested negative. And so I felt like we were safe. We were in the safest place in the world, in fact, in the White House. And so I did not wear a mask.

During that week, Governor Christie also attended a reception at the White House for Supreme Court Justice Amy Coney Barrett, an event that was later identified as a COVID superspreader event.

I left the White House that Tuesday, the day of the debate, and by Friday I was symptomatic and tested positive for COVID. And wound up being admitted to the hospital.

What was your experience in the hospital like?

Frightening and isolating. You know, you're physically isolated from others because you're, you're contagious. You're a COVID patient.

Governor Christie was in an intensive care unit. He wasn't allowed any visitors.

You know, a lot of what folks don't understand is how isolating that circumstance is and how that plays on your ability to get better as well. Because inside your own head, you don't have any outside validators for how you're looking, how you're feeling, and all the rest. And you're lonely as well. So it was, it was definitely a very challenging time in that way.

Even the nursing staff stayed out of his room. He was separated from everyone by a thick pane of glass.

I couldn't hear them if they were talking to me through the window. So we used to hold up whiteboards.

Were you sick enough that you were worried about whether you were going to make it out of there?

In the beginning, yes. In the first couple of days, I got in on a Saturday morning. Saturday and Sunday, the first two days in the intensive care unit, I was continuing to get worse.

Governor Christie was treated with steroids, remdesivir, and an experimental monoclonal antibody therapy. After those first hard days, he started to recover. He spent 7 days in the ICU before he left. Since he was discharged from the hospital last October, Governor Christie has been urging people to take the pandemic seriously. And voices like Governor Christie may be critical to reaching one of the groups most skeptical about COVID vaccines: conservative Americans. In recent months, conservatives have emerged as the group least likely to say they'll get vaccinated. Getting more conservative Americans comfortable with the vaccines will be needed to control the pandemic as national vaccination rates have started to slow and new variants spread across the United States. In this episode, we'll look at the results of a focus group attended by Governor Christie and other GOP leaders to listen to these voters' concerns and see if they could be convinced to get vaccinated. We'll hear some of the concerns these conservative voters had about the vaccine.

If they're more concerned about the vaccine and its long-term effects than they are the virus, then we won't get people vaccinated.

Why it's been so hard to reach this group.

30 minutes in, what went through my mind was, oh dear God, we're not going to change these folks' minds.

And who they trust when it comes to the vaccine.

I mean, so I think that, you know, being a validator in the The normal way that people validate things is not going to work. This is going to be— have to be from people who have a special training in this particular disease and for those who have had it.

Today on Epidemic, how to improve vaccine confidence among conservatives. Brian Castrucci is the president and CEO of the Beaumont Foundation, a public health think tank.

I am a public health expert who has a decade of governmental public health expertise. And who has led the de Beaumont Foundation for the past 10 years.

Brian says efforts to build vaccine confidence earlier in the pandemic were focused on communities of color.

Communities of color had a disproportionate burden of disease and death, but there's been good success there, and acceptance and vaccine confidence has gone up. When you then looked at the confidence data, you found that Republicans were pretty concerned about the vaccine, and, and that hadn't changed much. So I think it's our responsibility then to pivot to the group that is the most hesitant, because we're only going to be as safe as the group that is vaccinated the least.

So Bryan's think tank set out to see if they could improve vaccine confidence among Trump voters. In March, Bryan and Republican pollster Frank Luntz led an online focus group asking Republicans how they felt about the vaccines.

A miracle, albeit suspicious.

Unsure.

Too many questions.

Rushed. Experimental.

Depressive but hesitant.

Scary, not knowing the long-term side effects.

The group was made up of 19 people who voted for Donald Trump in 2020, identified as conservative Republicans, and said they would maybe or probably not get a COVID vaccine.

So we classified them more as hesitant but not hostile.

The participants were not anti-vaxxers. They had gotten other vaccines for diseases like measles, polio, and hepatitis.

And they were joined by Tom Frieden, who's the former director of the CDC, Senator Bill Cassidy, former Governor Chris Christie, House Minority Leader Kevin McCarthy, and Congressman Brad Wenstrup.

Bryan says the safety of vaccines was the biggest concern expressed by the focus group. Respondents were skeptical about the speed of the development. Worried about long-term side effects and if the vaccines even worked. Brian says the focus group got off to a rocky start.

Tom Frieden got on and we introduced him as the former director of the CDC, and that was unimpressive to them, and they quickly kind of were recalcitrant to anything he had to say.

Part of that feeling might have to do with how the group felt about the messages they had been getting from the official sources. Many were frustrated by the lack of information.

Point that I want to see. I want to see the data point that says when we reach herd immunity.

Others felt the messaging was inconsistent.

The minute they tell you that, the goalposts will move again, right? Because it was how many days until we're done and we can take off our masks in 3 weeks until if we all do this and it'll be over. And we're tired of that. They set it up and then it moves. And so how do you trust that if we all get to vaccination level, we're going to be done with this?

When or even if we'll ever reach herd immunity, these are answers everyone wants to know, including scientists. SARS-CoV-2 is a novel virus, and even though we've learned a lot in the last year, there's still so much we don't know. And this has been a huge dilemma for public health officials. How do you talk about something when you just don't have all the answers yet?

I think you answer it with, "We don't know." I honestly think that's one of our biggest challenges with COVID-19 is that we were too declarative early in the pandemic, and that has led to some confusion. I think we needed to be honest and transparent early on and just say, "We're not sure yet." But that's not what we said. And maybe we underestimated the American public in that just saying, "I don't know," or "We're still investigating that," may have been better than saying something declaratively that turned out to be something we had to go back on later.

Many were also suspicious of the timing around the vaccine.

They were very quick to note that they felt that the vaccines were delayed until after the election as a way to work against President Trump.

So what that the pharmaceuticals let the results out 5 days after the election?

And to me, that's a big so what.

It just, it makes you doubt a little bit of the motives and the politicization of science. So if you really want us to trust the science, I think politics has to be taken out of it. That suspicion extended into skepticism about the government in general. Here's Governor Christie.

I think that the biggest single surprise for me was people's deep-seated suspicion of anything that government does. And even when they're trying to help, people think there's some ulterior motive there or something.

Take, for example, a PSA created by the Ad Council featuring former presidents.

Right now, the COVID-19 vaccines are available to millions of Americans, and soon they will be available to everyone.

All the former presidents who were talking about the reasons to get, you know, just more encouraging people to get the vaccine, not really talking about facts, really giving them the emotional appeal. So we urge you to get vaccinated when it's available to you.

So roll up your sleeve and do your part.

This is our shot.

Now it's up to you. And when it was over, and I thought it was a very well-done ad, they asked the 24 people, "Anybody here was moved by that?" No, no, it didn't impact me.

I wasn't moved.

None. Zero. And no one had any positive comments about it? Not much, really.

It was kind of like propaganda, honestly.

Nothing but a celebrity endorsement.

Of the former presidents in the PSA, George W. Bush was the only Republican. Maybe former President Trump would have made a difference.

If we asked, would you rather listen to your doctor or would you rather listen to President Trump? And every single focus group participant said, I want to listen to my doctor, not President Trump when it comes to taking the vaccine. So adding President Trump to an ad with former presidents didn't really make a difference to them.

This was a big takeaway from the focus group. Participants said they did not want to hear from politicians about COVID or the vaccines. At this point in the focus group, Brian was getting worried.

Well, 30 minutes in, what went through my mind was, oh dear God, we're not going to change these folks' minds.

Focus group members weren't responding to public health leaders like Tom Frieden. Even the Republican lawmakers on the call were having a hard time reaching the participants. But then something happened to turn the conversation around.

We were able to move almost all of those folks to a point where they said, they would be willing to take the vaccine. And for me, that was a big win. We actually watched minds change.

We'll find out what resonated with the focus group and how those messages could hopefully convince more conservatives to get vaccinated. That's after the break. Before the break, it looked like nothing was going to change the focus group's mind.

What went through my mind was, oh dear God, we're not going to change these folks' minds.

But some things did start to break through. Remember when Brian Castrucci said former CDC Director Tom Frieden didn't resonate with the participants at the start of the focus group? Frank Luntz brought him back to try again.

Dr. Frieden, I'm gonna go to you now because Doug says he wants facts. Let's go. Give him 4 or 5 facts and let's see if you can move him right now.

1. If you get infected with the virus—

It was things like, if we get enough people vaccinated, we can prevent 100,000 deaths or more. That nearly all doctors who have been offered the vaccine have taken it. The speed of the vaccine's development was due to cutting red tape, not corners, that the vaccines are more effective than the flu vaccine, and that the trials for these vaccines had tens of thousands of people in them.

Okay, I want a show of hands. How many of you would say that those 5 facts are impactful to you? Raise your hands if they're impactful. Yeah. Wow. Wow. That's a lot of you.

Brian says the simple list of facts without an emotional appeal or celebrity endorsement was the most effective way to reach these voters.

When you gave those facts, It then opened up the focus group participants to hear other messaging, like the reason you would take the vaccine is the same reason you put your seatbelt on anytime you're driving. It's not because you know you're going to get into an accident. You do it to prevent harm should something happen.

By the end of the session, several people said Dr. Frieden's facts moved them. My opinion has changed, so I probably went from a 5 out of 10 to maybe a 7 out of 10.

I would say I was 50/50 when we started. I'm maybe 75 in favor now of getting it.

Governor Christie's personal experience with COVID also affected the focus group.

I would say I was probably 80% against when this started today. Now I'm probably 50/50-ish between the numbers that Dr. Friedman gave and honestly, the story that Governor Christie gave about a healthy adult that ended up passing away from it, it really has made me think a little bit.

He started off by emphasizing that COVID acts in seemingly random ways.

Let's start with the fact of how I got it. No one would have believed that you were going to actually get it in the White House with all those people being tested. Secondly, you know, they say that, you know, you're much less susceptible to getting seriously ill if you don't have any preexisting type conditions, comorbidities as they call them.

Governor Christie may have ended up in the hospital because he's overweight, or has other underlying conditions. But so did other members of the governor's family, people like his cousin who didn't have any medical conditions.

She was 62 years old, no previous medical conditions of any kind. She got it, got— tried to deal with it at home at first, got increasingly sicker and more difficult to breathe. She wound up giving COVID to her husband, who was a 62-year-old longshoreman, still actively working on the docks in New Jersey, and someone in, in really good physical condition and no problems either. Both of them wound up in the hospital. Both of them wound up intubated. My cousin, she died of complications while she was intubated. Her husband, who was across the hall from her and also intubated, a few days after that started to get better, and they were talking about removing him from the intubation, and then he had a stroke and turned up brain dead. And so their one child— they had an only child— lost both of her parents within 6 days without any reason to believe when they first got sick, based upon what you hear on TV or read in the newspapers, that they were at significant risk for serious illness or death. You should not think if you're in one of the protected classes that it won't happen to you because it is a very random, very random disease.

After his experience in the hospital and what happened to his cousin, Governor Christie isn't taking any chances.

I have been vaccinated, fully vaccinated now. I was vaccinated in late January of this year. And the reason I got vaccinated was because I feel like it's an extra safety measure. And to me, it's like wearing your seatbelt. You know, it's not going to guarantee you that you're not going to have serious injury or death in a car accident, but it's going to make it much, much less likely. And so on that basis, I decided to go ahead and take the vaccine.

After the focus group, Bryan's organization conducted a poll of 1,000 additional Republican voters. They've since released a messaging guide called Changing the COVID Conversation about how organizations can most effectively reach conservatives about vaccines. Some of the takeaways are things you might expect.

We're going to need politicians to step aside and we're going to need to lead with public health practitioners and doctors. We're going to have to rely on people that other people trust. It's our clergy. It's our physicians. And honestly, a lot of the vaccination questions I think are going to be answered across the kitchen table. And so it's family talking to family.

And avoid using judgmental language.

You know, there is an air in some people who are completely convinced that the right thing to do is to be vaccinated, that to think otherwise means you're either blind or stupid. I think people have really interesting, valid questions to ask. We should put experts in front of them. This is going to have to be from people who have a special training in this particular disease and for those who have had it, talking to people about the randomness of it and the severity of it and how much better they feel now that they've been fully vaccinated.

Others are going to be thornier, like decoupling science and politics.

Public health is very much at the whim of some elected officials. Over 200 state and local health officials have resigned, retired, left their positions because their science was not in alignment with elected officials. And so I think that's one of the things that we have to reckon with moving forward is how do we have a society where science and politics can coexist and not corrupt one or the other?

And finding a way to educate people in a way that makes them feel empowered not forced.

This isn't just Republicans. This is everybody. No one wants to be manipulated or forced into doing something to their body. For certain political groups or certain people holding political— certain political ideologies, freedom and individualism are very strong values, and we don't want to in any way impugn those values because that could in some ways make them less likely to get the vaccine.

The messaging guide has been used by the Utah and Virginia Departments of Health, and the city of Boston. Their findings have also been incorporated into vaccine communication toolkits used by groups like the National Association of Republican Mayors. Governor Christie came away from the focus group hopeful.

We wound up changing the minds of a third of them who now said that they were inclined to now go and get the vaccine. I think that's pretty good work for 2 hours worth of a focus group. But it also tells you something much more important. It tells you that it is possible to convince people. People if you do so in a calm and deliberative way. And I think that's what I did, and I personalized it for folks, and I think all those things helped in persuading people. That's what we should be shooting for here— convince them to come to their own decision.

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