When reports of a highly infectious novel coronavirus emerged from China in January 2020, Sheila Murphy joined a team of fellow public-health experts at the Southern California Clinical and Translational Science Institute (SC CTSI). 

“Prior to 2020, the public health community had been bracing ourselves to combat a highly transmissible and rapidly mutating virus. We knew it was not a matter of if, but when such a virus would emerge. By January 2020, we recognized that COVID-19 had the potential to become a worldwide pandemic”, said Murphy, PhD, professor of communication at the USC Annenberg School for Communication and Journalism as well as professor of Population and Public Health Sciences at the Keck School of Medicine. “We knew there would be misinformation not only about how the virus spreads, but especially about alleged risks of a potential vaccine. From experience, we knew that for historical, socioeconomic and cultural reasons underserved populations would be less likely to get vaccinated. So, minority groups needed special outreach to address vaccine hesitancy.” 

Murphy, Jeremy Kagan and Lourdes Baezconde-Garbanati had previously completed a National Institutes of Health-supported study, the award winning Tamale Lesson, that identified which storytelling techniques are likeliest to change attitudes and behavior. 

“There are two key ingredients that make information embedded in a story persuasive and lead to behavior change. First, a narrative is most effective when there is a character audience members can identify with,” said Murphy.

Identification with a character can be some combination of a shared ethnicity, language, age, family role, or other connection.

“Second, the story must be sufficiently absorbing, allowing audience members to become transported into the narrative. In this transported state audience members are less suspicious and more accepting of new information. Without those two key ingredients – identification with a key character and being transported into the story – the messaging is not effective.”   

In January of 2020, Murphy once again partnered with Jeremy Kagan, a film director professor at the USC School of Cinematic Arts, and Lourdes Baezconde-Garbanati, Associate Dean for Community Initiatives at the Keck School of Medicine and Professor in Population and Public Health Sciences to develop three short, narrative films that countered prevalent vaccination myths. This was possible with funding from the W. M. Keck Foundation to Michelle Kipke and Baezconde-Garbanati for Vaccinate L.A., in a joint effort between CTSI, CHLA and USC. To takle this new challenge on coronavirus, they were joined by Ashley Phelps, a graduate student at the Annenberg School for Communication at USC, who served as co-producer.

“We had learned from previous public health intervention campaigns that to achieve behavior change, and increase adoption and adherence to new mitigation behaviors for reducing coronavirus risk, we needed to develop messaging that resonated with the values of each cultural audience we were working with. We also had to address the fears and vast misinformation that was prevalent in each community fueling hesitancy in vaccine adoption,’ said Baezconde-Garbanati.  

Each film drew information from focus groups and listening sessions that were held by staff in Vaccinate L.A., supported in part, by SC CTSI staff technical expertise. They vividly dramatize a family or community discussion over COVID-19 vaccination. Each story exposes common vaccination falsehoods and presents compelling arguments about why family members should get vaccinated to protect themselves and their loved ones.

SC CTSI staff members organized listening sessions with underserved communities to learn which vaccination messages would be most effective for them. At each stage of script writing, Murphy collaborated with SC CTSI staff to ensure that the stories countered key myths of vaccination and the overall narrative resonated with the intended community members. 

“Together, we went through various versions of scripts until we were all happy that the important messages came through clearly,” said Murphy. “They would look at the script and say, ‘This works, but this doesn’t. Could you make this point better?’” 

Before the first COVID-19 vaccines became widely available, the filmmakers had already completed “Of Reasons and Rumors,” a film made on location in Eastern Los Angeles about a close-knit Latino family who face conflict when one member is hesitant to get vaccinated. The story was written and filmed by Latino graduate students from USC.  

The team’s second film, “Happy Birthday, Granny,” drew on African American filmmaking talent from USC. The story is about an African-American family roiled by a debate over vaccination myths and hesitancy that could affect the safety of their 80-year-old grandmother.  

A third film, “Team Player,” focuses on vaccination misinformation and hesitancy among parents and school-age children. 

Importantly, each of the films emphasize the crucial role of women in family decisions about vaccination. 

“We know that the single greatest predictor of whether a child is vaccinated is whether their mother is vaccinated,” said Murphy. “We want our message to reach women because once you get them on board, then their husbands, but even more importantly, their kids are more likely to get vaccinated.” 

Seeing the success of the films, Reasons and Rumors was utilized as part of a training produced by Baezconde-Garbanati and Kipke with KSOM and CTSI staff, to build capacity among a network of over 500 Community Vaccine Navigators (CVNs). CVNs were composed of promotores de salud and community health workers in the Vacunas-Health Research Services Administration (HRSA) program of the National Alliance for Hispanic Health. As of June of 2022, 65,962 individuals in the Hispanic community had received either a first or second COVID-19 vaccine dose, and 30,484 a first or second booster with the assistance of trained CVNs in 38 cities across the United States. By September 2022, a total of 6,570,792 persons had received outreach and education information on coronavirus and of these 247,817 agreed to get vaccinated.

The three films were part of a the broader efforts of Vaccinate LA, which involved USC, hospitals, local governments, employers, and hundreds of community organizations. The films have been shared widely on social media, the coalition partners, the California Department of Public Health, California Governor Gavin Newsom’s office, the Los Angeles Unified School District and the White House Office of Public Engagement, COVID-19 Community Task Force.

These films showcased the power of narrative, culturally-tailored storytelling to influence health decisions in diverse communities in a real-world public health crisis.