Phil Maytubby, deputy CEO of the Oklahoma City County Health Department, acknowledges that the misinformation and distrust surrounding COVID-19 vaccines now threatens to undermine other public health priorities, including common childhood vaccines. “We’re worried about a resurgence of measles,” Maytubby says. (Photo for KHN by Nick Oxford)

This story is republished from Kaiser Health News.

OKLAHOMA CITY — By the summer of 2021, Phil Maytubby, deputy CEO of the health department here, was concerned to see the numbers of people getting vaccinated against covid-19 slipping after an initially robust response. With doubt, fear, and misinformation running rampant nationwide — both online and offline — he knew the agency needed to rethink its messaging strategy.

So, the health department conducted something called an online “sentiment search,” which gauges how certain words are perceived on social media. The tool found that many people in Oklahoma City didn’t like the word “vaccinate” — a term featured prominently in the health department’s marketing campaign.

“If you don’t know how your message is resonating with the public,” Maytubby said, “you’re shooting in the dark.”

Across the country, health officials have been trying to combat misinformation and restore trust within their communities these past few years, a period when many people haven’t put full faith in their state and local health departments. Agencies are using Twitter, for example, to appeal to niche audiences, such as NFL fans in Kansas City and Star Wars enthusiasts in Alabama. They’re collaborating with influencers and celebrities such as Stephen Colbert and Akbar Gbajabiamila to extend their reach.

Some of these efforts have paid off. By now, more than 80% of U.S. residents have received at least one shot of a covid vaccine.

But data suggests that the skepticism and misinformation surrounding covid vaccines now threatens other public health priorities. Flu vaccine coverage among children in mid-December was about the same as December 2021, but it was 3.7 percentage points lower compared with late 2020, according to the Centers for Disease Control and Prevention. The decrease in flu vaccination coverage among pregnant women was even more dramatic over the last two years: 18 percentage points lower.

Other common childhood vaccination rates are down, too, compared with pre-pandemic levels. Nationally, 35% of all American parents oppose requiring children to be vaccinated for measles, mumps, and rubella before entering school, up from 23% in 2019, according to a KFF survey released Dec. 16. Suspicion swirling around once-trusted vaccines, as well as fatigue from so many shots, is likely to blame.

Part of the problem comes down to a lack of investment that eroded the public health system before the pandemic began. An analysis conducted by KHN and The Associated Press found local health department spending dropped by 18% per capita between 2010 and 2020. State and local health agencies also lost nearly 40,000 jobs between the 2008 recession and the emergence of the pandemic.

This made their response to a once-in-a-century public health crisis challenging and often inadequate. For example, during covid’s early days, many local health departments used fax machines to report covid case counts.

“We were not as flexible as we are now,” said Dr. Brannon Traxler, director of public health at the South Carolina Department of Health and Environmental Control.

At the start of the pandemic, Traxler said, only two people worked on the media relations and public outreach team at South Carolina’s health department. Now, the team has eight.

The agency has changed its communication strategies in other ways, too. Last year was the first year, for example, that South Carolina published data on flu vaccinations every two weeks, with the goal of raising awareness about the effectiveness of the shots. In South Carolina, not even one-quarter of adults and children eligible for a flu shot had been vaccinated by early December, even as flu cases and hospitalizations climbed. The flu vaccine rate across all age groups in the U.S. was 51.4% last season.

Those who have opted out of both the covid and flu shots seem to be correlated, Traxler said.

“We’re really just trying to dispel misinformation that’s out there,” Traxler said. To that end, the health department has partnered with local leaders and groups to encourage vaccinations. Agency staffers have also become more comfortable talking to the press, she said, to better communicate with the public.

But some public health experts argue that agencies are still failing on messaging. Scientific words such as “mRNA technology,” “bivalent vaccine,” and “monoclonal antibodies” are used a lot in public health even though many people find them difficult to understand.

A study published by JAMA found that covid-related language used by state-level agencies was often more complex than an eighth-grade reading level and harder to understand than the language commonly used by the CDC.

“We have to communicate complex ideas to the public, and this is where we fail,” said Brian Castrucci, CEO of the de Beaumont Foundation, a charitable group focused on strengthening public health. “We have to own the fact that our communication missteps created the environment where disinformation flourished.”

Most Americans support public health, Castrucci said. At the same time, a small but vocal minority pushes an anti-science agenda and has been effective in sowing seeds of distrust, he said.

The more than 3,000 public health departments nationwide stand to benefit from a unified message, he said. In late 2020, the foundation, working with other public health groups, established the Public Health Communications Collaborative to amplify easy-to-understand information about vaccines.

“The good guys need to be just as well organized as those who seek to do harm to the nation,” he said. “One would think we would learn from this.”

Meanwhile, a report published in October by the Pew Research Center found 57% of U.S. adults believe “false and misleading information about the coronavirus and vaccines has contributed a lot to problems the country” has faced amid the pandemic.

“I was leery like everyone else,” said Davie Baker, 61, an Oklahoma City woman who owns a business that sells window treatments. When the shots became widely available in 2021, she thought they had been developed too quickly, and she worried about some of the things she’d read online about side effects. A pharmacist at Sam’s Club changed her mind.

“She just kind of educated me on what the shot was really about,” Baker said. “She cleared up some things for me.”

Baker signed up for her first covid shot in May 2021, around the same time the health department in Oklahoma City noticed the number of vaccines administered daily was starting to decline.

The department updated its marketing campaign in early 2022. Instead of using the word “vaccinate” to encourage more people to get their covid shots — the term the agency’s social media analytics revealed people didn’t like — the new campaign urged people to “Choose Today!”

“People don’t trust like they used to,” Maytubby said. “They want to make up their own minds and make their own decisions.” The word “choose” acknowledged this preference, he said.

Maytubby thinks the “Choose Today!” campaign worked. A survey of 502 adults in Oklahoma City conducted during the first half of 2022 found fewer than 20% of respondents reacted negatively or very negatively to a sample of “Choose Today!” advertisements. And an estimated 86.5% of adults in Oklahoma City have received at least one dose of a covid vaccine — a rate higher than the state average of about 73%.

Other factors are likely at play that have helped bolster Oklahoma City’s vaccine numbers. In the same survey of Oklahoma City adults, some people who were recently vaccinated said family members or church leaders urged them to get the vaccine, or they knew someone who had died from covid. One person said money was the motivation — they received $900 from their employer for getting the covid vaccine.

Meanwhile, the war against misinformation and disinformation wages on. Childhood vaccination rates for the immunizations students typically need to enter kindergarten are down 4.5% in Oklahoma County since the 2017-18 academic year as parents increasingly seek exemptions to the requirements.

That worries Maytubby. He said the primary tactic among those trying to sow distrust about vaccinations has been to cast doubt — about everything from the science to their safety.

“In that aspect, they’ve been pretty successful,” Maytubby said. “Misinformation has changed everything.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. Subscribe to KHN’s free Morning Briefing.

John Lites was one of the first police officers to respond to the shooting that killed nine people at Mother Emanuel African Methodist Episcopal Church in Charleston, S.C., in 2015. He lives with post-traumatic stress disorder, the scene inside the church imprinted on his memory. (Photo by Gavin McIntyre for KHN) )

This article was first published by Kaiser Health News.

McCLELLANVILLE, S.C. — John Lites was one of the first police officers to respond to a 911 call from Mother Emanuel African Methodist Episcopal Church in Charleston, S.C, on June 17, 2015, when a white gunman murdered nine Black people attending a Bible study.

Lites arrived at the scene only minutes after the first emergency call was placed. He held one of the victim’s hands as the man died. Lites then stood guard inside the fellowship hall all night — remaining even through a bomb threat — to prevent people who didn’t need to be there from entering the room.

“I didn’t want anyone else to see it,” Lites said. “I was totally traumatized.”

Crime scenes are inherently disturbing. A few weeks after the mass shooting in?Charleston, Lites found himself in the clutches of post-traumatic stress and unable to sleep. The scene inside the church was imprinted on his memory.

“The worst thing you can possibly think of — it’s worse than that,” said Lites, who retired from the police force in 2018. “No one else needs to see that.”

A question that continues to be debated publicly — and is raised in the wake of each new mass shooting — is whether the publication of violent images, including those depicting gunshot wounds or police brutality, might be effective in preventing future carnage.

Advocates for publishing the images argue that if the public were forced to reckon with the gruesomeness of the deaths, people would respond by demanding that lawmakers enact meaningful reform. The advocates cite historical examples of photos that moved people to action or prompted changes in law or public opinion.

After the brutal death of Emmett Till — a teenager from Chicago who in 1955 was tortured and killed in Mississippi by a group of white men — photos of his mangled body appeared in Jet magazine. Scholars credit those images with galvanizing a generation of civil rights activists.

In 1972, a 9-year-old child named Kim Phuc Phan Thi became known as the “Napalm Girl” after an image of her — distressed, naked, and fleeing a bombed village in Vietnam — was published by The Associated Press. The image won a Pulitzer Prize, turned public opinion against the conflict, and arguably became the most famous photograph depicting the atrocities of the Vietnam War.

“We must face this violence head-on,” Phan Thi wrote in a guest essay for The New York Times this year. “The first step is to look at it.”

In June, former Homeland Security Secretary Jeh Johnson wrote a similar piece, arguing that such images “do more than speak a thousand words.”

“Some actually reveal to us what no words can adequately convey,” he wrote.

But there are those, like Lites, who argue that publishing photos of violence runs the risk of retraumatizing survivors, families who lost loved ones, and the public. They say that disseminating graphic photos for mass consumption is disrespectful to the dead and that there is no guarantee pictures from Colorado Springs, Colo.; Uvalde, Texas; Buffalo, N.Y.; Parkland, Fla.; Las Vegas; and the hundreds of other sites of mass murders would do anything to prevent future attacks or prompt lawmakers to action.

Moreover, they argue, there is no way to control how the images are used once they are released online. The opponents of publishing them fear the photos could amount to “trauma porn,” a grisly term used to describe a perverse fascination with tragedy or misfortune.

“The way I see it is America doesn’t get to ask me for one more damn thing,” said Nelba Márquez-Greene, a family therapist whose 6-year-old daughter, Ana Grace, was killed at Sandy Hook Elementary School in Newtown, Conn., on Dec. 14, 2012.

After the mass shooting at an elementary school in Uvalde, Texas, in May, Márquez-Greene wrote a guest essay in The New York Times in which she expressed opposition to the demands placed on families to seek the release of crime scene photos.

Márquez-Greene told KHN that calls to release photos of Ana Grace inside the elementary school began on the same day she was murdered. “It’s just so voyeuristic and gross; like, we’re literally empowering the masses to make this demand,” she said.

Concerns about how images might be used are rooted in history, said Mari Crabtree, an associate professor of African American studies at the College of Charleston.

More than 100 years ago, she said, photos of lynchings across the South were shared to advance very different agendas. The images were sometimes co-opted by racists to “celebrate Black death,” she said. But they were also used by civil rights groups — like the nascent NAACP — to raise awareness about the atrocities of the Jim Crow era.

In the early 1900s, the NAACP published and republished violent photos to push federal lawmakers to create anti-lynching legislation, Crabtree said. But it took Congress more than 100 years to pass the Emmett Till Antilynching Act, in March 2022. The amount of time it took to make lynching a federal hate crime casts doubt on the ability of such images to expedite reform, she said.

For her forthcoming book, “My Soul Is a Witness: The Traumatic Afterlife of Lynching,” Crabtree decided against including a depiction of lynching on the cover. “Lynching was about dehumanizing Black people into objects of white wrath,” she said. “I didn’t want it to be reinforcing that.”

She also wanted to avoid inflicting trauma on anyone who came across her book — if, for example, it was placed on a coffee table. Consuming images of Black death in such a casual way can be very disturbing, she said.

Images of violence can also cause mental harm, particularly for people who have post-traumatic stress disorder, said Nicole Sciarrino, a psychologist for the Department of Veterans Affairs and an expert in PTSD. Images, videos, and sounds can be “triggering” and exacerbate symptoms, she said. They can also be catalysts that cause someone to ask for help, she added.

Images alone don’t cause PTSD, psychologists said. But there is debate about whether watching violence unfold online — such as a live feed of a mass shooting on social media — can inflict a post-traumatic stress response, Sciarrino said.

The Diagnostic and Statistical Manual of Mental Disorders excludes exposure to trauma via electronic media, TV, or video games from the criteria for a PTSD diagnosis. But some psychologists think that should change, Sciarrino said. Their perspective emerged after 9/11, when millions of people watched the World Trade Center towers in New York City collapse on live TV. Photographs taken in Lower Manhattan that day continue to be controversial.

Repeated exposure to graphic images online could desensitize people to violence, said Erika Felix, an associate professor of clinical psychology at the University of California-Santa Barbara. Mass shootings are so frequent that humans often employ a coping mechanism that Felix calls “emotional dampening,” a term used to describe the tendency to emotionally tune out.

“Sometimes, scary images do make change,” she said. “Sometimes, these things do change public discourse. I don’t negate that.” But, Felix said, there’s also a risk the photos could do more harm than good: “That’s a fairly big risk in my opinion.”

John Lites retired from police work nearly four years ago, after a hip injury, and then moved with his wife to McClellanville, a rural town on the northern edge of Charleston County.

He takes medication for PTSD but rarely talks about the night of the church shooting.

A few years ago, he attended a training in Columbia, S.C., where he met officers from Connecticut, who spoke about their experiences inside Sandy Hook Elementary. Lites recognized himself in their stories. “It helped me move on, which I had not been able to do,” he said.

He is disappointed that the 2015 church shooting wasn’t the country’s final mass casualty event. Lites now views mass shootings in America as a symptom of a much larger mental health crisis.

“We’re not doing anything to solve it,” he said. “What does publishing those photos do to get us there?”

KHN?(Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs?at?KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.