In the U.S. and worldwide, cases, hospitalizations, and deaths from COVID-19 are surging. The health care workforce is overworked, and increasingly, more people appear to be experiencing mask fatigue. In the midst of this, there is exciting news. A few weeks ago, initial promising results from two phase 3 COVID-19 vaccine trials were released. The vaccines reportedly showed 90 to 95 percent efficacy, exceeding expectations, and providing much-needed optimism.

Vaccines are great, but they only work if they get to the right person at the right time.

Recent polls on willingness to take the COVID-19 vaccine by Americans show that 40 to 60 percent of people would not take a vaccine when it first becomes available. In most of these polls, African-Americans are less likely to accept COVID-19 vaccines when available, despite being disproportionately impacted by the pandemic. Some people polled plan to wait for a while (how long?) before vaccination; others don’t plan to ever take it. Main concerns have included safety in light of the rapid development timeline, mistrust of the health care system from past trauma, politics involved in the process, concerns about the new vaccine technologies, and unknown long-term side effects of the vaccines. This is not entirely unexpected as only 45 to 50 percent of U.S. adults get the influenza vaccine each year, with significant differences by race.

So, as we get excited about vaccine news and results, we need to evaluate our messaging and how we can get to high enough COVID-19 vaccination rates to achieve herd immunity. This requires broad and frequent education on the safety and efficacy of the vaccines. It also requires active listening to address concerns so people can make informed decisions. The 7 Habits of Highly Effective People by Stephen Covey are relevant to the task ahead of us to combat COVID-19.

Habit one: Be proactive

We need to be proactive in forming partnerships between the scientific community and community organizations to survey public acceptability and prepare messaging to inform and address concerns. We need to broaden our messaging beyond our traditional educators in clinics and hospitals to expand our impact. We can develop simple educational materials, including cartoons and short videos to break down complex information and reach audiences through social media and various platforms. We need to have trusted key opinion leaders in health care, and the community be part of the conversation. Being proactive means understanding that representation matters and having health care providers and scientists of color be part of conducting the trials and providing community education. Understanding key barriers and addressing them accurately. This is happening and needs to continue and intensify as vaccines get rolled out.

Habit two: Begin with the end in mind

When we approach an individual or community to discuss COVID-19 vaccines and acceptability, we need to begin with the end in mind. The “end” is to have a meaningful conversation and exchange of information, so the recipient can make an informed decision. Entering a conversation with this in mind allows you to be objective and not defensive or dismissive.

Habit three: Put first things first

The “first thing” is the person receiving the information about vaccination, not you as a researcher, clinician, primary care provider, or educator. By focusing on the recipient, you can be reminded of the end goal, which relates to habit number two.

Habit four: Think win-win

A “win” is participating in an exchange of information about the science of the vaccine development process and the safety and efficacy of a vaccine. Having an audience is already a win. At best, they decide to get vaccinated; at worst they refuse vaccination. Later on, some refusers may do their independent research and engage in follow-up conversations with others. Also, we garner information around reasons for refusal, which help with our messaging priorities. We talk about prevention measures already in place during a vaccine discussion, such as wearing a mask, physical distancing, handwashing, and flu vaccination. Thus, even if the answer to COVID-19 vaccination is a “No,” we have provided education on other important topics, and that is a win-win.

Habit five: Seek first to understand, then to be understood

As researchers, as clinicians, and as public health professionals, we understand the rationale and cost-effectiveness of vaccination, the safety processes in place for trials, and we know what terms like “EUA” and “herd immunity” mean. However, we need to understand others who don’t share our point of view or enthusiasm. We need to listen actively to understand hesitation and refusals. We need to be open, non-defensive, acknowledge past wrongdoings of the medical system. We need to acknowledge and not dismiss or disregard the mistrust people have in the health care system resulting from past trauma. First, we can understand, then we can seek to be understood.

Habit six: Synergize

This habit is an important one because we need to work smarter and not harder. Who are people doing similar work in providing this education? Who are the ambassadors, advocates, champions, and leaders already working within communities? Those are the people we should synergize with so we’re not duplicating messages and efforts but building upon existing networks and successful processes. This synergy moves the message forward in a more efficient, expeditious manner.

Habit seven: Renewal or sharpening the saw

Renewal is what happens at the end of the process. Renewal starts after we have successfully reached target populations and achieved high vaccination rates by harnessing habits one through six. This is a time we celebrate our successes and a time to reflect on what worked, what didn’t work, and what got us to where we are. Reflecting on these allows us to build on our strengths and work on our challenges.

To get us from vaccines to vaccinations, we need to channel these 7 Habits of Highly Effective People. We all agree that vaccines are great, but vaccinations are even better.

Toyin M. Falusi is an infectious disease physician.

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