Lisa M. Koonin, DrPH, MN, MPH, BSN, a member of Sigma’s Eta Psi Chapter, recently served with an integral research team to produce The Public’s Role in COVID-19 Vaccination: Planning Recommendations Informed by Design Thinking and the Social, Behavioral, and Communication Sciences, published by The Johns Hopkins Center for Health Security. Prior to founding Health Preparedness Partners, LLC, a company that helps organizations prepare for health emergencies, she worked at the Centers for Disease Control and Prevention for more than 30 years.
For over half of her tenure at the CDC, Lisa led efforts to improve pandemic preparedness and response and was one of the original architects of CDC’s pandemic social distancing policy published in 2007.
Tell us about the moment you were asked to be on this committee. What was your first thought?
I was enthusiastic to collaborate with the stellar group that Johns Hopkins assembled for this task and wanted to contribute to this effort as a public health professional. I’ve had some previous collaborations with one of the leads of this project and was asked to join this multi-disciplinary team because of my expertise in pandemic planning and experience with the use of vaccines during public health emergencies. I have spent over a decade thinking about pandemic response and felt I could contribute to this effort.
What are your thoughts on the findings in the report? Was there anything that stood out to you?
The findings of the report were based on solid science, and I was proud to be a part of the incredibly experienced and talented team that produced them. At the time the report was written, there was much discussion about vaccine development, efficacy, and manufacturing—several public polls taken over the summer and early fall in 2020 showed alarmingly low willingness of some people to accept vaccines. The recommendations from this report aimed to enhance planning for uptake of vaccines by addressing public concerns about the safety of the vaccine. The working group recommendations emphasized that critical pre-vaccine-release social science research was needed to ensure that the vaccine program would be tailored to the needs of the population to enhance acceptance of vaccines.
Uptake of the COVID-19 vaccine, as with the adoption of other preventive strategies, requires that individuals have equitable access and are able to make informed choices with information that is accurate and culturally relevant. This past year has shown a bright light on inequities in our society. Future research and planning should address the importance of recognizing and factoring those lived experiences into disaster planning and response.
What is design thinking, and how does it play a role in the planning recommendations for a COVID-19 vaccination?
In a pandemic, it is the collective actions of individuals that can lead to an effective community-level response. So individual human behavior is the critical enabler—public policies can rarely drive solutions without the buy-in and uptake of the affected population and sub-populations. In the report, we say “The purpose of the working group was to develop and disseminate recommendations informed by design thinking and evidence from social, behavioral, and communication sciences, that would support realistic planning for a US COVID-19 vaccination campaign.”
The design thinking model emphasizes that when developing a product or service, you design it with the user in mind—that you “stand in their shoes” and leverage the user’s perspectives in creating the product, policy, or service. In particular, it helps us when creating policies and strategies during a health emergency, to listen to the concerns and develop empathy with the target user. This approach is very useful in tackling problems that are ill-defined or unknown, by re-framing the problem as perceived by the target audience.
Of course, this notion is not new to nurses—we are trained to be holistic in our assessments, respect the individual, and to develop patient communication and education tailored to the needs and perspectives of the patients we serve. But not everyone thinks this way, and the working group felt that it was necessary to emphasize the importance of a social science approach to planning for a COVID-19 vaccine program.
Additionally, public health officials have never been tasked with the herculean effort of rapidly vaccinating almost the entire US population to curb the effects of a pandemic. Because the population is not homogenous—in its culture, education, understanding of vaccines, experience with vaccines, health/disease state, socioeconomic status, acceptance of vaccines, experience with inequities, and other factors—developing a successful vaccination program necessitates understanding that multiple segments of the population will need tailored messages, education, and communication that resonates with their life experiences. There truly cannot be a “one size fits all” approach.
Do you have any international insights about the vaccine?
The pandemic will never be controlled or minimized until there are sufficient worldwide levels of immunity. The virus knows no geographic boundaries and will keep spreading if there are naive populations. We need to work with our international partners to ensure that vaccine is made available to countries all over the world.
What are the next steps? What are key takeaways for the nursing community?
There are multiple next steps that, in large part, depend on the actions of nurses to ensure that the COVID-19 vaccination campaign is successful and that we can emerge from this pandemic as soon as possible. Immediately, this requires that nurses educate themselves about this vaccine and get immunized. Currently, a sizable proportion of nurses and other healthcare professionals are refusing to get vaccinated. Nurses lead by example and their behaviors and perspectives influence those of their patients. Also, most vaccines are administered by nurses—so nurses have the opportunity to listen to their patients' concerns, dispel myths, and educate them about the vaccine.
Finally, I am so proud to be a nurse (even though I do not currently practice). It seems that this pandemic has brought an awareness, for the first time, of the critical and life-saving services nurses provide every day to support their patients and families. I deeply appreciate the many heroic nurses who are on the front line!
Lisa M. Koonin, DrPH, MN, MPH, BSN, is the founder of Health Preparedness Partners, LLC, a company that helps organizations prepare for health emergencies. She is a member of Sigma’s Eta Psi Chapter (North America Region).