At this webinar, the International Longevity Centre-UK (ILC) launched a major new piece of novel research which has tested the potential of using social media to engage different generations with vaccination.

1. Generation Vax
Leveraging intergenerational relations to increase routine
vaccination uptake

2. Context: social media be used to reduce
health inequalities
• Older people from deprived areas and black communities in the UK don’t get routine
vaccinations – against flu, shingles and pneumococcal diseases – as much as other groups.
• As more older people, including those from marginalised groups, take to social media, this
channel offers a real opportunity to address these inequalities.
Pneumococcal and shingles vaccination uptake by level of area of deprivation (%)
Most deprived decile (area) National average Least deprived decile
Pneumococcal (PPV) (aged 65+) 68.4% 69.5% 70.9%
Shingles (aged 70+) 41.0% 44.4% 46.4%

3. Context: younger generations could
make this more effective
• But younger people are still more likely to use social media
and to engage with its content.
• There’s emerging evidence younger people can influence the
health behaviour of older relatives
• Older people tend to use social media to keep up with friends
and family
Could younger users could be part of the solution?

4. What were our research qs?
Methods:
Part 1: Preliminary research: Nat rep survey + 4X focus groups with people from our target groups
Part 2: Used this into to design campaigns and then tested impact
1. Whether social media ads can be used to increase routine vaccination uptake among
older people from deprived communities
2. Whether it’s more effective to engage older social users directly or to use younger
users as a conduit to persuade older relatives to get vaccinated

5. Why is this different?
Using younger generations as a conduit hasn’t been tried on
social media before.
Previous social vaccine campaigns often haven’t explicitly
targeted marginalised groups or measured the impact.

6. Lack of awareness is main barrier to
shingles & pneumococcal vaccines
 56% & 69% of our target communities
didn’t know they didn’t need the
pneumococcal and shingles vaccines.
 Many people also hadn’t heard of
these vaccines (46% and 55%) , or
didn’t know where to get them from
(38% and 33%).
 Many hadn’t received a physician
recommendation - but seems to be a
key motivator for vaccination
“I’ve only recently heard about
shingles but my doctor hasn’t invited
me to have it”

7. Barriers to flu vaccination are more
varied
 In contrast, people who hadn’t been vaccinated
against the flu had more varied reasons: not
wanting to go to the doctor, not knowing they
needed it, beliefs that the flu isn’t dangerous, and
not having time.
 Of those from deprived areas who had been
vaccinated against flu, the main reasons were
because:
 it was routine (65%)
 they thought the flu is dangerous. (57%),
 they had received an NHS reminder (46%)
 To protect family (33%)

8. Some young people already try to influence the
health behaviour of older relatives
 35% of older people said that younger relatives pass
on health messages– rising to 55% among ethnic
minorities.
 The main barrier for all younger people is lack of
knowledge and worry about passing on
misinformation from social media.
 Many younger people in their 30s and 40s (rather
than 20s) say they would have a conversation about a
vaccination campaign.
 Some previous campaigns that have either
encouraged younger people to influence older
relatives, or used intergenerational messaging - but
there’s little information on impact.
Now that you’ve mentioned it, I think I’ll actually discuss it with my
grandparents because I’d be interested to know how they feel about that
sort of vaccine.”

9. Marginalised groups use social-media
just as much
 Although more older people are using social media (mainly
FB), they still use it less than younger people (who mainly use
Instagram) and are less engaged
 Deprived populations & ethnic minorities aren’t less likely to
use social media. >80% of target communities use social
media
 Older people use social media mainly to keep in touch with
friends & family (oldest groups, mainly distant relatives)
 75% of older social users from (espec) deprived areas interact
with younger family members on social media
 There’s some distrust among our target communities using
social media as a channel for serious health messages –
mostly trust a professional organisation e.g. NHS
“Howmuchoftheinformationismadeup,howmuchofit isbeingchangedalongtheway.Iwouldn’ttakeitasgospel!”

10. Messaging must avoid being seen as
coercive or manipulative
 The 50-65 age group perceive themselves as healthy, are more prone to anti-vax sentiment, and
suspicious of ‘coercion’ or ‘guilt tripping’; they prefer positive, factual information.
“It’s just propaganda to me. It’s like being forced. So, I can’t enjoy myself unless I’ve had the flu
vaccine?”
 The 65+ age group responded more positively in general, including to factual messages and
statistics
Preferred messages among people aged 50+ in deprived communities:
Most popular message: ‘pop down to your local pharmacy
or GP to get your free jab today.’
Least popular message: ‘Get your jab so you can be there
on your child/grandchild’s wedding day’

11. Messaging must be conversational,
warm and family orientated
• Messages for younger groups should focus on:
• breaking down communication barriers
• encouraging them to feel comfortable about discussing health and
routine vaccinations with their older relatives, including emotive
messaging about looking after them.
We settled on creating adverts that were trustworthy,
conversational and open, family orientated and emotive, as well
as informative.

12. Designing and testing the campaigns
• The adverts were shown to 2 clear audience groups from December 2021 to January
2022 (within people living in deprived areas in Great Britain) on Facebook & Instagram,
where we tried to keep the (paid) reach roughly constant:
• Group A: Older people who qualify for the flu jab (aged 50+) and/or pneumonia jab (aged 65+)
• Group B: Younger people aged 18-49 (for the flu jab) and 18-64 (for the pneumonia jab)
5X campaigns about the flu vaccine
5x campaigns about pneumococcal vaccine
2X campaigns to each group per vaccine (static image,
video), 1 age-neutral GIF showed to both audiences

13. Designing and testing the campaigns
Each advert called on viewers to “Learn more” – if clicked, they led to a landing
page with options to book an appointment, share the campaign – which we
tracked. Also to complete a survey, and learn more.

14. Our campaigns effectively increased vaccineup-take, especiallythe
pneumococcal campaigns
 Our campaigns resonated with people from deprived areas, but not clear for ethnic minorities
(>1m reach, 1m forms of post engagement):
• The campaigns effectively increased uptake: Flu vaccine ads targeted at older adults likely
increased up-take cost effectively. The ICER per QALY for the flu ads was £7,486.21 < £20k-£30k
NICE threshold
• The pneumococcal ads > booking clicks at the lowest cost (lower uptake/less known)?
Cost per vaccine booking
click
The click through rate (CTR) was 2.5 X better than
the 2021 CTR for healthcare ads
(2.08% vs 0.83%)
76% of those who
saw the ads engaged
Overall -
£35.5
Flu ads targeted at older
adults - £45 (56 X cheaper
than treating a flu patient in
hospital)
Pneumococcal ads targeted at
older adults - £12.5 (136-425 X
cheaper than pneumonia induced hospital
costs)

15. Our campaigns effectively increased vaccineup-take - especially
pneumococcal campaigns
• Our campaigns effectively increased booking links –underestimates?
• Flu vaccine campaigns targeted at older adults likely increased up-take cost effectively
The ICER per QALY for the flu ads was ~£7,486.21 < £20k-£30k threshold
• The pneumococcal ads generated booking clicks at the lowest cost – despite audience being
more expensive to reach.
Costs per booking click:
• Likely because fewer people know that you can be vaccinated against pneumococcal disease
& fewer people have had this vaccine
“I'm pleased there's a campaign as I personally wouldn't have known about the
Pneumonia jab as I have never been offered one when visiting the Doctors.”
Overall - £35.5
Flu ads targeted at
older adults - £45
Pneumococcal ads
targeted at older
adults - £12.5

16. Our campaigns resonated with our
target communities
 Despite our target communities being ‘hard to reach offline’, our campaigns received significant
engagement (1m forms of post engagement):
• Few landing page survey responses came from ethnic minorities (none from black visitors), but
can’t track social media users by ethnicity. Not engaged OR simply didn’t complete survey?
The click through rate
(CTR) was 2.5 X better
than the CTR for
healthcare ads in 2021
(2.08% vs 0.83%)
76% of those who
saw the ads
engaged
The cost per view
(CPV) was lower thant
the average across all
industries on
Facebook (0.5 vs 1-15
cents)

17. The ads targeting older audiences
generated the most trackable impact
• The ads targeted at older audiences generated
greater engagement & booking clicks
• 76% of all shares and saves came from our older audiences.
• 0.03% of older vs 0.015% younger audiences shared ads
• Costs per booking click:
• vs
• Video format>GIF>single-image ad
• Older adults least preferred the GIF, but video resonated
• Younger audiences were most likely to click on the GIF
Younger
audiences -
£193
Older
audiences -
£20.5

18. But younger audiences were more likely to enter the
landing pages - we just couldn’t track offline actions
 Younger audiences showed higher engagement in one way
 they were more likely to click through to the landing page
per view (3.5% vs 2.6%) – mainly aged 35+
 Yet once on the landing page, they were less likely to act e.g.,
share the ads
 Younger adults may have spoken to older friends/relatives offline
 Survey findings: 45% of younger pneumococcal respondents
said they planned to share the ads mainly offline (e.g., text,
call, in-person)
 Couldn’t track offline conversations (most landing page
users were on social media)
 Younger audiences visited the landing pages ~ 4.4 times >
saw the ads ~ 3.8
 Cost per click: younger vs older audiences, £0.72 vs £1.4 –
worth exploring?

19. Landing page survey responses
• Many follow-up actions weren’t immediate
• Over 60% of older pneumococcal respondents
said they’re planning to, or thinking about,
getting the jab
• Many cited GP related barriers to getting vaccinated
• Many respondents who still hadn’t booked an
appointment said their GP hadn’t
recommended the vaccine or they found it
difficult to book
• Largely positive impact: 70% of pneumococcal
survey respondents said they now feel more
positively /now know about the vaccines
"Pop down to your GP?!? Was this post written in 2018 or
something, the Loch Ness monster is easier to see than a
GP round here"

20. Most comments were negative – but did
they increase engagement?
• While most FB reactions were positive, most ad
comments were negative (but others
responded positively)
• Our campaigns likely resonated most with
undecided users rather than with staunch anti-
vaxxers
• Were the negative comments + or – for
engagement?
“It’s deceitful, full of false
claims, just propaganda to
coerce people to get jabbed and
that worries me,.”
Many personal anecdotes:
“Everyone I know that took the
jab are the ones that are sick.”
“I had mine done as a trial for
pneumococcal and it was 7
years ago and touch wood not
even a common cold. Go for it
nothing to lose.”

21. Recommendations: scale-up findings
The Department for Health and Social Care and the NHS should:
• Build the evidence base and scale up findings.
• Increase investment in social campaigns to increase the uptake of routine
(espec unknown) vaccinations among older deprived adults
• Measure the impact and cost-effectiveness of future social
health campaigns
• Analyse and publish the results of future social vaccine campaigns.
• NICE and other key stakeholders could provide guidance on the cost per
vaccine booked ‘threshold’– including for marginalised groups
“This should be advertised more. I didn’t know about
it until years after the time I should have had one.
Had it now”

22. Recommendations: address health
system barriers
Address knowledge and accessibility barriers to vaccination
• Offer the NHS pneumococcal vaccine in community pharmacies.
• Ensure that all GP practices send reminders and consistently discuss
pneumococcal vaccination with eligible patients.
• Create a single online hub where people can book all routine
vaccination appointments and display these options prominently on
the NHS website
“Why has my GP not told me anything about this in the
past?”
“The site is pointless as you just get bumped to your GP’s
site where it is not possible to book an appointment.”

23. Recommendations: for further
exploration
Health policy makers should:
Explore ways to use social media data for public good
• Explore ways to encourage social media owners to share data with
gov health systems or researchers while mitigating potential risks
Test unanswered questions from our study
• Explore whether using social media to engage younger family
members can cost-effectively increase older adults’ vaccine uptake
• Explore whether anti-vax comments on social campaigns to promote
vaccination affect the impact of those campaigns.

24. Conclusion
• Social campaigns may be an effective way to increase vaccine uptake
among older deprived adults, espec pneumococcal campaigns
• Targeting older users directly with the correct messaging works &
generated better trackable results (shares & booking link clicks)
• A combinationofwarm,emotive, family-orientedpersonalvideo clipswithfactualcontentfromahealthprofessional,using
informativeratherthanpersuasivelanguage,workedwell witholderaudiences
• Younger users were more likely to click on the landing pages – but less
likely to then act. They may have acted offline, but we couldn’t track this
– may be worth exploring in future research

25. Conclusion

26. What our preliminary research findings
meant for the campaigns
• Add something on ethnicity for previous slides?
• 35%of young people already trytoinfluence the health behaviour of older relatives, offering scope touse younger social media users
as conduits
• People living in deprived areas and fromethnic minority backgrounds use social media as much as,or more than, other older people
especially to interact with younger relatives
• Messaging must avoid being seen as coercive or manipulative –it should stick to information and emphasise the ease and speed of
vaccination
• (just last slide on messaging and then what it means forthe campaign)..
•

27. What do we want to achieve?
1. Our vision – To test how effective peer-to-peer approaches are at
encouraging vaccination uptake in people who are at-risk and ethnic
minority, with a view to create methods that can be scaled up
2. Our objectives – Design, test and evaluate the effectiveness of peer-to-peer
communication methods, and compare these to communication led by an
expert figure/community leader
3. Our indicators for success – If people have responded positively by being
more likely to get vaccinated thanks to the conversations they’ve had, this
could demonstrate the effectiveness of using more tailored, peer-to-peer
communication to promote vaccination

28. What does ILC have to say that it
unique?
• Why are we excited about this project?
• This project is an opportunity to explore new research methods, evaluate
in-person studies and build on existing research
• How does it fit into our broader strategy?
• This research ties into our aims of reducing health inequalities through
prevention (vaccination), which helps to maximise the longevity dividend
associated with healthy ageing
• Why give us the money and not someone else?
• We are the experts on vaccination, have good connections with patient
charities and can shape and influence health policy

29. Why is this important?
• Routine vaccination uptake is low in clinical risk groups, especially in ethnic
minority groups with underlying health conditions – structural barriers often
prevent people from accessing vaccination
• Reducing the risk highlighted that peer-to-peer communication could allow
people from at-risk groups to gain trust in vaccination – speaking to people
from the same communities and health backgrounds can improve trust and
removes any barriers
• Gen Vax showed that there is huge potential in using young people as a
conduit for informing older generations about vaccinations, but gaps remain
when it comes to looking at how best to encourage people from ethnic
minority backgrounds to get vaccinated

30. Research questions
1. Is peer-to-peer communication an effective way to encourage people who
are at-risk and ethnic minority to receive routine vaccination(s)?
2. Are peer-led approaches more effective than using medical
experts/community leaders to encourage uptake of vaccination at-risk,
ethnic minority individuals?
Hypothesis: peer-led communication will be more effective at encouraging
ethnic minority at-risk people to get vaccinated

31. Why peer-to-peer communication?
• Peer-to-peer communication has the potential to encourage more people to
take up vaccination
• In Reducing the risk, we highlighted the benefits of using at-risk people to
encourage their at-risk peers to receive vaccination:
• “I think people will trust…using peer-led approaches to educate and communicate with people.
Somebody who looks like you and is living with HIV is far more likely to convince you to take
something like a vaccine than a Government minister.” (Terrence Higgins Trust)
• “I actually think word of mouth amongst support services, if your mates getting it, and they’ve
got some good information…I think you’re much more likely to do it [get vaccinated].” (National
AIDS Trust)
• “Some people will have quite fixed views that won’t be changed by others. Some will have
views that will be changed by others and will receive reassurance from peers, or from the
information that we’re able to give them about what’s going on.” (Kidney Care UK)

32. What are the research gaps?
• While we know peer-to-peer vaccination could be a more effective way of
encouraging general at-risk groups to get vaccinated, gaps remain when it
comes to at-risk ethnic minority groups
• Given ethnic minority groups are more likely to face structural barriers with
healthcare provision, and that trust can be sought through peer groups, there
is an opportunity to see how peer-to-peer communication works among
people who are at-risk and identify as an ethnic minority
Trustin people and
organisations with
similar experiences
and beliefs
Peer-led
communication
between people with
similar health
outcomes

33. Overview – what we will do
• ILC will work with a local charity to test whether peer-to-peer communication
is effective in encouraging routine vaccine uptake
• We want to work with a local charity that engages with people who are both
at-risk and ethnic minority – ILC research suggests charities are best placed
to work with these groups, as they can build rapport and are trusted by their
service users
• We will use different approaches to test peer-led and expert-led
communication, using the local charity to source participants
• This project will take place over the course of a flu vaccine season, with the
focus group taking place during the winter of 2022 and an evaluation and
report being produced in the spring of 2023

34. Our communication methods
• We will use a sample of 100 ethnic minority at-risk people; half who have
received a routine vaccination in the past two years, and half who have
received one over five years ago or never received one
• We will test 2 communication methods (1 expert-led, 1 peer-to-peer):
• Method 1: 60-minute discussion with 50 ethnic minority at-risk people who
have not received a vaccine and a doctor/HCP/community leader (an
expert figure)
• Method 2: Individual discussions between two ethnic minority at-risk
people (1 vaccinated, 1 non-vaccinated)

35. Evaluation
• The research would be measured through a survey of the 50 non-vaccinated
participants – one at the beginning and one at the end of the flu season
(February 2023)
• The first survey would ask about their intentions to get vaccinated and what
would encourage them to do this
• The second survey would ask them whether they got vaccinated, and which
methods were effective in helping to make that decision
• We would use this data to complete a follow-up evaluation and report on
what works well/best in terms of peer-to-peer communication